301 Physician Assistant Scope of Practice 2015
institution.143 This process involves a review of the PA’s education and
training, including postgraduate studies, continuing medical education, certification, and state licensure.144 Additionally, a thorough background
check, including any past disciplinary actions or malpractice claims, may be
sourced.145 The credentialing process typically takes place as the individual
seeks hospital privileges.146
Once a PA is credentialed by a hospital or licensed facility, they are authorized to engage in a specific scope of practice through a process known
as “privileging.”147 The standards of the Joint Commission—a major hospital accrediting agency—require hospitals to credential and privilege PAs in
a manner similar to that of physicians.148 After privileges are granted, the
PA is permitted to see patients, assist in surgery, or perform other specific
duties delegated by the supervising physician.149
D. Determinant 4: State Law and Regulation
Another determinant of PA scope of practice is state law.150 Medical
boards are charged with administering systems to monitor provider behavior, ensure public safety, and provide appropriate medical discipline.151 As
such, most jurisdictions license and regulate PAs through the state medical
board, but eight states have regulatory bodies strictly for PAs.152 Nearly all
of the states where PAs are regulated by the medical board have PA com-
mittees.153 All states require two basic criteria for licensure: graduation
from a PA program accredited by ARC-PA, and passage of the Physician
Assistant National Certification Examination (PANCE) administered by the
National Commission on Certification of Physician Assistants
(“NCCPA”).154 The NCCPA’s PANCE exam functions as the de facto li-
147. See id. at 275-82.
148. See generally HOOKER ET AL., supra note 89, at 420 (stating that the Joint Commission evaluates an organization’s credentialing program and that, as a general matter, credentialing programs for PAs are conducted in a manner parallel to those for physicians).
149. See HOOKER ET AL., supra note 89, at 276.
150. See id. at 418.
151. Id. at 420. See also FEDERATION OF STATE MEDICAL BOARDS, REPORT OF THE
FSMB WORKGROUP ON INNOVATIONS IN STATE BASED LICENSURE 2 (2014), available at
152. See STATE LAWS 14TH ED., supra note 101, at 3 (States with a regulatory bodies
strictly for PAs include Arizona, California, Iowa, Massachusetts, Michigan, Rhode Island,
Utah, and Texas).