Physician assistant practice is governed by state-level supervision regulations that fall into three broad models: Optimal Team Practice (OTP), collaborative practice, and required (delegated) supervision. The model in your state affects scope, ratios, prescribing, chart-cosignature, and how flexibly a PA can be deployed. APR tracks supervision regulations in every state.
OTP eliminates the legal requirement for a specific PA-physician agreement at the state level and instead empowers PAs and physicians to determine practice arrangements at the practice level. OTP states typically permit PAs to be paid directly by insurers, eliminate restrictive ratios, and remove chart-cosignature mandates. Examples: NC, KS, ND, UT, WV, FL (recent), ME, RI, IL (limited), MN (modernized).
State law requires a written collaborative agreement between the PA and a physician but does not require active on-site supervision. Most states sit in this middle category as of 2026.
State law requires a delegating physician with active oversight, ratios, chart cosignature, or on-site presence requirements. A small minority of states remain in this category.
Optimal Team Practice (OTP) is the AAPA-supported model that removes state-level legal requirements for a specific PA-physician agreement and instead lets PAs and physicians define practice arrangements at the practice level. As of 2026, a growing number of states have enacted OTP.
OTP does not eliminate physician collaboration as a clinical practice; it removes the legal mandate for a specific written agreement at the state level. Many OTP-state PAs still work in physician-led teams.