The physician who provides medical supervision of other licensed healthcare practitioners is expected to provide adequate oversight. The physician must always maintain the ultimate responsibility to assure that high quality care is provided to every patient. In discharging that responsibility, the physician should exercise the appropriate amount of supervision over a licensed healthcare practitioner which will ensure the maintenance of quality medical care and patient safety in accord with existing state and federal law and the rules and regulations of the North Carolina Medical Board. What constitutes an “appropriate amount of supervision” will depend on a variety of factors. Those factors include, but are not limited to:
• The number of supervisees under a physician’s supervision
• The geographical distance between the supervising physician and the supervisee
• The supervisee’s practice setting
• The medical specialty of the supervising physician and the supervisee
• The level of training of the supervisee
• The experience of the supervisee
• The frequency, quality, and type of ongoing education of the supervisee
• The amount of time the supervising physician and the supervisee have worked together
• The quality of the written collaborative practice agreement, supervisory arrangement, protocol or other written guidelines intended for the guidance of the supervisee
• The supervisee’s scope of practice consistent with the supervisee’s education, national certification and/or collaborative practice agreement
Physicians should also be cognizant of maintaining appropriate boundaries with their supervisees, including refraining from requesting medical treatment by the physician’s supervisee.* Physician assistants and nurse practitioners are specifically prohibited from prescribing controlled substances for the use of their supervising physicians.
Practices owned solely by physician assistants or nurse practitioners may not hire or contract with physicians to practice medicine on behalf of the physician assistant or nurse practitioner owned practice. The physician assistant or nurse practitioner may contract with a physician to provide the legally required supervision of the physician assistant or nurse practitioner.
* See also the Board’s position statement on “Self-treatment and Treatment of Family Members.”