Physician assistants (PAs) are licensed medical professionals who deliver patient care in virtually all healthcare settings. Their scope of practice differs by state, which can leave PAs and facility leaders wondering, can PA's practice independently in my state?
Each state has different laws dictating how autonomous a PA may be at work, and it's crucial for both facility leaders and PAs to understand how these laws impact their duties and responsibilities. In this article, we'll provide an overview of what PAs are authorized to do in their roles, discuss how their practice authority differs by state, and answer other frequently asked questions to help you understand what falls inside and outside their scope of practice.
Can PAs Work Independently?
A PA's level of autonomy at work is dependent on limiting factors, such as experience, state laws, and employer policies. These limitations form a scope of practice that is highly individualized to the practitioner and their setting.
Scope of practice broadly refers to what healthcare professionals are legally authorized to do based on their level of education and training. In order to practice, PAs must graduate from an accredited PA graduate program and pass the licensure exam administered by the National Commission on Certification of Physician Assistants (NCCPA). While exact scope of practice guidelines differ by state and facility, passing this exam generally qualifies a PA to:
- Take medical histories.
- Perform physical exams.
- Order and interpret laboratory tests.
- Diagnose illnesses.
- Develop and manage treatment plans.
- Prescribe medications.
- Assist in minor procedures and surgeries.
How Is the Degree of PA Autonomy Determined?
A PA's level of independence is primarily determined at the state and practice level. At the state level, medical boards and other local governing bodies enforce laws in the PA practice act. The American Academy of Physician Associates (AAPA) recommends six key elements that every modern PA practice act should have, which include:
- "Licensure" as the regulatory term.
- Full prescriptive authority.
- Scope of practice, determined at the practice level.
- Adaptable supervision requirements.
- Chart co-signature requirements, determined at the practice level.
- Number of PAs a physician may supervise, determined at the practice level.
Many states have yet to adopt all six of these key elements, and there's still considerable variation in how much of a PA's authority is determined at the practice level. States with more lenient laws allow individual practices/healthcare teams to decide a PA's scope of practice based on their level of competence and patients' needs.
Physician Assistant Supervision Requirements by State
If you're asking, Can PAs practice independently? your next question is likely, What states allow physician assistants to practice independently? According to AAPA scope of practice guidelines, there are four practice categories that states use to define practice and supervision requirements. These four practice categories, and examples of states that follow them, are summarized below.
1. Optimal
PAs in optimal, or optimal team practice (OTP) states can practice to the full extent of their medical education, training, and experience. PAs collaborate, consult, or refer to members of the healthcare team as indicated by the patient's condition, the PA's competencies, and standards of care. Physician supervision or collaboration is not required for practice and prescriptive authority, but the profession remains based on a team model of care provision.
You may wonder, can PAs have their own practice in OTP states? While PAs may have financial ownership of a business, the team-care model guides clinical practice.
Example state: North Dakota grants a high level of autonomy to physician assistants. PAs with 4,000 hours of experience can apply for approval to practice independently with a scope of practice to be determined at the practice level.
2. Advanced
PAs in advanced states practice to the full extent of their medical education, training, and experience. However, they must also comply with administrative requirements outlined in state laws and regulations. Instead of being supervised, PAs can enter into a collaborative agreement with physicians for practice and prescriptive authority.
Example state: Oregon requires PAs to practice in collaboration with a physician appropriate to the patient's condition and PA's competence level. The degree of collaboration between a PA and a physician is determined at the practice level.
3. Moderate
Laws and regulations in moderate states pose additional administrative restrictions that limit the authority of the PA and healthcare team. Some level of supervision from a physician is required for practice and prescriptive authority.
Example state: Under the PA scope of practice, California requires all PAs to be supervised by a licensed physician. The supervising physician and PA can determine supervision rules at the practice level but are required to create and adhere to written guidelines.
4. Reduced
Laws and regulations in reduced states restrict the PA's ability to practice in at least one key element of modern PA practice. PAs in these states have restricted delegated authority and follow strict supervision requirements.
Example state: PAs in Kentucky must be supervised by a physician and get their scope of practice approved by the state's medical board. They must also obtain additional training and registration to prescribe certain scheduled medications.
