May PAs and their supervising physicians use an electronic signature for those supervisory documents requiring a signature per Board rules?
Yes. Board rules 21 NCAC 32S.0213 (d) and (e) require signatures by the physician assistant, primary supervising physicians, and if applicable, back-up supervising physicians for supervisory arrangements and quality improvement meetings. Rule 21 NCAC 32S .0215 requires a current list of signatures from the physician assistant, primary supervising physician, and all backup supervising physicians. For these documents, an electronic signature is acceptable.
Are physician assistants working part time or locum tenens positions required to document PA/supervising physician meetings at the same intervals as full time physician assistants?
Yes. There is no exception in the rules for physician assistants working part time or locum tenens positions. Physician assistants in any new practice arrangement are expected to meet monthly with their primary supervising physician for six months, then every six months thereafter. Physician assistants must make and maintain a written record of these meetings as required by board rule, 21 NCAC 32S .0213(e).
What does the Board expect to be documented in a PA/Primary Supervising Physician’s record of meetings?
The physician assistant and his or her Primary Supervising Physician should document a discussion of relevant clinical issues. The meeting and its documentation can take a variety of forms. Some PA/physician teams perform a medical record review while others structure the meeting as a journal club or choose a specific clinical topic for review. As long as the meetings occur, are documented and signed, and include a substantive discussion or review of relevant clinical issues, then the documentation requirement for meetings is likely to meet Board expectations.
Do PAs need to meet face-to-face with their primary supervising physician for quality improvement meetings?
No. The NCMB accepts electronic communication between a PA and his or her primary supervising physician as valid quality improvement meetings as long as the spirit of Rule 21 NCAC 32S.0213 (d) Supervision of Physician Assistants is satisfied.
I lost my primary supervising physician on short notice. What should I do?
The Board has an emergency policy to cover these situations. It involves notifying the Board within two days of the loss of supervisor and securing a new primary while practicing during a 30-day grace period. Read the official policy.
Are PAs required to recertify in order to keep their NC PA licenses active?
No. Currently, a PA license applicant must have passed the PANCE, the national certification examination, in order to meet criteria for licensure. There is no current requirement to maintain recertification for a NC license.
What kind of work can a PA who has graduated but is not yet licensed do?
A PA may shadow and do anything else a lay, unlicensed person can do in a physician’s office. They may not, under any circumstances, perform medical acts without an active NC PA license.
I need a copy of my Intent to Practice acknowledgement letter. Can the Board provide me with one?
No. The Board understands that PAs and/or their employers require a copy of the Intent to Practice acknowledgement letter to provide evidence of the physician assistant/supervising physician relationship for various credentialing purposes, including participation in federal programs such as Medicaid and Medicare.
When a physician assistant completes the Board’s online Intent to Practice (ITP) form, which establishes a physician assistant/supervising physician relationship, an acknowledgement confirming that relationship is emailed to the primary supervising physician and a copy is sent to the physician assistant via the current e-mail addresses we have in our database. Please make sure your e-mail address is current with the NCMB. It is the physician assistant’s responsibility to keep a copy of the acknowledgement email at all places where the physician assistant practices. Since instituting the online ITP process, the Board has not maintained copies of the acknowledgement letters and, thus, is unable to provide additional copies. Requests for copies of ITP letters will not be processed.
What if I am unable to find my ITP letter?
The information provided on the Board’s website may serve as an official confirmation of the physician assistant/supervising physician relationship. For example, if the Board’s website indicates that a physician assistant is currently being supervised by a particular physician, that indication is an official acknowledgement from the Board of that particular physician assistant/supervising physician relationship. The Board advises anyone not in possession of a written acknowledgement letter to use the information from the website in its place.
To find information about a particular physician assistant’s supervisory relationship, enter the physician assistant’s name using the “Look Up a Licensee” tool available on this website.
Can a PA prescribe controlled substances within U.S. DEA rule and not violate the Board's PA prescribing rules?
Do NC rules for PAs apply to those employed by the federal government and working in a federal facility?
