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Physicians who employ PEs should be very careful in their supervision. A physician should never accept responsibility for a PE without having the authority to supervise or decline to practice with the person. The physician is liable for negligent medical care rendered by PEs. The physician is also liable for nonmedical actions by the extender, such as sexual assault, if the physician is negligent in screening or supervising the extender.

The first step in selecting or accepting supervision of a PE is to check the person's credentials personally and carefully. The extender's license status must be checked in every applicable state, not just the state where he or she will work. The physician should find out the specifics of the PE's training and previous experience to gauge skill levels. Finally, the physician should talk to other physicians who have worked with this extender, asking specifically about the extender's willingness to accept physician authority, clinical skills, and readiness to ask for consultation from the physician. A PE who worked well with a physician who checks every patient and chart entry may not be compatible with a physician who prefers to delegate by written protocols.

The physician should observe a newly hired PE in providing patient care and repeating the physical assessment. It is not possible to know if the extender recognizes a bulging eardrum until the physician has reevaluated both negative and positive findings by the extender. This also gives the extender the opportunity to learn the physician's preferences and practice habits.

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