AAPA

INTRODUCTION

The model legislation reflects two principal concepts: that physician assistants (PAs) should be licensed to practice medicine with physician supervision and that PA scope of practice should be determined by supervising physicians.

Licensure is the most appropriate level of PA regulation in order to protect the public health and safety.  Some states have been using a de facto licensing system; that is, permission to practice is dependent on presentation of appropriate qualifications and approval by the state regulatory agency.  However, rather than calling this licensure, it has been called "certification" or "registration."

Experts have defined state certification as regulation of the use of a specific occupational title;  that is, it is illegal to use a professional title without state approval, but anyone may deliver the service if they refrain from using the protected title.

Registration creates an official list of persons.  Registration presumes the existence of the right to engage in activity and makes it illegal to practice in a regulated occupation without being registered.  It generally is not intended to assure the public of qualified practitioners.

The Pew Health Commission's Taskforce on Health Care Workforce Regulation issued a report in December 1995 recommending, among other things, that the term "licensure" be used for state regulation of health professions.  The taskforce stated that the term certification should be reserved for voluntary private sector programs that attest to the competency of individual health professionals.  For PAs, such a system is administered by the National Commission on Certification of Physician Assistants (NCCPA).

Thus, to eliminate confusion between private and state certification, as well as to identify the true level of regulation, the American Academy of Physician Assistants (AAPA) recommends that state laws use the term "license." The vast majority of state laws conform to this recommendation. Ninety percent of states use licensure as the regulatory term for physician assistants.

The model state legislation proposes an administrative process in which a PA presents his or her credentials to a state regulatory agency and receives a license in return.  The license is renewable, based on meeting state requirements.  Obtaining a license should occur independently of a PA's employment status.  One analogy is a driver's license - you get one before you buy a car so that you can start driving as soon as you're ready.  This system should be attractive to state licensing boards because it eliminates a lot of paperwork.  Many of the early statutes either granted permission to physicians to utilize specific PAs or required PAs to submit all transcripts, test scores, references, etc., every time they changed employers or supervisors.  Under such systems, PAs legally ceased to exist between jobs.

The model legislation does not propose that the regulatory authority approve or register supervising physicians. Any licensed physician (M.D. or D.O.) may supervise a PA unless the physician's ability to supervise has been limited by specific disciplinary action.

The scope of PA practice under the model legislation is dependent on what the supervising physician wishes to delegate.  This is consistent with the original concept of PA utilization and reflects a movement away from a regulatory micromanagement of physician/PA practices.

The model legislation allows physicians to delegate prescriptive authority, including controlled substances in Schedules II through V, as well as limited dispensing authority.  Also included is language clarifying a PA's authority to request, receive, and distribute professional samples.  Physician assistants who are delegated prescribers of controlled medications are required to register with the federal Drug Enforcement Administration.

It is stated quite clearly that a physician need not be physically on the premises as long as the PA and physician can contact one another easily.  The details of supervision are left to the physician/PA team.

Physician assistants should be involved in regulating the PA profession. How this occurs is dependent on the structure the state has created for regulatory agencies. The final section of the model law deals with the regulatory structure - a voting PA on the medical board; a separate PA board; and the most popular model, regulation by a medical board with a PA committee.

This model law was first drafted in 1991 and revised in 1994, 1998, 2001, 2002, 2004, 2005 and 2009 to reflect changes in the physician assistant program accrediting agencies and to incorporate other new provisions.  The AAPA's This e-mail address is being protected from spambots. You need JavaScript enabled to view it is available to assist with revisions and additions as needed and to explain what and why the model bill contains what it does.  We hope the ideas are clear and can be transformed into the appropriate style and format to be compatible with your existing state code.

While this model law represents an ideal state PA practice act, there are several other areas of state law that can affect PAs' abilities to provide patient care. Click here for a list of those laws.

September 2009

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MODEL STATE LEGISLATION - PHYSICIAN ASSISTANTS DEFINITIONS

"Physician assistant" means a health professional who meets the qualifications defined in this chapter and is licensed under this chapter to practice medicine with physician supervision.

"Board" means the Medical Licensing Board.

"Supervising physician" means an M.D. or D.O. licensed by the board who supervises physician assistants.

"Supervision" means overseeing the activities of, and accepting responsibility for, the medical services rendered by a physician assistant.  The constant physical presence of the supervising physician is not required as long as the supervising physician and physician assistant are or can be easily in contact with each other by telecommunication.

