Written by Lisa King, MD MS, Mayo Clinic PGY-3

If you drive across a state line in 2026, the rules governing who can practice medicine, and how much physician involvement is required, may change just as much as the scenery.

This year has brought a wave of active, and at times tumultuous, changes to physician-led care and nonphysician provider (NPP) scope of practice across the United States. The biggest takeaway is simple: scope of practice is no longer settled in any one place. Cross a border into another state, and an entirely different set of rules, and even job titles, will likely apply.

Physician assistants saw several major changes across the country. In Maine, PAs are now able to practice without a written practice agreement after 4,000 clinical hours. Similarly, in Virginia, PAs will be able to practice without a written practice agreement after three years of full-time clinical work once the Board of Medicine adopts implementing regulations. Virginia still requires PAs to consult, collaborate, and refer as the patient’s condition warrants, and ordinarily requires an attestation from the physician with whom the PA collaborated, although the Board may accept other evidence if the PA is unable to obtain one. Maine went further in the same bill, changing that duty from “shall” to “may.” A physician must remain accessible for consultation, but whether to seek that consultation is left to the PA’s judgment based on the patient’s condition, the PA’s education and experience, and the standard of care.

Meanwhile, physician assistants became “physician associates” in Iowa, and Kansas adopted the title while continuing to recognize “physician assistant” as well. Kansas did considerably more than propose a new, controversial job title: HB 2702, effective January 1, 2027, converts the practice agreement from supervision to collaboration after 4,000 clinical hours, specifies that collaboration does not require a physician’s physical presence, eliminates limits on how many PAs a physician may work with, and allows the PA and collaborating physician or physician group to set the terms and limits of that collaboration. For PAs practicing in hospitals or other licensed facilities, those limits may also be defined through the facility’s credentialing and privileging process. Kentucky went a different direction, keeping supervision but adding Schedule II prescribing authority, capped at a 72-hour supply for most narcotics. In other words, no two states are currently trading in the same currency when it comes to scope of practice.

The larger change came from New Jersey. On March 30, Governor Sherrill signed S2996, allowing advanced practice nurses with more than 5,000 hours to provide primary or behavioral health care and prescribe without a joint protocol with a physician. That authority had originated as a pandemic-era waiver and was set to expire on February 16. Three days before the deadline, the governor extended it for another 45 days by executive order. Then, on March 30, three days before that extension would have run out, the governor signed the change into permanent law. Prior physician-collaboration requirements were never allowed to return, and at no point did they have to be defended on their own merits.

New York took a different route to the same endpoint. In 2014, the state eliminated the written practice agreement requirement for nurse practitioners with more than 3,600 hours of experience, while retaining the requirement for a collaborative relationship with a physician. In 2022, it went a step further and suspended that collaboration requirement as well, but only temporarily. The provision was initially set to expire in 2024, then extended through July 1, 2026. Rather than allow it to lapse, Governor Hochul extended it again on May 28, this time through July 1, 2030. Two bills, S2360 and A1220, would remove the expiration date entirely and remain pending. Twelve years after New York first began loosening these requirements, it has still not eliminated the physician-collaboration requirement from state law; instead, it has repeatedly created temporary exemptions that allow experienced nurse practitioners to practice without it.

California moved in the same general direction. January 1 marked the first day nurse practitioners could qualify as “104 NPs” under AB 890: following the completion of the 103 NP work requirements, NPs who finish three years of practice in a group setting with a physician will subsequently be eligible to open solo practices without one.

But the movement this year was not one-directional.

As of the AMA’s late-April tally, bills to remove physician involvement from nurse practitioner practice had been defeated in Florida, Indiana, Mississippi, Tennessee, Virginia, and West Virginia. Bills to remove physician assistant supervision failed in Idaho, New Mexico, Tennessee, Wisconsin, and West Virginia. The AMA counted more than 150 scope expansion bills defeated across forty-plus states in 2025, and 89 percent of state medical association executives and national medical association executives named scope of practice their number one advocacy priority for 2026.

We are not losing every fight. We are simply fighting all of them, every year, in fifty places at once.

Minnesota’s change was quieter.

HF 3825 became Chapter 115 on May 27. Buried in an omnibus health occupations bill covering acupuncture, mortuary science, and marriage and family therapy, it loosened Minnesota’s requirements for the 2,080-hour transition-to-practice period for nurse practitioners and clinical nurse specialists. On first passage, the bill cleared the House 134 to 0. Those providing primary care or mental health services are no longer required to complete those hours in a hospital or integrated clinical setting where physicians and APRNs work together. That setting requirement remains, however, for those practicing in other specialties. The collaborative agreement itself may be with either an experienced physician or an APRN with at least three years of practice.

