title: State laws governing physician assistant practice in the United States and the impact on emergency medicine.
abstract: BACKGROUND
  Midlevel providers, including physician assistants (PA), have been recommended by some to fill the current inadequate supply of providers nationally, including in emergency medicine.
  
  
  OBJECTIVE
  PA practice is governed by state law. We described the differences in qualifications, scope of practice, prescriptive authority, and physician supervision required by individual states for PA practice and describe the impact this may have on emergency medicine.
  
  
  METHODS
  A cross-sectional analysis of United States laws governing PA practice by abstraction from each state's public website. State characteristics were collected from the American Academy of Physician Assistants and United States Census websites and dichotomized by median values.
  
  
  RESULTS
  Only six states (12%), all of which were larger-population states, required physician review of medical records within 1 week of a PA-only patient encounter. However, one state (Virginia) explicitly required onsite physician presence for PA practice in the emergency department. All states allowed PAs to assist in invasive procedures, but 13 (25%) restricted independent performance. Restriction of this practice was more likely in states with a higher population (38%), lower rural proportion (40%), and lower number of PAs per population (40%). Eleven (22%) states restricted performance of sedation or general anesthesia. An expanded scope of practice for disaster situations was allowed by 24 (47%) states and was more likely in larger population states (62%). All but two states (Florida and Kentucky) allowed PA prescribing of schedule III-V medications, and 37 (73%) allowed prescribing of schedule II medications.
  
  
  CONCLUSIONS
  Laws governing PA practice in emergency departments differ by state, but generally allow for a broad scope of practice and limited direct supervision. Smaller, rural states were less likely to have tighter restrictions or oversight.
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wiler
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Adit A
authors.initials: AA
authors.lastname: Ginde
mesh_terms: D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000331:legislation & jurisprudence*; D006801:Humans; D010823:Physician Assistants / Q000331:legislation & jurisprudence*; D010819:Physician's Role; D014481:United States; D000078329:Workforce
keywords: emergency medicine; health care workforce; physician assistant; scope of practice; state laws