QUALIFICATIONS FOR LICENSURE

Except as otherwise provided in this chapter, an individual shall be licensed by the board before the individual may practice as a physician assistant.

The board may grant a license as a physician assistant to an applicant who

1. submits an application on forms approved by the board;
2. pays the appropriate fee as determined by the board;
3. has successfully completed an educational program for physician assistants accredited by the Accreditation Review Commission on Education for the Physician Assistant or, prior to 2001, by either the Committee on Allied Health Education and Accreditation, the Commission on Accreditation of Allied Health Education Programs;
4. has passed the Physician Assistant National Certifying Examination administered by the National Commission on Certification of Physician Assistants;
5. is mentally and physically able to engage safely in practice as a physician assistant;
6. has no licensure, certification, or registration as a physician assistant under current discipline, revocation, suspension, or probation for cause resulting from the applicant's practice as a physician assistant, unless the board considers such condition and agrees to licensure;
7. is of good moral character;
8. submits to the board any other information the board deems necessary to evaluate the applicant's qualifications;  and
9. has been approved by the board.

The board may also grant a license to an applicant who does not meet the educational requirement specified in subsection 3, but who passed the Physician Assistant National Certifying Examination administered by the National Commission on Certification of Physician Assistants prior to 1986.

TEMPORARY LICENSE

A temporary license may be granted to an applicant who meets all the qualifications for licensure but is awaiting the next scheduled meeting of the board.

INACTIVE LICENSE

Any physician assistant who notifies the board in writing on forms prescribed by the board may elect to place his or her license on an inactive status.  A physician assistant with an inactive license shall be excused from payment of renewal fees and shall not practice as a physician assistant.  Any licensee who engages in practice while his or her license is lapsed or on inactive status shall be considered to be practicing without a license, which shall be grounds for discipline under section _____ of this Act.  A physician assistant requesting restoration from inactive status shall be required to pay the current renewal fee and shall be required to meet the criteria for renewal as specified in section _____ of this Act.

RENEWAL

Each person who holds a license as a physician assistant in this state will, upon notification from the board, renew said license by

1. submitting the appropriate fee as determined by the board;
2. completing the appropriate forms; and
3. meeting any other requirements set forth by the board.

EXEMPTION FROM LICENSURE

Nothing herein shall be construed to require licensure under this Act of

1. a physician assistant student enrolled in a physician assistant educational program accredited by the Accreditation Review Commission on Education for the Physician Assistant;
2. a physician assistant employed in the service of the federal government while performing duties incident to that employment; or
3. technicians or other assistants or employees of physicians who perform physician delegated tasks but who are not rendering services as a physician assistant or identifying themselves as a physician assistant.

SCOPE OF PRACTICE - DELEGATORY AUTHORITY - AGENT OF SUPERVISING PHYSICIAN

Physician assistants practice medicine with physician supervision.  Physician assistants may perform those duties and responsibilities, including the ordering, prescribing and dispensing, and administration of drugs and medical devices that are delegated by their supervising physician(s).

Physician assistants may provide any medical service that is delegated by the supervising physician when the service is within the PA's skills, forms a component of the physician's scope of practice, and is provided with supervision.  A physician assistant may perform a task not within the scope of practice of the supervising physician as long as the supervising physician has adequate training, oversight skills, and supervisory and referral arrangements to ensure competent provision of the service by the PA.

Physician assistants may pronounce death and may authenticate with their signature any form that may be authenticated by a physician's signature.

Physician assistants shall be considered the agents of their supervising physicians in the performance of all practice-related activities including, but not limited to, the ordering of diagnostic, therapeutic, and other medical services.

PRESCRIPTIVE AUTHORITY

A physician assistant may prescribe, dispense, and administer drugs and medical devices to the extent delegated by the supervising physician.

Prescribing and dispensing of drugs may include Schedule II through V substances as described in [the state controlled drug act] and all legend drugs.

All dispensing activities of physician assistants shall

1. comply with appropriate federal and state regulations; and
2. occur when pharmacy services are not reasonably available, or when it is in the best interest of the patient, or when it is an emergency.

Physician assistants may request, receive, and sign for professional samples and may distribute professional samples to patients.

Physician assistants authorized to prescribe and/or dispense controlled substances must register with the federal Drug Enforcement Administration [and any applicable state controlled substance regulatory authority].

SUPERVISION

Supervision shall be continuous but shall not be construed as necessarily requiring the physical presence of the supervising physician at the time and place that the services are rendered.

