Most important takeaways…
- AAPA expects 12 states to pursue PA practice act modernization in 2027.
- Ten states, including Utah and Wyoming, have removed physician supervision for PAs.
- AANP's map shows 27 full-practice and 11 restricted-practice states in 2026.
For nurses weighing NP education against other advanced practice routes, nurse practitioner full practice authority is the variable that changes everything. As of October 2026, 10 states have removed the supervising physician requirement for physician assistants, and the American Academy of Physician Associates is pushing further legislation in 2027, according to MedPage Today1.
That makes PA supervision reform a parallel track to NP scope advocacy, not the same fight. The practical question is where NP authority and PA scope actually diverge in your state, and what that means for prescribing, employer credentialing, and how much autonomy you can really use.
What AAPA Is Pushing for in 2026 and Why It Isn't Only About Supervision
What exactly is AAPA asking state lawmakers to change in 2027, and is physician supervision removal the only reform on the table?
According to MedPage Today, roughly 12 additional states are expected to pursue PA practice act modernization in 2027.1 Not all of those bills will focus solely on removing supervision, so NPs watching their own legislature should look beyond the headline, particularly in full practice authority states.
The 2027 bill mix
AAPA says supervision removal is the top priority.1 But the association's modernization agenda includes several related models: replacing the legal term "supervision" with "collaboration," defining PA scope of practice by education, training, and experience, and adopting Optimal Team Practice language that lets the practice or employer determine team-based collaboration based on patient need.2 Other expected bills target physician-to-PA ratio limits and physician-on-site requirements that can make it too costly to hire PAs or open retail clinics. In practice, that means moving away from a specific physician-to-PA supervisory link and toward collaboration, consultation, and referral based on patient condition, PA competency, and the standard of care.
Why this matters for access
AAPA's Chantell Taylor told MedPage Today that inconsistent state laws are "a huge barrier to bringing access to care into that more restrictive state" for PAs working across state lines.1 She also said practice modernization and healthcare workforce issues do not tend to fall into a partisan camp.1 For NPs, that is a useful reminder that PA scope reform often travels on the same workforce-access arguments that nurse practitioner scope of practice debates use.
Bill counts and language shift during each legislative session, so treat early predictions as a starting point and verify current status before assuming a supervision-removal or collaboration bill has actually moved.
The 10 States That Removed PA Supervision, Next to Their NP Authority Category
Comparing PA supervision reform state by state alongside NP practice authority shows overlap, but not a perfect match. The 10 states most often grouped as having removed the physician supervision requirement for PAs are North Dakota, South Dakota, Wyoming, Utah, Montana, Iowa, New Hampshire, Virginia, Maine and Delaware.2 For NPs, nine of these are full practice authority states, while Virginia is classified as reduced practice.1 NP advocates often point to PA momentum as evidence that physician oversight can be updated without harming care, but NP supervision requirements by state still differ by profession.
Where the legal labels are clearest
Among the 10, AAPA's public materials most clearly identify North Dakota, South Dakota, Wyoming, Utah, Iowa and New Hampshire as having eliminated the formal supervisory agreement.2 All six are full practice states for nurse practitioners. In these states, NP and PA authority have moved in a similar direction, though the statutes still use different language for each profession.
Four states worth watching
Montana, Maine and Delaware are full practice states for NPs, while Virginia remains reduced practice. PA supervision removal is sometimes included in 10-state lists for these four, but state-level documentation is less uniform, and the precise legal model, collaboration versus optimal team practice, may differ. If you practice or plan to practice in one of these states, check the current PA and NP board language before assuming either profession's authority. Prescribing and hospital credentialing can diverge even when the supervision label looks similar.
NP Practice Authority vs PA Scope: Legal Authority, Not Just Job Duties
AANP’s 2026 state map counts 27 full-practice states, 12 reduced-practice states, and 11 restricted-practice states. Indiana moved to full practice in 2026. So NPs do not automatically have more practice authority than PAs , a key point in any Nurse Practitioner vs. Physician Assistant comparison. NP authority is a licensure-level category, while PA authority is defined through supervision, delegation, collaboration, or team-practice requirements.
The four layers behind authority
Statute: a full-practice state lets an NP evaluate, diagnose, prescribe, and manage treatment under the board of nursing. In PA supervision-removal states, the statute removes physician oversight but may leave delegation details to the PA board. Board regulation: California's AB 890 created 103 and 104 designations requiring 4,600 hours or three years of clinical practice before qualifying NPs may practice without physician supervision in specified settings. Employer policy: a hospital, retail clinic, or health system may require collaborative agreements or on-site physician presence even when state law does not constrain nurse practitioner scope of practice. Day-to-day autonomy depends on privileging and bylaws, which can narrow what an NP or PA actually does.