Can PAs Practice Independently? State Laws at a Glance
The following chart summarizes the physician assistant scope of practice by state. While this chart provides an overview of each state's practice category and prescriptive authority, it's important to visit your state licensing board's website for more details about the PA practice act.
The laws regarding PA autonomy evolve as states navigate provider shortages and changing healthcare demands, raising questions such as:
- Can physician assistants prescribe medications?
- What types of medications can they prescribe, and under what circumstances?
To accurately answer these questions in your practice environment, reference current state law. The AAPA is engaged in advocacy efforts to promote modernization of PA scopes of practice, and these efforts continue to impact legislation.
| State | Practice Category | Prescriptive Authority | Licensing Board(s) |
|---|---|---|---|
| Alabama | Reduced | Schedule III – V | Board of Medical Examiners |
| Alaska | Advanced | Schedule II – V | State Medical Board |
| Arizona | Advanced | Schedule II – V, withlimitations based on experience level30- to 90-day limits for some types of controlled substances | Regulatory Board of Physician Assistants |
| Arkansas | Advanced | Schedule III – VSchedule II limited underAR Code 17-105-108 | State Medical Board |
| California | Moderate | Schedule II – V | Physician Assistant Board |
| Colorado | Advanced | Schedule II – VOpioid prescriptions limited underCO Revised Statutes 12-30-109 | Board of Medicine |
| Connecticut | Advanced | Schedule II – V | Division of Medical Quality Assurance |
| Delaware | Advanced | Schedule II – V | Board of Medical Licensure and Discipline |
| Florida | Reduced | Schedule II – IV7- to 14-day limit on Schedule II,dependant on circumstances | Board of MedicineBoard of Osteopathic Medicine |
| Georgia | Reduced | Schedule III – VSchedule IIlimited to healthcare settings, must be co-signed by physician | Composite Medical Board |
| Hawaii | Reduced | Schedule III – VSchedule II allowed if PA is extended privileges by facility | Hawaii Medical Board |
| Idaho | Advanced | Schedule II – V | Board of Medicine |
| Illinois | Advanced | Schedule II – V | Division of Professional Regulation |
| Indiana | Moderate | To the extent delegated by thecollaborating physician | PA Committee |
| Iowa | Optimal | Schedule II – V | Board of Physician Assistants |
| Kansas | Reduced | Schedule II – VSchedule II prescriptions by telephone/oral communicationlimited to emergency situations. | Board of Healing Arts |
| Kentucky | Reduced | Schedule III – V with board approval and additional training under Kentucky Revised StatutesSection 311.858 | Board of Medical Licensure |
| Louisiana | Moderate | Schedule II – V | Board of Medical Examiners |
| Maine | Advanced | Schedule II – V | Board of Licensure in MedicineBoard of Osteopathic Licensure |
| Maryland | Moderate | Schedule II – V, when acting asdelegatee of a physician, with exceptions | Board of Physicians |
| Massachusetts | Advanced | Schedule II – VISchedule II must be reviewed by supervising physician within 96 hours | Board of Registration of Physician Assistants |
| Michigan | Advanced | Schedule II – V | Task Force on Physician’s Assistants |
| Minnesota | Advanced | Schedule II – V | Board of Medical Practice |
| Mississippi | Reduced | Schedule II – V | Board of Medical Licensure |
| Missouri | Moderate | Schedule II – VSchedule II may have restricted authorityHydrocodone and Schedule III narcotic controlled substances limited to 5-day supply with no refills,with exceptions | State Advisory Commission for Physician Assistants |
| Montana | Optimal | Schedule II – VSchedule II must not exceed34 days | Board of Medical Examiners |
| Nebraska | Moderate | Schedule II – V | Board of Examiners in Medicine and Surgery |
| Nevada | Reduced | If authorized by the Board of Medical Examiners, mayprescribe controlled substances | Board of Medical ExaminersState Board of Osteopathic Medicine |
| New Hampshire | Optimal | Schedule II – VWhen prescribingcontrolled substances via telemedicine, must undergo evaluation at least annually | Board of Medicine |
| New Jersey | Moderate | Schedule II – V | Physician Assistant Advisory Committee |
| New Mexico | Advanced | Schedule II – V | Medical Board |
| New York | Moderate | Schedule II – V, to the extent assigned bysupervising physician | Office of the Professions |
| North Carolina | Advanced | Schedule II – V,with limitations | Medical Board |
| North Dakota | Optimal | Schedule II – V | Board of Medicine |
| Ohio | Moderate | Schedule II – VSchedule II limited underR.C. 4730.411 | State Medical Board |
