Section 271.10 - Licenses; exemptions; nonresident practitioners; graduate students; biennial registration and continuing medical education(a) Physicians who have complied with the requirements of the board, have passed a final examination, and have otherwise complied with the provisions of this act shall receive from the Commissioner of Professional and Occupational Affairs in the Department of State, or whoever exercises equivalent authority, a license entitling them to practice osteopathic medicine and surgery without restriction in this Commonwealth. The license shall be recorded in the office of the board in a record to be kept for that purpose. It shall be open to public inspection. A certified copy of the record shall be received as evidence in all courts in this Commonwealth. This section shall not apply to medical officers in the medical service of the armed forces of the United States, the United States Public Health Service, the Veterans Administration, or physicians employed within Federal services while in discharge of their official duties, to anyone who may be a duly licensed practitioner of osteopathic medicine and surgery in any jurisdiction who may be called upon by a licensed physician of this Commonwealth to consult with him in a case under treatment, to physicians of other jurisdictions who are training for certification in special departments of osteopathic medicine and surgery, or to anyone serving as a clinical clerk under the supervision of the osteopathic medical or surgical staff in any hospital. Nothing contained in this section shall be construed to entitle a clinical clerk to practice osteopathic medicine and surgery or to prescribe drugs. A duly licensed physician residing in or maintaining his office of practice in a state near the boundary line between said state and this Commonwealth whose practice extends into this Commonwealth shall have the right to practice in this Commonwealth, at the discretion of the board, provided he files with the secretary of the board a certified copy of his license in the state where he resides, and that the board of examiners of the adjoining state reciprocates by extending the same privilege to physicians in this Commonwealth. He shall receive from the secretary of the board a license which shall automatically become null and void whenever he changes his residence or office of practice. A record of all persons so licensed shall be kept in the office of the board and shall have the same efficacy as any other license issued by the board.(b) Physicians who are legally authorized to practice osteopathic medicine and surgery in this State or other states or territories of the United States or the Dominion of Canada who apply for training and certification in special departments of osteopathic medicine and surgery in institutions in this Commonwealth recognized by the board with advice and consultation with the various examining boards in osteopathic medical specialties approved by the Council on Osteopathic Education of the American Osteopathic Association as proper for such training, shall receive a graduate certificate limited to said training within the complex of the hospital or its affiliates or community hospitals where he is engaged in such training. This training experience shall not be converted into a staff service. The certificate shall be valid for one year. It may be renewed from year to year. A person who has been certified in a specialty discipline recognized by the board who makes an application for licensure to practice osteopathic medicine and surgery without restriction in the Commonwealth, upon the payment of a fee may be given a qualifying examination. The examination shall emphasize the subject matter of the specialty discipline for which the applicant has been trained. It may include material from the general field of osteopathic medical science.(c) It shall be the duty of those licensed to practice osteopathic medicine and surgery without restriction to register with the board and to reregister at such intervals and by such methods as the board shall for a period determine. Such renewal period shall not be longer than two years. The form and method of such registration shall be determined by the board.(d) The board shall adopt, promulgate and enforce rules and regulations establishing requirements for continuing medical education to be met by persons licensed to practice osteopathic medicine without restriction. Each person licensed to practice osteopathic medicine and surgery without restriction, during the two-year period immediately preceding a biennial date for reregistering with the board, must complete a program of continuing medical education, as defined by and acceptable to the board. The number of hours of continuing education to be met by licensees shall be set by the board by regulation. No credit shall be given for any course in office management or practice building. In issuing rules and regulations and individual orders in respect of requirements for continuing medical education, the board, in its discretion, may, among other things, use and rely upon guidelines and pronouncements of recognized educational and professional organizations; may prescribe for content, duration and organization of courses; shall take into account the accessibility of such continuing education; may waive such requirements in instances of individual hardship where good cause is shown and the board finds that the public's safety and welfare are not jeopardized by the waiver of such requirements; and shall waive such requirements with respect to retired physicians not engaged in the active practice of osteopathic medicine and surgery.(e) A person registering with the board shall pay, for each biennial registration, a fee. It shall accompany the application for registration. Upon receiving a proper application for registration accompanied by the fee and evidence satisfactory to the board of compliance with the continuing medical education requirements of subsection (d), the board shall issue its certificate of registration to the applicant. It and its renewals shall be good and sufficient evidence of registration.(f) The board shall grant licensure to physician assistants which licensure shall be subject to biennial renewal by the board. As part of biennial renewal, a physician assistant shall complete continuing medical education as required by the National Commission on Certification of Physician Assistants. The board shall grant licensure to applicants who have fulfilled the following criteria: (1) Satisfactory performance on a proficiency examination approved by the board.(2) Satisfactory completion of a certified program for the training and education of physician assistants approved by the board.(3) For candidates for initial licensure after January 1, 2005, obtainment of a baccalaureate or higher degree from a college or university and completion of not fewer than 60 clock hours of didactic instruction in pharmacology or other related courses as the board may approve by regulation. In the event that completion of a formal training and educational program is a prerequisite to taking the proficiency examination, the board shall have the power, if it determines that the experience of the applicant is of such magnitude and scope so as to render further formal training and education nonessential to the applicant in assisting a physician in the provision of medical care and services, to waive the training and education requirements under this section.
