PA State Practice Environment

PA Practice Modernization

Patients deserve modern, integrated healthcare delivery led by healthcare providers who are all practicing to the top of their scope of practice.

Modernizing PA practice laws unlocks the full potential of the PA profession and can help to ensure patients in all communities have access to timely, affordable, and high-quality care.

AAPA advocates for updates to state laws and regulations that are essential to achieving an optimal PA practice environment.

PA State Practice Environment Map

Current as of July 2025

This map provides a snapshot of the current practice environment for PAs across the country. States are assigned a category as determined by their enactment of laws and/or adoption of regulations that support PA Practice Modernization.

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Reduced
Moderate
Advanced
Optimal

Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration
Key Elements
- Scope Determined at Practice Level
- Adaptable Proximity Requirements
- Chart Co-Signature at Practice Level
- No PA-physician ratios
- Eliminated the legal requirement for a specific relationship between a PA and a physician or any other health care provider
- Collaboration

Key Laws and Regulations that Support PA Practice Modernization

Optimal Modernization Criteria

Elimination of the legal requirement for a specific relationship between a PA and a physician or any other healthcare provider.
A separate PA regulatory board or one or more full PA voting member(s) on the medical/healing arts board.
Direct pay to PAs (as opposed to practice/employer).

Foundational Modernization Criteria

PA Scope of practice is determined at the practice level.
Adaptable proximity requirements (including onsite, in-person, and time/distance requirements).
Chart co-signature requirements are determined at the practice level
Number of PAs a physician may collaborate with is determined at the practice level.

Collaboration (as opposed to “supervision”)

Practice Categories

Optimal

All 3 Optimal Modernization Criteria

Advanced

All 4 Foundational Modernization Criteria
OR
3 Foundational Modernization Criteria + Collaboration

Moderate

3 Foundational Modernization Criteria
OR
2 Foundational Modernization Criteria + Collaboration

Reduced

2 or fewer of the Foundational Modernization Criteria
OR
1 Foundational Modernization Criterion + Collaboration

Contact [email protected] for more information.