The federal government may employ a PA to work in a federal facility in North Carolina without requiring the PA to hold a NC license. However, many PAs employed by the federal government and working in federal facilities do hold an active NC license.
Federally employed PAs are governed by federal rules and regulations in regard to how they practice while working within federal facilities. However, a federally employed PA who holds a NC license and wants to maintain the license must comply with NC rules that pertain to maintaining an active license (i.e. annual renewal, CME and payment of fees). Also, any PA who carries a NC license is expected to practice competently, act professionally and be of requisite good character no matter where, or for whom, he or she works. PAs employed by federal facilities are not required to submit an Intent to Practice Form with the Board prior to beginning their practice at the federal facility.
I completed my Intent to Practice form, when can I begin practicing?
You must see “active” under your name and the primary supervising physician’s name along with the date on the website in order to begin practicing. An email acknowledging receipt of the ITP will be sent to the PA and the supervising physician. The Board no longer sends letter via snail mail. A copy of the emailed ITP acknowledgment should be kept at all practice sites.
What’s the best way to complete the Intent to Practice form?
Intent to Practice forms are processed on the Board’s website. As soon as you complete the form you will be able to view the information on the website under your name. If the primary supervising physician is not displayed as “active” but rather says “pending,” this may be because the PA, physician or both have a public file/other issues. These types of Intent to Practice forms may take longer to process.
Be sure to use correct grammar and punctuation and include the full site address when completing this form. Failure to do so may delay processing.
May a PA supervise a physician in a resident training program?
No. A physician in a resident training program must be supervised by a fully licensed physician.
Does the supervising physician have to cosign inpatient chart entries made by a PA?
No, this is not required under state law or by the NCMB. However, PA entries into inpatient charts (hospital, long-term care facilities) must comply with the institution’s rules and regulations. This means that any given supervising physician, medical practice, hospital or medical facility is free to impose its own guidelines, including co-signing of patient charts, and the physician assistant is expected to comply with that physician’s or institution’s rules and regulations.
How often must a supervising physician meet with the PA?
First six months of new supervisory arrangement: The primary supervising physician and the PA in a new practice arrangement must meet monthly for first six months to discuss relevant clinical problems and quality improvement measures.
After first six months: The primary supervising physician and PA must meet at least every six months to discuss relevant clinical problems and quality improvement measures.
A record of all of these meetings must be signed and dated by both primary supervising physician and PA and be available for NCMB representative inspection.
Is the supervising physician responsible for the PA’s medical acts?
Yes, the supervising physician is accountable to the Board for the physician assistant’s medical activities and professional conduct at all times, whether the physician personally is providing supervision or the supervision is being provided by a Back-up Supervising Physician.
Is on-site, physical presence of supervising physician required at all times the PA is practicing?
No. However, PAs may not practice without a primary supervising physician in place. Physician and PA teams must ensure that the PA’s scope of practice is identified, that the delegation of medical tasks is appropriate to the skills of the supervising physician as well as the PA’s competence level, and that the relationship of, and access to, each supervising physician is defined, and that the PA’s performance evaluation process is established.
How many supervising physicians are required to be designated for each PA?
A PA is only required to have one primary supervising physician. The primary supervising physician is the physician who accepts full responsibility and liability for the PA’s medical activities and professional conduct at all times, whether the physician personally is providing supervision or supervision is being provided by a back-up supervising physician.
A physician assistant is not required to have a back-up supervising physician but is encouraged to have one during those times a primary supervising physician may not be readily available. The back-up supervising physician is the physician who accepts responsibility for supervision of PA’s activities in absence of primary supervising physician. The back-up supervising physician is responsible and liable for PA’s activities ONLY when providing supervision.
All supervising physicians must be licensed by NCMB and not prohibited from supervising PAs. Primary and back-up supervising physicians must ensure PA has adequate back-up for any procedure performed by PA in any practice location (office, home, hospital, etc.).
What written form of “Supervisory Arrangement” is required between a PA and supervising physician?
A supervisory arrangement is a written statement that describes medical acts, tasks and functions (including prescriptive authority instructions) delegated to the PA by the primary supervising physician appropriate to the PA’s qualification, training, skill and competence. The primary supervising physician and the PA must sign and date the supervisory arrangement, keep it on file at all practice sites and make it available to the Board if requested.
