Last week we talked scope of practice regulations for physician assistants here on the ThriveAP blog. While the physician assistant career looks similar in many ways for PAs across the country, state laws do affect the way physician assistants are allowed to practice. For example, state scope of practice regulations may dictate the type of medications PAs are allowed to prescribe, or outline what physician supervision for PAs looks like. 

Such scope of practice regulations can have far-reaching effects on physician assistants, particularly in more restrictive states. In areas where physicians assistants have limitations when it comes to the medications they prescribe, for example, PAs are not as helpful in certain practice settings as their hands are tied by state law. Physician supervision requirements may mean red tape for employers hiring PAs. The more difficult supervision requirements are for employers to accommodate, the less useful physician assistants become. So, employers in states with restrictive PA scope of practice may opt to hire other kinds of providers such as physicians or nurse practitioners. 

Which states (in no particular order) are the most restrictive when it comes to physician assistant scope of practice?

1. Kentucky

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Whereas some states allow PA scope of practice to be determined by healthcare facilities themselves, in the Bluegrass State, law requires the specifics of scope of practice for PAs to be approved by the state medical board. Furthermore, PAs in Kentucky are not allowed to prescribe or administer scheduled drugs, perhaps and even more significant impediment to their ability to practice. Finally, physicians in Kentucky may not supervise more than four PAs total, and no more than two physician assistants at any given time. 

2. Iowa

Physician assistants practicing in the Hawkeye State are similarly restricted. Physician assistants in Iowa are not permitted to prescribe schedule II depressant medications which can limit their ability to work in some practice settings. State law also lists the services PAs are permitted to provide, allowing for less clinical flexibility than in states where scope of practice is determined at the employer level. Finally, physicians supervising PAs in Iowa must review and co-sign the PA’s charts on a weekly basis making for additional paperwork and hastle. 

3. West Virginia

Like our prior picks, physician assistants in West Virginia face prescribing limitations. PAs in the state may not prescribe schedule II controlled medications. This means logistical difficulties for practice employing PAs in the Mountain State. State law also determines the means by which physician supervision is accomplished and requires that scope of practice for individual PAs be approved by the state medical board. In West Virginia, physicians may supervise as many as three PAs at one time, or four in the hospital setting. 

4. Georgia

Laws governing PAs are not so peachy keen in Georgia. The state government determines both the services physician assistants are allowed to provide as well as physician supervision requirements, rather than giving practices the flexibility to do so on their own. Furthermore, PAs working in Georgia are not permitted to prescribe schedule II medications limiting practice utility. 

5. Pennsylvania

While Pennsylvania does not place limitations on prescribing for PAs, it does have strict physician supervision requirements. MDs in the state may only supervise two physician assistants at one time. They must also review records for each patient seen by the physician assistant within ten days, an administrative burden for any practice. Like our prior picks, the Keystone State also outlines the specific services physician assistants are permitted to provide. 

6. South Carolina

Physician assistants working in South Carolina enjoy full prescriptive authority. They do not, however, have freedoms when it comes to their scope of services – the scope of practice of each physician assistant must be approved by the state medical board. Supervision requirements are similarly cumbersome. MDs overseeing PAs in the Palmetto State must review, initial and date all charts for patients seen by the physician assistant within five working days. 

How does scope of practice for physician assistants in your state compare?


You Might Also Like: How Do NP & PA Scope of Practice Laws Compare?


2 thoughts on “6 Worst States for Physician Assistants”

  1. Janice Shipe-Spotloe

    The cited codes for WV in this article are not accurate. The relationship of Physicians and PAs is one of collaboration, not supervision (changed in 2017), however you are correct that the medical boards need to approve the collaborative agreements. Also incorrect is the ratio of collaboration for PAs and MD/DOs, which has been 1/5 ratio since 2014. The prescriptive authority of PAs is restrictive as noted, but in parity with RX authority of our NP colleagues in WV.

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