What a PA can do that an NP cannot
Usually the gap is not a procedure list. PA training follows a generalist medical model, so PAs can move among specialties without adding a new population certification. An NP often needs additional education or certification to change population focus, such as moving from adult-gerontology primary care into family nurse practitioner scope. In restricted states, an NP may need transition hours before independent practice, while a PA may practice sooner under delegation.
California shows the difference
AANP still classifies California as restricted because law requires career-long physician supervision, delegation, or team management for some NP practice. AB 890's 103/104 pathway gives qualifying NPs a route to practice without physician supervision in specified settings, but it is not all-settings full authority. Two California NPs can have different legal standing depending on whether they completed the 4,600-hour transition and obtained the 104 designation. PA scope in California generally remains tied to physician delegation or practice agreements in settings outside the supervision-removal states.
Prescribing and Controlled Substances: Where NP and PA Rules Diverge
NP and PA controlled-substance authority in the same state often diverges because each profession's prescribing power comes from its own state practice act, not from a shared rulebook. Both NPs and PAs must hold their own DEA registration, but that registration does not decide Schedule II through V limits, quantity or refill rules, or collaboration and supervision conditions. State law sets those limits. Through December 31, 2026, federal telemedicine flexibilities generally allow DEA-registered practitioners to prescribe Schedules II through V without a prior in-person visit, subject to stricter state telehealth laws for nurse practitioners.
When the same state treats NPs and PAs differently
Alabama shows how profession-specific details can matter. Certified registered nurse practitioners and certified nurse midwives in Alabama face an annual Quality Assurance and Controlled Substances Certification (QACSC), must hold DEA and PDMP registrations, need an unrestricted controlled-substance certificate from their collaborating physician, and gain Schedule II approval only within their specialty. Those conditions attach to the NP pathway, not to every PA with the same DEA registration. In a full-practice NP state, a nurse practitioner may still need Schedule II collaboration or extra registration even though the state removed career-long supervision. So NP independence does not mean a PA in the same state will receive identical controlled-substance treatment.
Independent prescribing vs delegated prescribing
An NP in a full-practice state often prescribes under nursing-board authority. A PA's prescribing is more frequently tied to a supervising or collaborating physician, even in states that have eased supervision. Removing a supervision requirement does not by itself create unrestricted Schedule II through V authority for PAs. In some states, a PA may prescribe only within the scope of a delegation or practice agreement.
Check your own board's rules
Because nurse practitioner scope of practice by state is set by state boards that publish profession-specific controlled-substance rules, nurse practitioners should not assume parity with PAs in the same state. Verify your own board's requirements for Schedule II prescriptions, PDMP use, and any collaboration or registration conditions. Do not carry over rules from the PA pathway or from another state.
Employer Policy vs State Law: Why Retail Clinics, Hospitals and Credentialing Matter
CVS and Walgreens are not hiring physician assistants or opening clinics in states that require a physician on-site or set physician-to-PA ratios, according to the American Academy of Physician Associates (AAPA). AAPA says those requirements make the cost of doing business not worth it.
State law is only the floor
Even when state law allows independent NP practice or reduced PA supervision, hospital privileging, credentialing committees, malpractice carriers, and the terms of a collaborative or supervisory agreement can narrow what you are actually allowed to do. A hospital may impose stricter physician co-signature rules than the state requires, or a malpractice policy may restrict certain procedures or prescribing patterns. For both NPs and PAs, the practice you are hired into can look very different from the authority on paper.
FNP vs PA primary care autonomy
In states with full practice authority for nurse practitioners, a family nurse practitioner can open a primary care practice without a collaborative agreement in many circumstances. A PA still typically practices within a team or agreement structure, even in states that have removed formal supervision requirements. That difference matters when you are comparing an FNP path to a PA path for long-term autonomy.
Questions to ask before accepting a job
- Privileges: What specific procedures and admitting rights does the facility grant you?
- Agreements and ratios: Is there a physician-to-PA or physician-to-NP ratio in your contract, and who covers you on the nurse practitioner patient care team when that physician is unavailable?
- Prescribing and malpractice: Will the malpractice carrier cover your state-allowed scope, including controlled substances?
- Credentialing timeline: How long does it take to get credentialed at the hospitals or clinics where you want to work?
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The AOA supports physician-led, team-based care but remains concerned about efforts to authorize independent practice by clinicians without the same education, training, and licensure as physicians.
