Which state does not require a supervising physician for PAs?

• A. Iowa
• B. Montana
• C. New Hampshire
• D. New York

Answer: (A)

The key idea here is that supervision rules for physician assistants vary by state, shaping how autonomous a PA can be in daily practice. In this case, the state that does not require a supervising physician for PAs is Iowa. That means PAs in Iowa can operate under a collaborative or protocol-based framework without the necessity of an ongoing, in-person supervising physician to oversee every patient encounter. The supervising physician relationship exists, but the law does not mandate a physician be physically present or directly supervise all activities.

In the other states listed, the practice acts require some form of physician supervision or a formal collaborative relationship for a PA to practice. This typically involves a supervising or collaborating physician who is responsible for oversight, availability for consultation, and sometimes sign-off or adherence to a written protocol or agreement. The specifics can vary—some states require direct supervision for certain procedures, others require ongoing collaboration or a supervisory protocol.

So, Iowa stands out because it does not impose the same mandatory physician supervision structure on PAs as Montana, New Hampshire, and New York do, allowing PAs to practice with a different level of autonomy under state rules.