FNP indie practice: Internist supervisor OK?

[kevagonia]

Re: starting an indie practice as FNP, specifically with regard to the supervising MD and our scope of practice requirements... If we plan to treat the whole family, is an Internist per se adequate from a medicolegal standpoint or is the only good or legal option a Family Practice doc as supervising MD?

Thanks guys,

-K

[BostonFNP, APRN]

Re: starting an indie practice as FNP, specifically with regard to the supervising MD and our scope of practice requirements... If we plan to treat the whole family, is an Internist per se adequate from a medicolegal standpoint or is the only good or legal option a Family Practice doc as supervising MD?

Thanks guys,

-K

If you are required to be working under a collaborating MD then I would be very cautious about seeing patients outside of board cert of the MD. Check with your state BON, this could vary widely by state.

[zoidberg, BSN, RN]

varies by state, mine you need a physician of any specialty to sign you off, then you practice in your trained specialty, it has nothing to do with your SP.

[SycamoreGuy]

It really does depend on the state. In my state you only need a collaborating MD/DO for prescriptive authority, you can practice to the full extent of your training (with the exception of writing scrips) without any MD/DO involvement. Not sure how useful an FNP would be without prescriptive authority though.

[kevagonia]

Understood, thanks. In TN we have full prescriptive priveleges but bill have to contact BON re: above. ..

[kevagonia]

our BON states that in FNP collaborative practice, the MD must have "experience in, or specialty in the area", so I would imagine most internists would have "experience in" Family Practice areas. Of course there is a dearth of Family Practice BC MD's - K

[SycamoreGuy]

That "experience in" line seems pretty vague. I wonder if a family practice rotation in med school counts as "experience."

Reminds me of a Physician my wife was referred to for a derm problem. She asked if he was a dermatologist, the secretary replied, "no, but he has had extra training in dermatology" lol

[kevagonia]

Sometimes "extra training in Dermatology" will mean an extensive amount of continuing education. He/She might have a pretty impressive background in derm. one never knows unless one asks.

-K

[SycamoreGuy]

He may very well have been better than some dermatologists. The point is that it's kinda vague just like saying "experiance in" without any further qualification.

[pro-student]

It may be legal in some states but this sounds like a bad idea for a collaborating physician. Imagine if something happens and goes to the lawyers. Being supervised by a physician without credentials with kids makes you look that your going rogue for that part of your practice. If your state requires chart review or any formal collaboration actions, how would an internist do this competently? Would you feel comfortable consulting them with peds cases?

Sure all Physicians did a rotation in peds and many in family practice as a med student but all nurses took OB in nursing school. That alone is not adequate experience or make for a competent provider. Board certification might not be required for a collaborating physician but unless the MD really has adequate (and current) clinical practice, your setting yourself up for a potential disaster.

[kevagonia]

point well taken pro-student

I still see this is a challenge that there must be a solution for... Otherwise all the FNP-owned clinics are "at risk". I was asking originally if anyone had a solution or an answer to this challenge, but it seems like it's going to be one of those "gray areas" that are elusive or with only "second-best" options...

_K

[pro-student]

The alternative is to seek collaborating physicians for each area you practice. With the shortage of family physicians, I'm certain every FNP in a collaborative practice requiring state won't have one to turn to. It would be prudent to "fill in the gaps." If you see adults and children, there is nothing that precludes you from having one internist collaborator for adults and a pediatrician for children. That way you're truly covered for your entire practice. Some FNPs end up only seeing a certain pt population. In that case it would be fine to just have a collaborating physician for that area. I know an FNP who only does adult orthopedics so her ortho colleague can reasonably be her collaborating physician.