Background:

I. Physician Assistants.

A physician assistant is an individual licensed to practice medicine pursuant to a delegation agreement with a physician. A physician assistant may only practice with the approval of the Washington Medical Commission (WMC) and only to the extent allowed by the WMC. A physician assistant may provide a service that he or she is competent to perform based on his or her education, training, and experience.

A. Delegation Agreement.

The delegation agreement must be submitted jointly by the supervising physician and the physician assistant. The agreement must delineate the manner and extent to which the physician assistant will practice and be supervised.

A physician may enter into a delegation agreement with a maximum of five physician assistants, unless the WMC grants a waiver. Regardless, a physician may not supervise more than three physician assistants at a remote site or more physician assistants than the physician can adequately supervise.

B. Supervision.

Physician assistants may practice only under the supervision and control of a physician, but the supervision does not require the physical presence of the physician. The physician and physician assistant determine which procedures may be performed and the degree of supervision for the procedures. The physician assistant's practice may not be beyond the expertise and practice of the physician. The physician and physician assistant retain professional responsibility for any act performed by the physician assistant that constitutes the practice of medicine.

C. Signing Documents.

A physician assistant may sign and attest to any certificates, cards, forms, or other documentation that his or her supervising physician may sign as long as it is within the physician assistant's scope of practice and consistent with the practice arrangement plan.

D. Remote Sites.

A physician assistant may not practice at a remote site without approval of the WMC. The WMC may approve such practice if:

there is a demonstrated need;
there is adequate provision for timely communication between the physician and the physician assistant; and
the supervising physician spends at least 10 percent of the practice time in the remote site, unless he or she demonstrates that adequate supervision is being maintained through another method, such as telecommunication.

A physician assistant holding an interim permit may not practice in a remote site.

II. Osteopathic Physician Assistants.

An osteopathic physician assistant is an individual licensed to practice osteopathic medicine under the supervision of an osteopathic physician and pursuant to a delegation agreement. Osteopathic physician assistants are licensed and regulated by the Board of Osteopathic Medicine and Surgery.

Summary of Bill:

I. Physician Assistants.

A. Practice Agreements.

Instead of a delegation agreement, a physician assistant must practice pursuant to a practice agreement with one or more physicians. At least one physician on the agreement must work in a supervisory capacity. Entering into a practice agreement is voluntary—a physician may not be compelled to participate in the agreement as a condition of employment. Prior to entering into the agreement, the physician or his or her designee must verify the physician assistant's credentials. The practice agreement must be maintained at the physician assistant's place of work and must be made available to the WMC upon request.

A practice agreement must include:

the duties and responsibilities of the physician assistant, the supervising assistant, and alternative physicians—the agreement may only include acts, tasks, or functions that the physician assistant and supervising or alternate physician are qualified to perform by education, training, and experience and that are within the scope of expertise and clinical practice of both the physician assistant and supervising or alternate physician;
a description of supervision requirements for specified procedures or areas of practice;
a communication, availability, and decision making process when providing medical treatment in the event of an acute health care crisis not covered by the practice agreement (communications may occur in person, electronically, by telephone, or by an alternate method);
if there is only one physician on the agreement, a protocol for designating an alternate physician when the physician is not available; and
the written or electronic signature of the physician assistant and the supervising physician.

The practice agreement must also include a termination agreement, which may be used for a single supervising physician without terminating the agreement with the remaining physician. If a termination results in no physicians being party to the agreement, the agreement is not valid unless a new physician is designated. A party to the agreement must provide at least 30 days' notice prior to termination, unless there are good faith concerns regarding unprofessional conduct or failure to practice medicine with reasonable skill and safety, in which case the agreement may be terminated immediately.

A practice agreement may be amended for any reason, including to add or remove supervising or alternate physicians or to amend the duties and responsibilities of the physician assistant. A physician assistant or physician may participate in more than one practice agreement if he or she is reasonably able to fulfill the duties and responsibilities in each agreement. The limitation on the number of physician assistants with whom a physician may enter an agreement is eliminated.

The WMC may take disciplinary action against a physician assistant for practicing inconsistent with the practice agreement. Physicians subject to discipline related to the practice of a physician assistant must be referred to the appropriate disciplining authority.

B. Supervision.

The prohibition against a physician assistant's practice being beyond the expertise and practice of the physician is limited to expertise and clinical practice of the physician. It is clarified that the physician and physician assistant each retain professional responsibility for any act performed by the physician assistant that constitutes the practice of medicine.

C. Signing Documents.

A physician is not required to countersign orders written in a patient's clinical record or an official form by a physician assistant with whom the physician has a practice agreement.

D. Remote Sites.

The limitations on physician assistants working at remote sites are eliminated.

II. Osteopathic Physician Assistants.

The osteopathic physician assistant license is eliminated on July 1, 2022. Beginning July 1, 2021, no new osteopathic physician assistant licenses may be issued and existing licensees will be converted to physician assistants on their renewal dates.

When disciplining a physician assistant being supervised by an osteopathic physician, the WMC must consult with the Board of Osteopathic Medicine and Surgery (BOMS). It is clarified that the prohibition against physician assistants practicing chiropractic does not prohibit a physician assistant from practicing osteopathic medicine as long as he or she is supervised by an osteopathic physician.

III. Miscellaneous.

The WMC must conduct an education and outreach campaign to make license holders, health carriers, and the public aware of the requirements relating to physician assistants and the elimination of the osteopathic physician assistant credential. The WMC and the BOMS are authorized to adopt any rules necessary to implement the requirements.