It is the obligation of each team of physician(s) and physician assistant(s) to ensure that the physician assistant's scope of practice is identified; that delegation of medical tasks is appropriate to the physician assistant's level of competence; that the relationship of, and access to, the supervising physician is defined; and that a process for evaluation of the physician assistant's performance is established.

SUPERVISING PHYSICIAN

A physician wishing to supervise a physician assistant must

1. be licensed in this state;
2. be free from any restriction on his or her ability to supervise a physician assistant that has been imposed by board disciplinary action;
3. maintain a written agreement with the physician assistant. The agreement must state that the physician will exercise supervision over the physician assistant in accordance with this act and any rules adopted by the board and will retain professional and legal responsibility for the care rendered by the physician assistant. The agreement must be signed by the physician and the physician assistant and updated annually. The agreement must be kept on file at the practice site and made available to the board upon request.

SATELLITE SETTINGS

Nothing contained herein shall be construed to prohibit the rendering of services by a physician assistant in a setting geographically remote from the supervising physician.

EXCLUSIONS OF LIMITATIONS ON EMPLOYMENT

Nothing herein shall be construed to limit the employment arrangement of a physician assistant licensed under this Act.

VIOLATIONS

The board may, following the exercise of due process, discipline any physician assistant who

1. fraudulently or deceptively obtains or attempts to obtain a license;
2. fraudulently or deceptively uses a license;
3. violates any provision of this chapter or any regulations adopted by the board pertaining to this chapter or any other laws or regulations governing licensed health professionals or any stipulation or agreement of the board;
4. is convicted of a felony;
5. is a habitual user of intoxicants or drugs to such an extent that he or she is unable to safely perform as a physician assistant;
6. has been adjudicated as mentally incompetent;
7. is physically or mentally unable to engage safely in practice as a physician assistant;
8. is negligent in practice as a physician assistant or demonstrates professional incompetence;
9. violates patient confidentiality except as required by law;
10. engages in conduct likely to deceive, defraud, or harm the public;
11. engages in unprofessional or immoral conduct;
12. prescribes, sells, administers, distributes, orders, or gives away any drug classified as a controlled substance for other than medically accepted therapeutic purposes;
13. has committed an act of moral turpitude;
14. is disciplined or has been disciplined by another state or jurisdiction based upon acts or conduct similar to acts or conduct that would constitute grounds for disciplinary action as defined in this section;
15. fails to cooperate with an investigation conducted by the board;
16. represents himself or herself as a physician.

DISCIPLINARY AUTHORITY

The board, upon finding that a physician assistant has committed any offense described in section _____, may

1. refuse to grant a license;
2. administer a public or private reprimand;
3. revoke, suspend, limit, or otherwise restrict a license;
4. require a physician assistant to submit to the care or counseling or treatment of a physician or physicians designated by the board;
5. impose corrective measures;
6. impose a civil penalty or fine;
7. suspend enforcement of its finding thereof and place the physician assistant on probation with the right to vacate the probationary order for noncompliance;  or
8. restore or reissue, at its discretion, a license and remove any disciplinary or corrective measure which it may have imposed.

IMPAIRED PHYSICIAN ASSISTANT PROGRAM

The board shall establish and administer a program for the rehabilitation of physician assistants whose competency is impaired due to the abuse of drugs or alcohol.  The board may contract with any other state agency or private corporation to perform duties under this section.  The program shall be similar to that available to other health professionals licensed in this state.

TITLE AND PRACTICE PROTECTION

Any person not licensed under this Act is guilty of a [felony or misdemeanor] and is subject to penalties applicable to the unlicensed practice of medicine if he or she

1. holds himself or herself out as a physician assistant;
2. uses any combination or abbreviation of the term "physician assistant" to indicate or imply that he or she is a physician assistant; or
3. acts as a physician assistant without being licensed by the board.

An unlicensed physician shall not be permitted to use the title of "physician assistant" or to practice as a physician assistant unless he or she fulfills the requirements of this [Act].

IDENTIFICATION REQUIREMENTS

Physician assistants licensed under this Act shall keep their license available for inspection at their primary place of practice and shall, when engaged in their professional activities, identify themselves as a "physician assistant."

PARTICIPATION IN DISASTER AND EMERGENCY CARE

A physician assistant licensed in this state or licensed or authorized to practice in any other U.S. jurisdiction or who is credentialed as a physician assistant by a federal employer who is responding to a need for medical care created by an emergency or a state or local disaster (not to be defined as an emergency situation which occurs in the place of one's employment) may render such care that they are able to provide without supervision as it is defined in this section of law, or with such supervision as is available.

