Recent statistics indicate over 115,000 Physician Assistants (PAs) practice in the United States. A PA is a licensed medical professional with an advanced degree who can provide direct patient care. PAs work with patients of all ages in virtually all specialties and primary care areas, diagnosing and treating common illnesses and performing procedures. Generally,  the supervising physician and state law determine the specific duties of PAs, but they provide many of the same services as primary care physicians. They practice in every state and various clinical settings and specialties. While PAs have historically worked in collaboration with a supervising physician, this does not mean they work under the direct supervision of a physician. Most PAs work independently, operating under a set scope of practice determined by state law. Some states are now taking that independence a step further.

Arizona (HB 2043), Montana (HB 313), and Iowa (HF 424) are changing PA practice laws and helping PAs practice to the full extent of their education, training, and experience. These new regulations are changing practice authority and, depending on state-specific requirements, permit PAs to practice without physician supervision as long as they follow state mandates on lifting  the supervision agreement requirement. Those state requirements are detailed further below. 


On April 17, 2023, Arizona Governor Katie Hobbs signed H.B. 2043 into law. With the signing of H.B. 2043, PAs in Arizona who meet the law’s requirements can now expand patient care through more modernized, team-based healthcare. Licensed PAs who have obtained 8,000 or more practice hours are no longer required to be supervised by a physician. Those with less than 8,000 practice hours will still be required to practice under the supervision of a physician until they have reached the required 8000 practice hours. 

PAs in Arizona, with 8,000 practice hours must still collaborate with physicians and refer patients to the appropriate healthcare specialist required by their condition and commensurate to the PA’s education and experience. The legislation will also update who is responsible for the care provided by PAs. It allows the Arizona Board of Physician Assistants to determine appropriate regulations for changes in specialty and allow for direct payment to PAs. The new law will take effect on December 31, 2023. 


On April 18, 2023, Montana Governor Greg Gianforte signed HB 313 into law. HB 313 removes the requirement that PAs work under physician supervision. PAs with fewer than 8000 practice hours must collaborate with a physician or an “experienced” PA (defined as a PA who is licensed and with 8,000 or more practice hours). Licensed PAs with 8000 or more practice hours are exempt from working under a collaboration agreement with a physician. However, they are still required to collaborate with healthcare team members and refer to or consult with other providers when the patient’s condition requires it.


On May 10, 2023, Iowa Governor signed HF 424 into law. HF 424 removed the requirement for PAs in Iowa to be supervised by a physician to practice medicine. The state now considers them “health care providers” that no longer require a supervising agreement with a licensed physician when they satisfy specific requirements. Newly licensed PAs will still be required to work under the supervision of a physician during the first two years of practice if they did not work under physician supervision or in collaboration with a physician or other healthcare professional for at least two years. 

The Iowa Board of Physician Assistants and the Iowa Board of Medicine will adopt joint rules in compliance with HF 424 that will determine the term of collaboration requirements for PAs who want to engage in independent practice. 


All these regulations are new, and Arizona HB 2043 will not go into effect until the end of 2023. Many are optimistic that the liberalized rules for PAs will help address the shortage of healthcare providers that face many states, particularly in expanding access to healthcare in rural areas. It is exciting to see other states following in the footsteps of Arizona, Montana, and Iowa in growing the practice scope of PAs. We will monitor the effects of these new regulations within those states’ jurisdictions and any possible domino effect on other states.

*This blog post is for informational purposes only and does not constitute legal, financial, or medical advice or the forging of an attorney-client relationship. Please retain the services of an attorney licensed in your state to receive legal advice on how the law applies to your business.