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Physician Assistant board urges regulatory tweaks as PA workforce expands; ratio debate intensifies
Summary
The Physician Assistant Board reported a 22% growth in licensed PAs since the last sunset review and urged state action on fee caps, workforce supports and practice‑agreement regulations while stakeholders called for reducing or eliminating physician‑to‑PA ratios to expand access.
The California Physician Assistant Board told a joint Assembly–Senate sunset hearing that the state now licenses about 18,200 physician assistants — a roughly 22% increase since the last sunset review — and said it is pursuing modest fee increases to maintain enforcement and licensing services while lawmakers and stakeholders debated changes to practice agreements and physician‑to‑PA ratios.
Why it matters: Committee members and PA advocates framed ratio and practice‑agreement rules as a key lever to improve access to primary and rural care. Stakeholders from the California Academy of PAs and practicing PAs told the committee that statewide ratio limits and mandatory practice agreements can block hiring and force patients to travel long distances for care.
Board presentation: Board President Vasco Deonkidd and Executive Officer Rosanna Khan said the board took full responsibility for enforcement in 2020, now supports about 11 staff, and faces rising costs with no fee adjustments in two decades. The board said enforcement accounts for roughly half the budget and proposed raising the initial licensing fee from $200 toward a statutory cap of $250 to maintain operations.
Practice‑agreement debate: Stakeholders argued for removing rigid top‑down ratio and written practice‑agreement mandates and letting supervising physicians and employers allocate supervision based on practice setting and clinician experience. The board said it’s tracking other states but has not recommended a specific statutory shift; it noted AB 1070’s example increasing a ratio to 1:8 for home‑health settings and flagged 22 states that now have no numerical ratio.
Workforce pipeline: The board said PA educational capacity has grown to 20 accredited programs in California with additional programs awaiting accreditation and that more than 1,000 PA graduates could enter the workforce annually if programs remain active.
Ending: Legislators signaled support for exploring ratio adjustments while emphasizing patient safety; the board told the committee it will continue stakeholder engagement on fees, ratios and practice‑agreement reforms.
