Sen. Rachael Cabral-Guevara (R-Appleton) and Rep. Nancy VanderMeer (R-Tomah) began circulating to their colleagues in the legislature a bill draft relating to physician assistants. Please see below a memo to the legislature from the Wisconsin Medical Society asking legislators NOT to sign on as cosponsors. Included in this email is the memo and bill draft from Cabral-Guevara and VanderMeer.
Be assured that our coalition of the Wisconsin Medical Society and physician specialty organizations continue to work on these scope issues.
Please don’t hesitate to contact your state legislators asking them not to sign on to this legislation.
Members of the Wisconsin State Legislature:
On behalf of the Wisconsin Medical Society – the state’s largest physician membership organization representing more than 10,000 physicians statewide – we respectfully urge you not to cosponsor LRB 0509/1 and instead oppose. This proposal would create a path for physician assistants (PAs) to practice independently, which we believe is not in the best interest of Wisconsin patients.
Patients receive the highest-quality care when they have access to physician-led health care teams, which include physician assistants and other professionals. Unfortunately, this bill would further fragment those teams, weakening the collaborative model that best serves patient safety and outcomes.
Physicians undergo the most rigorous education and training of any health care provider. By contrast, PAs complete shorter educational programs (typically 2-2.5 years compared to physicians’ 4 years of medical school) and are not required to complete residency training. Physicians, on the other hand, complete 3-7 additional years of residency after medical school before practicing independently. Clinical experience requirements also differ significantly: approximately 2,000 hours for PAs versus 12,000 - 16,000 hours for physicians. These differences are appropriate because PAs are valued members of physician-led teams – not independent practitioners.
This proposal is an outlier nationally: 45 states currently require physician supervision or collaboration for PAs. Eliminating that requirement in Wisconsin would move us away from the proven team-based model that benefits patients.
Finally, the bill proposes changing the title “physician assistant” to “physician associate.” If the goal is independence from physician-led care, why maintain the term “physician” in the title? This risks confusing patients who reasonably assume that the word “physician” indicates someone who has completed medical school and residency.
There are additional concerning elements within the bill that we would be happy to discuss in detail with you or your staff. Please feel free to contact us with any questions.
Mark Grapentine, JD
Chief Policy & Advocacy Officer
Wisconsin Medical Society
mark.grapentine@wismed.org
CO-SPONSORSHIP MEMORANDUM
TO: All Legislators
FROM: Sen. Rachael Cabral-Guevara
Rep. Nancy VanderMeer
DATE: September 2nd, 2025
RE: Co-Sponsorship of LRB-0509/1 relating to: adopting the title of physician associate for physician assistants, independent practice of certain physician associates, extending the time limit for emergency rule procedures, and providing an exemption from emergency rule procedures.
DEADLINE: Wednesday, September 10th, 2025 at 3:00 P.M.
The Physician Assistant/Associate (PA) profession was established over 50 years ago in response to a critical shortage of physicians, particularly affecting underserved rural and urban communities — a challenge that remains relevant today. This proposal offers a valuable opportunity to ensure that these vulnerable populations throughout Wisconsin continue to have access to high-quality, cost-effective healthcare.
Currently, PAs in Wisconsin are licensed and regulated by the Physician Assistant Affiliated Credentialing Board. There are over 4,600 licensed PAs practicing across the state in diverse medical specialties. All PAs receive comprehensive education and training, earning a Master’s degree through rigorous didactic coursework and more than 2,000 hours of supervised clinical rotations. Wisconsin is home to four accredited PA educational programs. Upon graduation, PAs must pass the Physician Assistant National Certifying Exam (PANCE) administered by the NCCPA before obtaining licensure. To maintain certification, PAs must complete at least 100 hours of continuing medical education every two years and pass a recertification exam every ten years to demonstrate continued medical knowledge in all areas of medicine, regardless of the specialty in which they may practice.
A PA’s scope of practice includes conducting physical examinations, diagnosing and managing illnesses, assisting in surgery, and prescribing medications. Presently, Wisconsin law requires PAs to practice pursuant to a collaborative agreement or under the overall direction and management of a physician.
This bill aims to modernize the PA practice in Wisconsin by allowing PAs who have completed four years of clinical practice with a physician to apply for autonomous practice outside of a formal collaborative agreement — largely mirroring recent changes signed into law for advanced practice registered nurses (APRNs). Importantly, PAs will continue to be restricted to practicing within the bounds of their experience, education, and training to ensure patient safety and would continue to be legally required to consult with or refer to another healthcare provider when a patient's care needs exceed the physician assistant's experience, education, or training. Furthermore, similar to APRN regulations, PAs would be required to collaborate with a physician when using invasive techniques to treat pain syndromes, except when working in hospital or hospital-affiliated clinic settings.
