You have a lot of career opportunities when you graduate from a physician assistant degree program. However, due to the nature of work as a PA, you can only practice medicine under the supervision of a fully qualified doctor. The extent to which you must be supervised depends on the regulations of the state in which you work, according to the United States Bureau of Labor Statistics (BLS). State laws regarding the supervision of physician assistants include regulations on co-signature requirements, ratios of PAs to supervising doctors, the authority to prescribe medications, the scope of practice and the availability of on-site supervision or direct communication, according to the American Medical Association.

Does a PA Need to Have an MD With Them While They Care for Patients?

A physician assistant and their supervising physician don’t have to be joined at the hip. In fact, one of the benefits PAs offer to the healthcare industry is extending its resources to care for more patients. If physician assistants could only work with a doctor standing right over them and watching their every move, they wouldn’t be able to expand the capacity of healthcare systems and facilities to provide care to more patients.

Instead of requiring the constant physical presence of the doctor, most states are more lenient. They may require a schedule of on-site, in-person direct supervision of a PA by the physician that meets minimum standards, like one to two days per week or at least one day every two weeks, according to the American Medical Association. In addition to or instead of these requirements, states may establish communication requirements. A PA may be able to practice medicine only so long as their supervising doctor is readily available to communicate with them, or as long as some amount of communication takes place within a prescribed period of time, such as a month.

Regardless of what a state’s specific supervision requirements are, the PA and their supervising physician are part of a collaborative team. They, and other members of the care team, share responsibilities and the same goal: to provide the best patient care.

Although most states classify the relationship between doctors and PAs as “supervisory,” Alaska and Illinois have “collaborative” relationships instead, the American Medical Association reported.

What Is an MD Required to Do Concerning a PA They Are Supervising?

What Kind of Supervision Does a PA Need to Be Able to Practice

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Ultimately, regardless of the level of direct, in-person supervision a state requires, the supervising physician is the one who is ultimately responsible for a patient’s care. That means, in many states, the PA shares responsibility for a patient with their supervising doctor, according to the Texas Academy of Physician Assistants – even if the PA is the one serving as the direct primary care provider.

The precise expectations of a supervising MD or DO can vary wildly from one state to another. While a supervising physician in New Jersey must review every patient chart and co-sign or countersign every medical order issued by their PA, supervising doctors in other states aren’t required to co-sign a PA’s medical orders at all. States can also limit the types and quantities of medication a physician assistant can prescribe without the direct review or prior approval of a supervising physician. For the supervising physician, this may mean addressing medication changes with the PA prior to a patient’s appointment or reviewing and approving the PA’s proposed prescription following the appointment. If the patient’s condition calls for any new medication or refill that the PA is not authorized to prescribe, the supervising physician must personally handle prescribing that drug.

Physician assistants don’t just pick and choose what they want to do. Generally, a written agreement between the supervising physician and the PA, developed to comply with all state regulations, stipulates what procedures the PA may and may not carry out, according to Scope of Practice Policy.

Some states have more extensive requirements for new PAs and allow for less rigorous supervision of experienced physician assistants. In Pennsylvania, for example, supervising physicians must co-sign 100 percent of patient records handled by PAs who are new to medical practice or to a particular medical specialty, according to the American Medical Association. As a PA acquires more experience, the percentage of patient charts the supervising physician must sign decreases.

Another way states regulate the supervision of PAs is by establishing maximum ratios of PAs to supervising physicians. These regulations exist in 39 states and include limits that range from two to six PAs per physician, the American Medical Association reported.

Additional Resources

Are There Any Limitations as to What Kinds of Services a PA Can Do?

What Is the Difference Between a Medical Assistant and a Physician Assistant?

Are PAs Allowed to Write Drug Prescriptions?