Across the United States, physician assistants (PAs) continue to be vital members of the care team, expanding access to high-quality healthcare in settings ranging from primary care to specialty services. With more than 191,000 PAs now practicing nationwide and projected employment growth of 28% from the U.S. Bureau of Labor Statistics from 2023 to 2033, PAs are well-positioned to help meet growing patient needs.

As care delivery evolves and healthcare systems adapt to rising demand, many PAs are exploring new ways to contribute meaningfully to team-based care. This includes stepping into flexible or autonomous roles where permitted by state law, joining collaborative teams in high-need areas, or choosing locum tenens assignments that support care continuity. For PAs considering their next step, understanding where practice environments support a broader scope of care is an important part of the decision-making process.

Can Physician Assistants Practice Independently?

In a growing number of states, yes—but the answer depends on how each state defines "independence." Most states do not use that term explicitly in legislation. Instead, they establish levels of oversight or collaboration, often specifying whether a physician must be involved in care decisions, sign off on charts, or be physically present.

Some states have shifted toward allowing employers and care teams to determine these relationships based on the patient's needs and the provider's expertise. Others maintain legacy models that still require formal delegation or supervision. Understanding this spectrum is key for any PA considering where to practice or expand their scope.

What is the Scope of Practice by State for Physician Assistants?

To clarify these differences, the American Academy of Physician Assistants (AAPA) developed a four-tier model that categorizes each state’s regulatory environment:

  • Optimal: PAs are permitted to function at the full level of their education, clinical training, and experience. While collaboration, consultation, or referral may still occur, these decisions are based on the patient’s needs, the PA’s capabilities, and prevailing standards of care. In such environments, collaboration structures are typically determined by employers or healthcare teams rather than imposed by state law.
  • Advanced: PAs can practice to their full clinical capacity but are subject to additional administrative requirements imposed at the state level. These mandates, while not directly limiting scope, introduce operational complexity.
  • Moderate: The regulatory framework includes administrative constraints that affect how PAs and healthcare teams coordinate care. These requirements may limit the flexibility needed to optimize PA contributions in dynamic clinical environments.
  • Reduced: State policies restrict at least one component of PA practice. These limitations often reflect outdated supervisory models that constrain the autonomy of both the PA and the broader care team, reducing responsiveness to evolving patient and system needs.

Where Are PAs Practicing with Greater Autonomy in 2025?

States continue to move along this spectrum as legislative efforts modernize existing policies. While "independent practice" is not the legal framework in most cases, many states are trending toward models that emphasize team-based flexibility over rigid oversight.

The map below provides a snapshot of how each state is currently categorized in 2025 according to the AAPA:

PA State Practice Environment

  • =Optimal
  • =Advanced
  • =Moderate
  • =Reduced

 

It's important to note that this map is intended to provide a general overview of PA practice environments as of 2025. For the most accurate and current details, individuals should consult state-specific laws and regulations.

The Benefits of Working Locum Tenens as a Physician Assistant

Locum tenens gives physician assistants the flexibility to shape a career around their goals and interests. For some, it is a way to explore different care settings and clinical teams. For others, it offers a long-term path built on variety, autonomy, and meaningful impact.

Depending on their preferences, PAs can choose assignments in a wide range of environments, including rural hospitals, outpatient clinics, specialty practices, and community health centers. This ability to tailor each role makes it easier to grow professionally while maintaining balance and control over when and where to practice.

Flexibility is one of the most valued aspects of locum tenens work. Physician assistants can align their schedules with personal priorities, gain exposure to different practice models, and work in states that support broader clinical authority.

At Medicus, we collaborate with physician assistants to match each opportunity with their goals. Whether the focus is exploration, consistency, or a combination of both, locum tenens offers a dynamic and rewarding way to practice.

Choosing Where to Practice as a Physician Assistant

As physician assistant roles expand across the country, understanding state practice environments is essential for making informed career decisions. Each state offers a different level of practice authority, and knowing where PAs can work with more autonomy helps guide both short-term opportunities and long-term planning.

Whether exploring the flexibility of locum tenens work or looking for a setting that supports full use of clinical training, PAs have more options than ever. By aligning career goals with state-specific regulations, physician assistants can build a path that supports professional growth, meaningful care delivery, and lasting impact.

Interested in working as a locum tenens physician assistant with Medicus? View our locum physician assistant jobs here, or complete the short form below to connect with a Medicus recruiter.