Before you enroll in one of the top physician assistant degree programs, you should understand what kinds of services a PA performs and what limitations they face. The biggest limitation is that physician assistants must work under the supervision of a doctor, although this doesn’t mean a doctor must be directly hovering over them at all times. The scope of professional practice for a PA places limits on the services they can perform, as can state regulations and employer requirements.
Understanding the Scope of a Physician Assistant’s Practice
Generally, physician assistants practice medicine as a fully licensed physician does, but they can do so only under a doctor’s supervision, according to the United States Bureau of Labor Statistics. The doctor takes primary responsibility for the patient’s care but delegates to the PA the performance of services that range from ordering and reading the results of diagnostic tests to carrying out treatment procedures and therapies.
What this distinction means in practice can differ considerably from one situation to the next. If you work in a specialty like primary care, your job duties may be very similar to that of a doctor with regard to clinical practice. In other specialties, you may be more limited, particularly when it comes to performing complex medical interventions or making decisions about challenging medical cases. A PA who specializes in surgery, for example, performs more of a support role, closing the patient’s incisions while the doctor is the one who performs surgical techniques to remove or implant objects.
PAs’ ability to work is dependent on having a supervisory physician, so they can’t enter into private practice and establish their own medical facility without a physician overseeing them. In some states, though, PAs may own as much as 99 percent of a medical practice.
Who Sets Limitations on a PA’s Scope of Practice?
Historically, state regulations have been a big factor in determining what limitations a PA must follow. In most states, however, the decisions pertaining to a physician assistant’s scope of practice are no longer dictated primarily by a regulatory agency but instead established by the individual medical practice, according to the American Academy of PAs.
This regulatory trend is seen as positive, because it frees physician assistants and medical facilities up from the struggle to comply with regulations that may not be practical for the situation. That said, states still have the right to make laws limiting the services a PA can provide, and some states are more heavy-handed with these regulations than others.
Many limitations now set on physician assistants come from policies of the health system or facility in which they work or a written agreement with their supervising doctor. These limitations on a PA’s scope of practice may be more fluid and flexible than state regulations. A supervising doctor may expect PAs to determine their limits based on the amount of training they have in performing a certain service and on the level of complexity of an individual patient’s situation.
The extent of a PA’s experience in the field is another factor that influences their limitations. In some states and under some employers, the restrictions on a PA’s scope of practice are stricter for new physician assistants than for experienced PAs.
Common Limitations on Physician Assistants
One common limit physician assistants face is the need for their supervising doctor to co-sign or countersign medical records and paperwork. Different states can have very different regulations for PAs when it comes to co-signatures. Some states require a physician to sign off on or review the charts of every patient the PA sees, while other states have no co-signature requirement. Requiring a co-signature doesn’t necessarily mean that the PA can’t treat the patient without the doctor in the room, but it may necessitate more communication and collaboration between the PA and their supervising physician, particularly in cases of a more challenging nature.
Physician assistants have some level of authorization to prescribe medications in every state in the U.S. However, they don’t have unlimited authority to prescribe any drug for any purpose. There are many different limitations on a physician assistant’s prescribing authority, according to the American Academy of PAs.
PAs may be limited on which schedules of drugs they can prescribe, with a schedule referring to a classification established by the United States Drug Enforcement Administration based on the substance’s acceptable medical use and level of potential for dependency or abuse. Physician assistants may also be limited in the quantity or dosage of drugs they prescribe, the frequency or duration of the prescription and the format or delivery route of the medication.
Other limitations PAs face include the types of paperwork they are permitted to fill out, the types and amounts of medical malpractice insurance required to work (if any) and under what circumstances a PA must have written protocols to be allowed to practice medicine.
Additional Resources
What Kind of Supervision Does a PA Need to Be Able to Practice?