PA · Pennsylvania
Supervision Agreement for Physician Assistants in Pennsylvania
Yes, a written supervising-physician agreement is required. Pennsylvania calls it a Written Agreement.
No experience- or hours-based independent-practice pathway exists for PAs in Pennsylvania. Acts 78/79 of 2021 modernized supervision (no more Board pre-approval of agreements, no flat 100% countersignature after year one) but did not create a route to practicing without a supervising physician.
What the supervision must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
Available remotely (no on-site requirement)
Supervision 'shall not require the onsite presence or personal direction of the supervising physician' so long as the physician and PA are, or can be, easily in contact with each other (63 P.S. § 422.13; 49 Pa. Code § 18.144). No mile/minute radius is codified.
Supervision ratio
Up to 6 at a time
A physician may not have primary responsibility for more than 6 PAs at any one time absent a Board-approved waiver for good cause (63 P.S. § 422.13; 49 Pa. Code § 18.152(b)(2)).
Chart review
first 12 months post-graduation, or first 12 months in a new specialty: 100% of charts · As needed (within 10 days of the encounter) · countersignature required
49 Pa. Code § 18.142/§ 18.159. After this initial period, the primary supervising physician sets the countersignature rate by written agreement rather than a fixed statutory percentage.
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
No Schedule I. Schedule II: up to a 72-hour supply without prior approval, or up to a 30-day supply with supervising-physician approval, with notice to the supervising physician within 24 hours of issuance (49 Pa. Code § 18.158). Schedule III–V limits are not separately specified in this section and are left to the written agreement.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional corporation, restricted professional company, or LLP formed to provide medical services — only licensed physicians may be shareholders, partners, or members (Medical Practice Act of 1985, 63 P.S. § 422.1 et seq.); all ultimate beneficial owners must be licensed. PAs are not separately listed as eligible independent owners.
This ownership rule is legally distinct from the clinical supervisory arrangement — the supervising physician does not need to be the entity owner.
Legal sources for these rules (5)
- 63 P.S. § 422.13 — Medical Practice Act of 1985 (supervision, ratio)secondary
- 49 Pa. Code § 18.142 — Written agreements
- 49 Pa. Code § 18.152 — Prohibitions (supervision ratio)
- 49 Pa. Code § 18.158 — Prescribing and dispensing drugs
- Pennsylvania Society of Physician Associates — Summary of PA Regulations (Acts 78/79 of 2021)secondary
What a supervising physician costs here
Typical monthly cost in Pennsylvania
$500 – $600
Estimate for one Physician Assistant. This state's proximity rules add a small premium.
About Pennsylvania's rules
Pennsylvania has no independent-practice pathway for CRNPs — SB 25-style full-practice-authority bills have been introduced every session without passing. PA (physician assistant) reform via Acts 78/79 of 2021 removed prior Board pre-approval of written agreements and the flat 100%-countersignature rule after the first year, but a written agreement and supervision remain mandatory. PA is a CPOM state: only licensed physicians may own a medical professional corporation.
Other clinicians in Pennsylvania: see the state overview.