How Mid-Level Providers Raise a Physician's Malpractice Risk Through Vicarious Liability

Nurse practitioners and physician assistants, considered midlevel practitioners or physician extenders, are very common in many physician practices. Midlevel providers supply many benefits for the doctor practice including: allowing a practice to serve more patients while also giving those patients more individual focus; they can be paid less than medical doctors; and lastly, they can be easier to get an appointment with since primary care physicians are retiring at an amazing rate in part due to increased government regulations and lack of compensation.

Midlevel providers can increase malpractice risks, however. Nurse practitioners and physician assistants work under the supervision of a medical doctor. Those physicians may be held responsible for their actions and for not adequately supervising the treatment they provide.

Vicarious liability is the legal term for extending liability through a connection with another party. Under this particular concept, a person who does not cause injury can be held liable through the relationship to the individual who did cause the injury.

Courts have ruled that the midlevel is an agent of the physician and can be held vicariously liable for negligence, even if the physician never saw the patient. Physicians often don't recognize the level of supervision needed to keep the liability risk low. Medscape does admit that the number of cases involving midlevel professionals is expected to grow given their increasing numbers in medical practices.

However, the American Academy of Physician Assistants sites numerous studies that show midlevel professionals are much less likely than physicians to be named in a malpractice suit. When they are sued, settlements and the awards are smaller than in cases involving doctors. The American Academy of Orthopedic Surgeons notes that many cases involving midlevel professionals also name the supervising doctor. Settlements that don't involve the physician are uncommon.

Physicians can minimize their liability risk by taking preventative measures:

• Thorough Review when Hiring. In the event the doctor knows or has reason to know the the midlevel is incompetent or unfit, he/she can be found negligent.
• Clear Definition of Scope of Work. Physicians must be specific regarding the estimated obligations and obligations of the midlevel to avoid potential errors. 
• Collaborative Communication. Midlevels ought to be made to feel comfortable coming to the physician with any issues or difficulties and should maintain a collaborative relationship.
• Communication with Patients. Patients should know they are seeing a midlevel professional and not a doctor. 

Vicarious liability suits are anticipated to continue to climb since midlevel practitioners are the future in outpatient medicine and primary care.

To find out more regarding the legal risks associated with midlevel professionals and the best way to minimize them, contact us!