Additionally, the bill updates the professional title from “Physician Assistant” to “Physician Associate.” From the profession’s inception, PAs were never intended to be mere assistants but largely autonomous healthcare providers. The current title has often caused confusion about their role. Adopting the “Physician Associate” title aligns Wisconsin with the national standard used by the AAPA and reflects the terminology embraced by a growing number of countries worldwide, providing clarity and consistency about the important role PAs play in modern healthcare.
We encourage you to join us in co-sponsoring this legislation to support Wisconsin’s healthcare workforce and improve access to care for all communities.
If you would like to cosponsor this legislation, please contact Sen. Cabral-Guevara’s office at 6-0718 or Rep. VanderMeer’s office at 7-9170, or by email.
Analysis by the Legislative Reference Bureau
This bill adopts the term “physician associate” for “physician assistant” in the statutes, changes the title of the credentialing board that licenses physician associates to “Physician Associate Affiliated Credentialing Board,” allows physician associates to assume the title “physician associate” in addition to other titles allowed under current law, and allows a physician associate to practice independently from physicians if the physician associate satisfies certain criteria.
Under current law, a physician assistant who provides care to patients may provide the services of a physician assistant only if there is a physician who is primarily responsible for the overall direction and management of the physician assistant’s professional activities and for assuring that the services provided by the physician assistant are medically appropriate or if the physician assistant has entered into a written collaborative agreement with a physician that describes the physician assistant’s individual scope of practice and includes a protocol for identifying an alternative collaborating physician for situations in which the collaborating physician or the physician’s designee is not available for consultation.
To qualify to practice independently under the bill, a physician associate must satisfy certain criteria, including that the physician associate has completed 7,680 hours of clinical practice as a physician associate while practicing with a physician who is primarily responsible for the overall direction and management of the physician associate’s professional activities and for assuring that the services provided by the physician associate are medically appropriate or while practicing under a written collaborative agreement that satisfies the requirements under current law. In order to qualify to practice independently, the physician associate must maintain certain evidence that, during the 7,680 hours of clinical practice, the physician associate maintained a mutual, professional relationship with at least one physician; maintained documentation indicating the relationships the physician associate had with one or more physicians to deal with issues outside of the physician associate’s knowledge, training, or experience; and maintained evidence that he or she was subject to a quality assurance program, peer review process, or other similar program or process that was implemented for and designed to ensure the provision of competent and quality patient care and that also included participation by a physician. The 7,680 hours of clinical practice may include the lawful practice of the physician associate outside this state or the lawful practice of the physician associate in this state prior to the effective date of this bill, the lawful practice of the physician associate as an employee of the federal government as a civilian or as a member of a uniformed service while performing duties incident to that employment or service, including hours of independent practice outside of a supervisory or collaborative relationship with a physician, and any clinical hours completed pursuant to an educational program that qualifies an individual for licensure as a physician assistant under current law.
The bill provides that, regardless of whether a physician associate has qualified to practice independently, a physician associate may provide treatment of pain syndromes through the use of invasive techniques only while practicing with a physician who, through training, education, and experience, specializes in pain management and who either is primarily responsible for the overall direction and management of the physician associate’s professional activities and for assuring that the services provided by the physician associate are medically appropriate or is under a written collaborative agreement with the physician associate. However, the bill provides that a physician associate may provide treatment of pain syndromes through the use of invasive techniques if the physician associate has qualified to practice independently under the bill and provides treatment of pain syndromes through the use of invasive techniques in a hospital or a clinic associated with a hospital. Further, the bill provides that a physician associate may provide treatment of pain syndromes through the use of invasive techniques if the physician associate has qualified to practice independently under the bill and has privileges in a hospital to provide treatment of pain syndromes through the use of invasive techniques without a collaborative relationship with a physician.
Finally, the bill adds physician associates who have qualified to practice independently as mandatory participants in the Injured Patients and Families Compensation Fund. The Injured Patients and Families Compensation Fund provides excess medical malpractice coverage for health care providers who participate in the fund and meet all other participation requirements, which includes maintaining malpractice liability insurance in coverage amounts specified under current law. Under current law, no physician assistant may practice as a physician assistant unless they maintain such medical liability insurance.
For further information see the state fiscal estimate, which will be printed as an appendix to this bill.