| Oklahoma | Moderate | Schedule II – VSchedule II medications only when under the supervision of adelegating physician, after filing a form | Board of Medical Licensure and Supervision |
| Oregon | Advanced | Schedule II – V | Medical Board |
| Pennsylvania | Reduced | Schedule II – VSchedule II limited to72-hour supplywhen used for initial therapy, with notification to physician within 24 hoursSchedule II limited to 30-day supply when used for ongoing therapy, if approved by supervising physician | Board of MedicineBoard of Osteopathic Medicine |
| Rhode Island | Advanced | Schedule II – V | Department of Health |
| South Carolina | Reduced | Schedule II – VSchedule II withstrict limitations | Board of Medical Examiners |
| South Dakota | Optimal | Schedule II – V | Board of Medical and Osteopathic Examiners |
| Tennessee | Moderate | Schedule II – VSchedule II and III limited to 30-day supply | Committee on Physician Assistants |
| Texas | Moderate | Schedule II – VSchedule II drugs underChapter 481 ProvisionsSchedule III-V limited to 90-day supply | Physician Assistant Board |
| Utah | Optimal | Schedule II – V | Physician Assistant Licensing Board |
| Vermont | Advanced | Schedule II – V | Board of Medical Practice |
| Virginia | Advanced | Schedule II – V | Board of Medicine |
| Washington | Advanced | Schedule II – V | Medical Commission |
| Washington D.C. | Reduced | Schedule II – IV | Board of Medicine |
| West Virginia | Advanced | Schedule II – VSchedule II narcotics limited to3-day supplywithout refills | Board of MedicineBoard of Osteopathic Medicine |
| Wisconsin | Advanced | Schedule II – V | Physician Assistant Affiliated Credentialing Board |
| Wyoming | Optimal | Schedule II – V | Board of Medicine |
PA Scope of Practice: FAQ
We've provided an overview of what PAs can do and how their scope of practice differs by state. However, you may still have some questions about their role and responsibilities. To provide more clarity, we'll answer some additional FAQs about the PA scope of practice below.
In what states can PAs practice independently?
The following states give PAs the most independence and are the only seven states that the AAPA has categorized as having optimal practice environments:
- Iowa
- Montana
- New Hampshire
- North Dakota
- South Dakota
- Utah
- Wyoming
PAs have historically been required to have a supervisory relationship with a physician in order to practice. But in recent years, these states have modernized their PA scope of practice laws to minimize or remove this requirement.
Can a physician assistant prescribe medication?
Physician assistants can prescribe non-controlled medications in all 50 states and U.S. territories. However, some states place restrictions or supervisory requirements on prescribing scheduled medications.
What are physician assistants not allowed to do?
While physician assistants have been granted more practice authority in recent years, there are still limits on what they can do in their roles. Specific restrictions vary by state; but, generally, PAs are not authorized or trained to:
- Perform complex procedures and surgeries.
- Prescribe certain scheduled medications in some states.
- Open their own practice in most states.
- Sign death certificates in some states.
What's the difference between a physician and a PA?
The main differences between a physician and a PA are their levels of training and autonomy. PAs receive two years of graduate training, while physicians undergo four years of graduate training and additional residency. Since physicians receive more training, they have full practice authority and carry out responsibilities that go beyond the PA scope of practice.
What's the difference between a PA and an NP?
PAs and Nurse Practitioners (NPs) are both advanced healthcare professionals, but they're trained under different care models. NPs are trained under the nursing model, while PAs are trained under the medical model. NPs also have full practice authority in 28 states, while PA independent practice laws are much more restrictive.
Can a PA practice independently in Iowa, Montana, and other OTP states?
Some states have modernized their laws to align with the AAPA's OTP standards, allowing for more professional autonomy. For instance, PAs in optimal practice states may be able to collect payments directly, rather than always going through an employer. This supports independent contracting. However, teamwork remains a cornerstone of the profession.
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Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current, as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.