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Physician Assistant board urges regulatory flexibility as PA workforce expands
Summary
The Physician Assistant Board reported a 22% increase in PAs in California and urged the Legislature to consider changes to physician‑to‑PA ratios and practice agreements to expand access, especially in rural and underserved regions.
Dr. Vasco Deonkidd (identified in testimony as Vasco Deonkidd), president of the Physician Assistant Board, told the joint sunset hearing that California now licenses roughly 18,200 physician assistants, a 22% increase since the last review, and that the number of accredited PA programs in the state has grown from 16 to 20 with additional applicant programs in the accreditation queue.
"California is home to the second largest PA population in the nation," Dr. Deonkidd said, adding that if all current programs remain operational, "more than 1,000 PA graduates will enter the workforce annually." He and board staff said the board is focusing on modernizing regulation after the passage of SB 697 (implemented Oct. 1, 2024) and on fee adjustments to sustain enforcement activities.
Why it matters: Committee members and public commenters emphasized that PAs are central to expanding access to primary and behavioral health care in rural areas and health‑care deserts. Witnesses and commenters argued that state‑level restrictions — notably the physician‑to‑PA ratio and practice‑agreement paperwork — can inhibit rapid deployment of PAs where they are most needed.
Practice agreements and ratios: The board and multiple public commenters urged statutory flexibility. The board noted a previous statutory change (AB 1070 for home health) that allowed a 1:8 ratio in a narrow context and observed 22 states now have no statutory physician:PA ratio. Board witnesses suggested 1:8 as an example of an approach other states have taken; public speakers, including urgent‑care and community health PAs, argued for eliminating or loosening the ratio to improve access.
Fees and enforcement: The board said enforcement accounts for roughly 50–53% of its annual budget and that it has not adjusted fees for two decades; the board plans regulatory work to increase an initial licensing fee (from $200 toward the statutory cap of $250) and asked the committee to consider fee cap adjustments for long‑term sustainability.
Emerging technology and workforce: Committee members asked about artificial intelligence; the board said it has not received complaints tied to inappropriate AI use but is monitoring developments. Members also discussed workforce development and rural training pipelines, and the board noted Central Valley capacity constraints and encouraged removing regulatory barriers to practice where possible.
Public testimony: Representatives of the California Academy of PAs and practicing PAs testified in favor of regulatory reforms to ratios and practice agreements; the California Medical Association cautioned that statutory protections (ratios/practice agreements) help define supervisory responsibilities and patient safety.
Next steps: The board said it is tracking other states' reforms and will continue studying practice agreements and ratio changes; committee members encouraged stakeholder engagement and asked the board for additional analysis on safety and oversight mechanisms that could accompany ratio reform.
