The PMA Identity Crisis: Where Do We Go From Here?
As a practice management consultant, I have become more concerned about how the uniformity of this position impacts the business of practice. If specific job descriptions were in place for PMAs, there would be more established hiring criteria, more balanced salaries and standardized benchmarks to measure performance expectations. Does The Scope Of Practice For MAs Provide Any Guidance For PMAs? In 2001, the American Medical Technologists and the American Association of Medical Assistants accepted a unified understanding of a model state law outlining the scope of practice for medical assistants (MAs). Some might say we should not reinvent the wheel and instead should consider aligning ourselves with a similar scope with duties that are already defined. While the MA scope of practice does not distinctively address podiatry tasks, it does offer definitive guidelines in a medical practice. Medical assistants can perform delegated clinical and administrative duties within the supervising physician’s scope of practice. These duties are consistent with the certified medical assistant’s (CMA) education (through an accredited MA education program), training and experience while clarifying that these duties “shall not constitute the practice of medicine.” Section 18.402 of the Pennsylvania Code states that a medical doctor may not delegate the performance of a medical service if performance of the medical service or recognition of the complications or risks associated with the delegated medical service requires knowledge and skill not ordinarily possessed by non-physicians. According to a related article published by Michael N. McCarty, the Legal Counsel for the American Medical Technologists, the medical practice laws of a number of states expressly allow a physician to delegate basic clinical tasks to an unlicensed assistant provided that: • the task is generally one that can be delegated; • the task is within the scope of the assistant’s training; • the delegation is not prohibited by other laws or regulations; and • the assistant is under the supervision of a licensed medical practitioner (physician, osteopath, podiatrist, etc.), who assumes responsibility for the assistant’s actions. However, without applying specific definition to the terms “generally,” “basic,” “skill” and “training” to duties within our specialty (via an outlined scope of practice), is it left to the individual discretion of a podiatrist to interpret them any way he or she wishes? If this is the case, a doctor could say one of the following statements: • “My assistants ‘generally’ give local anesthesia to patients in my office.” • “I allow my assistants to do a ‘basic’ P&A procedure as long as I am somewhere in the office.” • “I have personally ‘trained’ my assistants to suture capsule and skin after surgery. I am confident they can perform these duties ‘skillfully’ and ‘competently,’ and am willing to accept full responsibility for their actions.” According to McCarty’s article, it appears that “only seven states (AZ, CA, FL, NJ, MD, SD and WA) have adopted laws or regulations directly addressing the practice of medical assisting” and while some (like SD and WA) stipulate that assistants or “health care workers” register with their state licensing board or health department, “none require that medical assistants be licensed.” Is There Any Clarity About What Constitutes ‘Invasive’ Procedures? Clearly, the majority of doctors I have questioned have expressed extreme opposition to allowing an assistant to perform any “invasive” procedure. Most say that assistants simply are not licensed to do so no matter how much “hands-on” training they have received in the practice. In fact, some admit they are even apprehensive delegating suturing to qualified hospital personnel. John Guiliana, DPM, a practice management consultant based in Hackettstown, NJ, agrees that the line of delegation is gray. He admits that distinguishing right from wrong should be based upon one's own value system as well as decisions based upon reason. His own personal decision of where to draw the line is based upon “invasiveness.” He feels there are three components of surgery: opening/dissection, wound closure and postoperative bandaging and care. Dr. Guiliana states that he could not, in clear conscience, delegate any of the invasive components of this process to non-licensed individuals.