Pushing for PA Modernization

The US — as well as the world at large — is facing a growing healthcare provider shortage. Recent projections, in fact, suggest that the US will be short by more than 3 million healthcare workers by next year, which will have significant impact on the country’s ability to provide timely and effective patient care.

To help fill this gap, many states are pursuing new legislation to modernize physician associate (PA) practice, allowing PAs to work at the top of their knowledge, experience, and skillset.

“Across the country, we are seeing a growing number of legislators express a stronger understanding of the critical role that PAs play in today’s healthcare system,” said Chantell Taylor, chief of public affairs and advocacy at the American Academy of Physician Associates (AAPA). “Today, an estimated 79 million Americans lack adequate access to primary care services. Even worse, 123 million Americans lack adequate access to mental health services…Modernizing PA practice laws aims to address the problem of too few healthcare providers and mounting patient care needs.”

Over the past few years, PA organizations in various states have pushed for policy changes to make it easier for patients to access the care they need, including support for the PA Licensure Compact, PA title change, and the removal of unnecessary supervisory requirements.

Going Where Providers are Needed Most

Several states face greater provider shortages than others. Tennessee, New York, and Oregon, for example, are all expected to see future shortages. PAs could help — yet, moving between states, historically, has required these essential healthcare providers to apply to the state’s licensing board, potentially take a required exam, and pay fees.

This often makes it harder for PAs to relocate where they are most needed. Over the past two and a half years, however, 17 states have joined the PA Licensure Compact, which facilitates multi-state practice for PAs. Several other states, including North Carolina and Oregon, have filed legislation to join the compact.

“PAs with unencumbered licenses in one compact state will be able to provide care to patients in other compact states,” said Taylor. “This can be especially beneficial for rural communities and/or areas where healthcare providers are few and far between.”

A PA by Any Other Name

In 2024, Oregon became the first state to legally change the title of “physician assistant” to PA. In summer 2025, both Maine and New Hampshire also enacted new laws to promote a title change. Kathleen Moneghan, a PA from Maine, said this legislation was important to challenge ongoing misconceptions about what PAs do — and help facilitate future practice modernization efforts.

“I remember when I first graduated as a PA and I was seeing patients, they’d say, ‘Oh, when am I going to see the doctor?’” she explained. “They thought what we do is assist the doctor, when, in reality, we see patients on our own. We have our own patient panels, we treat, we diagnose, we prescribe. Having the right title creates a better understanding for patients about what we do — and also helps ensure they trust the care we give to them.”

Removing Physician Supervision

Taylor said that there is growing support across multiple states for new laws to remove supervision requirements for experienced PAs. Historically, PAs needed to sign a contract with a physician to “supervise” their work or participate in a collaboration agreement. But Sarah Leslie, a PA in New Hampshire, said that such requirements are costly and onerous. Worse, they often led to PAs losing their jobs when doctors refused to do the paperwork because of liability concerns.

“Most of these doctors weren’t even in the office with us, despite the fact they were tied to our license. They weren’t even supervising,” she explained. “And there are so many stories about PAs being let go. I know of literally an entire family practice office that got rid of all of their PAs because the doctor didn’t want to sign the forms.”

The need for a supervising physician could also be quite expensive for PAs who needed a supervising physician to keep their practice doors open.

“I was paying $1000 a month to a doctor who wasn’t even in the practice to just sign a piece of paper,” Leslie said.

“Doctors and medical societies often say things like, ‘Without supervision, PAs are going to start doing open heart surgery in the cafeteria,’ but when we talked to legislators about what we really do and how we can improve access, they saw the value in us being able to practice without this kind of paperwork.”

Now, the state of New Hampshire has enacted new legislation to remove those supervisory requirements. When a PA has reached 8000 postgraduate clinical hours, PAs can own and run their own practice.

Other states, including Iowa, Montana, Wyoming, and Colorado, have done the same — and many have already seen tangible benefits from removing or relaxing supervisory requirements, said Taylor.

“Following supervision removal in Iowa, a PA operating a mental health clinic was able to drastically improve access to care for patients. She redirected funding that had been used on supervision to hire more providers,” Taylor said. “In 2024 alone, her clinic saw more than 800 new patients, the vast majority of whom were able to get a mental health appointment within 2 weeks.”

Pushing for Quality and Safety 

Both Moneghan and Leslie are continuing to push for PA practice modernization in their states. They see it as essential to helping provide the vital healthcare Americans will need in the years to come. And, as research thus far shows, these changes are enhancing care, not negatively affecting patient safety as some physician organizations have argued. Taylor hopes that more states will see the value in enacting laws that allow PAs to do their jobs.

“To date, there has been no research or evidence provided that shows that quality or safety of care declines, or malpractice rates increase, when PA supervision is removed,” Taylor said. “What has been proven is that providers can practice in a manner consistent with their experience, training, and education, and patients can better access the high-quality healthcare they deserve.”

Kayt Sukel is a healthcare and science writer based outside Houston.