Does Broad PA Scope of Practice Impact Patient Safety & Malpractice?

A new study led by researchers affiliated with the American Academy of Physician Associates (AAPA) showed that expanding physician assistant/associate (PA) scope of practice does not negatively impact patient safety, as measured by medical malpractice suits.

In fact, the study, published in the Journal of Medical Regulation, showed that expanded scope of practice was actually linked to a reduction in medical malpractice lawsuits for both PAs and physicians.

Scope of practice laws are usually set state-by-state, and they determine the relationship an advanced practice provider, like a PA, has with a physician. In some states, PAs practice somewhat autonomously, while others require a stronger supervisory and advisory role for the physician.

Organizations representing advanced practice providers like AAPA have long advocated for expanded scope of practice laws, which would allow PAs to practice with more autonomy and less oversight from an advising physician.

“Modernizing PA practice laws will strengthen team-based care and expand patient access at a time when so many communities are struggling to keep up with patient demands,” AAPA CEO Lisa M. Gables, CPA, said in a press release.

“In fact, more than two-fifths of U.S. adults say their community does not have the resources needed to keep people healthy,” Gables, who was not a part of the research team, continued. “Unleashing the full potential of PAs by removing unnecessary barriers will empower healthcare teams to increase their capacities, and this research affirms that quality of care will remain high – putting to rest the questions some stakeholders have raised when state legislatures consider updates to PA practice laws.”

But PA practice laws—and scope of practice for all APPS, which include nurse practitioners—have been a contentious debate. While PA and NP groups argue that expanded scope of practice can increase patient access to care and help fill in workforce shortages, physician groups like the American Medical Association have asserted that expanded scope of practice can be a threat to patient safety.

This latest study calls that argument into question by analyzing the link between state practice laws and the frequency of medical malpractice lawsuits.

The researchers looked at medical malpractice payment report (MMPR) data from between 2010 and 2019 and compared it with the laws and regulations in states during the same period. The team compared states with lenient practice laws (defined as four or more permissive scope of practice reforms) with those with more restrictive laws (defined as three or fewer scope of practice reforms).

Overall, permissive scope of practice laws resulted in no statistically significant difference in MMPRs compared to more restrictive states, but certain laws proved more beneficial than others.

For example, states with legislation removing physician co-signature requirements for PAs led to a 16.2 percent increase in PA MMPRs. The researchers said this could be indicative of a more “accurate attribution of care and accountability rather than an overall increased risk to patients.”

Conversely, general legislation allowing PAs to practice outside the scope of their collaborating/supervising physician saw a 58.3 percent reduction in PA MMPRs, indicating that PAs could be afforded greater practice authority without a threat to patient safety.

“Almost all the PA SOP elements included within these statistical models illustrate that creating a more permissive PA practice environment leads to a reduction in MMPRs for PAs and physicians,” the research team wrote in the discussion section of the study.

“The exact cause of the decreased overall MMPRs is unknown, but allowing PAs and physicians to have flexible collaboration determined at the practice site may result in more meaningful collaboration, optimized practice, and efficiency of care that improves healthcare and reduces risk.”

AAPA added that patients want their PAs to have greater scope of practice. In 2023, 91 percent of adults told Harris Poll that they think PA practice laws should be updated to expand scope of practice.