BOSTON – Compared with physicians, PAs are twelve times less likely to be sued for malpractice and reduce a practice’s liability costs compared with physicians, according to a presenter at the American Academy of Physician Assistants IMPACT 2014 meeting.

Despite these advantages, PAs still need to be cautious and detailed to avoid malpractice suits, Jeffery Nicholson, PA-C,PhD, founder of the PA Experts Network medicolegal consulting service told an audience here. He offered several tips aimed at helping new PAs and students navigate their career and avoid future lawsuits.

Details are key

Nicholson’s overarching suggestion to PAs was to be detailed in all aspects of the job. Keeping detailed medical notes and taking an accurate medical history are two ways to keep malpractice suits down.

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PAs should record what they tell the patient, especially when it comes to follow-up appointments and potential drug interactions if medication is prescribed. “You need to have the note discussing the schedule,” cautioned Nicholson, “it saves you from getting sued and from loosing a career.”

Additionally, PAs should use medical notes as an opportunity to provide as much information as possible, especially if there isn’t a decisive diagnosis. “If you don’t give a definitive diagnosis, you need to list differential diagnoses and state how you will rule out the alternatives diagnoses,” cautioned Nicholson.

Patient histories are an important tool in a correct diagnosis. “Ninety percent of your diagnosis is an accurate and detailed patient history,” said Nicholson. Because complications due to wrong diagnoses are one of the top reasons for malpractice awards, taking a detailed patient history is crucial.

Collaboration, communication

PAs need to work well and communicate with all types of help on the medical team, and shouldn’t be afraid to ask for help or a second opinion. “Get all films read by a superior, it’s really important, even if you’ve been a PA for 20 years,” suggested Nicholson.

If a patient requires care that is outside of a PAs comfort zone, Nicholson advises finding an appropriate referral.   This keeps the PA protected and the patient in good care. “A PA shouldn’t prescribe medication they are not comfortable with,” added Nicholson.

When scheduling follow-up appointments or discussing test results, PAs need to clarify whom in the practice is assigned to communicating with the patient, especially in primary-care practices. “If there’s a primary-care relationship present in a patient’s chart, PCPs are responsible for communicating the results of ordered tests.”

For new PAs, Nicholson advised learning about malpractice policies. “There are occurrence policies will cover you no matter when they occur. They are the best policy, and it’s the one you want.”

If a practice only offers a time-specific policy, PAs should ask if the practice covers the tail. “[If a] practice will not pay for it, make sure you understand what will be expected of you to pay.”

The legal state for PAs is changing with new health care laws.  PAs have more autonomy, but with that comes more responsibility and liability risk. Understanding how they communicate, collaborate and record patient visits are the most effective ways to limit malpractice suits.


  1. Nicholson J. “Malpractice Avoidance and Malpractice Insurance: Keeping Both my Patients and my License Safe.” Presented at: AAPA 2014. Boston; May 23-28, 2014.