Scope of practice laws have wide-ranging effects on both the nurse practitioner and physician assistant professions. NPs and PAs are trained and work similarly in the clinical setting. However, state laws may make one profession more favorable than the other from a practice standpoint. Regulations affecting nurse practitioner and physician assistant’s ability to practice are constantly changing but follow some overarching themes. Just how do scope of practice laws for the two professions compare?

The most notable difference between nurse practitioner and physician scope of practice laws relates to physician supervision requirements. Law in all states mandate that PAs work under physician supervision. In contrast, 21 states and the District of Columbia allow nurse practitioners to diagnose, treat and prescribe without mandated physician supervision or collaboration. While state legislators are increasingly passing laws permitting NPs to practice to their full scope, the trend is not the same for physician assistants.

By nature of their title, physician assistants work in physician-directed teams. So, rather than advocating for the right to practice independent from physician supervision, physician assistant organizations campaign for state laws allowing supervisory decisions to be made at the practice rather than the state level. For example, allowing a supervising physician or hiring institution to determine if the PA’s charts must be co-signed by an MD offers more flexibility and is less restrictive than statewide regulations mandating co-signatures.

Similarly, physician assistant scope of practice is more favorable in states where decisions surrounding prescribing and what the MD-PA supervisory relationship looks like are made at the practice rather than state level. This allows for greater physician assistant autonomy. States are split in how they delineate PA supervision requirements. 25 states allow for adaptable supervision requirements at the practice level and 25 determine how physician assistant supervision is accomplished at the state level.

Nurse practitioner scope of practice is governed with a different approach. Because nurse practitioners may theoretically diagnose and treat patients without a supervisory physician relationship, NP organizations argue to eliminate physician supervision and collaboration requirements in their entirety. This is typically accomplished in a stepwise process with incremental increases in scope of practice related to issues like prescribing ability and co-signature requirements.

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For both nurse practitioners and physician assistants, favorable scope of practice legislation does not always translate to a change in real-life practice responsibilities. Healthcare institutions may place their own limitations on these NPs and PAs that are more restrictive than those required by state law. In most states and settings, nurse practitioners and physician assistants function similarly. It will be interesting to see if these roles diverge as changes to scope of practice legislation are made.

How does the scope of practice of PAs and NPs differ in your workplace?


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2 thoughts on “How Do NP & PA Scope of Practice Laws Compare?”

  1. Dave Mittman, PA, DFAAPA

    A number of comments. What we all DO day to day is the same. PAs have just passed “Optimum Team Practice” in the AAPA House of Delegates. It now allows states to pursue what NPs call FPA. I think you will see that soon in a number of PA states.
    Both professions are still very much in evolution.
    There are also 2-3 states where PAs do not need supervision now, Michigan where PAs need a “participating” physician and can prescribe totally independently. The others are collaborative states.
    Again, to us “supervision” is also different. In NY we don’t even have to tell the state who our SP is. Just have the information somewhere when needed. There are no real barriers there for PAs going wherever they are needed and many PAs have clinics in underserved areas.
    PAs have just entered the helm of modernizing their state laws also.
    All interesting and evolving.

  2. Gail Neuman MSN FNP-C

    In my state of Calif., PAs have to review 10 charts a month at a minimum with their supervising physician who then has to cosign the 10.

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