Beyond the Bedside: The Expanding Role of Physician Associates in Legal Medicine
About the Authors
Marilyn Suri, DMSc, MPA, MPLC, PA-C, FACHE, is a Physician Associate practicing in pulmonary and critical care medicine and a healthcare executive, educator, and advocate. Her professional work spans clinical medicine, healthcare operations and administration, professional advocacy, education, patient safety, healthcare policy, and legal medicine. She serves on multiple boards, including the Academy of Physician Associates in Legal Medicine (APALM), the Florida Academy of PAs (FAPA), and holds leadership roles within organized PA advocacy.
Christopher Cannell, DMSc, MPLC, MPAS, PA-C, DFAAPA, CAQ-EM, is an Assistant Professor of Healthcare Law, President of APALM, a member of the ADPA Board of Directors, and a senior clinical leader. His clinical background includes emergency medicine, critical care, internal medicine, and orthopedic trauma. His professional work has included PA and NP leadership, healthcare system committee and operations/program management, consulting related to the NCCPA Certificate of Added Qualifications, artificial intelligence, AAPA risk management education, research peer review, state PA board leadership, and regional and national lecturing.
When most people think about the work of a Physician Associate (PA), they understandably picture the clinical environment: examining patients, developing differential diagnoses, ordering and interpreting diagnostic studies, prescribing treatment, performing procedures, and managing patients across the continuum of care.
That picture is accurate, but incomplete.
One of the defining characteristics of the PA profession is its adaptability. PAs practice throughout medicine, from primary care and emergency medicine to surgery, critical care, psychiatry, internal medicine subspecialties, and numerous other fields. The National Commission on Certification of Physician Assistants (NCCPA) reported 201,038 Board Certified PAs at the end of 2025. More than half 52.7% reported changing specialties at least once during their careers, illustrating the profession’s substantial mobility across specialties.1
That versatility can extend beyond traditional clinical practice. One particularly important and sometimes overlooked example is the field of Legal Medicine.
Where Medicine and Law Meet
Legal medicine brings clinical practice into conversation with healthcare regulation, patient safety, professional standards, and the law. PAs can translate clinical knowledge and healthcare experience for attorneys, insurers, healthcare organizations, regulators, and other stakeholders, emphasizing ethical practice, quality of care, and collaboration.²
This work encompasses medical record review, expert testimony (when appropriately qualified), risk management, peer review, healthcare fraud, quality improvement, and analysis of how clinical decisions interact with laws, regulations, and institutional policies.
In practice, these contributions may extend across several areas of medical-legal consulting, including:
Litigation and Expert-Witness Consulting
● Case screening and merit review to identify clinically supportable issues and clarify the medical questions in dispute.
● Medical-record review, chronology development, and analysis of key clinical decisions, omissions, documentation, and care transitions.
● Standard-of-care analysis and appropriately scoped written opinions, affidavits, depositions, or trial testimony when the PA is qualified to address the issue.
● Objective work for either plaintiff or defense counsel, with opinions grounded in the record, applicable clinical standards, the limits of the consultant’s expertise, and jurisdiction-specific requirements governing expert testimony.
Clinical-Analysis and Healthcare-Dispute Consulting
● Independent review of emergency, urgent-care, inpatient, orthopedic, primary-care, and specialty records, including fragmented or clinically complex cases.
● Identification of clinical decision points, handoffs, escalation, follow-up, documentation patterns, and potential gaps or inconsistencies.
● Analysis of disputed claims, medical necessity, clinical rationale, and documentation issues in payer-provider matters. Certain out-of-network payment disputes may proceed through the federal Independent Dispute Resolution process established under the No Surprises Act.3
● Translation of complex medical information into clear, concise case summaries for attorneys, healthcare organizations, or other non-clinical audiences.
Compliance, Risk, Quality, and Systems Consulting
● Review of clinical workflows against applicable regulations, organizational policies, accreditation expectations, and risk controls.
● Incident, near-miss, root-cause, and systems analyses examining staffing, workflow, communication, technology, training, handoffs, care transitions, and organizational design, including Just Culture and high-reliability approaches.
● Support for compliance reviews, audits, and investigations involving utilization, referrals, documentation, billing patterns, possible unbundling, fraud, waste, or abuse. Clinical consultants assess the evidence; legal conclusions remain with counsel or authorized investigators.
