The truth about PA 'scope of practice'
What is "Scope of Practice" ?
PA “Scope of Practice” means what the PA is authorized to do clinically (diagnose, treat, prescribe, etc.)
PA Scope of Practice in Wisconsin
Under Wisconsin Statute, a PA has authority to “examine into the fact, condition or cause of human health or disease, or treat, operate, prescribe or advise for the same, by any means or instrumentality.”
Guardrails
PA “shall limit his or her practice to the scope of his or her experience, education, and training.”
And Guardrails
The statute also explicitly says the board’s rules “may not permit a broader scope of practice than that which may be exercised in accordance the statute".
More Guardrails
The statute says that an employer, hospital, health plan or similar entity can add extra rules or requirements for a PA as a condition of employment or affiliation—meaning even if the state allows something, the employer can demand more
Even More Guardrails
The statute requires consultation with or referral to other licensed health care providers with a scope of practice appropriate for a patient’s care needs when the patient’s care needs exceed the physician assistant’s experience, education, or training.
Note:
SB435/AB438 Wisconsin PA Modernization Act leaves all guardrails in place
current practice Pathways - 2 options
Option 1: Collaborative Agreement Required
A written collaborative agreement with a physician that describes the PA’s individual scope of practice consistent with the PAs own education and experience and includes a plan for consultations, referrals and for an alternate collaborator when needed. The collaborator need not be present during delivery of care.
Note: The alternate collaborator role may be filled by an experienced PA
Option 2: No Collaborative Agreement Required
The PA or employer keeps a document (like a job description, policy or org chart) showing that a physician administrator (e.g., department director, chief of staff, etc.) oversees the PA’s professional activities and clinical care. The administrator need not be present during delivery of care.
Note: This provision was created to ensure employers' ability to bill under existing Centers for Medicare and Medicaid Services (CMS) billing guidelines. CMS has since updated rules deferring to state PA practice law.
a third option proposed
Three pathways: Same Scope of Practice
After learning about PA scope of practice, you can now recognize that the addition of an optional, independent pathway for experienced and skilled PAs does NOT alter the scope of PA practice.
Option 3: Optional Autonomous Pathway SB435/AB438
This proposed optional pathway is reserved to only experienced PAs having completed thousands of hours of supervised or collaborative practice under systems of peer review and quality assurance. These select PAs will be held to the same rigorous continuing education requirements and safe practice guidelines. This reasonable and measured pathway will improve opportunities for seasoned PAs to expand access to safe, high-quality care in Wisconsin.
Note: Our neighbors in Iowa have had this since 2023.
Current practice - pa's already do it
Wisconsin PAs Practice with Autonomy
Wisconsin PAs Practice with Autonomy
Wisconsin PAs Practice with Autonomy
Current Law: Since their introduction in Wisconsin in the 1970s, licensed PAs have been practicing without a mandate for a physician’s physical presence or direct on-site oversight — because they are highly trained and capable providers
Federal Service
Wisconsin PAs Practice with Autonomy
Wisconsin PAs Practice with Autonomy
Current Law: A Wisconsin licensed PA who is employed by the federal government as a civilian or member of the uniformed services while performing duties incident to that employment or service is not required to maintain a collaborative agreement or otherwise qualifying employment arrangement.
Collaboration Interrupted
Wisconsin PAs Practice with Autonomy
During Declared State of Emergency or Other Disaster Situation
Current Law: When a PA’s collaborating physician becomes unavailable (e.g., employment change, license issue, or illness, etc.), a PA with 2,080 or more hours of experience may continue practicing without a collaborating physician for up to 120 business days (after notifying the board) while searching for a new collaborator; if the PA has less than 2,080 hours of experience, they either enter into an interim collaboration with a physician or with an experienced PA for that same 120-day period
During Declared State of Emergency or Other Disaster Situation
During Declared State of Emergency or Other Disaster Situation
During Declared State of Emergency or Other Disaster Situation
Current Law: For the duration of a declared state of emergency or other disaster, a Wisconsin licensed PA may deliver all medical services within their competence without being required to maintain any collaborative physician agreement or a employment arrangement .
Sporting Camps or Events
During Declared State of Emergency or Other Disaster Situation
Scene of an Accident or Emergency
Current Law: A Wisconsin licensed PA may provide volunteer medical care at camps or sporting events, in the absence of a collaborative agreement or qualifying employment arrangement.
Scene of an Accident or Emergency
During Declared State of Emergency or Other Disaster Situation
Scene of an Accident or Emergency
Current Law: A Wisconsin licensed PA may render such emergency medical care that they are able to provide at the scene of an accident or emergency situation in the absence of any collaborative agreement or qualifying employment arrangement.