287 Physician Assistant Scope of Practice 2015
Laws addressing the professional conduct of health professionals are
evolutionary, and their historical roots have evolved in the United States
over the past 140 years.8 Significantly, the evolution of medical practice
regulation broadened healthcare professional scopes of practice to include
medical tasks previously restricted to physicians.9
In 1965, Duke University introduced physician assistants (“PAs”) as a
strategy to help over-extended physicians provide more services.10 By
1974, thirty-seven states had passed legislation to authorize practice by
these new practitioners.11 Within four decades, a series of laws developed
to govern the PA practice, including a network of statutes and regulations in
the states, the District of Columbia, the United States Territories, and federal systems.12
In general, states are far from achieving uniformity in their laws, and PA
legislation is no exception.13 In less than fifty years, PA regulation originated through considerable legal activism, largely on the part of state and
national PA organizations. This involved considerations of appropriate
medical scope of practice, concern for public safety, and assurance of
ruled in favor of West Virginia, holding that the state had the authority and responsibility to
restrict medical practice to those who are licensed “in the exercise of its power to provide for
the general welfare of its people.”
8. AMERIGER, supra note 1, at 13.
9. Barbara J. Safriet, Closing the Gap Between Can and May in Healthcare Providers’
Scope of Practice: A Primer for Policymakers, 19 YALE J. ON REG. 301, 308 (2002). Prior to
1965, the only persons who could legally perform the acts of medical diagnosis and treatment were physicians. With the creation of PAs and NPs and their recognition in law, the
legal notion that these tasks could be delegated to others became accepted and established in
10. Eugene A. Stead, Jr., Conserving Costly Talents—Providing Physicians’ New Assistants, 198 J. AM. MED. ASS’N 1108, 1108-09 (1966).
11. Roger M. Barkin, Directions for Statutory Change: The Physician Extender, 64 AM.
J. PUB. HEALTH 1132, 1134 (1974).
12. See James F. Cawley et al., Origins of the Physician Assistant Movement in the
United States, 25 J.. AM. ACAD. PHYSICIAN ASSISTANTS 36, 36-42 (2012) (discussing generally the forty year period during which there were laws passed in every state that permitted
PAs to practice with physician supervision as well as acts authorizing prescribing of medications. All fifty states, the District of Columbia, and all U.S. territories, with the exception of
Puerto Rico, authorize licensed PAs to practice medicine in teams with physicians, engage in
a wide range of medical diagnostic and treatment activities, prescribe medication, and be
reimbursed for their services).
13. AM.ACAD. OFPHYSICIANASSISTANTS,PHYSICIANASSISTANTSSTATELAWS AND
REGULATIONS tbl.1 (14TH EDITION 2014) (illustrating the variation in laws and regulations
from state to state).
14. See Nicole Gara & Ann Davis, The Political Process, in PHYSICIAN ASSISTANT: A
GUIDE TO CLINICAL PRACTICE 80, 551-65 (Ballweg Thomas Moore et al. eds., 5th Elsevier
Science 3d ed. 2013) (discussing the history and evolution of physician assistant laws and
regulations since the inception of the profession).