SCOPE OF PRACTICE
GASTROENTEROLOGY
Name
License #
Supervising Physician
Alternating Supervising Physicians
Physician Assistant
Practice Site
Address
Phone
*Please add additional practice sites*
Hospital or University Affiliation
Signatures
Supervising physician
Physician Assistant
Alternate supervising
Date _________________________
.
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SUPERVISION STATEMENT
The Relationship
Guidelines for Practice
The physician is responsible for managing the health care of patients in all practice settings.
Heath care services delivered by physicians and physician assistants must be within the scope of
each practitioner's authorized practice as defined by state law. The physician is ultimately
responsible for coordinating and managing the care of patients and with the appropriate input of
the physician assistant ensuring the quality of health care provided to patients. The physician is
responsible for the supervision of the physician assistant in all settings. The role of the physician
assistant (s) in the delivery of care should be defined through mutually agreed upon guidelines
that are developed by the physician and the physician assistant and based on the physician's
delegatory style. The physician must be available for consultation with the physician assistant at
all times either in person or through telecommunication systems or other means. The extent of
the involvement by the physician assistant in the assessment and implementation of treatment will
depend on the complexity and acuity of the patient’s condition and the training and experience
and preparation of the physician assistant an adjudged by the physician. Patients should be made
clearly aware at all times whether they are being cared for by a physician or a physician assistant.
The physician and physician assistant together should review all delegated patient services on a
regular basis as well as the mutually agreed upon guidelines for practice. The physician is
responsible for clarifying and familiarizing the physician assistant with his supervising methods
and style of delegating patient care. The relationship between a supervising physician and PA is
care to the patients of the practice, to consult with the physician or refer to the physician those
based on mutual respect and trust. The physician relies on the PA to provide physician-quality
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care to patients who require physician care and to abide by any guidelines determined by the
supervising physician and the state body charged with overseeing physician/PA practice. The PA
relies on the supervising physician to be available for consultation, provide learned advice and
assume care of patients who have conditions that place them outside the scope of PA practice.
Care of the patients shall include but not be limited to:
-Performance of an appropriate history and physical exam
-ordering / interpreting / performing appropriate diagnostic test
-establishing and implementing appropriate treatment plans consistent with the standard of care:
This shall include counseling / instructing / performing tasks approved by SBME / prescribing
medications and dispensing sample medications as dictated by the PA's prescriptive privilege or
state law or under the verbal order of the supervising or alternate supervising MD.
Medication formulary consists of those medications appropriate to the treatment of patients in a
gastroenterology/hepatology practice including prescribing medical devices.
Excluding - any Class II medication
Ophthalmic steroids
Initiating Class III antiarrhythmics
MAO inhibitor
Anabolic steroids
Sublingual Nifedipine for BP control
-For inpatient encounters, the PA, if requested by the supervising physician may order parenteral
medicine or Category II controlled substances under the verbal order of the supervision or
alternate supervising MD. The PA may examine and write orders as directed by their supervising
MD for admission / consultations requested.
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-
Patients presenting with conditions, which are life threatening, requiring immediate
hospitalization, or surgery, should be evaluated by a physician.
-
In a life-threatening situation the PA may direct ACLS / PALS / BLS protocols while
awaiting the arrival of a MD.
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Gastroenterology and Hepatology Scope
General Complaints
Evaluation of abdominal pain
Evaluation of dyspepsia
Evaluation of nausea/vomiting
Evaluation of dysphagia
Evaluation of constipation
Evaluation of diarrhea
Evaluation of gastrointestinal bleeding
Evaluation of elevated liver enzymes
Evaluation of weight loss
Alimentary Tract
Diseases of the Esophagus
GERD
Esophageal Dysmotility
Barrett’s Esophagus
Esophageal Cancer
Esophagitis (Infectious and Ulcerative)
Achalasia
Esophageal varices
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Diseases of the Stomach and Duodenum
Gastritis
Helicobacter pylori infection
Gastroduodenal Ulcer Disease
Gastric Outlet Obstruction
Mallory-Weiss Tear
Gastroparesis
Gastric Carcinomas
Carcinoid
Gastrointestinal Lymphoma
Diseases of the Small Intestine
Celiac Sprue
Whipple’s Disease
Small Bowel Carcinoma
Diseases of the Colon and Rectum
Irritable Bowel Syndrome
Colitis, acute self-limiting, non-specific
Infectious Colitis
Microscopic Colitis
Ischemic Colitis
Ulcerative Colitis
Crohn’s Disease
Diverticular Disease
Colorectal carcinoma
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Anorectal Diseases
Hemorrhoids, external and internal
Abscess
Carcinoma
Liver, Biliary Tract, and Pancreas
Diseases of the Liver
Bacterial and viral hepatitis
Autoimmune hepatitis
Hemochromatosis
Non-alcoholic steatohepatitis
Alcoholic hepatitis
Cirrhosis
Spontaneous Bacterial Peritonitis
Ascities
Hepatic encephalopathy
Hepatocellular carcinoma
Diseases of the Biliary Tract
Cholelithiasis
Cholecystitis
Choledocholithiasis
Primary Biliary Cirrhosis
Primary Sclerosing Cholangitis
Cholangiocarcinoma
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Diseases of the Pancreas
Pancreatitis
Pancreatitc pseudocyst
Pancreatic carcinoma
Sphincter of Oddi Dysfunction
TASKS
TASKS ALL CERTIFIED PA'S SHOULD BE QUALIFIED TO PERFORM INCLUDE:
Local anesthesia
Suture lacerations
Start IV's / Flush port-a-cath
Venipuncture
ACLS/CPR
A Nationally certified PA may request additional tasks at the time of initial application if able to
provide documentation of their competency in performing this task
Documentation should consist of :

Number of times procedure performed

Documents from prior employer as to competency level

Documents of prior training
A recent graduate applying for their initial position, as a PA must work with their employer six
months before requesting additional task.
Task list should be reviewed yearly - additional task may be added when further training is
documented and request is made to PA committee/SBME.
Under no circumstance should a PA perform any task in which his supervising MD is not
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credentialed to perform.
Training for additional tasks may be undertaken as delegated by the PA's supervising M.D.
However under no circumstance shall a PA perform a new task without direct supervision until
approval has been received from SBME/PA committee. The committee has the right to request
documentation and formal training modalities for these new tasks prior to approval.