Brief Reports| Volume 48, ISSUE 2, e49-e58, February 2015

State Laws Governing Physician Assistant Practice in the United States and the Impact on Emergency Medicine

Published:November 11, 2014DOI:



      Midlevel providers, including physician assistants (PA), have been recommended by some to fill the current inadequate supply of providers nationally, including in emergency medicine.


      PA practice is governed by state law. We described the differences in qualifications, scope of practice, prescriptive authority, and physician supervision required by individual states for PA practice and describe the impact this may have on emergency medicine.


      A cross-sectional analysis of United States laws governing PA practice by abstraction from each state’s public website. State characteristics were collected from the American Academy of Physician Assistants and United States Census websites and dichotomized by median values.


      Only six states (12%), all of which were larger-population states, required physician review of medical records within 1 week of a PA-only patient encounter. However, one state (Virginia) explicitly required onsite physician presence for PA practice in the emergency department. All states allowed PAs to assist in invasive procedures, but 13 (25%) restricted independent performance. Restriction of this practice was more likely in states with a higher population (38%), lower rural proportion (40%), and lower number of PAs per population (40%). Eleven (22%) states restricted performance of sedation or general anesthesia. An expanded scope of practice for disaster situations was allowed by 24 (47%) states and was more likely in larger population states (62%). All but two states (Florida and Kentucky) allowed PA prescribing of schedule III–V medications, and 37 (73%) allowed prescribing of schedule II medications.


      Laws governing PA practice in emergency departments differ by state, but generally allow for a broad scope of practice and limited direct supervision. Smaller, rural states were less likely to have tighter restrictions or oversight.


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      1. Kaiser Family Foundation; Kaiser Commission on Medicaid and the Uninsured, 2010. “Massachusetts Health Care Reform: Three Years Later, Sept 2009.” Available at: Accessed November 1, 2012.

      2. Association of American Medical Colleges, Center for Workforce Studies, 2010. “The Impact of Health Care Reform on the Future Supply and Demand for Physicians Updated Projections Through 2025.” Available at: Accessed November 1, 2012.

      3. American Academy of Physician Assistants. Available at: Accessed November 1, 2012.

      4. National Commission on Certification of Physician Assistants, 2010. specialty certificates of added qualifications. Available at: Accessed November 1, 2012.

      5. US Census Bureau, 2010. Available at: Accessed November 1, 2012.

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