On April 13, 2021, Delaware Governor John Carney signed into law House Bill No. 33, as amended, which, among other things, changes the relationship between physicians and physician assistants in Delaware from supervisory to collaborative. Importantly, this legislation requires physician assistants in Delaware to enter into a written collaborative agreement with a collaborating physician who is licensed to practice medicine in the State of Delaware.
Written Collaborative Agreement
A collaborative agreement is a written document that expresses an arrangement of “collaboration” between a licensed physician and a physician assistant. As defined in the legislation, “collaboration” is the “process in which the physician who oversees patient services and the physician assistant jointly contribute to the health care and medical evaluation and treatment or management of patients with each performing actions he or she is individually licensed for and has the education, training, and experience to perform.”
The collaborative agreement must include the following information:
- the physician assistant’s scope of practice;
- a provision regarding the delegation of any medical tasks to ensure that the delegation is appropriate to the physician assistant’s level of competence, education, training, and experience;
- the relationship with, and access to, the collaborating physician; and
- a process for the evaluation of the physician assistant’s performance.
In addition, the agreement must be kept on file at the primary location where the physician assistant provides care.
Collaborating Physician’s Duties
Under the legislation, a collaborating physician must:
- be available for consultation with the physician assistant during the time of the patient encounter with the physician assistant, if necessary to provide advice on the ongoing care of the patient;
- be involved in active patient care on a regular basis, and not involved in patient care in name only;
- only assign medical acts to a physician assistant that do not exceed the physician’s license; and
- only collaborate with up to four physician assistants at a given time unless the physician and physician assistants practice in the same physical office or facility building and there is active, physician coverage (e.g., an emergency department).
While a collaborating physician must be available for consultant as noted above, the constant physical presence of the physician is not required on-site in the practice setting if the physician is readily accessible by some form of electronic communication. However, if the physician is not routinely present, the physician must ensure that the means and methods of collaboration are adequate to ensure appropriate patient care (e.g., telecommunication, chart review, etc.).
Physician Assistants’ Scope of Practice
Physician assistants are not authorized to practice independently from a collaborating physician. However, the legislation expanded the scope of practice for physician assistants to now permit physician assistants to:
- practice medicine within the education, training, and experience of the physician assistant (previously, the physician assistant could only perform delegated medical acts);
- perform medical services customary to the practice of the collaborating physician (previously, the physician assistant could only perform services customary to the practice of the supervising physician);
- record patient progress notes in inpatient and outpatient settings (previously, this was only permitted in an outpatient setting);
- order, relay, transcribe, and/or execute specific diagnostic or therapeutic orders or procedures (previously, physician assistants could only relay, transcribe, or execute such orders);
- conduct medical acts of diagnosis and prescription of therapeutic drugs and treatments (previously, these acts had to be specifically delegated by a physician);
- refer patients to specialists as needed (previously, this was not a medical act that was expressly permitted); and
- prescribe therapeutic drugs and treatments within the scope of the physician assistant’s practice (previously, these acts had to be specifically delegated by a physician).
In addition, the scope of practice for physician assistants still includes the use of telemedicine and the use of, and participation in, telehealth.
Volunteering and Emergency Care
Under the legislation, physician assistants are not required to collaborate with a physician if the physician assistant (i) volunteers to render medical care at public or community events at which the physician assistant does not receive any compensation or remuneration or (ii) renders medical care in response to an emergency or a state or local disaster (other than an emergency that occurs at that individual’s place of employment). In order to provide care without collaborating with a physician in these situations, the physician assistant must be licensed in any state in the United States, credentialed by a federal employer, or meet the licensure requirements of the individual’s federal agency as a physician assistant.