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A Guide to the PA Wheel: Physician Assistant Scope of Practice Laws

Posted on: October 11, 2017


written by

Claire Cavanaugh

Paw Provider

It’s National PA Week! Thank you to PAs across the profession for your hard work and dedication to healthcare. We here at Barton Associates are celebrating with you by publishing PA-focused content all week long. Happy 50th anniversary!

PA employment is projected to grow 30 percent from 2014 to 2024. As demand for their talent grows, so has PA scope of practice. Fully updated with the most recent state legislature information from the American Academy of PAs (AAPA), Barton Associates’ PA Wheel is an interactive guide that can be easily navigated by anyone who is curious about PA scope of practice.

In celebration of National PA Week, we’re breaking down the AAPA’s Six Key Elements of Modern PA Practice Act by state: licensure terminology, prescriptive authority, where scope of practice is determined, supervision requirements, cosignature requirements, and limits on physician supervision. Currently, Massachusetts, Michigan, Minnesota, North Carolina, North Dakota, Rhode Island, and Vermont have all six elements in their state practice acts.

As hospitals, practices, and companies across the country battle a challenging physician shortage, more and more of them are turning to the talent, quality of care, and diverse experience that PAs offer. Are you considering hiring locum tenens PAs to meet your facility’s staffing needs? It’s time to get familiar with your state’s practice regulations.

“Licensure” As a Regulatory Term

After using terms such as “certified” or “registered,” state laws now use “licensed” and “licensure” to describe a state’s authorization process for PA scope of practice. Unlike previously employed language, “licensure” better emphasizes the state’s responsibility to authorize PA practice. While Ohio was previously the only exception, “licensure” is now recognized as a regulatory term across all 50 U.S. states.

Full Prescriptive Authority

While PAs undergo comprehensive education and training in pharmacology, these medical professionals aren’t authorized to prescribe medications without physician collaboration. Forty-four states allow supervising physicians to determine which drugs the PA is authorized to prescribe, while other states completely restrict PAs from prescribing schedule II drugs. Some argue this may be impeding patient access to care.    

Scope of Practice Determined on Site

In many cases, a PA’s collaborating physician has the best idea of their abilities within their scope of practice. In 37 states, this physician determines which tasks and procedures a PA can perform on site. This law enforces the PA’s role as part of a larger healthcare team, allowing the team to operate in ways that are specific to their dynamic.

The remaining states require an individual PA’s scope of practice to be determined by the state medical board.

Adaptable Supervision Requirements

Optimal functionality of a PA’s practice heavily depends on their relationships with collaborating physicians. Twenty-nine states allow physicians to determine their supervising relationship with PAs at their practice. In other states, the law specifically defines responsible physician supervision. This clarifies details about a physician’s proximity while the PA is assisting with a procedure, using a telecommunication platform, and more.,

Cosignature Requirements

Through the years, outcomes of PA and physician collaboration have cemented the importance of practice-level requirements. When it comes to patient care and chart review, 30 states allow supervising physicians to determine cosignature requirements at the practice level. The 20 remaining states define different timelines for when a physician should cosign a certain amount of PA charts.

Limits on Number of PAs a Physician Can Supervise

The limits on a number of PAs a physician can supervise are determined depending on facility, specialty, complexity of setting, and other factors. Fourteen states have no limit on the number of PAs a physician can supervise, while others have laws that define a limit between between two and six.

The PA profession has come so far over 50 years of practicing medicine. That being said, they also have a long, bright future ahead. Which laws affect PA practice where you live? Are there any you wish could be changed?

It’s National PA Week, and we’ve celebrated accordingly on the Barton blog. Check out our new PA-focused content and explore the PA Wheel to learn more!

Claire Cavanaugh
About Claire Cavanaugh

Claire Cavanaugh is the junior copywriter at Barton Associates' Peabody, MA, headquarters. She joined Barton after four years of blogging as a student ambassador for St. Michael's College, where she received a bachelor of arts in media studies, journalism, and digital arts.