● Policy development, peer review, credentialing, scope-of-practice analysis, patient-safety initiatives, and proactive risk assessments are intended to prevent future harm.
Technology, Education, and Professional Development
● Clinical expertise for healthcare technology and AI initiatives, including assessment of AI-generated documentation, decision support, workflow integration, usability, patient safety, implementation risks, and potential liability.
● Education for clinicians on documentation, malpractice risk, ethics, professionalism, and medical-legal concepts, as well as clinical education for attorneys and legal teams.
● Development of CME, workshops, courses, and case-based education that translate real-world clinical experience while protecting patient confidentiality.
● Consultation on professional practice, workforce models, leadership development, and the operational realities of team-based healthcare.
Effective medical-legal consultation requires reconstructing clinical events, assessing what was known at the time, separating an adverse outcome from a potential departure from accepted care, and communicating findings without overstating certainty. Clinical experience, objectivity, clear communication, and respect for the limits of one’s expertise are essential; complex cases may require collaboration with legal, coding, pharmacy, or specialty experts.
Those skills are increasingly valuable in a healthcare system in which clinical care, regulation, reimbursement, organizational policy, credentialing, professional scope, technology, and liability are deeply interconnected.
Clinical Experience Becomes a Different Kind of Expertise
Our clinical careers demonstrate how these areas converge. Experience in pulmonary and critical care, emergency medicine, and orthopedic trauma brings firsthand knowledge of decisions under uncertainty, rapidly changing patient conditions, multidisciplinary teamwork, documentation, and the operational consequences of clinical decisions.
A medical record, for example, is not simply documentation created to satisfy a requirement. It is the longitudinal account of what clinicians observed, considered, communicated, and did. A hospital policy is not merely an administrative document; it can influence workflow, clinical expectations, patient safety, credentialing, accountability, and ultimately how care is delivered. Likewise, a statute or regulation that appears straightforward on paper may have substantial consequences once translated into everyday clinical practice.
Understanding these overlapping mechanisms is part of what makes legal medicine so compelling.
Over time, clinical experience can expand into healthcare operations, administration, education, advocacy, policy, peer review, risk management, consulting, and healthcare law. Rather than replacing clinical medicine, these experiences can change the way clinicians understand it.
Why PA Expertise Matters in Medical-Legal Review
When litigation, regulatory review, or organizational questions involve PA care, understanding the PA role becomes particularly important.
PA practice varies according to clinical specialty, experience, institutional privileges, state law, employer policy, and the structure of the healthcare team. Evaluating PA care, therefore, requires an understanding not only of the medicine involved but also of the professional and regulatory framework in which that care occurred.
A clinician experienced in PA practice can help distinguish among questions involving clinical judgment, professional standards, institutional processes, documentation, scope of practice, and regulatory requirements.
The objective should never be advocacy for one side simply because a PA is involved. Credible medical-legal work requires independence, careful review of the evidence, recognition of the limits of one’s expertise, and an objective assessment of the care provided.
Ultimately, the purpose is not simply to participate in litigation. It is to help the legal and healthcare communities understand clinical practice accurately. Healthcare is nuanced, and translating its clinical, operational, and regulatory complexities for other professionals requires both subject-matter expertise and clear communication, skills that many experienced PAs develop throughout their careers.
Legal Medicine Can Also Improve Clinical Medicine
Perhaps the greatest value of medical-legal work lies in what occurs before a lawsuit ever exists.
Examining adverse events, documentation failures, communication breakdowns, unclear policies, and system vulnerabilities can reveal opportunities to improve healthcare delivery. That knowledge can then be brought back into clinical practice.
What could have been documented differently? Where did communication fail? Was responsibility clearly defined? Did institutional policy reflect actual clinical workflow? Could a system change have prevented an error or reduced risk?
These are medical-legal questions, but they are also patient-safety questions.
APALM has helped develop this multidisciplinary approach within the PA profession. Its public resources address medical malpractice, risk management, expert-witness consulting, and the PA scope of practice, while its expert directory connects attorneys with PAs who may assist with medical record review and testimony regarding PA standards of care.2,4 APALM reports a membership of more than 275 PAs across a broad range of clinical specialties.4
That diversity matters because legal medicine is not a separate universe from clinical medicine. It depends upon clinicians who understand what happens at the bedside, in the operating room, in the emergency department, in outpatient practice, and within healthcare organizations.
