The Preceptor Who Was Never Approved
Dr. R has an active Delaware license and wants to precept Dr. L, a recent graduate who has passed the national board examinations but has not yet been issued a Delaware license. Dr. R plans to have Dr. L see patients independently at his Newark office three days a week while Dr. R works at a second clinic. No preceptor application or written supervision plan has been submitted. Dr. R also received a public reprimand in 2022 for failing to maintain adequate records. Last week Dr. L performed a cervical adjustment and told a patient she had a “C5 subluxation”; the patient later asked the front desk whether Dr. L was a licensed doctor. Dr. R says the arrangement is fine because Dr. L is “board eligible” and he reviews charts weekly.
1. What must be established before Dr. R may serve as a preceptor, and does he appear to qualify?
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Preceptor approval is discretionary and not automatic. The Board’s preceptor rules typically require an active, unencumbered license; a minimum period of practice; no recent or serious discipline; a written preceptor agreement; a defined supervision plan; and Board approval before the graduate begins patient care. The Board may also review the site and the preceptor’s availability.
Dr. R’s 2022 public reprimand for recordkeeping must be disclosed and may disqualify him or require conditions. He cannot self-designate as a preceptor, and he cannot begin the arrangement while the application is pending. The written plan should specify on-site supervision, chart review frequency, and the preceptor’s accessibility. “Board eligible” describes examination status; it does not create a license or preceptor authority.
2. Evaluate the supervision and unlicensed-practice issues in Dr. L’s independent work.
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Dr. L is not licensed; “board eligible” is not a license. Seeing patients independently, performing a cervical adjustment, and diagnosing a “C5 subluxation” constitute unlicensed practice. Dr. R would be aiding and abetting unlicensed practice. Weekly chart review is not supervision for procedures that require on-site oversight.
The patient’s question about whether Dr. L is a licensed doctor is a warning sign of misrepresentation. The Board can sanction both individuals, issue a cease-and-desist order, and require Dr. L to apply for licensure. Dr. L may perform only limited tasks expressly allowed to unlicensed graduates, if any, and only under direct supervision. The preceptor’s approval must precede any patient contact, not follow it.
3. What immediate corrective steps should Dr. R take?
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Dr. R should immediately stop independent patient care by Dr. L; notify the Board; submit a preceptor application and supervision plan; ensure he is on-site for all patient encounters until approval; correct any advertising or statements about Dr. L’s status; audit the charts Dr. L touched; notify patients if misrepresentation occurred; and cooperate with the investigation.
He should also address the underlying recordkeeping issue from 2022 with a compliance plan. If the Board declines preceptor approval, Dr. L must find another approved preceptor or complete licensure before practicing. Finally, Dr. R should document his corrective actions and avoid any retaliation against staff who raised concerns.