Can Physician Assistants Own Independent Medical Practices?

Physician Assistants (PAs)s must understand their state’s regulations regarding practice ownership and operations.

Physician assistants (PAs), also called physician associates, are credentialed to practice medicine with physician collaboration or supervision. What qualifies as proper physician involvement varies significantly by state, however. There’s also the separate question of whether a PA can own a medical practice in their state of licensure. 

Supervision 

PA interest groups have lobbied for less restrictive regulations and more autonomy. In some cases, they have been successful in their efforts. The American Academy of Physician Associates (AAPA) works closely through its state chapters to advance PA-positive policies, including a title change. Most efforts focus on expanding PA prescriptive authority and scope by allowing PAs to work with physicians in a collaborative capacity (as opposed to being supervised). 

Wisconsin is an example of a state that has passed “collaborative” legislation. Wisconsin’s new PA statute transitioned the state’s oversight requirements from direct supervision to a collaborative model. Under this new model, a written collaborative agreement between a collaborating physician and PA can establish the PA’s scope of practice. The physician need only be reasonably available through telecommunications. Notably, Wisconsin’s model ties the PA’s scope of practice to the individual PA’s experience and expertise, not the collaborating physician’s scope of practice. Alternatively, a PA can work as an employee where the physician is primarily responsible for the medical services.

In contrast, New York does not allow PAs and physicians to collaborate. Instead, the physician plays a supervisory role. In New York, the supervising physician may delegate clinical functions to the PA if the PA has appropriate training in those specific services. However, the services must fall within the physician’s scope of practice. In other words, PAs are limited to the scope of practice of their supervising physician.

PA Practice Ownership

Not only do state laws and regulations determine supervision requirements, but they also limit physician assistants’ ability to have ownership interests in medical practices. It’s easy to conflate these two concepts. However, states that allow PAs to offer medical services without on-site supervision do not necessarily allow PAs to own medical practices through a professional business entity. 

Take New York as an example. PAs cannot own and operate independent private practices in New York. While nothing will prevent PAs from filing professional business entities with the state, New York severely limits the practical capabilities of those PA entities. Essentially, PAs cannot practice medicine independently through their entity, employ physician supervisors through the entity, or bring in physician supervisors through an independent contractor relationship. This makes satisfying the state’s supervision requirements through an independent PA practice infeasible. 

In contrast, other states allow for ownership or partial ownership. For instance, Texas law allows PAs to co-own a practice with physicians. However, Texas limits the allowable ownership interest and imposes other management restrictions. 

Legislative Responses to COVID-19

Further complicating an already complex regulatory landscape, the COVID-19  pandemic led some state officials to issue executive orders or emergency legislation temporarily loosening PA supervision requirements. However, many of those emergency orders or statutes only allowed for temporary changes — meaning some changes are being rolled back or are no longer in effect. As a result, some PAs may be operating under collaborative arrangements that no longer comply with state law.

Get Legal Help 

Are you a PA planning to open a practice? Or are you moving to a new state and need a collaborative agreement with a physician? Experienced healthcare attorneys can help you form a compliant startup plan and draft agreements that comply with your state’s laws. If you live in one of the states where we practice, set up a free consultation to learn more. 

This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.