Collaborative Practice for Physician Assistants: Addressing the Confusion
Newly enacted legislation gives seasoned physician assistants extra flexibility but does not grant independent practice.
Misinformation has created a murky fog of confusion around the extent of physician assistants’ scope of practice in our state. Conflicting information began to swirl in the healthcare community following the passage of
HB2043 — a bill to redefine PAs scope of practice — during Arizona’s 2023 Legislative Session.
As confusion continues to intensify, the Arizona Medical Association is here to provide clarity.
Working Together Toward a Shared Goal
In 2021, the Arizona State Association of Physician Assistants reached out to ArMA regarding an update to PAs’ practice act. ArMA firmly believes in the power of collaboration to craft safe, long-standing healthcare legislation. So, a physician taskforce was created and worked alongside ASAPA to define appropriate policy language through a robust stakeholder process.
ASAPA’s goal was to create earned flexibility within the workplace for PAs, helping the profession recruit and retain talent while also addressing access to care challenges in Arizona. Under the original statute, PAs found themselves at a disadvantage with respect to their Advanced Practice Provider peers, nurse practitioners, when it came to employment opportunities. ASAPA hoped to address these concerns by updating Arizona’s statute, which defines the professionals’ scope of practice.
Productive collaboration and negotiations were successful in producing a bill mutually agreed upon by ArMA and ASAPA.
The final product, HB2043, has appropriate and thoughtful guardrails that both protect patient safety through physician-led care teams and accomplish ASAPA’s goal.
What HB2043 Does, According to Its Language
The result of a years-long collaboration between stakeholders is a bill that checks all the boxes. HB2043 creates appropriate flexibility for seasoned PAs through collaboration agreements, which will theoretically ease access to care challenges and, most importantly, will maintain patient safety. Here is how HB2043 is implemented into practice:
Clinical Hours Are Key
HB2043’s language clearly distinguishes PAs with more than 8,000 hours of clinical practice in a single specialty under their belt from those falling under this threshold.
It Takes Two to Collaborate
After completing the required 8,000 hours of clinical practice, which must be documented by the Arizona Regulatory Board of Physician Assistants (ARBoPA), PAs are eligible to enter into a collaboration agreement, pending approval from their employer. The collaboration agreement can be established between a PA and a designated physician, licensed healthcare institution, or physician-owned practice.
Notably, the bill defines a “collaborating physician or entity” as one or more physicians who must be designated by name or position and who will be responsible for the oversight of the physician assistant.
Practically speaking, this definition allows PAs to work under multiple physicians, granting them additional flexibility in the workplace.
The Proof is in the Rules
The Arizona Medical Board has finalized the
rules that implement HB2043, providing the healthcare community with further guidance.
The final rules outline the required information for new collaboration agreements between PAs and physicians or entities. The rules adhere to HB2043’s intent by requiring the agreements to note:
- the name or position of the physician responsible for providing oversight;
- a description of the practice setting, specialty, and any limitations if applicable; and
- a description of the level of collaboration required between the physician and PA.
Trained to Support the Physician-Patient Relationship
PAs are important members of the healthcare team and work in supportive roles with physicians on a daily basis. Their excellent training in the medical model prepares them to serve patients and support the sacred physician-patient relationship.
Since the profession’s establishment in the 1960s, PAs have improved and expanded patients’ access to high-quality healthcare.
Now, through HB2043, PAs can earn and apply flexibility in their practice to further their impact on patient care.
Far From an "Untethering"
HB2043 is not “independent practice” legislation, nor is it an “untethering of the relationship between PAs and physicians.”
ArMA is proud to have been a stakeholder in this legislation, and we stand by it as a measure that creates appropriate flexibility while maintaining standards that protect patient care.
