By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Healthcare workforce shortages continue to pressure hospitals, physician practices, and healthcare systems nationwide. In response, states are increasingly turning to interstate licensure compacts as a way to improve access to care and increase provider mobility. One of the newest developments in this area is the Physician Associate (PA) Licensure Compact, an emerging interstate agreement designed to streamline multistate practice for physician associates/physician assistants (PAs).
The proposed compact reflects a growing national trend toward reducing licensing barriers for healthcare professionals. Similar compacts already exist for nurses, physicians, psychologists, EMS personnel, and physical therapists. These agreements generally allow qualified professionals licensed in one participating state to practice in other member states without going through the entire onerous application process and obtaining a completely separate license in each state.
The PA Compact is the collaborative effort of the Federation of State Medical Boards (FSMB), the American Academy of Physician Associates (AAPA), the National Commission on Certification of Physicians Assistants (NCCPA) and The Council of State Governments (CSG). The initiative began in 2019 with grant support from the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of funding for the Licensure Portability Grant Program.
What the Physician Associate Licensure Compact Could Mean for PAs.
For physician assistants, the PALC could significantly enhance workforce flexibility, particularly in rural and underserved communities. Healthcare organizations struggling with staffing shortages may gain faster access to qualified professionals, while PAs could benefit from expanded employment opportunities across multiple states. Healthcare organizations struggling with staffing shortages may gain faster access to qualified professionals, while PAs could benefit from expanded employment opportunities across multiple states.
However, healthcare professionals should understand that the compact is not a “free pass” to practice anywhere without regulatory oversight. Each participating state still maintains authority over licensing requirements, scope of practice, prescribing authority, supervision standards, and disciplinary enforcement.
State Laws and Scope of Practice Still Apply.
A physician associate practicing under compact authority remains subject to the laws and regulations of the state in which the patient is located. This means that a PA practicing in multiple states may face different requirements regarding physician collaboration, chart review obligations, controlled substance prescribing, and telehealth standards.
Healthcare professionals who fail to recognize these differences may unintentionally violate state laws or licensing board regulations. Employers must also ensure that their policies and credentialing procedures reflect the legal requirements of every jurisdiction in which their providers practice.
Telemedicine Creates Additional Compliance Risks.
The PALC may be particularly significant for telemedicine providers and multi-state healthcare organizations. As virtual care continues to expand, physician associates increasingly provide services to patients located across state lines. Unfortunately, many providers underestimate the complexity of multistate compliance.
Organizations should carefully evaluate malpractice coverage, payer enrollment, collaborative practice agreements, and state-specific telehealth requirements before authorizing compact-based practice. Even seemingly minor oversights can lead to licensing investigations, reimbursement denials, or allegations of unauthorized practice.
Disciplinary Actions May Follow Providers Across State Lines.
Another important issue involves disciplinary reporting and information sharing among member states. Most interstate licensure compacts include centralized systems that allow participating states to exchange information regarding investigations, sanctions, license restrictions, and adverse actions.
As a result, disciplinary problems in one state can quickly impact a provider’s ability to practice in other compact states. Healthcare professionals should recognize that increased portability often comes with increased regulatory transparency and scrutiny from state licensing boards.
Healthcare Providers Should Prepare for Regulatory Changes.
As more states consider adopting the Physician Associate Licensure Compact, healthcare professionals and employers should expect ongoing regulatory developments and implementation guidance. Physician associates considering multistate practice should consult experienced health law counsel before relying on compact privileges, particularly when telemedicine or controlled substance prescribing is involved.
Healthcare entities should also proactively update credentialing policies, compliance procedures, and employment agreements to address this evolving legal landscape. Although the PALC may create substantial opportunities for healthcare access and workforce mobility, providers must fully understand the legal obligations that accompany interstate practice.
As of June 2026, Florida has not enacted the PA Compact into its legislation.
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Sources:
Radix, Stephanie. “Understanding the Physician Associate Licensure Compact.” Health Law Connections, American Health Law Association. (November 1, 2025). Web.
“PA Licensure Compact.” American Academy of Physician Associates (AAPA). (May 21, 2026). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2026 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced in any way in any medium without the written permission of the copyright owner. The author of this work reserves the right to have his name associated with any use or publication of this work or any part of it.
