Physician Associates Push for State Practice Modernization in 2027 Legislative Agenda

As the year draws to a close, physician associates (PAs) across the United States are preparing to advance their state legislative agenda for 2027, with a central focus on easing scope-of-practice restrictions.

“State practice laws and licensure are not partisan issues,” said Chantell Taylor, chief of public affairs and advocacy at the American Academy of Physician Associates (AAPA), during an online interview attended by members of the press. “While the midterm elections will influence health policy broadly, our priorities and coalition partnerships are unlikely to shift significantly. Practice modernization and healthcare workforce challenges do not align neatly with either political camp.”

A top priority for the AAPA is eliminating the requirement that PAs practice under physician supervision. Because this mandate is governed by state law rather than federal regulation, change must occur state by state. To date, nine states—North Dakota, Wyoming, Utah, Montana, Iowa, New Hampshire, Virginia, Maine, and Delaware—have removed the supervision requirement. Approximately 12 additional states are expected to introduce legislation to modernize their PA practice acts, though an AAPA official noted that not every state will focus exclusively on removing supervision mandates.

This patchwork of regulations creates complications for PAs who practice across state lines, Taylor explained. “It presents a significant barrier to expanding access to care in more restrictive states,” she said. “Health systems operating across multiple jurisdictions tend to adopt the most restrictive standards. We need to raise standards uniformly across states rather than allow a race to the bottom.”

The supervision requirement also affects retail clinic operators such as CVS and Walgreens, according to Taylor. “These companies want to expand their footprint, but when states require a physician to be on site or mandate specific physician-to-PA ratios, they decline to hire PAs or open new clinics because the financial model does not work,” she noted. “It is not cost-effective to build infrastructure just to satisfy a ratio or obtain a physician’s signature on a chart.”

Physician organizations generally oppose loosening restrictions on PAs.

“The American Osteopathic Association supports physician-led, team-based care and recognizes the important role PAs play in patient care,” said Kathleen Creason, the association’s CEO, in a statement 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.”

“Physicians—both DOs and MDs—complete four years of medical school, a comprehensive licensing examination, and three to seven years of supervised residency training before practicing independently,” she said. “PAs are valuable members of the healthcare team, but their training pathway differs significantly.”

Regarding efforts to remove state-mandated physician supervision, Creason added, “Proponents argue these changes could alleviate workforce challenges, but research has not consistently demonstrated that independent practice by nonphysician clinicians reduces costs or improves patient outcomes. Patients are best served by physician-led care teams that leverage the expertise of every healthcare professional while upholding high standards of quality and accountability. Removing physician oversight will not resolve the physician shortage. Expanding residency positions and supporting physicians in rural and underserved communities will.”

The AAPA contends that physician supervision mandates do not enhance quality of care. The organization points to a 2023 study analyzing ten years (2010–2019) of medical malpractice payment reports from the National Practitioner Data Bank. The study, which included three AAPA staff members among its authors, found that states with more permissive practice environments did not experience increased malpractice payouts compared with more restrictive states.

The AAPA also cited a separate 2023 paper finding that relaxing scope-of-practice laws for PAs and nurse practitioners “leads to a statistically significant decrease in healthcare-amenable deaths.”

Taylor characterized the supervision requirement as “an outdated model of physician-led care that is standing in the way of providing care across the country.” She added that organized medicine has a financial incentive to maintain the status quo, since PAs must pay for physicians to sign off on charts or prescriptions. “That transaction can average up to $10,000 per year,” she said. “Ultimately, patients bear the cost.”

Beyond state legislation, the AAPA is monitoring several federal bills, including measures to ease restrictions on PAs treating certain federal workers and to lift a prohibition on PAs prescribing therapeutic shoes for diabetes patients, Taylor said.

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