(g) The supervising physician shall file, or cause to be filed, with the board an application to utilize a physician assistant including a written agreement containing a description of the manner in which the physician assistant will assist the supervising physician in his practice; the method and frequency of supervision, including, but not limited to, the number and frequency of the patient record reviews required by subsection (j.1) and the criteria for selecting patient records for review when 100% review is not required, and the geographic location of the physician assistant. The written agreement and description may be prepared and submitted by the primary supervising physician, the physician assistant or a delegate of the primary supervising physician and the physician assistant. It shall not be a defense in any administrative or civil action that the physician assistant acted outside the scope of the board-approved description or that the supervising physician utilized the physician assistant outside the scope of the board-approved description because the supervising physician or physician assistant permitted another person to represent to the board that the description had been approved by the supervising physician or physician assistant. Upon submission of the application, board staff shall review the application only for completeness and shall issue a letter to the supervising physician providing the temporary authorization for the physician assistant to begin practice. If the application is not complete, including, but not limited to, required information or signatures not being provided or the fee not being submitted, a temporary authorization for the physician assistant to begin practicing shall not be issued. The temporary authorization, when issued, shall provide a period of 120 days during which the physician assistant may practice under the terms set forth in the written agreement as submitted to the board. Within 120 days the board shall notify the supervising physician of the final approval or disapproval of the application. If approved, a final approval of the written agreement shall be issued to the supervising physician. If there are discrepancies that have not been corrected within the 120-day period, the temporary authorization to practice shall expire. There shall be no more than four physician assistants for whom a physician has responsibility or supervises pursuant to a written agreement at any time. In health care facilities licensed under the act of act of July 19, 1979 ( P.L. 130, No.48), known as the "Health Care Facilities Act," a physician assistant shall be under the supervision and direction of a physician or physician group pursuant to a written agreement, provided that a physician supervises no more than four physician assistants at any time. A physician may apply for a waiver to employ or supervise more than four physician assistants at any time under this section for good cause, as determined by the board. In cases where a group of physicians will supervise a physician assistant, the names of all supervisory physicians shall be included on the application. (g.1) In health care facilities licensed under the "Health Care Facilities Act," the attending physician of record for a particular patient shall act as the primary supervising physician for the physician assistant while that patient is under the care of the attending physician.(g.2)(1) Except as limited by paragraph (2), and in addition to existing authority, a physician assistant shall have authority to do all of the following, provided that the physician assistant is acting within the supervision and direction of the supervising physician: (i) Order durable medical equipment.(ii) Issue oral orders to the extent permitted by a health care facility's bylaws, rules, regulations or administrative policies and guidelines.(iii) Order physical therapy and dietitian referrals.(iv) Order respiratory and occupational therapy referrals.(v) Perform disability assessments for the program providing Temporary Assistance to Needy Families (TANF).(vi) Issue homebound schooling certifications.(vii) Perform and sign the initial assessment of methadone treatment evaluations in accordance with Federal and State law, provided that any order for methadone treatment shall be made only by a physician.(2) Nothing in this subsection shall be construed to:(i) Supersede the authority of the Department of Health and the Department of Public Welfare to regulate the types of health care professionals who are eligible for medical staff membership or clinical privileges.(ii) Restrict the authority of a health care facility to determine the scope of practice and supervision or other oversight requirements for health care professionals practicing within the facility.(g.3) Professional liability.-- (1) A licensed physician assistant in this Commonwealth shall maintain a level of professional liability insurance coverage in the minimum amount of $1,000,000 per occurrence or claims made. Failure to maintain insurance coverage as required shall subject the licensee to disciplinary proceedings. The board shall accept from physician assistants as satisfactory evidence of insurance coverage any of the following: (ii) personally purchased liability insurance; or(iii) professional liability insurance coverage provided by the physician assistant's employer or similar insurance coverage acceptable to the board.