PAMED Expresses Concern Over Physician Assistant Legislation; Hopes to See Changes in House

Last Updated: Jun 29, 2021

Physician assistant (PA) legislation that would among other things abolish the countersignature requirement, discontinue medical board approval of PA agreements, and remove limitations on the number of PAs a physician could supervise passed the Senate on June 25, 2021. It now awaits consideration by the House Professional Licensure Committee.

The Pennsylvania Medical Society (PAMED) opposes Senate Bills 397/398 in their current form and sent a letter to members of the Senate Professional Licensure Committee expressing our opposition until critical elements are addressed in the bills’ language.

PAMED, along with our physician colleagues, are hopeful that SB 397/398 will ultimately contain language that continues to embrace the physician/PA relationship and improve efficiencies, all the while maintaining the highest quality patient care. We will work throughout the summer to discuss with Representatives, particularly members of the House Professional Licensure Committee, the language that would accomplish these goals, including:

  • Language needs to be added to delineate that supervision can be accomplished in-person, virtually, via phone, or by other means of direct communication and that the frequency of this communication is at the discretion of the supervising physician.

  • In addition to the current language in SB 397 and SB 398, physicians should be required to review and countersign 100 percent of a PA’s patient charts for 12 months when a PA changes specialties given differences in clinical complexities. After 12 months, review of PA patient charts will be at the discretion of the physician.

  • Since physician/PA practice agreements will no longer require the approval of the state board of medicine or osteopathic medicine under these proposals, the boards—through the Bureau of Professional and Occupational Affairs—must be required to audit a minimum of 10 percent of these agreements per year to ensure appropriate clinical compliance.

  • Language must be included to “protect” physicians from being forced or required, as a condition of employment or otherwise, to sign any PA agreement that they feel could compromise their ability to provide appropriate supervision.


Over the past few legislative sessions, we have seen the introduction of legislation intended to modify physician oversight PAs. Given the collegial relationship between physicians and PAs, PAMED reached out to the PAs in early 2019 in an effort to better understand their concerns and to work cooperatively to improve the current system for both physicians and PAs. While those discussions were largely positive, there remained underlying concern for patient safety.

This year, PAMED has joined with other physician advocacy organizations such as Pennsylvania Osteopathic Medical Association, the Pennsylvania Academy of Family Physicians, American College of Physicians, the PA Chapter of the American Academy of Pediatricians, and the Pennsylvania Orthopedic Society, to explore possible alternatives to the current legislative proposals.

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  1. Samuel Wilson | Jun 11, 2021

    Are we to believe that the traditional team approach now lacks the strength of its original intention and design. 

    Are we to believe transitional training should be replaced with something else?

     The practice of medicine ( all specialities) requires a life long training , leaning; acquiring knowledge , skill, and experience. It is Not complete with an exam score and a certificate. We seem to be losing sight of what is necessary , as requirement for competency : we should strive for the highest standards where human life is at risk. Yet more and more , i see the standard , being the lowest common denominator collimating in a test score and certificate obtained .  

    Much of this background discussion is being drive by cost savings motivations . individual professions are being manipulate where practitioners are often are placed in positions  , insufficiency prepared. Knowledge , experience, wisdon.  The team model remains critical, for the success of health care , driven toward patient benefit  , as the ultimate goal. 

    Can cost be contained in one of the more expensive care deliver systems in the industrialize world?

    It’s reported “ we pay a lot for the poor quality we receice “ when compared to other nations. 

    When asked, we are told the “fix” is complicated. For certain, if delivery , if benifit  , if administrative cost continue on the present course, the system will derail .  Its already likely, more Americans receive poor care than is being reported. ( unsatisfactory is an option on your survey questionnaire after treatment)   Some say, it’s already Not repairable.  The insurance ‘s solution is to not “pay”, reject clains through hurdles , denial, and complicated entry processes.  Now , its being suggested , services received be denied by the insurer based on the insurers assessment of patient verified illness after the fact( seen , diagnosed, treated then denied based on the “Emergency Validity”. 

    This is muddy  Ground for denial of payment. Congress passes laws to prevent “ surprise Biling”, yet post treatment rejection - of service charges based on the insurance company’s review questions the sanity of this behavior .    Ultimately the patient suffers Ultimately. 

    May be something resembling a  Universal health care process; faireness in access, equity in delivery, reliable , dependable, reproducible, as a Team Model deserves to be sustained.   Other industrialized nations have succeeded in health care of its citizens at Less cost per capita and better outcomes. 

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