Do Physician Assistants (PAs) Have Autonomous Practice Authority?

“Under collaboration, a PA’s scope of practice is based on what they have learned to do, what they are credentialed to do, and what their experience enables them to do.”

Saje Davis-Risen, PA-C, PA Advocate and Director of the Pacific University School of Physician Assistant Studies

Physician assistants (PAs)—also referred to as physician associates—have been making critical contributions to patient care since the mid-1960s. As their name suggests, physician assistants were originally intended to be working alongside a doctor.  The American Academy of Physician Associates notes, “across all medical and surgical specialties, PAs provide medical care, enhance care coordination, increase patient access, and contribute to improved quality. PAs are a cost-effective resource for meeting patients’ medical needs.” 

The demand for primary care providers has continued to rise, and many underserved communities struggle to access affordable healthcare. Care that PAs can expertly provide. Healthcare systems are rapidly evolving, and PAs are increasingly asked to take on more independent roles and responsibilities for diagnostic decisions in various medical settings. PAs have been shown to provide excellent care and patient outcomes, and expanding their scope of practice and autonomy could alleviate some of the strain on the healthcare system.

“PAs are highly educated medical providers dedicated to their communities and doing great work. Their focus is on patients and taking care of more patients, primarily, the more vulnerable patients who need more providers,” says Saje Davis-Risen, director of the Pacific University School of Physician Assistant Studies. 

Currently, PAs in the US practice in collaborative or supervisory relationships with a physician. This is intrinsic to this profession. Many states have been moving towards more autonomous and collaborative practice models that provide PAs with greater latitude to practice medicine. However, this has raised concerns regarding patient safety, standardization of care, and adequate training and education. 

Davis-Risen has been instrumental in implementing new laws in Oregon that expand PAs ability to care for patients. The law shifted the physician supervision requirement to that of a collaborative one. “PAs not seeking independent practice. Honestly, no medical provider has independent practice anymore. We’re all in teams at this point because medicine is simply too big, and there are too many specialties and patients,” she says. “In Oregon. PAs are dedicated to the idea of team-based practice.” 

Not everyone was immediately on board with changing the law. “Some people worried about how a PA could practice independently in something like surgery. We are not qualified to perform surgery, so it would never be an issue. It is not in our scope of practice. We worked hard with our stakeholders to more clearly explain what we were looking for is to be held responsible for their own medical decision-making and taking the burden off of our physician partners,” explains Davis-Risen. “We clarified that we were not looking for independent practice, but rather we were looking for more flexibility to serve patients in rural and underserved areas, without the burden of supervision making it more difficult to serve those patients.”

Every year, PA Week is celebrated October 6-12 to recognize the invaluable contributions of these healthcare professionals.

Keep reading to learn how Oregon has moved toward more flexible collaborative practice, what scope of practice means, and the difference between supervision and collaboration.

Meet the Expert: Saje Davis-Risen, MS, PA-C

Saje Davis-Risen, PA-C, is the director of the Pacific University School of Physician Assistant Studies. She received her master’s of science in physician assistant studies at Pacific and joined the faculty in 2011. 

Before joining Pacific, she worked as a clinician in pediatric medicine for the Puyallup Tribe and emergency medicine in a critical access hospital and neurosurgery in a Level 2 trauma center. During her tenure at Pacific, Davis-Risen has served in both clinical and didactic teaching positions, developed and led the Global Healthcare Track, and most recently served as associate dean of interprofessional education. 

Davis-Risen has also served nationally on the House of Delegates for the American Association of Physician Assistants and on the board as president of the Oregon Society of Physician Assistants.

Collaborative vs. Independent Practice

The American Association of Physician Assistants says, “The professional relationship between PAs and physicians is collaborative and collegial. The most successful clinical teams are those that utilize the skills and abilities of each team member most fully. The most up-to-date practice laws allow healthcare teams to decide at the practice level how they will collaborate to best meet the needs of patients in their particular setting and specialty.”

