What the Heck is a Collaborator? How NPs and PAs Play the Regen Med Game

As a physician who has been practicing medicine for 32 years, I’ve heard all of the medical terms. Some are in common use and some are pretty obtuse. However, I was just exposed to a brand new one that ties into yesterday’s story. That term is “Collaborator” and it’s a key part of the system whereby physicians can rent out their medical licenses in exchange for cash so that NPs and PAs can practice regenerative medicine with minimal supervision. Let’s dig in.

An Email

Many of my stories begin with an email from a blog reader. Considering that there are tens of thousands of patients, physicians, and industry experts that read this blog, as you might imagine, I get lots of emails. The one I got yesterday was fascinating in that it was simply a web address to a company calling itself “ColabSTAT”. Even more interesting was that this company is run again by no other than Angela Jayne, the NP protagonist in yesterday’s story about an Ohio clinic offering fake stem cell injections to elderly patients in Wyoming.

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What is a Collaborator?

The ColabSTAT website says that this is a connection service and uses the term “collaborator”:

“CollabSTAT is an all-in-one platform designed to securely connect collaborators.

Huh? I had never heard that term used in a medical context, but apparently, it’s now a “thing”. This is from a recent article put out by a credentialing service:

Physician assistants move from supervision to collaboration” 

The article goes on to state:

“The role of a physician assistant (PA) has historically been one of a “dependent practitioner” requiring close physician supervision, which included co-signatures, chart review requirements, co-locating physicians on-site where PAs deliver care, and limiting a PA’s scope of practice.

The trend in state regulatory laws, however, has been moving toward more remote supervision of PAs and fewer oversight requirements of PA clinical practice. This trend also includes states transitioning from supervision models to collaboration models. Some states have also eliminated or reduced requirements for chart review and supervision agreements. Several states have eliminated the need for a supervising physician to be physically co-located with the PA (Jones Day, 2020).”

What Does ColabSTAT Do?

This is what the website says:

Here an “Advanced Practitioner” is a mid-level. So this service allows mid-level providers like PAs and NPs to search for physicians who are willing to extend their medical licenses to those providers for a fee.

This is where we begin to enter the rabbit hole, as when you explore this concept, in my opinion, you begin to dance on the edge of what the state laws around mid-level providers were meant to accomplish.

What’s Going On? What is a Mid-level?

To understand why, in my opinion, this is really pushing the envelope, you need to understand the role of mid-levels in medicine. A mid-level is a non-physician provider who can, with the proper physician supervision, perform many of the functions of a doctor. For example, they can prescribe, perform minor surgery, and in some states, even see patients without a physician having to be on-site. There are two main categories, PAs (Physician Assistants) and NPs (Nurse Practitioners).

The mid-level societies have long sought to expand their scope of practice, meaning allowing PAs and NPs to do more with less physician oversight. In fact, the medical societies in many states often battle these groups on what mid-levels should be permitted to do. In my opinion, regrettably, for the public, the physician medical societies have mostly lost those battles. Meaning year over year, more states allow mid-levels to look more like physicians despite far less training. I’ve recently blogged on this phenomenon that I call, “Hold that Line!”. 

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Connecting Collaborators? The Four Hour Workweek

In my opinion, this is where we begin to dive deep down the rabbit hole and expose a huge fueling station for the explosion in regenerative medicine “bad actor” clinics. First, let’s explore this idea of a service connecting “collaborators” which reminds me of the best-selling book, “The 4-Hour Workweek”.

If you’re a physician looking for a mid-level, then you post on a medical job website. Similarly, if you’re a mid-level looking for a job in a clinic or hospital, you search on those same job websites. However, ColabSTAT is very different.

As a physician, if I were to list myself as a “collaborator” on this website, what am I getting myself into? I’m basically placing an ad to rent my medical license to allow a mid-level to practice in a distant location. Hence, in my opinion, for physicians, this is a “rent a license” website.

Let’s see how that works. Based on what I’ve observed, physicians can be paid $3,000-5,000 a month for the use of their medical license by a mid-level. While some states would have stricter laws than others, in some places I could amass a group of a dozen mid-levels where I’m listed as a “collaborator”. If I get paid on average 4K a month, that’s 576K a year! What do I have to do for that money? Not much. To keep it real, I could visit each clinic once a month or once a quarter, and spend a few hours documenting my role as the “collaborator”. So with travel, if I’m on the monthly visit plan, that’s 4 hours x 12 mid-levels or at most 48 hours a month or 12 hours a week! If I visit these mid-levels once a quarter, that’s 3 hours of work a week! Meaning, that I could finally achieve the “4-Hour” workweek!

Think I’m kidding? Check out this PA supervision (or “collaboration”) table put out by the AMA. There are about a dozen states that would allow this to happen. The rest mostly have limits on 4-6 PAs per medical license, so still a pretty great deal for the doctor.

Fueling the Regen Med Bad Actor Explosion

If you’re a mid-level wanting to open your own regen med practice or getting hired by a chiropractor’s office, you have a problem. You usually need a “collaborator” that you can list. In my opinion, this is where a service like “ColabSTAT” comes in very handy. It’s a master list of physicians who have agreed to rent their medical licenses for a fee.

Hence, as I document the explosion in “bad actor” mid-level run clinics or alternative medicine clinics that hire mid-levels, ALL of these need a physician “collaborator” to function. Hence, IMHO a service like this ends up being a fueling station for the shadow world of regen med clinics.

Why is This a Problem?

I’ve documented a crazy number of clinics that have a lone mid-level pretending to practice interventional orthobiologics who is usually way out of their depth. Those providers are often poorly trained and supervised. Consumers are often charged as much or more for this care as if they were seeing a highly paid physician subspecialist. In addition, crazy claims are often made about the efficacy of this care and vulnerable patient populations with incurable diseases are often targeted. While educated consumers usually don’t fall for this, it’s the elderly and uneducated working poor who often do, who are the least able to absorb the high cost of these poorly accomplished and overhyped procedures.

How Can the Legit Interventional Orthobiologics Community Help?

As physicians, we all know that we have colleagues who are interested in “The 4-Hour Workweek”. We also know colleagues who rent their medical licenses. Hence, we need to begin to speak up. We need to inform our “rent-a-license” colleagues that deals like this are below the standard of care. If our colleagues don’t or won’t listen, then, in my opinion, we should begin to file medical board complaints. There’s just no other way that we can bend the curve on this stuff.

The upshot? In my opinion, services like ColabSTAT are like huge fueling stations for the explosion in mid-level run “bad actor” regenerative medicine clinics. How can that be stopped? The legit interventional orthobiologic practitioners must act!

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile

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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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