Protocol · PA · Massachusetts
Practice Protocol for Physician Assistants in Massachusetts
Massachusetts does not define a named protocol for Physician Assistants. Here is what the state does require and what a written protocol usually covers.
MA has no independent-practice pathway for PAs — 243 CMR 2.08 requires ongoing physician supervision for the PA's full career, regardless of experience. No NC/VA-style autonomous-practice reform exists in MA as of this writing.
What a Physician Assistant protocol must contain in Massachusetts
Massachusetts requires a written protocol but gives it no statutory name. Governed by the Massachusetts Board of Registration in Medicine and the Massachusetts Board of Registration in Pharmacy. Each numbered item is a requirement the protocol must satisfy.
The Physician Assistant ("PA") shall practice under the continuous supervision of the Physician, as required by M.G.L. c. 112 §§ 9E-9I and 263 CMR 5.00. Supervision does not require the Physician's physical presence. The scope of practice and prescriptive parameters shall be set by guidelines mutually developed by the Physician and the Physician Assistant.
Massachusetts law does not fix a numerical limit on the number of Physician Assistants one physician may supervise; the adequacy of supervision is instead assessed by a multi-factor test considering geographic proximity, practice setting, patient volume and complexity, and the experience of the physician and the Physician Assistant.
- The protocol also carries 1 scope, 1 education and 1 registration clauses, authored in the document itself.
Terms it has to carry
Ratio, proximity, chart review, meeting and prescribing terms the protocol has to carry, from Massachusetts's supervision rules.
Proximity
Available remotely (no on-site requirement)
243 CMR 2.08(5)(a): supervision 'does not require the physical presence of the supervising physician' whenever the PA renders services; no mile/minute radius is codified. Diagnostic/treatment information must still be reviewed 'in a timely manner consistent with the patient's medical condition' — a continuous duty, not a fixed percentage quota.
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
PA has prescriptive practice authority: Quarterly
Supervising physician must review the PA's prescriptive practice at least every three months (243 CMR 2.08(6)).
review of the written prescriptive-practice guidelines themselves: Annually
Guidelines must be reviewed, dated, and initialed by both the PA and supervising physician at least annually (243 CMR 2.08(6)).
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Schedule II–V per mutually-developed written guidelines; Schedule II prescriptions specifically require supervising-physician review within 96 hours of issuance (243 CMR 2.08(6)). Requires MA Controlled Substance Registration and DEA registration; opioid prescribing must comply with MassPAT (M.G.L. c. 94C).
Written agreement
Required
MA does not require a single freestanding 'supervision agreement' document the way some states do — a PA registers a supervising physician with the Board, and written, mutually-developed 'guidelines' are specifically required for prescriptive practice (243 CMR 2.08(6)). Treated here as agreementRequired=True because prescriptive guidelines are the practical equivalent for any prescribing PA.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional corporation under M.G.L. c. 156A; one of the strictest corporate-practice-of-medicine regimes, generally limiting ownership of a medical practice entity to licensed physicians
These exceptions are the commonly cited categories in Massachusetts corporate-practice commentary.
Sources for the supervision rules (2)
About Massachusetts's rules
Full practice authority (Acts 2020, c. 260, § 36; 244 CMR 4.00) lets NPs, PMHNPs and CNMs practice independently in Massachusetts: CNMs immediately, NPs and PMHNPs after a Board-attested transition (244 CMR 4.07). PAs and CRNAs have no independent-practice pathway. Massachusetts's professional-corporation ownership rules (M.G.L. c. 156A) are notably strict, and APRN and PA entity ownership remains unsettled.
Other clinicians in Massachusetts: see the state overview.