Physician associates are heading into 2027 state legislative sessions with supervision rollbacks at the top of their agenda. Physician groups are preparing to fight them.
Ten states have removed the requirement that PAs practice under physician supervision, according to MedPage Today: North Dakota, South Dakota, Wyoming, Utah, Montana, Iowa, New Hampshire, Virginia, Maine and Delaware. An American Academy of Physician Associates official told the publication that another 12 states are expected to pursue legislation to modernize their PA practice acts next year. Not all of those efforts will focus only on supervision.
Here are five things to know about where PA scope policy stands and where it may move next:
1. 2026 brought more incremental gains than clean wins. Virginia enacted HB 746. The law allows PAs to practice independently after three years of full-time clinical experience in their specialty, according to the American Medical Association’s April 24 state advocacy update. Maine’s LD 2088 removed the written practice agreement requirement for PAs with more than 4,000 hours of practice.
Kansas took a middle path. HB 2702, signed by Gov. Laura Kelly and effective Jan. 1, 2027, shifts experienced PAs from “supervision” to “collaboration” after 4,000 clinical hours. It also drops physician-to-PA ratio limits, removes the requirement for physicians to be physically present and recognizes “physician associate” as a title, according to the AAPA. The bill passed the Kansas Senate 40-0. The AMA noted that the law still keeps a supervision and collaboration framework in place. Kentucky kept physician supervision but granted PAs Schedule II prescribing authority, and Iowa authorized the “physician associate” title, according to the AMA.
2. Physicians stopped supervision removal in five states. Bills to eliminate physician supervision or collaboration for PAs failed in Idaho, New Mexico, Tennessee, Wisconsin and West Virginia this year, according to the AMA. A Mississippi bill that would have let the state board set PA scope was also defeated.
The AMA reported stopping more than 150 scope bills in 2025. In its 2026 survey, 89% of state and national medical society executives ranked scope of practice as their top issue, and 25% expected PA-related activity in their states. The AMA has committed $1 million a year to its Scope of Practice Partnership.
3. Massachusetts is a state to watch. Companion bills H.2371 and S.1502 would let PAs with 2,000 hours under a collaborative agreement practice and prescribe without a supervising physician. They would also allow PAs to bill payers directly and operate limited-service clinics, according to Holland & Knight. H.2371 moved to the House Ways and Means Committee on July 23, 2026, according to the Massachusetts Legislature’s bill history.
4. Advocates are framing the issue around multistate systems and retail clinics. Chantell Taylor, chief of public affairs and advocacy at the AAPA, told MedPage Today that health systems operating across state lines often default to the most restrictive rules. That creates barriers to access in more restrictive states. She said supervision and ratio requirements also discourage retail clinic operators such as CVS and Walgreens from hiring PAs or opening locations.
“It’s not worth having to put an infrastructure in place to meet a ratio or sign a chart,” Ms. Taylor said. She also said the physician sign-off arrangement costs PAs up to $10,000 a year.
Interstate practice may get easier through another route. The PA Licensure Compact now has 20 member states, with New Jersey the most recent to join, and is projected to reach full implementation by early 2027, according to the National Commission on Certification of Physician Assistants.
5. The research base is thin, and both sides cite it. Few studies isolate the effects of PA scope laws, and the most-cited one has ties to PA advocates.
The AAPA points to a study in the Journal of Medical Regulation, published by the Federation of State Medical Boards. The study compared 10 years (2010-2019) of National Practitioner Data Bank malpractice payment reports with state practice laws. States with four or more permissive PA practice reforms had no greater risk of PA malpractice payment reports than states with three or fewer. Three of the study’s four authors were AAPA staff members.
A 2023 paper in the Journal of Public Economics looked at mortality. Benjamin McMichael, a University of Alabama law professor, found that allowing PAs to practice remotely from physicians was associated with about 10 fewer healthcare-amenable deaths per 100,000 residents, or roughly 1.75%. The effect was concentrated in rural counties, at about 26 fewer deaths per 100,000. In urban counties, it was not statistically significant. Mr. McMichael noted that the data cannot separate gains in access from gains in quality.
State regulators have flagged the same gap. A 2025 study by Virginia’s Department of Health Professions, directed by state lawmakers, found no published information on the costs and benefits in states that have expanded PA scope.
The American Osteopathic Association reads the evidence differently. “Research has not consistently shown that independent practice by nonphysician clinicians reduces costs or improves patient outcomes,” AOA CEO Kathleen Creason told MedPage Today. She said expanding residency positions and supporting rural physicians would do more to address shortages.
Ms. Taylor said she does not expect November’s midterms to change the AAPA’s priorities.
“Practice modernization and the healthcare workforce don’t tend to fall into a partisan camp,” she said.
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