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What Physician Assistants Are and Are Not Allowed To Do

July 27, 2023

Physician assistants (PAs) are health care professionals who care for patients under the leadership of a licensed physician. They can provide a wide range of medical services, focusing on preventative care, patient education and clinical training. PA education, in general, aims to prepare newly graduated PAs to work in any field, but specifically focuses on primary care. Once a PA has graduated, they will have the full authority to evaluate, diagnose and treat patients.

PAs fulfill a critical role in health care as they help extend the reach of health care providers like doctors—but that doesn’t mean you follow orders all day. Physician assistants have the authority to make informed patient decisions. Because of this, PAs give patients more options to access health care services, which is particularly important in areas with high demand or provider shortages. 

All responsibilities of a physician assistant involve patient-centered care. Their versatility means they can spend time with patients, family members or other members of a health care team. Depending on your preferred role, you can find employment in a hospital, doctor’s office, primary care clinic, surgical unit or specialty practice.

What Are the Typical Duties of Physician Assistants?

Many responsibilities for this position require direct patient care. However, you might also spend time ordering tests, serving as an assistant during surgery or providing referrals to other providers or specialists in your health care system.

Some of the typical duties of a physician assistant include: 

  • Performing diagnostic exams: Assessing patient vital signs, physical symptoms and cognitive function to identify any signs of a health condition.
  • Exploring patients’ health histories: Gathering information about a patient’s history of illness, disease and current symptoms. This information might also include details on family medical history and any genetic conditions.
  • Diagnosing conditions: Identifying likely health conditions based on results from a patient’s diagnostic exam and health history.
  • Ordering medication and treatment: Prescribing solutions to patient illness or injury.
  • Ordering tests: Requesting further tests for more insight into specific results. For example, you might order a urine sample to evaluate a patient’s kidney function.
  • Performing minor patient surgeries: Handling aspects of procedures like draining and suturing wounds, removing splinters and applying local anesthesia.
  • Giving shots: Administering vaccines or other injections.
  • Offering patient guidance: Counseling patients about continued care and lifestyle choices that can reduce risk of illness or injury.

While PAs generally work in general medicine and family practice settings, they are also trained to respond to emergencies. These responsibilities include cardiopulmonary resuscitation (CPR), allergy treatment, managing trauma and addressing neurological issues like stroke.

What Are the Categories of PA Practice?

Physician assistants typically practice medicine under licensed practitioners. However, their specific scope of practice—what they can and cannot do—will vary by state. In addition, many states are getting rid of collaborating agreements, meaning that PAs do not have to be overseen by a physician or have their work co-signed. 

To identify designated limits in each state, the American Association of Physician Associates (AAPA) has outlined four categories of practice across the United States. These four classifications—reduced, moderate, advanced and optimal—further explain how a PA can legally practice medicine in each state.

Explore more details about reduced, moderate, advanced and optimal PA state practice environments below.


In reduced practice environments, PAs are restricted in at least one area of practice, through supervision requirements or laws restricting authority. In general, states with these types of environments are typically seen as outdated when compared to other environments. Currently, 15 U.S. states operate with reduced practice levels.


Moderate practice means PAs do not have reduced responsibilities. However, they are still subject to additional administrative processes. These burdens can still affect their practice environment and their ability to provide efficient, quality care. Under moderate practice levels, both PAs and health care teams have limited flexibility to make decisions on behalf of patients. Currently, 14 states operate with moderate practice levels.


Advanced practice states allow PAs to practice medicine to the fullest extent that their training allows them. They can leverage their experience and education in health care to make informed decisions about patient outcomes. However, those same health professionals are still subject to additional administrative requirements. These requirements, mandated by state laws, still have the potential to affect their output. 18 states currently operate with advanced practice levels.


Similar to advanced practice, optimal practice allows PAs to operate to the full extent of their training. They have the freedom to practice medicine with the authority that their education allows. In addition, optimal practice also allows you to consult with and refer patients to other members of a health care team where appropriate. Health care teams, organizations and employers can set their own standards for communication and referral, even if these standards are beyond what state laws require.

North Dakota, Wyoming and Utah are the only three states currently allowing for optimal PA practice.

How Hard Is It To Become A Physician Assistant?

Becoming a physician assistant can require a significant amount of education. You’ll need to learn skills in basic patient evaluation, diagnosis, treatment and emergency response. However, these requirements are still shorter and less taxing than the steps to become a doctor.

As a primary step, you may choose to obtain a relevant bachelor’s degree. Advisors typically recommend a science, technology, engineering or mathematics (STEM) degree, one that focuses on human health. For example, students can pursue a Bachelor of Science in Biological Sciences to learn about organ functionality, body chemistry and internal systems. However, other PA programs allow applicants to go directly from high school into college. Commonly called 3+2 programs or 5-year PA programs, enrolled students can complete their bachelor’s in three years and their master’s in two. 

Before you can enroll for a master’s degree, many universities require a certain number of health care experience (HCE) or patient care experience (PCE) hours. You will typically need to complete between 500 and 2,000 hours, depending on your preferred university. Some students begin work as EMTs, medical assistants or therapy aides while pursuing a bachelor’s degree to reduce their workload over time.

You’ll learn the latest medical technologies and clinical methods while completing a Master of Science in Physician Assistant Studies. Most students can complete this degree program in two years, as long as they balance coursework with clinical rotations.

After graduating from an accredited program, there are only two remaining steps. First, you must pass the Physician Assistant National Certifying Examination (PANCE) exam. Then, you can apply for a license through your state’s board of medicine.

Becoming a PA can take time. The studies prerequisites—HCE and PCE hours plus a bachelor’s degree—can take five to seven years. A master’s degree takes an additional two years. Assuming you pass the PANCE test, the entire process can take up to nine years. However, becoming a doctor typically takes 10-14 years. The path to PA success connects you with patients faster, allowing you to make a positive difference in medicine on an accelerated timeline.