Expanding Our Definition of a PA Career
The breadth of the PA profession is perhaps best understood not simply by the specialties in which PAs practice, but by the ways clinical experience can evolve into leadership, education, administration, advocacy, research, policy, and legal medicine.
These roles do not require leaving one’s identity as a clinician behind. Rather, they often depend upon the perspective developed through years of caring for patients and working within complex healthcare systems.
Dr. Marilyn Suri was recently recognized by Becker’s Hospital Review among its “Rising Stars: 188 Healthcare Leaders Under 40” for 2026.⁵ Beyond an individual honor, that recognition illustrates how a career rooted in patient care can expand into operations, education, advocacy, policy, leadership, and legal medicine.
Dr. Cannell has been recognized by the AAPA, APALM, multiple healthcare systems, and Constituent Organizations as a leader in the Healthcare Law Space, with over 23 years of experience across multiple domains as a clinician, leader, academic, and consultant. He is a Lead in the Healthcare Law Curriculum, regularly lectures on Healthcare Law, is finishing up his Healthcare Law Certificate, and is a certified Medical Professional Legal Consultant.
Legal medicine is one example of that evolution. The same skills required to evaluate a critically ill or injured patient, careful analysis of available evidence, recognition of competing explanations, attention to documentation and chronology, and clear communication of complex information can become valuable in medical-legal review. What changes is the context in which those skills are applied.
For PAs considering similar paths, the lesson is not that every clinician should pursue administration, advocacy, or legal medicine. Rather, the PA profession provides a clinical foundation from which many forms of expertise can develop.
A career may move among the bedside, classroom, boardroom, legislative arena, or courtroom while remaining grounded in the same fundamental responsibility: using knowledge and experience to improve healthcare. Whether working as a clinician, expert witness, or in any capacity in the field of legal medicine, all PAs must follow established ethical and professional guidelines.6-8
As healthcare grows increasingly complex, the individuals helping interpret that system should reflect the professionals actually practicing within it. PAs bring clinical experience, adaptability, interdisciplinary training, and firsthand knowledge of modern team-based healthcare to that conversation. PAs who pursue advanced education and focused training in healthcare law can further expand their ability to contribute across many of these areas.
The PA profession should not be defined solely by where PAs practice, but also by where their expertise can contribute.
The bedside may be where our expertise begins. It does not have to define the limits of where that expertise can lead.
References
National Commission on Certification of Physician Assistants. 2025 Statistical Profile of Board Certified PAs. NCCPA; 2026. doi:10.64936/SR0513. Accessed September 25, 2026. https://www.nccpa.net/2025-statistical-profile-of-board-certified-pas-report/
Academy of Physician Associates in Legal Medicine. The Academy of Physician Associates in Legal Medicine. Accessed September 25, 2026. https://www.apalm.net/
Centers for Medicare & Medicaid Services. About Independent Dispute Resolution. Updated September 15, 2026. Accessed September 25, 2026. https://www.cms.gov/initiatives/no-surprise-billing/overview/engaging-idr/about-independent-dispute-resolution
Academy of Physician Associates in Legal Medicine. Find a PA expert. Accessed September 25, 2026. https://www.apalm.net/find-a-pa-expert
Falvey A. Rising stars: 188 healthcare leaders under 40 | 2026. Becker’s Hospital Review. Published September 25, 2026. Accessed September 25, 2026. https://www.beckershospitalreview.com/hospital-management-administration/rising-stars-188-healthcare-leaders-under-40-2026/
Academy of Physician Associates in Legal Medicine. Public resources. Accessed September 25, 2026. https://www.apalm.net/public-resources
American Academy of PAs. Guidelines for Ethical Conduct for the PA Profession. American Academy of PAs; 2021. Accessed October 12, 2026. https://www.aapa.org/wp-content/uploads/2021/11/Guidelines-for-Ethical-Conduct-for-the-PA-Profession-7-1-21.pdf
American Academy of Physician Assistants. Guidelines for the Physician Assistant Serving as an Expert Witness. American Academy of Physician Assistants; 2001. Accessed October 12, 2026. https://www.paexperts.com/Guidelines%20for%20the%20Physician%20Assistant%20Serving%20as%20an%20Expert%20Witness.pdf
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