The physician associate title change, which was buried in an omnibus bill as well, did not pass here. MNACEP joined the MMA and five specialty societies in opposing the title change, with the MMA citing an AMA-commissioned survey in which 22 percent of patients believed physician assistants were medical doctors, promoting confusion over enhanced clarity. But don’t worry: we will likely be debating this issue all over again in 2027.

Finally, watch the interstate compacts. Under the existing 2020 APRN Compact model, an eligible APRN with a multistate license could practice in other member states. Although APRNs would generally remain subject to the practice laws of the state where the patient is located, the compact specifically allows multistate license holders to practice independently of physician supervision or collaboration requirements. The compact has never reached the seven states required for implementation, and NCSBN is now redesigning it toward what it describes as a “licensure-only” model. The final language of that redesign has not yet been released. Minnesota has not joined.

The PA Licensure Compact works differently: it makes it easier for PAs licensed in one member state to obtain authority to practice in another, but it does not override that state’s scope-of-practice laws. A PA practicing under a compact privilege must still follow the laws and regulations of the state where they are practicing. Minnesota is a member, although compact privileges are not yet being issued.

The distinction is important: the PA Compact preserves each state’s existing scope-of-practice laws, while the 2020 APRN Compact would have allowed multistate license holders to practice independently of physician-collaboration requirements; whether that feature survives the current 2026 redesign remains to be seen.

“Scope of practice” is a topic in medicine discussed ad nauseam, yet somehow still not effectively enough to produce meaningful change, consensus, or unity across the country. For those of us who have endured medical school, residency, and a seemingly endless series of boards and examinations, the difference in training is obvious. Less obvious is why, despite that difference, the line between physicians and NPPs continues to erode, and why patients are left to navigate a system that increasingly obscures who is actually providing their care. At its core, this debate is not simply about titles or professional territory: it is about whether patients will continue to have clear, reliable access to physician-led care in the United States.

Amazon offers thousands of reviews and pages of information to help consumers distinguish between something as inconsequential as one blanket or umbrella and another. Yet when patients follow a blue “H” sign to a hospital, there is often far less transparency about something much more consequential: who will actually be providing their medical care, what training that person has, and what role a physician will play in their treatment. As a society, we demand extraordinary transparency when making even trivial consumer decisions; patients should be able to expect the same clarity, if not more, when making decisions about their health. 

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Citations

Physician assistants / physician associates

Maine

  1. Maine LD 2088 (HP 1403), “An Act to Increase Access to Primary Care Provided by Physician Associates,” 132nd Legislature; P.L. 2025, ch. 604, emergency enacted and signed April 3, 2026, effective on approval. https://legislature.maine.gov/legis/bills/getPDF.asp?paper=HP1403&item=3&snum=132
  2. Me. Rev. Stat. tit. 32, § 3270-G, “Physician associates; scope of practice and agreement requirements.” https://legislature.maine.gov/statutes/32/title32sec3270-G.html
  3. “Legislation Signed by Maine Governor Mills Will Optimize PA Workforce, Expand Patient Access to Care.” American Academy of Physician Associates, April 2026. https://www.aapa.org/news-central/2026/04/legislation-signed-by-maine-governor-mills-will-optimize-pa-workforce-expand-patient-access-to-care/

Virginia

  1. Virginia HB 746 (2026), Acts of Assembly Chapter 418, signed April 8, 2026. Virginia Legislative Information System. https://lis.virginia.gov/bill-details/20261/HB746/text/CHAP0418
  2. “Legislation Signed by Virginia Governor Spanberger Will Modernize PA Practice Law, Expand Patient Access to Care.” American Academy of Physician Associates, April 2026. https://www.aapa.org/news-central/2026/04/legislation-signed-by-virginia-governor-spanberger-will-optimize-pa-workforce-expand-patient-access-to-care/
  3. “Chapter 418 (HB 746).” Virginia Academy of Physician Assistants, 2026. https://www.vapa.org/chapter-418-hb-746/

Iowa

  1. Iowa SF 2190 (2026), “An Act relating to the use of the titles physician assistant and physician associate,” 91st General Assembly; signed April 9, 2026, effective July 1, 2026. https://www.legis.iowa.gov/docs/publications/LGE/91/SF2190.pdf
  2. “Iowa Marks Major Milestone with Passage of Title Change Legislation.” American Academy of Physician Associates, April 2026. https://www.aapa.org/news-central/2026/04/iowa-marks-major-milestone-with-passage-of-title-change-legislation/

Kansas

  1. Kansas HB 2702 (2026), enrolled; signed by Gov. Laura Kelly, effective January 1, 2027. Kansas State Legislature. https://www.kslegislature.gov/li/b2025_26/measures/documents/hb2702_enrolled.pdf
  2. “Kansas Moves from ‘Supervision’ to ‘Collaboration’ and Closer to an Optimal Practice Environment.” American Academy of Physician Associates, April 2026. https://www.aapa.org/news-central/2026/04/kansas-moves-from-supervision-to-collaboration-and-closer-to-an-optimal-practice-environment/

