PA · South Carolina
Supervision Agreement for Physician Assistants in South Carolina
Yes, a written supervising-physician agreement is required. South Carolina calls it a Scope of Practice Guidelines.
No independent-practice pathway exists for PAs in SC. The 2019 reform (Act No. 32) removed a prior 3-PA-per-physician cap specific to PAs, but folded PAs into the combined 6-provider cap shared with NP/CNM/CNS (§40-47-195(D)(1)(c)) — not a net loosening for a physician juggling multiple provider types.
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
No proximity requirement
§40-47-955(A): supervision 'must be continuous but must not be construed as necessarily requiring the physical presence of the supervising physician at the time and place where the services are rendered.' When the supervising physician is not co-located with the PA, the board must give 'special consideration' to the monitoring plan and grant prior approval (§40-47-195(C)(3)) — not a fixed mile/minute radius.
PA with <2 years continuous practice, or changing specialties: On-site presence required
§40-47-955(C): may not practice at a location off-site from the supervising physician until completing 60 days of on-site clinical experience with that physician — waivable in writing by the supervising physician on a board-approved form.
Supervision ratio
Up to 6 at a time (combined across provider types)
§40-47-195(D)(1)(c): a physician may not enter scope-of-practice guidelines/practice agreements with more than the equivalent of 6 full-time PAs, NPs, CNMs, or CNSs COMBINED — e.g. a physician already supervising 4 NPs may take on at most 2 PAs. The board may approve an exception on application.
Chart review
Percentage set by agreement · As needed · countersignature required
§40-47-955(C): the supervising physician or alternate must 'review, initial, and date' an offsite PA's charts periodically 'as specified in the written scope of practice guidelines' — required, but no statutory percentage or fixed cadence; the practice's own guidelines set the schedule.
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
§40-47-965: drugs/devices must be authorized in the written scope of practice guidelines. Oral Schedule II narcotics require express supervising-physician authorization, a direct patient evaluation, an initial supply capped at 5 days, and physician consultation/approval (documented in the chart) for any subsequent prescription. Parenteral Schedule II in a hospital setting requires a prior physician examination. Requires individual DEA registration and, every 2 years, 4 CE hours on prescribing/monitoring Schedule II–IV substances.
Written agreement
Required
SC's statute calls this a 'written scope of practice guidelines' document (§40-47-960), not a 'practice agreement' — functionally the same gating document required before a PA may practice, signed by all supervising physicians and the PA and kept on file at every practice site.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional Corporation under Title 33, Chapter 19 (Professional Corporation Supplement) — medical practices must be wholly owned by physicians licensed to practice medicine in SC.
Legal sources for these rules (5)
- S.C. Code § 40-47-955 — Scope of PA's Practice; Physical Presence Requirements of Supervising Physician
- S.C. Code § 40-47-960 — Scope of Practice Guidelines
- S.C. Code § 40-47-965 — Requirements for Writing Prescriptions for Drugs, Controlled Substances, and Medical Devices
- S.C. Code § 40-47-195 — Supervising Physicians; Scope of Practice Guidelines (combined 6-provider cap)
- S.C. Board of Medical Examiners Advisory Opinion on Corporate Practice of Medicine (Nov. 21, 2022)
What a supervising physician costs here
Typical monthly cost in South Carolina
$550 – $850
Estimate for one Physician Assistant. This state's rules add a restrictive-tier premium.
About South Carolina's rules
A physician may not hold practice agreements/scope-of-practice guidelines with more than a COMBINED 6 full-time-equivalent PA+NP+CNM+CNS at once (§40-47-195(D)(1)(c)) — a single shared cap, not four separate ones. A widely-repeated '3 PA' cap was repealed in 2019 (Act 32). SC remains restricted-practice for APRNs; a 2,000-hour full-practice-authority bill (S.45/H.3580) is pending, not yet law.
Other clinicians in South Carolina: see the state overview.