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Senate committee backs bill letting experienced physician assistants practice without a practice agreement
Summary
House Bill 746, reported with a substitute, would allow physician assistants who document three years (or equivalent) of full-time clinical experience and an attestation from a supervising physician to practice without a standing practice agreement; proponents said the measure improves access while including safeguards for referrals and scope.
The Senate Education and Health Committee reported House Bill 746 with a substitute that allows physician assistants (PAs) with specified clinical experience to practice without a practice agreement if a physician or other attesting clinician verifies their competence and an appropriate referral plan is in place. Delegate Henson presented the bill, explaining the substitute adds a definition of full-time clinical experience (1,800 hours) and an attestation process and that the language was negotiated with the Department of Health Professions and medical stakeholders to address scope concerns.
Multiple PA advocates testified in support. Sarah Knisely, identified in the transcript as "a PA of 24 years, immediate past president of the Virginia Academy of PA and chair of the Department of PA Studies at Radford University," described PA education and clinical training and said the bill "mirrors the content of that legislative code for nurse practitioners" and is intended to provide parity with nurse practitioner practice while preserving collaborative relationships with physicians. Bobby Cockrum, president of the Virginia Academy of PA and an Inova Health System leader, told the committee that regulatory requirements such as indefinite practice agreements can limit patient access and that the substitute reflects a multi-year stakeholder process including the Medical Society of Virginia and the Board of Medicine.
Committee members asked how authorization is maintained over time and how PAs should handle referrals for complex patients. Witnesses said authorization remains tied to continued practice in the same scope and that PAs already follow referral practices and continuing-education and recertification cycles; the substitute adds a requirement that PAs have a plan for referral for complex cases and emergencies. The committee adopted the substitute and the clerk recorded the roll as reflected in the transcript.