If there is a back-up supervising physician, they are required to complete the back-up supervising physician form. This form must be signed and dated by the back-up supervising physician, primary supervising physician and the PA. This form must be kept onsite as a part of the supervisory arrangement.
What is meant by “scope of practice”?
A PA’s scope of practice includes those medical acts, tasks or functions, including prescribing and dispensing of drugs and medical devices, that are delegated by the supervising physician in his or her individualized supervisory arrangement.
If I fail to renew my license, how much time do I have before my license is made inactive?
All active licensees in NC must register their license no later than 30 days after their birthday. After 30 days, if you have not registered, then you will be sent a certified return receipt letter stating that you have 30 days from the date of receipt to register (as evidenced by the return receipt). It is during the second 30 days you must pay the late fee. If your registration is not received within this period your license will be placed on inactive status.
Does a PA need to renew his or her license every year?
Yes. All active PA licensees must renew annually within 30 days of their birthdays.
How many PAs can a physician supervise?
There is no specific limit. However, the supervising physician is expected to provide adequate supervision and comply with all applicable laws and rules.
My birthday is now here. Do I need to pay the registration fee so soon after receiving my PA license?
Yes. North Carolina law requires that physician assistants register with and pay a fee to the NCMB within thirty days of their birthday each year, no matter when the PA license is issued.
What does my PA badge need to read?
When engaged in professional activities, PAs must wear a name tag consistent with N.C.G.S. 90-640. It is acceptable for physician assistants to use the abbreviation “PA” on their badges. Please note: A badge is not required if the patient is seen in an office where the PA’s name and license are provided on signs, in brochures or where the PA license is posted.
Do I need to provide documentation of CME with my PA license application and if so, how much?
If it has been less than two years since your graduation, you are not required to submit CME with your application. Applicants who graduated from a PA program two or more years ago must submit documentation of at least 50 hours of Category I CME.
Does the NCMB specify what medical tasks a PA may perform?
No. The primary supervising physician must ensure that the PA’s scope of practice is clearly identified and that the delegation of the medical tasks is appropriate to the skills and competencies of both the supervising physician and the PA.
Do I need to put my PA license on inactive status if I no longer have a primary supervising MD?
No, you need not place your license on inactive status; however, you are required to find a new primary supervising physician in order to practice, generally within 30 days. You will be required to successfully submit a new Intent to Practice form with the new supervising physician’s information in order to resume practice as a PA in NC.
Do I need to send NCMB a list of backup supervising physicians?
No, but you are required to keep a backup supervising physician list at all practice sites of all backup supervising physicians. The lists must be signed and dated by each backup supervising physician, the primary supervising physician, and the PA.
Must I receive written acknowledgement of my Intent to Practice from NCMB before I may practice?
No. You can verify your Intent to Practice was received by utilizing NCMB’s Licensee Search tool. If you look up your name on the website and can see your name as active with the primary supervising physician’s name as active along with the date, you can begin practicing. Letters are processed and emailed within two business days. The Intent to Practice acknowledgement letter is emailed to the physician assistant and to the primary supervising physician. PAs and their primary supervising physician(s) should keep a copy of the Intent to Practice acknowledgment letter at all practice sites. The NCMB cannot provide copies of Intent to Practice letters.
How do I submit the Intent to Practice Form?
As of January 2007, Intent to Practice forms are processed via the Board’s Website. Paper forms are no longer accepted. Processing via the website occurs in real time. As soon as the process has been completed you should be able to view the information on the website under your name. If your primary supervising physician is not showing as “active” but rather as “pending” this is because either the PA, the physician (or both) may have a public file or other issues. These types of Intent to Practice forms will take longer to review and process.
How long does it take for a PA application to be processed and a license to be issued?
The average processing time is 3 months from the time payment has been submitted for the application until the license is issued.
Do I need a primary supervising physician prior to applying for a PA license?
No; however, you may not commence practice until you receive notification that your Intent to Practice form has been processed by the Board.