delegating physician

[Jeremy G]

So, I'm a Georgia ANP-BC with 8 years assisting in orthopedic surgery and other specialties. I was recently told by a physician that my delegating physician had to be board certified in whatever type of practice I was going to work in. Typically, NPs work with physician practices and have one of those physicians as their state sponsor and continue to provide the same type of service. But, in some cases NPs in Georgia or other collaborative states can have a state sponsor that just oversees a practice run by NPs (community health clinics, etc...) The physician I spoke with mentioned that the sponsoring physician in the state of Georgia had to have the same specialty or board certification of whatever the NP was providing services for. i.e. an internal med physician is supposed to be the sponsor for only NPs that are providing internal med, a pediatrician for a NP working in pediatrics and so forth. However, when I read through the GA board of nursing and the GA medical board rules the sponsoring physician is just called a "delegating physician". This just means that they need to have a license to practice medicine in the state of Georgia. I don't see anything saying they have to have the same specialty that I do. To me I don't see why a psychiatrist cannot sponsor me to open my own say primary care office.

Has any other APRNs in the state of Georgia heard anything different?

Jeremy Garrard, MSN, ANP-BC, RN, ONC, CSFA, LSA

[Psychcns]

It sounds like they could legally but why would they- what kind if direction would a psychiatrist provide to a primary care practice? I think some states specify that the physician has to be board certified in the APN's specialty. Maybe check with your malpractice carrier. Am interested in what others say.

[Whispera, MSN, RN]

I don't know if it has changed since I began, but in Indiana, then ( the collaborating doc (not delegating...that wasn't an option), had to have the same specialty. I worked psych and my collaborator had to be a psychiatrist, by the state, grantors of prescriptive authority, and insurers...

Personally, I wouldn't want someone to be my collaborator (or delegator, if that's an option), if that person wasn't expert in the specialty. It seems that could lead to some scary situations. Also, in Indiana, collaborators have to review some of the APN's charts per time period. How would a non-expert know what to look for?

[Neuro Guy NP, DNP, PhD, APRN]

Hello! I just finished up school a short time ago and did my schooling in Georgia. What we learned in school (and one of my professors up until not too long ago served in the Georgia Board of Nursing) was that your collaborating physician has to be of SIMILAR specialty as the NP.

If the NP will be working internal medicine, the physician needs to be internal med or at least family practice. Now, it's a tad different if you are working acute care. You should be perfectly fine as an ANP working with ortho surgery. Many of my professors were NPs long before the ACNP-BC specialty came out (which is my specialty) and they were NPs in nephrology, family practice, ICU medicine, OB, etc. Georgia does not seem to be overly strict on this, so personally I would not fret too much. Besides, the state government had to review your collaborative practice agreement when you submitted it, right? imo if they didn't object when you submitted it, I wouldn't worry.

[Neuro Guy NP, DNP, PhD, APRN]

Also just think of all the FNPs and ANPs working the hospital. Technically, they are primary care trained but it's not illegal for them to work in the acute care environment in Georgia as they have been doing.

[Whispera, MSN, RN]

I think there's a huge difference between having your collaborator/delegator be a specialist in a form of med/surg if you're working in a form of med/surg and having your doc be a psychiatrist.

[Jeremy G]

Thanks, I agree. We submitted to protocol to the Medical Board of Georgia, if they approve it then it is approved. The only thing I will be doing for this practice is offering joint and trigger point low dose corticosteroid injections which is very simple and I have over a thousand documented joint injections supervised by physicians during surgery. I'm also a licensed and certified first assist which allows my to do this. The board rules go into discussion about the APRN needing to provide documentation, experience, education regarding those procedures they would be doing. In other words I would not try and start a central line since I have no experience or training in those procedures. An your right their are tons of FNPs doing central line in the hospital but they can probably document their years of courses and experience doing them as well which make it perfectly legal according to the way the board rules are written.

Thanks for everyones comments. It has helped.

Jeremy Garrard, MSN, ANP-BC, RN, ONC, CSFA, LSA

[Bumashes, MSN, APRN, NP]

Yeah, in MS our collaborator has to be practicing a type of medicine that is similar to what we are practicing. So if I do urgent care, then I need a primary care doctor, ER physician, urgent care doc, etc to collaborate with. So for example, an orthopedic doc wouldn't do. And it's all because if they have to be consulted or review our charts, then they need some practical working knowledge of the specialty they are collaborating with me on in order to do this.

[gettingbsn2msn, MSN, RN]

Yes, but in Georgia, we rarely, if ever see our collaborative physician. I saw him once when he signed the Georgia agreement. I called him another time when I had a lab question. I have 2 other collaborative physicians as it is impossible to get a full time gig in Georgia. However, they all 3 do exactly the same things that I do. I wish I could move to a less restrictive state. We do not do anything but bp checks and refills. Also weight loss consulting. The doc charges 750 cash for the consult and I make 50/hour. If we were less restrictive I could open my own practice!