The American Academy of Physician Associates (AAPA) is preparing a 2027 state legislative agenda focused on removing physician supervision requirements for physician associates. Nine states have already dropped the mandate, and a dozen more are expected to consider modernizing their practice acts. The group argues that the requirement is an outdated barrier to care, particularly for multi-state health systems and retail clinics.
AAPA officials say supervision mandates create inconsistencies across state lines and add costs, citing an average of $10,000 per PA per year for physician sign-offs, ultimately borne by patients. They also point to studies suggesting that more permissive practice environments do not increase malpractice payouts and may reduce healthcare-amenable deaths.
Physician organizations, however, remain opposed. The American Osteopathic Association says PAs have a different training pathway than physicians and that removing oversight has not consistently been shown to improve outcomes or reduce costs. The AOA argues that expanding residency positions and supporting physicians in rural and underserved communities would better address workforce shortages.