Access and Innovation in a Time of Rapid Change:
Physician Assistant Scope of Practice
Ann Davis, MS, PA-C, Stephanie M. Radix, JD, James F. Cawley,
MPH, PA-C, DHL (Hon), Roderick S. Hooker, PhD, MBA, PA, and
Carson S. Walker, JD
For more than a century, controversy has surrounded health professionals’ legal authority to practice.1 In the late nineteenth and early twentieth
centuries, states passed licensure laws to regulate physicians2 and protect
the public against quackery, commercial exploitation, deception, and professional incompetence.3 These laws enforced standards for physicians to
enter into and continue practice in the medical profession.4 As a result,
state medical practice acts developed ethical and educational requirements
for physicians relating to personal character, scientific education, and practical training or experience.5 The enactment of the Medical Practice Act of
1870 made medical licensure a function of the states.6 The unanimous decision of the Supreme Court in Dent vs. West Virginia in 1889, in favor of
the people of West Virginia, solidified the concept that states have the obligation to protect residents within their borders by regulating medical prac-
1. CARLF.AMERIGER,STATEMEDICALBOARDS AND THEPOLITICS OFPUBLIC
PROTECTION 13 (Johns Hopkins Univ. Press 1999).
2. RODERICKS.HOOKER ET AL.,PHYSICIANASSISTANTS:POLICYANDPRACTICE409
(F. A. Davis Co. 3d ed. 2010).
3. See ROSEMARY STEVENS, AMERICAN MEDICINE AND THE PUBLIC INTEREST 32 (Yale
Univ. Press 1972) (stating that, “. . . standards of education and practice were uneven . . .”
and that “. . . there seemed to be a glut of doctors . . .”). See also Dent v. West Virginia,
129 U.S. 114, 122-23 (1889). See also PAUL STARR, THE SOCIAL TRANSFORMATION OF
AMERICAN MEDICINE 130-132 (1982).
4. AMERIGER, supra note 1, at 13.
6. STEVENS, supra note 3, at 32.
7. See Dent, 129 U.S. at 122-23. The Supreme Court decided Dent vs. West Virginia in
1889. Frank Dent, a graduate of a school specializing in an alternate medicine known as “
eclectic medicine,” was practicing as a doctor of medicine in Newburg, West Virginia. The
state found that Dent did not have a license to practice allopathic medicine, and indeed was
not eligible for licensure as a physician. Dent was found guilty of practicing medicine without a license and fined $50. Dent appealed the state’s decision, holding that the state was interfering with his “vested right in relation to the practice of medicine.” The Supreme Court