Michigan bill would let experienced PAs practice without physician oversight

Michigan lawmakers are weighing legislation that would allow experienced physician assistants (PAs) to practice medicine without a physician oversight agreement, a move that could fundamentally reshape how PAs operate in the state and add fuel to a nationwide debate over scope of practice.

House Bill 5522, which was introduced Feb. 18 by Rep. Luke Meerman (R-Coopersville), with bipartisan support, would amend the state’s Public Health Code to exempt PAs with at least 1,000 hours of clinical experience from the current requirement to maintain a formal practice agreement with a physician. The bill was referred to the House Committee on Health Policy, where it remains as of early March.

The legislation would also introduce a new supervisory pathway: PAs with fewer than 1,000 hours of experience could enter into practice agreements with senior PAs rather than only with physicians, as current law requires.

It would replace the term “participating physician” throughout the Public Health Code with “participating medical provider,” a category that, beginning Jan. 1, 2027, would include both physicians and qualifying PAs.

Physician groups push back

The Michigan State Medical Society, which represents more than 15,000 physicians and medical students, has firmly opposed the proposal. The organization’s president, Amit Ghose, M.D., said the issue poses a concern to patient safety.

“We’ve seen what happens in states that weaken physician-led teams. Patients experience more fragmented care, higher out-of-pocket costs and increased emergency room visits,” Ghose said, as reported by MLive. “Expanding scope of practice for nonphysicians does not meaningfully improve access — it simply lowers the standard of care at a time when families are already paying more and getting less.”

The Michigan Academy of Physician Associates (MAPA) sees it differently. MAPA President Mike White, a PA with 35 years of practice in Marquette, argues that the bill does not expand PAs’ clinical scope. Education, certification and regulatory standards would remain unchanged, he said, and hospital bylaws would continue to define what PAs can and cannot do in those settings.

“In hospitals, it’s completely redundant because your privileges already define what you can and cannot do,” White told MLive. “PAs don’t do residency; they need guidance in their first years of practice. But for someone like me with 35 years, I work autonomously. I know the limits of my skills, I get medical doctors involved in care when I need them, but I don’t have anybody looking over my shoulder all day.”

A training gap — or just a different model?

The debate inevitably circles back to training.

PAs typically complete a four-year undergraduate degree followed by two to three years of graduate education at an accredited program, including more than 2,000 hours of supervised clinical rotations, according to the American Academy of Physician Associates (AAPA). To maintain certification, PAs must complete 100 hours of continuing medical education every two years and pass a recertification exam every decade.

Physicians, by contrast, complete a four-year undergraduate degree, before four years of medical school and three to seven years of residency, depending on specialty, in addition to continuing medical education — a training differential that physician groups say makes ongoing collaboration essential to safe patient care.

For proponents of the Michigan bill, though, the 1,000-hour threshold represents a practical acknowledgment that many experienced PAs are already functioning with significant autonomy in day-to-day clinical settings, particularly in primary care and rural communities. The practice agreement requirement, they argue, amounts to an administrative formality that can actually create care disruptions: Under current Michigan law, if a physician leaves a practice, the PAs in that practice cannot operate independently until a new agreement is established.

Malpractice implications

For practice-owning physicians, the legislation raises questions that extend well beyond the policy debate. The bill’s redefinition of “participating medical provider” could shift the liability landscape in meaningful ways. Under current law, the supervising or collaborating physician can be held vicariously liable for a PA’s clinical actions. If PAs with 1,000 or more hours of experience are no longer required to have a practice agreement, the chain of liability between the PA and a physician could be severed — at least in some circumstances.

States that have moved toward collaborative or independent PA practice models have grappled with this question.

In New Hampshire, for example, legislation signed in 2022 shifted PAs from a supervisory to a collaborative model and explicitly removed physician liability for care provided by PAs. As a result, patients injured by PA negligence could face a smaller pool of recoverable funds, depending on the PA’s insurance coverage.

Whether Michigan’s bill would produce a similar outcome would depend on how courts and insurers interpret the new framework. But physicians in states considering these changes would be wise to review their malpractice policies and understand how vicarious liability protections apply — or don’t — under an evolving regulatory structure.

A PA interstate compact

Separately, Michigan is advancing legislation to join the PA Licensure Compact, a multistate agreement that would allow PAs licensed in one member state to more easily obtain authorization to practice in other member states. House Bill 4309, introduced in March 2025 by Rep. Dave Prestin (R-Cedar River), passed the Michigan House by a 103-3 vote and cleared a Senate committee in November. The full Senate had not yet voted on the bill as of early March.

Twenty-two states have already enacted the compact, including Ohio and Wisconsin. The compact has reached the seven-state threshold required for activation, and the compact commission is working to operationalize the system, a process that typically takes 18 to 24 months.

If Michigan joins, PAs with an unrestricted license in the state could apply for a compact privilege to practice in any other member state through a single application, rather than navigating each state’s licensure process. The compact does not override state-specific scope-of-practice rules: PAs practicing in a remote state must still follow that state’s supervision, collaboration and prescribing requirements.

A nationwide trend

Michigan is far from alone in wrestling with these questions. According to the AAPA, the PA regulatory landscape ranges from “optimal” states where PAs can practice to the full extent of their training, to “reduced” states that maintain strict supervisory requirements. North Dakota, for instance, allows PAs with 4,000 hours of experience to apply for independent practice approval. South Dakota considered a similar measure in 2025, though it ultimately failed on the Senate floor.

Physician organizations have been active in opposing these measures. The American Medical Association has maintained that PAs should practice under physician direction and supervision, and medical societies across the country have defeated numerous scope-expansion bills in recent legislative sessions.

How Michigan’s two PA bills fare could depend on whether legislators view the physician shortage — which is especially acute in the state’s rural Upper Peninsula — as urgent enough to justify changes that the medical establishment considers a step too far. For now, both bills remain works in progress.