Medical care has become a team effort. Most of the laws dealing with
responsibilities of physicians and nonphysician medical care providers [This
term is used to denote physician’s assistants, nurse practitioners, child health
associates, public health nurses, and other personnel with medical care
training who participate in the medical care delivery team.] (NPPs) are out of
touch with modern practice patterns. This is most evident in MCOs where NPPs
are widely used with very diffuse supervision. Unlike private practice settings
where there are a few NPPs reporting to a smaller number of physicians, NPPs
in MCOs are often used in situations where they have no single physician who
is responsible for their practice. This is a legal problem because in many
situations the law, as embodied in the cases and statutes of each state, is at
odds with the routine practice of medicine. The law presumes that all patients
will have a single, identified treating physician who will control all aspects of
the patient’s care, and who is the boss of all the nonphysician members of the
medical care team. This is not the case in most MCO practice.