Empowering PAs, Enhancing Care: A Landmark Legislative Step Forward in New Hampshire

Introduction

In an era marked by increasing demand for accessible, high-quality healthcare, the role of Physician Associates/Physician Assistants (PAs) has never been more critical. PAs have long demonstrated their ability to provide safe, effective, and patient-centered care across a wide variety of settings. Yet, outdated legislative frameworks and supervisory mandates have historically limited the ability of PAs to practice to the full extent of their education, training, and experience.

Now, New Hampshire is taking a bold step forward. A newly released report from a bipartisan, bicameral study committee recommends modernizing the state’s practice laws by removing supervision requirements and enabling PAs to operate at the top of their license. This progressive move represents a significant win, not just for PAs, but for patients, healthcare teams, and the broader healthcare system.

The Study Committee’s Vision: A Path to Modernization

The New Hampshire General Court's study committee, composed of legislators from both parties and both chambers, was tasked with evaluating barriers to PA practice and identifying opportunities for reform. Their conclusion is resounding: modernizing practice laws and removing outdated supervisory requirements are essential steps to improving healthcare access and quality across the state.

The committee recognized that the current supervisory framework is both administratively burdensome and clinically unnecessary. It often restricts the flexibility of PAs and their collaborating teams, creating artificial bottlenecks in care delivery, particularly in rural and underserved areas. These restrictions are not supported by data showing improved outcomes; instead, they limit innovation and reduce healthcare system efficiency.

What the Report Recommends

The report advocates for legislative reform that would:

1. Eliminate Mandatory Supervision Agreements: Removing the legal requirement for a supervisory or collaborative agreement between a PA and a physician.

2. Authorize Autonomous PA Practice Within Scope: Allow PAs to practice independently within their scope of training, education, and certification.

3. Modernize Definitions and Regulatory Language: Update terminology in existing laws to reflect the current capabilities and professional standards of PAs.

4. Create a Unified Regulatory Structure: Streamline oversight through a centralized board or commission to reduce redundancy and ensure consistent standards of care.

The committee’s recommendations were developed with significant input from stakeholders across the healthcare spectrum, including PAs, physicians, healthcare administrators, and patient advocacy organizations. The result is a thoughtful, balanced set of proposals that prioritize patient safety and system sustainability.

Why This Matters for PAs

For practicing PAs, these recommendations signal a long-overdue recognition of professional capabilities. The removal of supervision requirements would allow PAs to:

• Practice More Flexibly: Especially in high-need areas like rural communities and critical access hospitals, where a supervising physician may not always be physically present.

• Respond More Efficiently to Patient Needs: Without needing approval or oversight for routine decisions within their scope of practice, PAs can act swiftly to provide timely care.

• Reduce Administrative Burden: Supervisory agreements often require ongoing paperwork, oversight, and compliance tracking, diverting resources away from patient care.

• Pursue Leadership and Innovation: PAs can more freely participate in leadership roles, research, policy development, and program design when not tethered to supervisory constraints.

  
  

Most importantly, these changes reaffirm what PAs have always known: our training, experience, and clinical judgment equip us to serve patients with the same level of excellence and integrity as any healthcare provider.

The Patient Perspective: More Access, Better Outcomes

The committee’s report places strong emphasis on patient outcomes and rightly so. Patients stand to benefit significantly from PA practice modernization in several key ways:

1. Improved Access to Care: Particularly in areas facing physician shortages, autonomous PAs can fill critical gaps, ensuring that communities receive continuous, high-quality care.

2. Continuity of Care: Without the risk of disruption due to supervisory changes (such as a physician leaving a practice), patients can maintain long-term relationships with their PA providers.

3. Lower Costs Without Compromising Quality: PAs have consistently demonstrated cost-effective care delivery without sacrificing safety or outcomes.

4. Faster Response Times: In both primary care and specialty settings, PAs can address concerns more quickly when not bound by supervisory protocols.

   
   

Data from other states that have adopted similar reforms, such as North Dakota and Utah, show positive results across these dimensions. Patient satisfaction, clinical outcomes, and system efficiencies all trend upward when PAs are empowered to work to their fullest capacity.

Aligning With National Trends

New Hampshire is not alone in reimagining PA practice laws. A growing number of states have already implemented or are actively considering similar reforms. National organizations such as the American Academy of PAs (AAPA) have long advocated for full practice authority, citing evidence-based research and best practices from around the country.

The movement toward modernized PA legislation reflects a larger shift in healthcare policy: one that values team-based care, recognizes the capabilities of all healthcare professionals, and seeks to dismantle systemic barriers that do not serve patients or providers.

Addressing Concerns and Misconceptions

As with any policy change, the path forward may raise questions or concerns from stakeholders. Some physicians may worry about the continuity of team-based care. Others may question whether autonomous practice reduces collaboration.

The committee’s report addresses these concerns by emphasizing that removing legal supervision does not remove teamwork. PAs will continue to work collaboratively with physicians, nurses, specialists, and other team members. In fact, removing formal supervisory requirements often strengthens team dynamics by removing hierarchical barriers and fostering mutual respect and shared decision-making.

Moreover, PAs are well-versed in seeking consultation when necessary. Our education and professional culture are rooted in collaboration, critical thinking, and patient-centered care. These values will continue to guide our practice, regardless of legislative changes.

A Call to Action for the PA Community

As this report transitions into policy proposals and potential legislation, the voice of the PA community will be essential. Advocacy, education, and engagement will play a pivotal role in ensuring that the report’s recommendations are enacted and implemented successfully.

PAs can contribute by:

• Educating Legislators: Share your stories and data that illustrate how outdated laws limit patient care.

• Engaging With Colleagues: Help physicians and healthcare leaders understand that this shift enhances care delivery, not competition.

• Mobilizing Public Support: Patients trust their PAs leverage that trust to help the public understand the importance of modernizing practice laws.

• Supporting Professional Organizations: Get involved with your state PA chapter or national organizations that are advocating for legislative reform.

Conclusion: A Transformative Moment

The bipartisan, bicameral committee report from New Hampshire is more than a policy proposal; it is a milestone. It reflects a growing understanding that PAs are not just mid-level providers or physician extenders, but essential healthcare workforce members with the knowledge, training, and judgment to practice autonomously.

Modernizing practice laws is a win for patients, for PAs, and for the healthcare system as a whole. It’s a chance to align legislation with the realities of modern medicine and to build a more flexible, responsive, and inclusive system of care.

For New Hampshire PAs, the path forward is clear. With advocacy, professionalism, and unity, we can help turn this vision into reality and continue to lead the way in delivering exceptional care to every patient, every time.

REFERENCE

1. Bipartisan, Bicameral Study Committee Report on PA Practice in New Hampshire: This report, released on November 5, 2024, by the American Academy of Physician Associates (AAPA), discusses the findings and recommendations of the New Hampshire study committee regarding the modernization of PA practice laws. ​

2. House Bill 1222 (HB 1222) – New Hampshire Legislation: This bill, signed into law on July 26, 2024, revises the requirements governing collaboration agreements for physician assistants and establishes a committee to study PA scope of practice. ​bills.nhliberty.org+4LegiScan+4Becker's Hospital Review+4

3. Final Report of the Committee to Study PA Scope of Practice: This comprehensive report provides detailed insights into the committee's findings and recommendations regarding PA practice in New Hampshire. ​AAPA

4. Becker's Hospital Review Article: An article titled "Removing PA supervision does not affect patient care, report finds," published on November 6, 2024, discusses the implications of removing supervision requirements for PAs in New Hampshire.