California’s Physician Assistants: How Scope of Practice Laws Impact Care


Timothy Bates, Joanne Spetz and Miranda Werts

September 25, 2018

Physician assistants (PAs) — state-licensed health professionals who practice medicine in collaboration with physicians and other providers — provide high-quality care, and are more likely to work in rural areas and with underserved populations than are physicians. Their training enables them to occupy a wide range of clinical areas, including family medicine, emergency care, and surgical and internal medicine subspecialties. Their training overlaps significantly with medical education, and is offered at the master’s degree level. Like nurse practitioners, PAs are invaluable in team-based care practices.

California places restrictions on PA practice, creating barriers to growth in team-based, efficient care. Two specific areas where PA scope of practice is limited by the state — a cap on the number of PAs who may collaborate with an individual physician, and cosignatory requirements that govern how much oversight physicians must provide over PAs’ work — represent opportunities for statutory reform.

California’s Physician Assistants: How Scope of Practice Laws Impact Care offers an overview of how PAs operate in the state, and explores the research behind the evidence for practice expansion. Key highlights include:

  • The statutory limit on the number of PAs a single physician may collaborate with limits care centers’ ability to meet the needs of a growing population. Community health centers are particularly dependent on PAs to provide care in tight budget constraints.
  • PAs are more likely than physicians to provide care in the places it’s needed most, including rural areas. The care they provide is high-quality, and evidence shows that patients are increasingly satisfied with it.
  • The cost-effectiveness of PAs is linked both to the fact that they are paid less than physicians, and that they can carry out tasks in a team-based practice that might have otherwise been carried out by physicians.

This paper is part of a series on scope of practice expansion, including an examination of how scope of practice laws affect nurse practitioners in the state. Read California’s Nurse Practitioners: How Scope of Practice Laws Impact Care here.

About This Series

This paper is one of a series that examines the scope of practice of selected California health professions. The series looks at professions discussed by the California Future Health Workforce Commission and its subcommittees and work groups during spring and summer of 2018. Each brief begins by describing the profession, including its legally permissible scope of work, and educational requirements. The brief then outlines how California’s permissible scope of practice compares with that of other states and provides a summary of research studies on the impact of the profession’s scope of practice on access to care, care quality, and costs. Finally, it summarizes demographic characteristics, practice settings, and geographic distribution.