The Case Of The Delegating Doctor, Or Why Micromanaging Is Sometimes Advisable

We all have had medical tests administered by employees of our doctors, rather than by the doctors themselves. This allows our physicians to devote more time to the things that only physicians can do: Diagnosing those difficult cases, keeping current on the latest medical research findings,  managing their stock portfolios, refining their golf swings, etc.

Recently, the Supreme Court of New Jersey put a limit on employee administered tests, at least with regard to one test. A Bergen County neurologist, whom we’ll call Dr. R., was letting a physician’s assistant perform this particular test. The test is called a “needle EMG”. (“EMG” is short for electromyography). A needle EMG involves inserting a needle electrode through the skin, into muscle tissue.  The procedure can detect nerve or muscle problems. Sounds painful.

However, the law authorizing EMGs states that they must be performed by to those who are licensed to “practice medicine and surgery.” The doctor argued that a physician’s assistant could nonetheless perform the test, based on the law that allows a PA to “assist” a physician to practice medicine.

The Supreme Court rejected the doctor’s argument. The Court noted that “assist” does not mean “perform in the place of.” Dr. R. is now facing separate legal action by the Board of Medical Examiners, for fraud.

I think that the Court got it right. However, the law needs to be clarified respecting other procedures.  In the future, both patients and physicians should know in advance exactly which procedures can be performed by non-physicians. As for Dr. R., I do not think that it would be fair to sanction his medical license for past offenses. After all, it was not crystal clear, until the court spoke, that his conduct violated the law.