Any physician who supervises a physician assistant providing medical care in response to such an emergency or state or local disaster shall not be required to meet the requirements set forth in this section of law for a supervising physician.

No physician assistant licensed in this state or licensed or authorized to practice in other states of the United States who voluntarily and gratuitously, and other than in the ordinary course of employment or practice, renders emergency medical assistance shall be liable for civil damages for any personal injuries which result from acts or omissions by those persons in rendering emergency care which may constitute ordinary negligence.  The immunity granted by this section shall not apply to acts or omissions constituting gross, willful, or wanton negligence or when the medical assistance is rendered at any hospital, physician's office, or other health care delivery entity where those services are normally rendered.  No physician who supervises a physician assistant voluntarily and gratuitously providing emergency care as described in this subsection shall be liable for civil damages for any personal injuries which result from acts or omissions by the physician assistant rendering emergency care.

RULE-MAKING AUTHORITY

The board shall promulgate, in accordance with the provisions of the [state] Administrative Procedures Act, all rules that are reasonable and necessary for the performance of the various duties imposed upon the board by the provisions of this Act, including but not limited to

1. setting licensure fees; and
2. establishing renewal dates.

REGULATORY OPTIONS

I. Regulation by the medical board

The state board of medical examiners shall administer the provisions of this Act under such procedures as it considers advisable and may adopt rules that are reasonable and necessary to implement the provisions of this Act. To assist in the administration of this Act, the governor shall appoint a licensed physician assistant to the board of medical examiners for a term of ___ years, [etc., in accordance with existing law]. The physician assistant member will have full voting privileges.

II. Regulation by a PA board

To administer this Act, there is hereby established a Board of Physician Assistant Examiners.  The board shall consist of five members appointed by the governor, each of whom shall be residents of this state, four of whom shall be physician assistants who meet the criteria for licensure as established by this Act, and one of whom shall be a licensed physician experienced in supervising physician assistants.

Initial appointments shall be made as follows:

1. two members shall be appointed for terms of four years;
2. one member shall be appointed for a term of three years;
3. one member shall be appointed for a term of two years;  and
4. one member shall be appointed for a term of one year.

Each regular appointment thereafter shall be for a term of four years.  Any vacant term shall be filled by the governor for the balance of the unexpired term.  No member shall serve more than two consecutive four-year terms, and each member shall serve on the board until his or her successor is appointed.

While engaged in the business of the board, each member shall receive a per diem of $_____ and shall also receive compensation for actual expenses paid in accordance with [other state regulations].

The board shall elect a chair and a secretary from among its members at the first meeting of each fiscal year.  The board shall meet on a regular basis.  A board meeting may be called, upon reasonable notice, at the discretion of the chair and shall be called at any time, upon reasonable notice, by a petition of three board members to the chair.

Powers and duties of the board shall include the following:

1. promulgation of all rules reasonable and necessary to implement the provisions of this Act;
2. review and approval or rejection of applications for licensure;
3. review and approval or rejection of applications for renewal;
4. issuance of all licenses;
5. denial, suspension, revocation, or other discipline of a licensee;
6. determination of the amount and collection of all fees.

III. Regulation by a medical board with a PA advisory committee

There is hereby created a physician assistant committee which shall review and make recommendations to the board regarding all matters relating to physician assistants that come before the board.  Such matters shall include, but not be limited to

1. applications for licensure;
2. disciplinary proceedings;
3. renewal requirements; and
4. any other issues pertaining to the regulation and practice of physician assistants in this state.

Committee membership

The committee shall consist of three physician assistants, one physician experienced in supervising physician assistants, and one member of the board.  All committee members must be residents of this state and hold a license in good standing in their respective disciplines.

The chair of the committee shall be elected by a majority vote of the committee members.

Committee members shall receive reimbursement for time and travel expenditures [consistent with usual state practices].

Appointments

The physician assistant and supervising physician members of the committee shall be appointed by the governor.  The board of medical examiners shall designate one member to serve on the board.  All appointments shall be made within 60 days of the effective date of this Act.  All appointments shall be for four-year terms, at staggered intervals.  Members shall serve no more than two consecutive terms.  Reappointments of the physician assistant and supervising physician members of the committee shall be made by the governor.

Meetings

The committee shall meet on a regular basis.  A committee meeting may be called, upon reasonable notice, at the discretion of the chair and shall be called at any time, upon reasonable notice, by petition of three committee members to the chair.