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Specialty Practice Issue Update
Update Dec. 03, 2002 The Florida Medical Association Board of Governors has approved their Legislative Council proposed agenda as outlined below in the entry of Nov. 6th. The FAPA Board is now examining our options and additional information will be posted after the Board of Medicine meeting the first weekend in December 2002. Update Nov. 6, 2002 The Board of Directors of the Florida Academy met for their quarterly meeting on Nov. 3rd in Orlando. The co-signature issue was discussed as well as the derm issue. Initially this issue was pertaining only to the specialty practice of Dermatology. The Florida Medical Association legislative agenda as currently proposed includes provisions to seek a change in the medical practice act which would require new patients in dermatology specialty practice and established patients in a dermatology specialty practice with new problems to be seen by the specialist and not by a physician assistant or an ARNP on the first visit. The patients could then be seen for follow-up by the PA or ARNP. This change would substantially alter the way PAs and NPs currently in a dermatology specialty practice in Florida. In addition, the FMA is asking the Board of Medicine to examine and clarify what is direct and indirect supervision in regards to PAs and NPs. The FAPA Board is currently evaluating how best to approach this situation. In the next few weeks before the legislative committees begin to meet prior to the session in February the Membership will be informed as to our recommended course of action. We are investigating every possible avenue to protect the interests of the PA profession in Florida. It will be a very proactive effort. More to come later.
The below information was posted October 6, 2002: A group of Dermatologists in Florida has raised an issue regarding the way PAs and NPs are allowed to function in the specialty practice of dermatology. In recent weeks the Board of Medicine was sent a letter from the President of the Florida Society of Dermatologists (FSD), Dr. Mark Nestor. They requested that the Board issue a declaratory statement that would require in a dermatology practice setting initial patient visits, and established patients with new problems to be seen by a board certified dermatologist. Treatment and procedures, and follow up care could then be performed by the PA or NP under the dermatologist's supervision. They alleged that there have been cases of misdiagnoses by midlevel providers and these may have been avoided had they been seen initially by a board certified dermatologist and not the midlevel provider. A group of FAPA leaders met with Dr. Nestor at the Summer Conference in Marco Island at his request to listen to his concerns. He was seeking our support on this matter. He subsequently submitted a proposal to FAPA for consideration. After some research and discussion, the FAPA Board determined that we could not support the FSD proposal and the FSD was advised of that decision. We were informed that it would be submitted to the Board of Medicine by the FSD with or without our support. The Board of Medicine held their meeting on October 4-6 and the issue was addressed by the Board on Friday afternoon, October 4th. Each side was allowed 15 minutes to present their case. The Florida Society of Dermatology was represented by their President, Dr. Nestor and Dr. Rosenberg, both of whom practice in South Florida. Accompanying them was the President of the American Academy of Dermatology (AAD). The AAD has issued a similar policy statement on the issue. The Florida Academy was represented by Juhan Mixon, our Legislative Consultant, and Mr. Allan Grossman, our attorney in this matter. There were twelve physician assistants observing including Steve Cohen as the FAPA Board representative, and also five physicians to speak in opposition to the FSD and AAD position. The FAPA position as stated by Mr. Mixon and Mr. Grossman was that there is no need for changes because there are already adequate rules and regulations in place to address the issue. The physicians voiced their objections to changes that would affect their ability to adminisiter their practices in the manner that they choose to do as is their right as a physician. After hearing each side present their arguments, the Board of Medicine voted not to change the rules that affect how PAs are allowed to function in a dermatology setting. The Legal Counsel for the Board then advised the dermatologists present that there are adequate rules in place to provide opportunities to report any acts of negligence to the Board in the future. The information for this article was furnished to me by those present at the Board meeting. We did consult with the appropriate AAPA leaders on this issue as well. As President Elect I will tell you that we will hear more about this issue in the future. The FAPA Board of Directors will, as usual on your behalf, continue to vigorously monitor the situation and take appropriate actions to protect our professional privileges. More importantly we want to fulfill our mission of ensuring that Florida citizens have adequate timely access to the health care they deserve, and are provided the highest standard of care. This issue in my opinion just shows that it is even more important now than ever that EVERY physician assistant practicing in the State of Florida needs to belong to the Florida Academy. Through the Academy and its' professional education efforts is the only way for a PA to be informed about what is really happening here in the State of Florida. The abilities and efforts of the FAPA leadership in this issue should prove once again to every PA in Florida that we are doing everything we can to protect the profession for all PAs in Florida, FAPA members and non-members alike. It is a given fact that we are not going to make everyone happy all the time, but this I will promise you - we will do the best that we can for the majority to keep our profession viable in this state. You owe it to yourself and your profession to support FAPA and the AAPA!
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