Physician assistants (PAs) celebrated many state legislative victories in 2019. North Dakota became the first state to eliminate the requirement that a PA have a written agreement with a physician in most settings to practice, and many other states shifted away from a supervisory model to a collaborative one, whereby physician responsibility over the PA was eliminated, according to the American Academy of Physician Assistants (AAPA).1

The legislation signed in North Dakota in April 2019 not only eliminated the requirement for PAs to have an agreement with a physician (or other provider) to practice, but it also made PAs responsible for the care they provide, removed all references to “supervision,” and defined PA scope of practice to align with the AAPA Model State Legislation.

The ceremonial signing of North Dakota House Bill 1175 with Governor Doug Burgum (center) and members of North Dakota Association of Physician Assistants. Photo courtesy of Jay Metzger, PA-C, President, North Dakota Academy of Physician Assistants. 

In 2019, West Virginia eliminated the requirement for PAs who work in hospitals to have an agreement with specific physicians to practice. The state of Colorado added a second PA to the medical board, as well as a PA to the licensing commission. Idaho created a PA seat on the Idaho Medical Board.

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Five states repealed the use of the word “supervision” in favor of “collaboration” to define the relationship between physicians and PAs: Rhode Island, Indiana, Missouri, North Dakota, and Virginia. In addition, Rhode Island removed physician responsibility for PAs; eliminated practice agreements; allowed PA scope of practice to be determined on the basis of the PA’s skills, education, and training; and added a third PA seat on the Rhode Island Board of PAs.

In total, “11 states and the District of Columbia now use a term other than ‘supervision’ to describe PA practice,” according to the AAPA.1

At this time, 8 states have adopted all 6 Key Elements of a Modern PA Practice. California repealed the requirement for chart review or countersignature. Hawaii repealed their 100% chart review requirement, allowing chart review determinations to be made at the practice level for PAs with more than 1 year of experience.

Utah and New Hampshire passed harmonization acts: Utah added PAs to 62 sections of statute where PAs were previously excluded, and New Hampshire added PAs to various statutes concerning mental health services, involuntary emergency admissions to mental health facilities, and insurance coverage.

Other legislative victories at the state level were in the fields of medical cannabis certification, income tax improvements, licensure requirements, and telemedicine.

Numerous states in 2020 have begun introducing legislation containing optimal team practice policies, language that shifts from supervision to collaboration, or Key Elements.


PAs Celebrate a Year of Unprecedented Wins at the State Level. Alexandria, VA: American Academy of Physician Assistants News Center; January 28, 2020. Accessed February 11, 2020.