303 Physician Assistant Scope of Practice 2015
of an individual PA’s scope of practice.164 For example, Idaho regulations
require all “specialized procedures” to be approved by the board.165 All
state PA practice acts specify some degree of physician oversight of care
provided by PAs, with all but one using the word “supervision” to describe
this oversight.166 Supervision is legally defined as “responsible control.”
Control implies the establishment of the overall limits of and the policies to
be followed by the supervised professional.167 Although all state laws require that PAs practice with physician supervision, no state requires that the
physician be continuously onsite.168 All state laws require the ready availability of the physician for consultation and with rare exception, authorize
availability via telecommunication.169 A typical definition of supervision is
provided in a New York statute: “[s]upervision shall be continuous but shall
not be construed as necessarily requiring the physical presence of the supervising physician at the time and place where such services are per-
An increasing number of states authorize the specific elements of supervision to be determined at the practice site, based on the complexity of patient problems common to the practice, the training and experience of the
PA, and the setting in which care is rendered.171 Generally, the more complex the task and the greater the potential risk to the patient, the more direct
and explicit the expectations for physician availability.172
In the eyes of the law, the PA serves as the agent of the physician.173
164. See generally STATE LAWS 14TH ED., supra note 101 (14th ed., Rev. 2014) (by adding up the individual states whose provisions qualify).
165. IDAHO ADMIN. CODE r. 22.01.03.030.03 (2004).
166. ALASKA ADMIN. CODE tit.12, § 40.430. See generally, STATE LAWS 14TH ED., supra
note 101 (14th ed., Rev. 2014) (demonstrating that the word used in all states but Alaska is
167. Gara & Davis, supra note 14, at 744.
168. Id. at 81.
169. See generally STATE LAWS 14TH ED., supra note 101 (referring to each state’s provisions on physician supervision). See specifically MINN. STAT. ANN. § 147A.01 Subd. 24
(2014) (defining “supervision” to mean overseeing the activities of, and accepting responsibility for, the medical services rendered by a physician assistant. The constant physical presence of the supervising physician is not required so long as the supervising physician and
physician assistant are or can be easily in contact with one another by radio, telephone, or
other telecommunication device. The scope and nature of the supervision shall be defined by
the individual physician-physician assistant delegation agreement).
170. N. Y. EDUC. LAW § 6542 (West 2013).
171. See generally STATE LAWS 14TH ED., supra note 101 (referring to each state’s provisions on scope of practice. As of 2014, twenty-five states and the District of Columbia allow the parameters of scope of practice to be determined at the practice site).
172. Gara & Davis, supra note 14, at 742.
173. See BLACK’S LAW DICTIONARY 62 (6th ed. 1990) (“ A relationship between two
persons, by agreement or otherwise, where one (the agent) may act on behalf of the other
(the principal) and bind the principal by words and actions.”).