Supervision of physician associates registered in the Physician Associate Provisional scope of practice
Effective and efficient supervision is a crucial part of the regulatory framework for physician associates registered in the Physician Associate Provisional scope of practice as they commence regulated practice in New Zealand.
During this initial period, the physician associate will be adjusting to a new practice environment and health system. They will also be developing working relationships with their supervisor(s), multidisciplinary team and other colleagues.
Application for registration
Any application for registration in the Physician Associate Provisional scope of practice must include a job offer, proposed primary supervisor, and proposed supervision plan from the employer. These will be considered by Council as part of the application and will only be approved if they meet requirements.
Registration pathways 1, 2, and 3
- 12 months (FTE) of satisfactory supervised practice.
Registration pathway 4 (New Zealand experiential)
- 6 months (FTE) of satisfactory supervised practice.
Primary supervisor specifications and delegation
A physician associate registered in the Physician Associate Provisional scope of practice must have a Council-approved primary supervisor who is a vocationally registered doctor in a scope of practice relevant to the physician associate's area of practice.
Details of the Council-approved primary supervisor and place of work will be recorded in the endorsement on the physician associate's practising certificate.
The primary supervisor must provide onsite supervision to the physician associate. At any time that the primary supervisor is not available onsite, they may delegate to a secondary onsite supervisor who must also be a vocationally registered doctor, to ensure that appropriate access to supervision and collegial support is always available to the physician associate when they are practising.
Onsite supervision requires that the primary supervisor, or any doctor that they delegate onsite supervision responsibilities to within this framework, work in the same facility as the physician associate and be available on a day-to-day basis to provide medical input, guidance, and advice to the physician associate.
The Council-approved primary supervisor retains overall accountability and supervision responsibilities as set out below.
If the primary supervisor is also a sole employer, a secondary offsite supervisor who is a vocationally registered doctor, is required. Their role is to mitigate possible conflicts of interest and ensure a physician associate registered in the Provisional scope of practice has appropriate support if there is a relationship breakdown with the primary supervisor. However, this is noting that all PAs must always work under onsite supervision.
Accountability and responsibility
The employer (via the Chief Medical Officer, Clinical Director (PHO), or Clinical Lead (general practice or urgent care) is responsible for:
- Nominating a primary supervisor for approval by the Council.
- Providing a job offer and proposed supervision plan to Council, as part of the application for registration, for consideration by Council.
- Using the Ministry of Health credentialling framework to credential the physician associate to define the specific clinical responsibilities that they are assigned (based on their qualifications, training and experience) in each specific service environment in which they practise (within the Physician Associate Provisional scope of practice). This includes undertaking a credentialling review at least annually, or when clinical responsibilities change.
- Ensuring the physician associate and primary supervisor are provided with credentialling reports of the physician associate, and any other employer guidelines.
- Ensuring that the primary supervisor provides quarterly reporting to Council for any physician associate registered in the Physician Associate Provisional scope of practice.
- Ensuring there is protected time for the primary supervisor and the physician associate to meet.
- Ensuring a system is in place for the primary supervisor to obtain feedback from any onsite supervisor.
The Council-approved primary supervisor is responsible for:
- Monitoring the performance of, and providing feedback to the physician associate, within:
- this framework
- the physician associate's employer-credentialled clinical responsibilities, and
- the Physician Associate Provisional scope of practice.
- Supporting the physician associate to meet the requirements of the supervision plan.
- Ensuring onsite supervision is available to the physician associate if the primary supervisor is not available.
- If delegating onsite supervision under this framework, ensuring the physician associate and onsite supervisor are provided with credentialling reports of the physician associate, and any other employer guidelines.
- Providing clinical input to the employer in relation to initial and annual credentialling review of the defined clinical responsibilities of the physician associate in each workplace.
- Holding regular, scheduled meetings with the physician associate and providing constructive feedback (incorporating feedback provided by any other onsite supervisor and the wider clinical team).
- Supporting the ongoing professional development of the physician associate through encouraging their engagement and participation in:
- multi-disciplinary team meetings
- peer review of difficult cases
- grand rounds (if applicable)
- journal clubs.
Online training will be provided to Council-approved primary supervisors.
The physician associate registered in the Physician Associate Provisional scope of practice is responsible for:
- engaging in all aspects of the employer-led credentialling process
- promptly raising with their employer and/or primary supervisor any issues relating to the effectiveness, functionality, or logistics of their supervision
- ensuring the ongoing delivery of culturally safe practice
- meeting the requirements of the supervision plan
- follow up to ensure that supervision meetings occurs and supervision reports are furnished.
While registered in the Physician Associate Provisional scope of practice, the physician associate must also meet the expectations of their primary supervisor (or their delegate) and seek their feedback and input both on a day-to-day basis in relation to specific clinical cases, and in terms of their general performance.
Meetings and reporting
Meetings between the primary supervisor and the physician associate registered in the Physician Associate Provisional scope of practice can be in person or conducted virtually. The approximate frequency of meetings should be:
- Day 1 – first meeting.
- End of weeks 1 and 2.
- End of month 1.
- Thereafter, as required. The frequency will reduce as the primary supervisor determines (e.g., as the physician associate progresses and acclimatises) but noting reports are to be submitted every quarter.
The primary supervisor must report to Council, using the Council report template, every three months, detailing their assessment of the physician associate's:
- knowledge and skills
- clinical reasoning
- communication with patients
- communication with the team and teamwork
- professional attitudes and behaviours.
Feedback should be sought by the primary supervisor from the wider multidisciplinary team (including any doctors who have provided onsite supervision within this framework) discussed with the physician associate and incorporated into the online supervision report. Feedback from consumers and whānau should also be sought for inclusion in supervision reports.
In addition to the three-monthly reporting, the primary supervisor must also report to the employer and to Council immediately, if they consider the physician associate's practice may pose a risk to patient safety. The employer and primary supervisor must put in place immediate steps to address any patient safety concerns.
If a physician associate registered in the Physician Associate Provisional scope of practice is reported by the supervisor (whether in the quarterly report or otherwise) to be not meeting the required standards or whose practice may pose a risk to patient safety:
- Council staff will liaise with the primary supervisor to ensure there are no immediate patient safety concerns.
- A remediation plan must be implemented by the employer, in liaison with the primary supervisor.
Key learning components
Orientation and induction of physician associates registered in the Physician Associate Provisional scope of practice must include:
- HDC (including the patient code of rights), ACC, privacy laws, clinical documentation, etc.
- Council statements and standards – for example, informed consent, record keeping, treating yourself and those close to you.
- Cultural competency and cultural safety training.
- IT training.
Confirmation must be provided as part of the first quarterly report to Council that the physician associate has completed appropriate orientation and induction.