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The fight has been brewing since 1997, when the Health Care Finance Administration, the agency that decides what Medicare will and will not pay for, first proposed lifting a federal rule requiring that nurse anesthetists be supervised by physicians.
Course duration was almost certainly too short, and many assumptions that drove curriculum development (TMs would see only stable, non-pregnant adult patients in clinical stages 1 or 2; clinical staging was feasible in this environment; TMs would not initiate ART; TMs would be supervised by physicians) proved to be incorrect.
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Nearly all the secondary level of care patients are seen by resident physicians as part of their professional training, and they are supervised by attending physicians.
Midlevel providers supervised by these physicians include residents from internal medicine, surgery and gynecology, as well as physician assistants.
Almost all other care for the severely ill — nursing, intravenous medications, lab tests, imaging studies — should be provided in the home and be supervised by personal physicians who know their patients well and are always available.
An emergency department observation unit (EDOU) is staffed by MLPs supervised by ED physicians.
The remaining two regions, located in the eastern provinces, were supervised by EM physicians affiliated with large, non-academic hospitals.
Calls are received and ambulances are dispatched by a police dispatch center, which is supervised by police physicians and paramedics not trained in emergency medicine [22, 25].
However, most available prevention programs were supervised by sport physicians or physical therapists.
However, the surgical emergency ward is mainly covered by junior or less experienced doctors, who are supervised by specialized physicians.
In the clinical setting registrars are supervised by family physicians as well as other specialists at the regional hospitals.
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