(2) A license applicant shall provide proof that the applicant has obtained professional liability insurance in accordance with paragraph (1). It is sufficient if the applicant files with the application a copy of a letter from the applicant's professional liability insurance carrier indicating that the applicant will be covered against professional liability in the required amounts effective upon the issuance of the applicant's license to practice as a physician assistant in this Commonwealth. Upon issuance of the license, the licensee has 30 days to submit to the board the certificate of insurance or a copy of the policy declaration page.(h) The board shall establish such rules and regulations, relating to physician assistants, as it deems necessary to protect the public and to implement the provisions of this act, including, but not limited to reasonable procedures for identification of physician assistants and for informing patients and the public at large of the use of physician assistants.(i) Information concerning the use of each type of physician assistant shall be collected and reports thereof furnished to the general assembly annually by the board, including the geographic location of physician assistants and the setting of their practice, i.e., rural, clinic, hospitals or physician's offices.(j) Nothing in this act shall be construed to permit a licensed physician assistant to practice osteopathic medicine without the supervision and direction of a licensed physician approved by the appropriate board, but such supervision and direction shall not be construed to necessarily require the personal presence of the supervising physician at the place where the services are rendered.(j.1) Patient record review.-- (1) The approved physician shall countersign 100% of the patient records completed by the physician assistant within a reasonable time, which shall not exceed ten days, during each of the following time periods:(i) The first 12 months of the physician assistant's practice post graduation and after the physician assistant has fulfilled the criteria for licensure set forth in subsection (f).(ii) The first 12 months of the physician assistant's practice in a new specialty in which the physician assistant is practicing.(iii) The first six months of the physician assistant's practice in the same specialty under the supervision of the approved physician, unless the physician assistant has multiple approved physicians and practiced under the supervision of at least one of those approved physicians for six months.(2) In the case of a physician assistant who is not subject to 100% review of the physician assistant's patient records pursuant to paragraph (1), the approved physician shall personally review on a regular basis a selected numberof the patient records completed by the physician assistant. The approved physician shall select patient records for review on the basis of written criteria established by the approved physician and the physician assistant. The number of patient records reviewed shall be sufficient to assure adequate review of the physician assistant's scope of practice. * * *
(k) This act shall not be construed to prohibit the performance by the physician assistant of any service within his skills, which is delegated by the supervising physician, and which forms a usual component of that physician's scope of practice.(l) Nothing in this act shall be construed to prohibit the employment of physician assistants by a health care facility where such physician assistants function under the supervision and direction of a physician or group of physicians.(m) The physician assistant being licensed in this act and functioning under the supervision of the physician defines his/her status as an employee and subject to the normal employer/employee reimbursement procedures.(n) No medical services may be performed by a physician assistant under this act which include the measurement of the range of powers of human vision or the determination of the refractive status of the human eye. This subsection does not prohibit the performance of routine vision screenings or the performance of refractive screenings in the physician's office.(o) Nothing in this act shall be construed to allow physician assistants to practice chiropractic.(p) Nothing in this act shall be construed to permit a physician assistant to independently prescribe or dispense drugs. The board and state board of pharmacy will jointly develop regulations to permit a physician assistant to prescribe and dispense drugs at the direction of a licensed physician.Amended by P.L. TBD 2019 No. 69, § 2, eff. 8/1/2019.Amended by P.L. 1145 2013 No. 101, § 1, eff. 1/26/2014.1978, Oct. 5, P.L. 1109, No. 261, § 10, imd. effective. Amended 1985, Dec. 20, P.L. 398, No. 108, § 4, effective Jan. 1, 1986; 2004, July 2, P.L. 486, No. 56, § 3, effective Aug. 31, 2004; 2007, July 20, P.L. 316, No. 47, § 1, effective in 60 days [Sept. 18, 2007]; 2008, July 4, P.L. 589, No. 46, § 4, effective in 60 days [Sept. 2, 2008].