Kentucky

  1. Kentucky SB 116 (2026 Regular Session), enrolled; effective July 15, 2026. https://apps.legislature.ky.gov/recorddocuments/bill/26RS/sb116/bill.pdf
  2. “SB 116 & Physician Assistant Prescribing Update.” Kentucky Board of Pharmacy. https://pharmacy.ky.gov/Documents/Kentucky%20Board%20of%20Pharmacy%20Important%20Update.PA%20Prescribing.pdf

Advanced practice nurses

New Jersey

  1. “Governor Sherrill Signs Legislation Eliminating Practice Restrictions for Most Advanced Practice Nurses.” Office of the Governor, State of New Jersey, March 30, 2026. https://www.nj.gov/governor/news/2026/20260330b.shtml
  2. “New Jersey Legislature Advances Amended APN Independent Practice Bill: SB 2996 Key Changes.” Frier Levitt. https://www.frierlevitt.com/articles/new-jersey-apn-independent-practice-bill-sb2996-update/
  3. “New Jersey Executive Order 13 Extends APN Independent Practice Waiver for 45 Days.” Frier Levitt. https://www.frierlevitt.com/articles/new-jersey-executive-order-13-apn-independent-practice-extension/

New York

  1. “Client Alert: New York Nurse Practitioner Independent Practice Authority Set to Expire in July 2026.” Frier Levitt. https://www.frierlevitt.com/articles/new-york-np-independent-practice-2026/
  2. “New York Extends Independent Practice Authority for Nurse Practitioners Through 2030.” McConville Considine Cooman & Morin, P.C. https://www.mccmlaw.com/news-and-articles/articles/new-york-extends-independent-practice-authority-for-nurse-practitioners-through-2030
  3. “New York Extends Nurse Practitioner Independent Practice Authority Through 2030.” Dermatology Times. https://www.dermatologytimes.com/view/new-york-extends-nurse-practitioner-independent-practice-authority-through-2030

California

  1. California AB 890 (2019–2020), “Nurse practitioners: scope of practice: practice without standardized procedures.” https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200AB890
  2. “Pulse Check: How is Your California Practice Leveraging ‘103 NPs’ — and Preparing for the Arrival of ‘104 NPs’ in 2026?” National Law Review. https://natlawreview.com/article/pulse-check-how-your-california-practice-leveraging-103-nps-and-preparing-arrival

American Medical Association

  1. “April 24, 2026: State Advocacy Update.” American Medical Association. https://www.ama-assn.org/health-care-advocacy/advocacy-update/april-24-2026-state-advocacy-update
  2. “More than 150 scope-creep bills defeated in 2025.” American Medical Association. https://www.ama-assn.org/practice-management/scope-practice/more-150-scope-creep-bills-defeated-2025
  3. “What tops the state advocacy agenda for doctors in 2026.” American Medical Association. https://www.ama-assn.org/health-care-advocacy/state-advocacy/what-tops-state-advocacy-agenda-doctors-2026

Minnesota

  1. Minnesota HF 3825, 94th Legislature (2026); Laws of Minnesota 2026, ch. 115, art. 11, § 1 (amending Minn. Stat. § 148.211, subd. 1c), signed May 27, 2026. https://www.revisor.mn.gov/bills/94/2026/0/HF/3825/
  2. Minn. Stat. § 148.211, subd. 1c. https://www.revisor.mn.gov/statutes/cite/148.211
  3. “Key MMA Priorities Signed into Law by Gov. Walz.” Minnesota Medical Association. https://www.mnmed.org/news-and-publications/news/key-mma-priorities-signed-law-gov-walz
  4. “Senate Scope Omnibus Bill Includes Physician Assistant Title Change.” Minnesota Medical Association. https://www.mnmed.org/news-and-publications/news/senate-scope-omnibus-bill-includes-physician-assistant-title-change

Interstate compacts

  1. “Key Provisions of the APRN Compact.” National Council of State Boards of Nursing. https://www.ncsbn.org/public-files/APRN_Key_Provisions_2020.pdf
  2. PA Licensure Compact, Frequently Asked Questions. https://www.pacompact.org/faq/
  3. “PA Licensure Compact.” American Academy of Physician Associates. https://www.aapa.org/advocacy-central/pa-licensure-compact/
  4. National Council of State Boards of Nursing. In Focus, 2026, Vol. 1. NCSBN In Focus 2026, Vol. 1
  5. National Council of State Boards of Nursing. “Strategic Initiative Statement.” 2026. NCSBN Strategic Initiatives