Up until 2022, Oregon laws stated that a physician must supervise PAs. However, supervision was limiting and cumbersome. “We were finding that the administrative burdens for health systems were incredibly challenging for PAs under supervision. And these burdens of supervision were causing health systems to stop hiring PAs,” says Davis-Risen. 

The state moved to a different system to help PAs better serve their patients and remove some of the administrative load: “In Oregon, our collaborative practice law came about because we live in a rural state. We essentially pursued collaboration to relieve that for health systems so that PAs could continue to practice in these rural and underserved areas,” she says. 

“Now, we work in collaboration with our physician partners. In the past, there was a requirement for a specific number of hours of supervision every month. And we had a supervision agreement that laid out exactly how many charts were reviewed and your specific scope of practice. Your scope of practice was limited to your supervising physician’s scope of practice,” explains Davis-Risen. 

Before this law’s passing, supervising physicians were responsible for the PAs’ decisions: “In the past, our supervising physicians could be held liable for any decision we made whether they saw the patient with us or not. They could be held responsible for any decision we made,” says Davis-Risen. “The Oregon collaboration bill removed supervision and made the law of collaboration. This decreased the responsibility of our physician partners, and now PAs are responsible for our medical decision-making.”

Oregon law left the structure of a collaborative agreement intentionally open-ended: “What collaboration looks like is defined by the practice, so it’s very flexible. It was designed that way on purpose because what works for a PA in rural Harney County looks much different than it does in downtown Portland in a surgical or family practice. A PA working in a rural county may collaborate via Zoom with their collaborating physician, whereas a surgical PA will be working side by side with their collaborating physician every single day. And that flexibility is what we were specifically looking for to serve patients,” says Davis-Risen. “It has to be specific, though. It can’t be completely amorphous. There needs to be an agreement signed at the practice level between either the practice or collaborating physician and the PA.”

Private Practice

Before collaborative practice was implemented, Oregon PAs could work relatively independently, even under supervision. “We’ve always been able to own our own practice as PAs in Oregon. They just had to employ a supervising physician and meet the state requirements. Supervision could be general where the doctor and PA were in different locations, direct where they are both in the same facility, or direct where the doctor is with the PA while they care for patients.”

Davis-Risen continues, “I wouldn’t expect a new PA to open their own practice shop in Oregon. We still have more delineation for new graduates, and they have supervision requirements for the first two years before they move to a collaborative agreement. We did that on purpose to be supportive of our new graduate. We didn’t want to send new graduates out into an environment where collaboration was minimal, and they struggled.”

Scope of Practice

In addition to being responsible for their own decision-making, PAs under the new law can have expanded autonomy regarding their scope of practice. “In Oregon, the scope of practice for PAs is quite broad. We’re one of the better states as far as what we have the legal right to do. We can practice medicine in Oregon, which is great,” says Davis-Risen.

Before the law changed in 2022, the scope of practice for PAs in Oregon looked different. What a PA could do was limited by what their supervising physician could do. “The example that we used when we were talking to the legislature was if you have a family practice PA who has 15 years experience inserting IUDs and they move to a practice where their new supervising physician doesn’t have any experience doing IUDs their scope of practice would be limited and that PA could no longer do IUDs. So that service could not be provided to patients, which otherwise would have expanded the services provided in that clinic,” says Davis-Risen. “Under collaboration, a PA’s scope of practice is based on what they have learned to do, what they are credentialed to do, and what their experience enables them to do.”

Kimmy Gustafson

Kimmy Gustafson

Writer

At HealthcareDegree.com, Kimmy Gustafson has delivered in-depth and insightful articles since 2019, aiding prospective students to navigate the complexities of choosing the right healthcare degree. Her recent work includes topics such as the ethics of gene editing and physician assistant’s fight for autonomy.

Kimmy has been a freelance writer for more than a decade, writing hundreds of articles on a wide variety of topics such as startups, nonprofits, healthcare, kiteboarding, the outdoors, and higher education. She is passionate about seeing the world and has traveled to over 27 countries. She holds a bachelor’s degree in journalism from the University of Oregon. When not working, she can be found outdoors, parenting, kiteboarding, or cooking.

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