I support the proposed regulatory change to language regarding physician/PA appropriate consultation rather than require review after the same complaint twice for the following reasons:

• PAs provide professional, team-based medical care. When a consultation or referral is needed, it will be sought. As a team member, the PA will assess the patient and provide the best care, including consultation as needed. The second visit rule is too restrictive.
• PAs have practice agreements. The practice level agreement is discussed with the PA/physician. Both providers have an understanding of the consultation process and when it is needed for that practice setting.
• There are many patients that may require an expected second visit with the same complaint. I work in pediatrics. I do not often prescribe medication for the initial visit runny nose and cough and recommend follow up-for the ‘same acute complaint’ if there is not improvement. Then the patient returns with the same complaint in three weeks. Do I need to have this case reviewed by a physician when seeing this patient? Right now, by regulation, I do. Is this a waste of time and resources for the physician? Absolutely! Does this patient truly need to be seen by a physician? Not likely, but if I thought they did, I would for best patient care.