Physician assistants (PAs) can now exercise autonomous medical decision making and assume full responsibility for the care they provide to American Indians and Alaska Native people following updates to the Manual of the Indian Health Service (IHS), a division within the US Department of Health and Human Services. The policy changes align with Optimal Team Practice, an initiative to enforce collaboration between PAs, physicians, and other healthcare professionals to provide quality care without administrative constraints.

Before the update, the IHS manual dictated that a PA work under a supervising physician who was responsible for the medical practice and quality of the care the PA provided. References to supervisory language have been removed from the manual along with the requirement that a physician cosign prescription or medication orders written by PAs.

The update states that PA’s clinical privileges shall be commensurate with their education, experience, competencies, and the operational needs of the organization where they are employed. In addition, PA scope of practice will be determined at the practice level. PAs are now permitted to engage in clinical teaching, patient education, and research, as well as serve in administrative and supervisory positions as assigned by local, area, or national authority. They may now participate in the review and evaluation of their colleagues’ clinical performance as directed by their supervisor and permitted by their local medical staff bylaws. IHS facilities are required to provide the time and necessary funding as appropriate to ensure all assigned PAs remain current in clinical skill.

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“These updates represent the hard work and dedication of the incredible PAs working in the IHS,” stated Benjamin Olmedo, PA-C, LCDR, USPHS, chief consultant for PAs at IHS. “Furthermore, these updates highlight the value and trust for the PA profession created by individual PAs providing high-quality, culturally appropriate, and team-based collaborative care to achieve the IHS mission: to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.”


American Academy of Physician Assistants (AAPA). Indian Health Service updates PA practice, giving PAs “autonomy in medical decision-making.”  AAPA website. Published August 20, 2019. Accessed August 27, 2019.