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The physician assistant (PA) fills a critical role in our health care system. These highly-trained medical professionals work alongside doctors to maximize practice efficiency, increase patient satisfaction, and improve flexibility. To become a PA, candidates must graduate from an institution certified by the American Academy of Physician Assistants (AAPA), and pass a certification exam. While their training may be similar, PAs often end up practicing medicine in very different ways.

The PA Scope of Practice

A scope of practice outlines the limits of a healthcare practitioner’s work. Within these guidelines, physicians can undertake procedures, actions, and processes that nurses, nurse practitioners, and PAs cannot. In turn, while PAs may not have the same scope of practice as a physician, they often have more freedom to treat patients than other healthcare providers. So how is the PA scope of practice determined? It usually depends on a few different factors:

  • Education and Training: PA training is designed to be broad. Before certification, all candidates must complete a 25-27 month educational period, which includes a year of classroom training and year of clinical rotations in several different specialties. Once certified, PAs may choose to focus on a particular field or participate in continuing education. This education and experience will form the basis of every PA’s scope of practice.
  • Facility-Specific Scope of Practice: Within a healthcare facility, PAs are usually credentialed by a medical staff committee in the same way physicians are. This arrangement gives facilities the freedom to use PAs in many different ways based on their education and training, tradition, community need, and more. However, a facility scope of practice cannot exceed state regulations.
  • Physician-Delegated Scope of Practice: PAs work under the supervision of a physician. As such, physicians have the freedom to determine how they delegate patient care to PAs. However, much like in a healthcare facility setting, a physician-delegated scope of practice cannot exceed what is allowed by the state.
  • State Law: States have final authority for setting a PA’s scope of practice. While each state has different guidelines, many are moving away from approved procedure lists and towards a physician-delegated scope of practice.

Because facilities, physicians, and states all operate differently, a PA’s scope of practice could be very different from place-to-place.

Differences in Scope of Practice by State

Ultimately, individual states are responsible for regulating the practice of medicine within its borders. This process includes defining the role of PAs. To help states establish this framework, the AAPA identified six key elements of a modern PA practice, which provide PAs and physicians flexibility and freedom to serve patient needs. They include:

  1. “Licensure” As a Regulatory Term: Rather than referring to PAs as “certified” or “registered,” all states should use the term “licensed” because it denotes the highest level of professional scrutiny.
  2. Full Prescriptive Authority: The AAPA also recommends that states allow PAs to prescribe medicine, including Schedule II-V controlled medications. States that don’t allow PAs full prescriptive authority risk interrupting the delivery of care.
  3. Scope of Practice Determined on Site: The AAPA recommends that states allow supervising physicians to determine the scope of practice on-site based on facility and patient needs.
  4. Adaptable Supervision Requirements: Some states require that collaborating physicians must work within a set distance of the PAs they supervise or must be on-site at specified intervals. These restrictions can often be unworkable, especially for PAs practicing in rural areas. Instead, the AAPA recommends states set adaptable supervision requirements that work well in all practice settings.
  5. Cosignature Requirements Determined at the Practice Level: Chart review requirements hinder a clinical team’s ability to decide how best to deliver care. That’s why the AAPA recommends states allow practices to determine when and how physicians should sign-off on PA chart entries.
  6. No Limit on Number of PAs a Physician Can Supervise: To enable maximum flexibility, the AAPA recommends states not place limits on the number of PAs a single physician can supervise.

Each state and the District of Columbia approach these six recommendations differently. Click here to view an interactive guide on how PA scopes of practice regulations differ across the country.

Find Your Perfect Fit

If you’re searching for more freedom in your role as a PA, we can help. Physician Assistant Solutions is a physician assistant recruiting firm dedicated to finding the perfect fit between employers and employees. We help PAs find the ideal position with job listings, detailed resume advice, and a nationwide network of employers. To learn how we can help, contact Physician Assistant Solutions by phone at 586.569.9776 or by filling out the form on our website.

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