PA State Practice Environment

It’s crucial for PAs and lawmakers to understand how state laws and regulations impact practice. States have modified their approach to PA regulation over the years in response to a growing body of evidence demonstrating the safety and high-quality care PAs provide coupled with the need to better utilize their healthcare workforce. AAPA has identified specific components that are essential to achieving optimal PA practice. This map is intended to be a broad snapshot of the practice environment for PAs; please review state specific information in AAPA’s state law profile or contact the state advocacy team.


More information is available to AAPA members. Log in here.

Current as of October 31, 2022

  • Reduced
  • Moderate
  • Advanced
  • Optimal
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration
  • Key Elements

    • Scope Determined at Practice Level
    • Adaptable Proximity Requirements
    • Chart Co-Signature at Practice Level
    • No PA-physician ratios
    • Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
    • Collaboration

Practice Categories

  • Optimal – PAs can practice to the full extent of their medical education, training, and experience. PAs continue to collaborate, consult, and/or refer to the appropriate member(s) of the healthcare team as indicated by the patient’s condition, the PA’s competencies, and the standard of care. The healthcare team, and/or their employer, may establish guidelines for collaboration, consultation, and/or referral beyond state laws and regulations.
    • How is it calculated? Optimal states have eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider.
  • Advanced – PAs practice to the full extent of their medical education, training, and experience, but must comply with additional administrative requirements as mandated in state law and/or regulation.
  • Moderate – State law and/or regulation requires additional administrative burdens that impact the practice environment. The PA and the healthcare team are limited in flexibility due to these administrative burdens.
  • Reduced – State law and/or regulation restrict the healthcare team and PAs’ ability to practice in at least one element of PA practice. Requires outdated practice models of limited delegated authority and/or restrictive supervision requirements.

What are the Components?

The Optimal Component recognized the elimination of the legal requirement for a specific relationship between a PA and a physician or any other health care provider.

The Flexible Practice Components are derived from the 6 Key Elements, that are critically focused on flexibility for PAs in a supervised/collaborative practice model.

The components are:

    • PA Scope of practice is determined at the practice level
    • Adaptable proximity requirements (including onsite, in-person, and time/distance requirements)
    • Chart co-signature requirements are determined at the practice level
    • Number of PAs a physician may collaborate with is determined at the practice level

The Collaboration Component recognizes states that have modernized the practice act to utilize the term “collaboration” instead of “supervision” to describe the PA-physician practice relationship.