Having Students at My Medical Practice Provides Lessons in Liability

by Melissa Gallogly | February 02, 2012 8:00 AM EST

I am a Family Nurse Practitioner and worked for a practice as an "Independent Contractor."I was wondering what other physicians would think about a practice that used students to fill in the gaps in the office, as opposed to hiring staff to complete office work. I worked in a practice for a brief period, that had a Part time Office Manager that was a Medical Assistant/Certified Biller/Coder, and they had a receptionist. These two in addition to 2-5 students ran the office and took care of all the office needs. The office also employed a Part-time business manager. The "Office Manager" supervised the students, and ran the office, and controlled what would be done, and by whom, etc.. Previous to this position I always worked in a setting that employed multiple personnel to complete the various office tasks required for day to day office operation, and I have been a Nurse Practitioner for 10 years. I was treated like a glorified student by this Office Manager and she would not perform tasks for me that would normally be done by office staff, such as completing a prior authorization for a PPI because I put the patient on the medication, and when my concerns regarding what her job was and my position as a Provider in the office were discussed with the Physicians in the office, I was basically told that I wasn't being treated any differently than any of the other providers in the office, and I was overreacting. This manager was in charge of submitting and monitoring collections for the patients I billed for, and I was making a percentage of my collections! So, I was trying to find out what other providers felt about this type of office set up, and the legality of using students and minimally qualified staff to complete all associated tasks required for day to day office functionality?

by Kimberly Spering | January 31, 2012 10:43 PM EST

I completely agree with Ms. Milek. Having precepted NP students from many schools for the past 10 years, they must meet stringent criteria for confidentiality, malpractice coverage, and other concerns prior to setting foot in a clinical setting. Asking patients if it is OK for a student to "sit in"or "start" a visit is perfectly acceptable and desirable. In my practice, my students start with one day of "shadowing," then progress to taking a history, with my watching the PE, then perform a complete visit with me repeating the history & exam after he/she does.

Yes, it takes time...lots of it. I will usually see another patient while my student is with one of my patients. However, it is a vital part of growth & learning, IMHO, to allow them to progress to this level. NP and PA students, just like residents, need to do the WHOLE visit, lest they miss out on opportunities for differential diagnoses, planning, decision-making, and evaluation. As for the issues of privacy and liability...well, the NPs learn as nurses (first) that these issues are vital. It is no different in the role of an NP/PA.

If they are injured, then the liability generally falls back toward the school policies in effect. I would check with them if you aren't familiar. However, there are generally standards of practice that address this. Students should NOT have to be on YOUR policy.

I precept once a year, and only will take students after they have had one semester of clinical. My high-volume, high-acuity Internal Medicine practice would be too overwhelming for a "newbie" student, just out of "classroom study" only. I maintain that we NPs and PAs need to excel and maintain as high of standards as our physician colleagues, and I accept no less. (smile)

Thank you for agreeing to precept! We need more people willing to do this job~

by Gayle Milek | January 31, 2012 2:01 PM EST

I am currently a FNP student;' I graduate in May. I signed a HIPPA statement, meet health standards for immunizations, CPR certification, and malpractice coverage prior to the preceptor clinical experience. I believe these student responsibilities are important to protect your patients and your practice. Patients need to understand that their privacy is protected when the student is in the room. Otherwise, many will opt out of letting a student be present in the room. I agree with you that the patients enjoy being part of the learning experience and the focus is on them. Thank you for supporting our education and clinical experience. Preceptors like yourself enhance the relationship of FNP's with MD's and I find our roles compliment each other. Thank you!