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Physician Assistants Will Have Increased Autonomy and Independence Under Proposed Rules

May 19, 2022

Overview

On May 23, 2022, the Oregon Medical Board (OMB) is hosting a public hearing on rules that propose major changes to the way physician assistants (PAs) practice in Oregon. The rules were written in response to House Bill 3036, which supporters have dubbed the “Physician Assistant Modernization Bill.” More broadly, the rules were written in response to mounting concerns about health care access and equity, especially for rural and minority populations. This article outlines some of the causes and effects of the proposed rule changes.

What do the new rules attempt to accomplish?

A key goal of the new rules is to allow PAs more authority to determine their own scopes of practice. To date, supervising physicians have exercised the primary authority to establish practice boundaries for Oregon PAs. But PA advocacy groups note that this model has produced uneven results. They contend that the range of services offered by a PA should turn on the PA’s education, training, and experience, not on the willingness (or unwillingness) of the supervising physician to delegate responsibility. 

HB 3036 attempts to strike a balance between the need to keep patients safe and the desire to allow PAs to work at the tops of their licenses. If adopted, the proposed rules will eliminate the requirement that PAs enter into supervision agreements with physicians. However, the rules will not make PAs independent providers. PAs will still be required to consult with physicians and other professionals. Only, under  the proposed rules, PAs will do so pursuant to collaboration agreements that describe circumstances when the buddy system will be used. PAs who fail to comply with the terms of their collaboration agreements will be subject to potential fines, licensing action, and malpractice liability.

When do the new rules become effective?

HB 3036 itself became effective on June 23, 2021. It is currently codified in various sections of Oregon Revised Statutes chapters 441, 677, and 688. OMB split the process of creating administrative rules to implement HB 3036 into four phases. The rules promulgated in the first three phases—which concern physician chart review and on-site supervision requirements, modify PA dispensing and prescribing rules, and create a PA telemedicine license—became effective on January 15, 2022. The rules proposed in the fourth phase, which shift PA practice from a supervision model to a collaboration model by the end of 2023, are set to become effective on July 15, 2022. 

What do the new rules mean for PAs and their employers?

Proponents of the idea that PAs should be able to practice in the same, independent manner as nurse practitioners and physicians may not agree with HB 3036 because PAs and their employers will still be required to contract with physicians for support and guidance.. But, after July 15, 2022, PAs and their employers will have greater discretion to decide which services the PAs may perform alone, and which services the PAs may perform only with the help of collaborating physicians or other professionals. Some expect this increased autonomy will make PAs more versatile and more valuable to their employers. Some also hope that it will allow PAs to work in settings and in ways that were previously off limits, thereby giving rural and other underserved communities greater access to quality health care.

This article summarizes aspects of the law and does not constitute legal advice. For legal advice for your situation, you should contact an attorney.

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