Check state laws for physician extenders

Many states’ laws describe a physician extender (i.e., a physician assistant or nurse practitioner) as a healthcare professional who practices medicine under physician supervision. Thus he or she can treat patients directly, but only with a physician’s oversight. Though some states require maintenance of detailed clinical protocols, such guides are no more appropriate for extenders than for physicians themselves. If too detailed, they may come back to haunt you in a malpractice claim.

Some states specify certain supervision requirements, like physician telephone or on-site access, chart review/sign-off, and conferencing. Research what your state requires and structure your supervision within those parameters.

Begin by requesting copies of national and state laws and regulations. Two good starting points that will help you narrow your search: The American Association of Physician Assistants ( and the American College of Nurse Practitioners (

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