In what states can physician assistants (PAs) practice independently?

Location matters for physician assistants (PAs), especially for locum tenens clinicians who may practice in several states over the course of their careers. Every state sets its own rules for PA licensure, scope of practice, prescribing, collaboration, and physician involvement.

That makes the common question, “In what states can PAs practice independently?” more complicated than it sounds. State statutes do not use one uniform definition of independent practice, and AAPA describes its preferred framework as Optimal Team Practice, not independent practice.

Here is what PAs should know as of September 2026.

Can physician assistants practice independently?

In some states, yes, depending on what “independently” means and whether the PA meets the state’s experience and practice-setting requirements.

Several states no longer require at least some PAs to be formally supervised by, collaborate through a written agreement with, or otherwise be legally tethered to a specific physician. That does not mean a PA practices without professional consultation, referral, credentialing requirements, or limits on scope. PAs remain responsible for practicing within their education, training, experience, competence, state law, and the applicable standard of care. Employers and healthcare organizations may also impose requirements beyond state law.

This distinction matters: removing a required agreement with a named physician is not automatically the same as unrestricted independent practice.

What states offer PAs an optimal practice environment?

As of September 2026, AAPA identifies eight states as having an optimal PA practice environment:

Iowa, Maine, Montana, New Hampshire, North Dakota, South Dakota, Utah and Wyoming.

Source: AAPA

In an optimal practice environment, PAs may practice to the full extent of their education, training, and experience. They collaborate, consult, and refer based on the patient’s condition, the PA’s competencies, and the standard of care rather than because state law requires an ongoing agreement with one specific physician.

AAPA’s rating evaluates the overall state practice environment. It should not be read as a simple list of every state in which a qualifying PA may practice without a named-physician agreement. Review AAPA’s current interactive state advocacy maps before relying on any state classification.

Other states with experience-based pathways to practice without a specific physician agreement

Several states outside AAPA’s eight-state optimal group allow, or have enacted pathways that will allow, qualifying PAs to practice without an agreement with a specific physician.

These examples show why a binary 50-state “independent versus supervised” map can be misleading. Some laws create an experience-based transition. Others depend on whether a PA works in a physician-led, group, rural, or other defined setting. Prescribing authority may follow separate rules.

For the most current state-by-state details, consult both AAPA’s interactive maps and the National Conference of State Legislatures’ PA practice and prescriptive-authority database. PAs should also verify requirements directly with the applicable state licensing board.

How recent state laws have changed PA practice

North Carolina: House Bill 67, signed in July 2025, eliminated the requirement for PAs with at least 4,000 clinical hours to maintain a specific physician relationship when working in a team-based setting. Read AAPA’s summary of the North Carolina law.

Virginia: House Bill 746, signed in April 2026, removed the on-paper physician agreement for PAs with more than three years of practice. Read AAPA’s Virginia update.

Delaware: Legislation signed in 2026 removed the on-paper agreement requirement for PAs with more than 6,000 practice hours. Read AAPA’s Delaware update.

Kansas: A 2026 law moved experienced PAs from a supervision model to collaboration after 4,000 clinical hours, but it retained a physician practice agreement. Read AAPA’s Kansas update.

Kentucky: A 2026 law expanded practice-level scope determination and Schedule II prescribing authority, but did not eliminate the physician relationship. Read AAPA’s Kentucky update.

Can a PA open their own practice?

Some PAs can own or operate a medical practice, but the answer depends on more than scope-of-practice law.

A PA considering practice ownership must examine:

• whether state law permits the PA to practice without a specific physician agreement;
• the state’s professional-entity and corporate-practice-of-medicine rules;
• ownership restrictions and licensing-board requirements;
• prescribing and controlled-substance authority;
• facility, payer-enrollment, credentialing, and malpractice-insurance requirements; and
• whether additional rules apply to services such as telehealth, aesthetics, behavioral health, or laboratory testing.

For that reason, it is inaccurate to say that every PA may open a practice or that all PAs in a particular state may do so under the same conditions. AAPA provides a practice-ownership checklist, but prospective owners should also consult the state licensing board and qualified healthcare counsel.

Does the PA Licensure Compact allow independent practice?

No. The PA Licensure Compact has been activated, but as of September 2026, PAs cannot yet apply for compact privileges. Once operational, the compact will provide eligible PAs with a more efficient way to obtain practice privileges in participating states. It will not create a national license or expand scope of practice.

A PA practicing through a future compact privilege will still be required to follow the supervision, collaboration, prescribing, and scope-of-practice laws of the state where the patient is located.

What should locum tenens PAs verify before accepting an assignment?

Before practicing in a new state, confirm:

• The PA license or compact privilege required for the assignment.
• Whether a supervision, collaboration, or practice agreement is required.
• Whether an experience threshold or specialty-change rule applies.
• The PA’s prescribing and controlled-substance authority.
• The facility’s credentialing, privileging, bylaws, and internal policies.
• Any chart-review, consultation, reporting, or proximity requirements.

State laws and regulations can change, and a facility may maintain stricter policies than state law requires. Barton’s licensing and credentialing teams can help clinicians navigate assignment requirements, but the relevant state board remains the authoritative source for legal requirements.

The bottom line for PAs

Eight states currently receive AAPA’s optimal-practice designation: Iowa, Maine, Montana, New Hampshire, North Dakota, South Dakota, Utah, and Wyoming. Additional states, including Arizona, Colorado, and North Carolina, allow certain qualifying PAs to practice without an agreement with a specific physician. Virginia and Delaware enacted similar authorization pathways in 2026, but PAs must satisfy each state’s approval and implementation requirements before practicing without an agreement.

The answer for any individual PA depends on experience, specialty, setting, prescribing needs, board authorization, employer policies, and current state law. Check with the relevant licensing board before every new assignment.

Want to explore locum tenens PA opportunities? View Barton Associates’ current PA jobs.

This article is for general informational purposes and is not legal advice. Laws, regulations, board guidance, and employer requirements can change. Verify current requirements with the relevant state licensing board.