An Act to amend and reenact §§ 54.1-2951.1, 54.1-2952, and 54.1-2952.1 of the Code of Virginia and to amend the Code of Virginia by adding a section numbered 54.1-2952.01, relating to physician assistants; authorization to practice without a practice agreement.
Summary
HB746 revises Virginia law governing physician assistants to create a pathway for certain physician assistants to practice without a written or electronic practice agreement. Under the bill, a physician assistant who has completed the equivalent of at least three years of full-time clinical experience in a specific specialty or practice area may obtain an attestation from a supervising physician or podiatrist and apply to the Board of Medicine for a new license designation authorizing practice without a practice agreement. The bill also allows physician assistants employed by hospitals, state behavioral health facilities, or federally qualified health centers to practice without a separate practice agreement if the facility’s credentialing and privileging process includes the same core collaboration, consultation, and supervision elements otherwise required by law.
The bill preserves a patient-care-team model for physician assistants who do not qualify for independent practice, but it relaxes the formal agreement requirement for those who do. It also maintains limits on the number of physician assistants a patient care team physician or podiatrist may collaborate with, continues rules on prescribing controlled substances and devices, and authorizes certain radiologic technology/fluoroscopy use for qualified physician assistants in radiology or orthopedics. The Board of Medicine must adopt implementing regulations, and the new authority does not take effect until those regulations are in place.
Impact
HB746 amends §§ 54.1-2951.1, 54.1-2952, and 54.1-2952.1 and adds § 54.1-2952.01 to the Code of Virginia. The practical effect is to create a new category of physician assistant licensure for experienced PAs who may practice within their current specialty without a practice agreement, while leaving existing supervision and practice-agreement rules in place for others. It also directs the Board of Medicine to establish the application, attestation, and licensing process and exempts the initial rulemaking from the Administrative Process Act.
Sentiment
The bill appears to have been broadly supported and moved through the legislature with strong bipartisan backing. Committee and floor votes were overwhelmingly favorable, including unanimous or near-unanimous committee reports and large floor majorities in both chambers. The final enactment suggests general agreement that the measure modernizes physician assistant practice while retaining patient-safety safeguards.
Contention
The main policy issue is the degree of independence granted to physician assistants. Support for the bill is reflected in the strong votes, but the structure of the law shows caution: independent practice is limited to experienced PAs, tied to a specialty-specific attestation, and still requires collaboration and referral planning. Another point of potential concern is ensuring that facility-based credentialing arrangements and Board regulations adequately replace the protections of a formal practice agreement. The bill also preserves restrictions for PAs licensed by endorsement or under the interstate compact unless they separately satisfy Virginia’s experience and attestation requirements.