Optimal Team Practice and the Advantages for PAs

Jennifer Vonderau
5 days ago
3 min read

An Oregon Case Study

Oregon was the first state in the US to officially change the PA name from Physician Assistant to Physician Associate in June 2024 (Oregon.gov). And the changes for PA practice in Oregon are definitely not in name only.

Also in 2024, Oregon fully transitioned to a "Collaborative Practice" model (Oregon.gov). In a "Collaborative Practice," direct physician supervision is no longer required; instead, PAs and physicians have Collaboration Agreements. But this isn't just a change in paperwork. These changes, collectively a part of Optimal Team Practice (OTP), mark a fundamental shift in how PAs practice, and it is significantly impacting the job market in Oregon and the opportunities for the PAs who work there.

What is OTP?

Optimal Team Practice is the professional standard where PAs, physicians, and other medical professionals work together with fewer burdensome administrative restrictions. In Oregon, this was codified through HB 3036 and HB 2584 (Oregon.gov).

These three components of practice law in Oregon are most impactful to PAs:

No "Supervising Physician": You are no longer legally "supervised" by a specific person. Instead, you enter into a Collaboration Agreement with an employer or a physician.
Autonomous Responsibility: PAs are now legally responsible for the care they provide. This puts PAs on a more equal footing with Nurse Practitioners (NPs).
Practice-Level Decisions: The degree of collaboration is now decided at the clinic level, not by rigid state mandates.

The Impact of OTP on PA Job Opportunities and Practice

By collecting data using the employer information at FindPAJobs.com, we can deduce a few ways that OTP is creating more opportunities for PAs:

1. Parity with NPs

For years, some health systems preferred hiring NPs over PAs because NPs required less direct supervision to practice and bill. With Oregon’s shift to OTP, that distinction is removed. Many roles in Oregon are named for an "Advanced Practice Provider" (APP), where both PAs and NPs are accepted for the position. This puts PAs and NPs on a more level playing field for job opportunities and growth.

2. Growth in Rural and Underserved Areas

Previously, if a small clinic in rural Oregon lost its one supervising physician, the PA could no longer legally see patients, forcing the clinic to close. Under OTP, PAs have more stability. Over half the job postings in Oregon are for positions in rural areas (cities with populations < 100,000 people).

3. Roles for "Clinically Experienced PAs"

Oregon law now recognizes PAs with over 2,000 hours of experience as being ready for higher levels of autonomy. There is now a distinction for PAs with significant practice experience to advocate for leadership roles and greater autonomy.

Oregon PA Jobs in Numbers

Our recent pull of Oregon job data shows a high concentration of roles in these expanding sectors:

Urgent Care & ER: 18% of recent listings (Benefiting from flexible staffing models).
Primary Care: 25% of recent listings (Filling the gap in physician-shortage areas).
Medical and Surgical Specialties: 45% of new listings (Utilizing the "Team-Based" efficiency of OTP).

How Does My State Compare?

Oregon is currently the most "modern" state in the country for PA practice. But several other states followed in changing PA practice law to include OTP and advanced autonomy for PAs.

These states include North Carolina, Utah, North Dakota, South Dakota, Iowa, Wyoming, Montana, and New Hampshire.

Oregon, Maine, and New Hampshire are the only states that have formally changed to the Physician Associate title.

Practice Model	Key States	Legal Relationship	Who Defines Scope of Practice
Optimal (OTP)	OR, NC, ND, UT, WY, IA, NH	Collaboration (No specific person named)	The PA and the employer/ clinic
Advanced	MI, MN, RI, VT, MA	Collaboration (Physician often still named)	Mostly defined at the practice level
Moderate	TX, FL, IL, PA	Supervision (Specific Physician required)	Defined by state board and/ or supervising MD
Restricted	CA, NY, AL	Strict supervision (Supervisory ratios, co-signatures)	Rigidly defined by state law