SIX KEY ELEMENTS

1) Licensure as the regulatory term for PAs: included as licensed health

professionals (vs. certified, registered)
2) Physician authorized to delegate prescriptive authority to include all
Schedules of drugs
3) Scope of practice determined by the supervising physician, the PA, and
any relevant facility
4) Adaptable supervision requirements (no mile limit, on site requirement)
5) Chart co-signature requirements determined by the practice

6) No ratio limitation (physician:PA)

Regulations are meant to establish a legal framework under which:

The public is protected from dangerous practices
Physician-PA teams are able to provide care to patients in the most
efficient and effective manner possible

Number of Key Elements Included in

State PA Law
June 2013

RI
DE
DC

One Key Element

Four Key Elements

Two Key Elements

Five Key Elements

Three Key Elements

Six Key Elements

NORTH DAKOTA
all six key elements: very few limitations
Regulatory body: North Dakota State Board of Medical Examiners

1) licensed HP by the state

2) PA may prescribe medications as delegated to do so by supervising physician
3) Scope of practice: no provisions; determined by physician
4) Supervision: no provisions; available for contact; adaptable
5) Chart co-signature: no provisions; determined by practice
6) PAs per physician: no provisions; no ratio limitation; consistent with good practice

How has this state achieved this level of good practices for PA regulation?
-only 257 certified PAs in the state; 1 PA school (UND)
-many rural areas, and shortage of care has allowed these regulations to come into place
and remain in practice

NEW YORK
-8,662 Practicing
PAs as of 2011
-21 PA schools

5/6 KEY ELEMENTS

1) Licensure as the regulatory term for PAs
2) Physician authorized to delegate prescriptive
authority to include all Schedules of drugs
3) Scope of practice is determined by the
supervising physician, the PA, and any relevant
facility
4) Adaptable supervision requirements
5) Chart co-signature requirements determined by
the practice
6) Ratio Limitation

RATIO LIMITATION
Ratio of Physicians to PAs is on a sliding scale.
Private Practice 1:2
Correctional Facility 1:4
Facility Licensed Pursuant
1:6
to PHL Article 28
(Hospitals and Nursing Homes)

OREGON
1) Licensure as the regulatory term
Yes:
Physician Assistants practicing in OR must be licensed by the
state. License must be renewed every 24 months.
2) Physician may delegate prescriptive authority to include all
Schedules of drugs
Yes:

Physician Assistants can prescribe schedule II V drugs.

However, prescribing rights for schedule II drugs (opioids, etc) requires

medical board approval per the individual practice agreement.
3) Scope of practice is determined by the supervising physician, the PA,
and any relevant facility
Yes:

Determined by the practice agreement.

 4) Adaptable supervision requirements

Yes:
Physician supervision can be adapted to the practice. 3 types
available.
Direct Physician and PA are in the same facility
Example: Working in the same the clinic at the same time, but seeing separate
patients
General Physician is NOT on site, but is available via telecommunication
Example: Working in a clinic remote from the physician, but quick contact is
available via phone.
Physician must be on-site for at least 8 hours per month.
Personal Physician and PA work side-by-side.
Example: Surgeon and PA perform surgeries together, or Physician and PA see
all patients in clinic together.
5) Chart co-signature requirements determined by the practice
Yes and No!

Charts must be reviewed, but there is not a defined minimum number

Allows the Physician to decide how many charts need to be reviewed per
month.
Depends on the type and needs of the practice

 6) No ratio limitation
No:

Maximums set by the state board

4 PAs per physician

A single PA can have up to 4 Supervising Physicians
A Supervising Physician Organization can oversee any number of PAs

CALIFORNIA
1) Person who meets requirements is licensed by the PAB
2) Physician authorized to delegate prescriptive authority to include all
Schedules of drugs: Yes
3) Scope of practice determined by the supervising physician, the PA, and
any relevant facility: Yes
4) Adaptable supervision requirements: Yes

5) Chart co-signature requirements: The supervising physician and surgeon

shall review, countersign, and date a sample consisting of, at a minimum, 5
percent of the medical records of patients treated by the physician assistant
functioning under the protocols within 30 days of thedate of treatment by the
physician assistant
6) Ratio limitation (physician:PA): No physician shall supervise more than 4
PAs at any one time.

COLORADO
1) Licensure as the regulatory term for PAs
2) Physician authorized to delegate prescriptive authority to include all
Schedules of drugs

3) Scope of practice is determined by the supervising physician, the PA,

and any relevant facility
4) Different: Supervision requirements
5) Different: Chart co-signature requirements

6) Different: Ratio limitation

SUPERVISION REQUIREMENTS
New graduate PAs require on-site presence of supervising physician for
1000 working hours.
For experienced PAs new to a practice setting, supervising physician
must complete performance review by the end of the first 6 months and
twice yearly thereafter.
Supervising physician must either be on site with PA or be readily
available by telecommunication.

CHART CO-SIGNATURE REQUIREMENTS

Based on the years of active practice by PA as listed in the table, the following
minimum activities must be performed for PAs that are New to a Practice
Setting.
The physician supervisor shall review the chart for every patient seen by a PA
no later than 14 days after the physician assistant has performed an act
defined as the practice of medicine. The physician supervisor shall document
the performance of such review by signing the chart in a legible manner.
Electronically-generated signatures accepted.
Meet with supervising physician twice yearly and physician must conduct
performance assessment.

Experience

Oversight
Duration

Patient
Encounters

6 mo up to 5 yrs

First 3 months

Minimum of 500
pt.

5 yrs up to 10
yrs

First 2 months

Minimum of 250
pt.

More than 10 yrs -----------------------

Minimum of 100
pt.

RATIO LIMITATION
A primary physician supervisor shall be the primary physician supervisor
for no more than 4 specific individual PAs, or their full-time equivalent.
Board may grant a waiver to this restriction for good cause.
A physician may not supervise more than 4 PAs at any one particular
moment in time.

ALABAMA
1) licensed HP by the state
2) Prescription limitations: Board may establish guidelines governing
delegated prescribing; after 12 months of active clinical employment
following certification, PA may apply for a DEA number in order to
prescribe Schedule III-V controlled substances
3) Scope of practice: The PA is prohibited from performing any medical
service, procedure, function or activity which is not specifically listed, in
detail, in the job description approved by the board
4) Supervision: Professional oversight and direction as may be required
by the regulations and guidelines of the medical board
5) Chart co-signature: Countersignature by supervising physician must
conform to established policy and/or applicable legal regulations
6) PAs per physician: Cumulative work time for all PAs supervised by an
individual primary supervising physician may not exceed 120 hours per
week. Board may determine number of PAs physician may supervise at
its discretion

WHAT CAN WE DO TO HELP?

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