Iowa Board of Medicine Establishes Minimum Supervision of Physician Assistants

From the Iowa Medical Society (hat tip: Dr. Menadue):

The Iowa Board of Medicine (IBM) recently announced adoption of a new administrative rule which establishes minimum standards for appropriate physician supervision of physician assistants (PA). IMS developed a brief summary to help physicians navigate and comply with the new rules.

In 2015, the Iowa Board of Physician Assistants (IBPA) noticed a proposed rule to eliminate the requirement for physicians and remote-site PAs to meet in-person at least once every two weeks. Physician organizations, including IMS, objected to elimination of the requirement, and through the process discovered that Iowa was the only state in the nation that did not grant its board of medicine clear authority to regulate physician supervision of PAs.

In response, the legislature enacted a bill requiring the IBM and the IBPA to work together to promulgate joint supervision rules. A subcommittee consisting of members from both boards met several times over the course of months and eventually agreed to a set of rules. Included in the rules was a requirement that physicians meet with PAs at least two times a year, that if the PA works primarily at a remote site clinic both meetings take place there, and that the two meetings be documented. This rule was intended to replace the requirement that physicians meet with remote site clinics in person every two weeks. After that set of rules was approved by the subcommittee, both licensing boards then needed to adopt the rules.

The IBM voted to formally adopt the rules last winter; they are now in effect and binding on Iowa physicians. However, the IBPA voted several times against adopting the rules. Because the IBPA did not adopt the rules, the process for rescinding the requirement that physicians meet with PAs in person every two weeks has stalled. Unfortunately, this means that physicians are currently bound by both rules: to meet with remote-site clinic PAs in person every two weeks as well as to meet with all PAs two times each year and document those visits.

The directive from the legislature required both the IBM and the IBPA to adopt joint rules. There is no precedent for a situation where a licensing board has not complied with a legislative directive, so it is unclear how the legislature and the Administrative Rules Review Committee will proceed.

IMS will continue to monitor the progress of the rules and keep members updated. In the meantime, if you have any questions about PA supervision, please contact Kate Strickler at


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