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

Timothy Bates, Healthforce Center at UCSF
Joanne Spetz, Healthforce Center at UCSF
Miranda Werts, Healthforce Center at UCSF


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.

The full report is available for download under Related Materials. 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.