PAs Hoping to Ease State Restrictions on Their Practice in 2027

As the year comes to a close, the nation’s physician associates (PAs) are looking forward to pursuing their state legislative agenda for 2027, including easing scope-of-practice restrictions.

“What’s interesting about state practice laws and licensure is they’re not a partisan issue,” said Chantell Taylor, chief of public affairs and advocacy at the American Academy of Physician Associates (AAPA), during an online interview at which a press person was present. “Even though the midterms will shape health policy top to bottom, there won’t be a ton of shift in our priorities or our coalition partners. Practice modernization and the healthcare workforce don’t tend to fall into a partisan camp.”

One of the biggest priorities for the AAPA is removing the requirement that PAs have to practice under physician supervision. That requirement is something that is governed by state, not federal, law, and so far nine states — North Dakota, Wyoming, Utah, Montana, Iowa, New Hampshire, Virginia, Maine, and Delaware — have removed the requirement. Another 12 states are expected to pursue legislation to modernize their PA practice acts, but not all of those states will solely be going after supervision removal, according to an AAPA official.

The inconsistency between states can be a problem when a PA works across state lines, Taylor said. “It is a huge barrier to bringing access to care into that more restrictive state. Health systems that have [practices] across jurisdictions … have a tendency to implement practices that are more restrictive … so we need to raise all boats, not lower them, by getting some consistency across the states.”

The physician supervision requirement is also a barrier for retail clinic purveyors like CVS and Walgreens, she continued. “They are eager to open more locations but when they have states that require a physician on site or [certain] ratios of physicians to PAs, they’re not hiring PAs or not opening clinics because the cost is not worth it,” Taylor noted. “It’s not worth having to put an infrastructure in place to meet a ratio or sign a chart.”

Physicians, however, are generally not fans of loosening restrictions on PAs.

“The American Osteopathic Association supports physician-led, team-based care and recognizes the important role PAs play in delivering patient care,” Kathleen Creason, the association’s CEO, said in an email to MedPage Today. “However, we remain concerned about efforts to eliminate physician oversight requirements and authorize independent practice by clinicians who have not completed the same comprehensive education, training, and licensure requirements as physicians.”

“Before practicing independently, DOs and MDs complete 4 years of medical school, a comprehensive licensing examination, and 3 to 7 years of supervised residency training,” she said. “PAs are valuable members of the healthcare team, but their training pathway is very different.”

As for the effort to remove state-mandated physician supervision requirements, “supporters say these changes may ease workforce challenges, but research has not consistently shown that independent practice by nonphysician clinicians reduces costs or improves patient outcomes,” Creason pointed out. “Patients are best served through physician-led care teams that draw on the expertise of every healthcare professional while maintaining high-quality care and accountability. Removing physician oversight won’t solve the physician shortage. Expanding residency positions and supporting physicians who practice in rural and underserved communities helps.”

The AAPA takes the opposite tack, arguing that physician supervision mandates don’t improve quality of care. The organization cites a 2023 study that looked at 10 years (2010-2019) of medical malpractice payment reports from the National Practitioner Data Bank. The study, whose authors included three AAPA staff members, found that states with more permissive practice environments did not have an increased risk of malpractice payouts compared with more restrictive states.

Another 2023 paper cited by the group found that relaxing scope-of-practice laws for PAs and nurse practitioners “leads to a statistically significant decrease in healthcare-amenable deaths.”

The PA supervision requirement represents “an outdated model of physician-led care that is standing in the way of providing care across the country,” Taylor said. “And organized medicine has a financial interest in maintaining the status quo” because PAs have to pay to have the doctor sign off on charts or prescriptions. “It averages up to $10,000 a year just for the transaction of a physician signing off. And who pays the cost? Ultimately, patients.”

The AAPA is also keeping an eye on several other bills in Congress, including one easing restrictions on PAs providing care to certain federal workers, and another lifting a ban on allowing PAs to prescribe therapeutic shoes for diabetes patients, Taylor said.