Physician Assistant Team Based Practice

A team-based setting or team-based practice must be either:

• A medical practice that meets all of the following:
• The majority of the practice is owned collectively by one or more licensed physicians.
• An owner who (1) is an NC licensed physician and (2) has consistent and meaningful participation in the design and implementation of health services to patients.
• The physician and team-based physician assistant that provide services at the medical practice must work in the same clinical practice area.
• A hospital, clinic, nursing home, or other health facility with active credentialing and quality programs where physicians have consistent and meaningful participation in the design and implementation of health services to patients.

• No. Team-based practice is only available to physician assistants that meet all of the following:
• More than 4,000 hours of clinical practice experience as a physician assistant AND more than 1,000 hours of clinical practice experience within the specific medical specialty of practice with a physician in that specialty.
• Practices at a team-based setting or team-based practice.
• Physician assistants, who are not eligible for team-based practice, must practice in accordance with all current NCMB rules pertaining to supervision.

Yes.

No. Team-based practice is not mandatory and whether you can be hired as a team-based physician assistant is up to your employer. If team-based practice is not adopted, then you must follow all current NCMB rules pertaining to supervision.

• PAs who are registered as team-based practice PAs do not need to file an intent to practice or have a supervisory arrangement with a physician. However, team-based practice physician assistants must work in team-based settings alongside licensed physicians who have consistent and meaningful participation in the practice. Physician assistants are required to consult, collaborate and refer with physicians as determined by the team.
• In addition, team-based practice physician assistants are limited to practicing in their registered team-based setting and designated area of practice. If their employment or area of practice changes, they must either file an intent to practice or register with the NCMB if the setting qualifies as a team-based practice.
• While NC laws and rules do not require team-based physician assistants to have supervising physicians, the law does not restrict or limit an employer’s ability impose additional requirements on employees, including supervision. Whether a physician assistant is hired or promoted as a team-based physician assistant is up to the employer. When employers choose not to participate in team-based practice, all physician assistants must comply with current supervision requirements under NCMB rules.
• Physician assistants, who are not eligible for team-based practice, must practice in accordance with all current NCMB rules pertaining to supervision.

• Physician assistants working in perioperative settings will need to be supervised by a physician as determined by NCMB rules. More details will be available in the Spring.
• Physician assistants cannot provide final interpretations of diagnostic imaging. However, they may provide final interpretations of x-rays if they have a supervising physician as determined by NCMB rules. More details will be available in the Spring.
• All physician assistants who compound must be supervised by an NC licensed physician and are subject to traditional supervision rules, including filing an intent to practice, having supervisory arrangements, and quality improvement meetings.

Yes. Employers are free to impose any additional requirements on their employees, including quality improvement meetings.

Yes. Any PA who is eligible for team-based practice and working in an appropriate team-based setting is required to submit proof to the NCMB of team-based practice qualifications. Physician assistants cannot commence practice as a team-based practice until they receive authorization from the NCMB. The process is still being developed. More details will be available in the Spring. Until a physician assistant is registered as a team-based physician assistant with the NCMB, all supervision requirements under NCMB’s current rules must be satisfied.

PAs will be able to apply for team-based practice status either after the NCMB adopts rules or June 30, 2026, whichever takes place first. Until then, all supervision requirements under NCMB’s current rules must be satisfied.

PAs that do not qualify for team-based practice are subject to traditional NCMB rules requiring the PA to complete an intent to practice listing a NC licensed supervising physician, having a supervisory arrangement that includes the PA’s prescriptive authority, and meeting with the supervising physician for the purposes of quality improvement.

No. Team-based practice only applies to team-based settings where a majority of the practice is owned by licensed physicians. A physician owner must have consistent and meaningful participation in the design and implementation of health services to patients in order to qualify. These practices are subject to the current NCMB rules pertaining to supervision.

No. A team-based setting or team-based practice does not include medical practices that specialize in pain management. Physician assistants working in practices that specialize in pain management must follow all rules pertaining to supervision, including maintaining a supervisory arrangement with a supervising physician and having quality improvement meetings. Physician assistants must consult with their supervising physician prior to prescribing targeted controlled substances if the therapeutic use of the targeted controlled substance will or is expected to exceed a period of 30 days.