How does your state’s APP practice environment stack up?

I practice dermatology in Michigan, and I often remark on how lucky I am to live and work in a “PA-friendly state.”  I say this because, in my personal experience,  I can practice with a large degree of autonomy. I have wonderful relationships with my amazing physician/NP/PA colleagues with whom I collaborate daily, and patients in Michigan genuinely seem to respect and value the care that APPs provide.  

I see reports of APP advocacy efforts nationwide to help PAs and NPs to obtain “full practice authority.”  But what exactly does this mean?  Which states are truly APP-friendly?  Do I actually live in a PA-friendly state?  For my NP colleagues, is Michigan also NP-friendly?

The American Association of Nurse Practitioners (AANP) describes “full” NP practice environments as:

State practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing (State Practice Environment, AANP) [1].

The American Academy of Physician Associates (AAPA) uses the phrase “optimal team practice,” and advises that:

States should eliminate the legal requirement for a specific relationship between a PA, physician or any other healthcare provider in order for a PA to practice to the full extent of their education, training and experience; create a separate majority-PA board to regulate PAs or add PAs and physicians who work with PAs to medical or healing arts boards; and authorize PAs to be eligible for direct payment by all public and private insurers (Optimal Team Practice, AAPA) [2].

According to the AANP, the states that currently provide full practice authority to NPs are [1]:

• Alaska
• Arkansas
• Arizona
• Colorado
• Connecticut
• Delaware
• Hawaii
• Idaho
• Iowa
• Kansas
• Maine
• Maryland
• Massachusetts
• Minnesota
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Mexico
• New York
• North Dakota
• Oregon
• Rhode Island
• South Dakota
• Utah
• Vermont
• Washington
• Washington D.C.
• Wyoming

The AAPA reports that the states that currently allow for PA optimal team practice are [3]:

• North Dakota
• Utah
• Wyoming

While Michigan is not on either of these lists, the AAPA considers Michigan’s laws for PAs to be “advanced.”   The AANP, however, rates Michigan as being “restricted” [2,3].  I should note that the Michigan Council of Nurse Practitioners (MICNP) is seeking full practice authority for NPs with Senate Bill 279 [4].  As a PA who aligns with all APPs, I have written to my district senator requesting them to support this bill for my NP colleagues.  I feel that it is only a matter of time before Michigan PAs will request similar legislative changes, and I hope that NPs will be equally supportive. 

How APP-friendly is your state?  

Do you agree with your state’s practice environment ranking?   If you don’t, is there anything you can do to help?  

Nikki Rataj Casady, DMSc, PA-C

email@appcolleague.org