Protocol · PA · Virginia
Practice Protocol for Physician Assistants in Virginia
Required. Virginia law names the instrument a Practice Agreement, and the clinical protocol is the content that instrument carries. Below: the board that governs it, what it must contain, and the terms it has to carry.
Pathway created by § 54.1-2952.01 (H.B. 746, Acts 2026 c. 418); contingent on Board of Medicine implementing regulations — confirm current effective status before treating as live. Separately, PAs employed by a hospital (§ 32.1-123), a state facility (§ 37.2-100), or an FQHC may already practice without a written practice agreement under § 54.1-2951.1(E).
Independent practice requires: ≥3 years full-time clinical experience, defined as 1,800 hours/year (~5,400 hours total); attestation from one or more patient care team physicians/podiatrists who supervised that experience (attestations from multiple physicians may be aggregated).
What a Virginia Practice Agreement must contain
Governed by the Virginia Board of Medicine and the Virginia Board of Pharmacy. Each numbered item is a statutory requirement the Practice Agreement must satisfy.
Unless the Physician Assistant is authorized to practice without a practice agreement under Va. Code § 54.1-2952.01, the Physician Assistant ("PA") shall practice pursuant to a written or electronic practice agreement with the Physician as required by Va. Code § 54.1-2952 and 18VAC85-50-101. The practice agreement shall describe the roles and functions of the Physician Assistant and the Physician, the scope of tasks delegated to the Physician Assistant consistent with the Physician Assistant's training and experience, and guidelines for the Physician's availability for consultation, collaboration, and input on complex clinical cases, emergencies, and referrals. Continuous supervision by the Physician is required, but the Physician's physical presence at the Physician Assistant's practice site is not.
A licensed physician may not serve as patient care team physician or podiatrist to more than six (6) Physician Assistants at any one time, as provided under Va. Code § 54.1-2952. A Physician Assistant who has completed the equivalent of at least three years of full-time clinical experience (1,800 hours per year) in a specific clinical specialty or practice area may obtain from the Virginia Board of Medicine a license designation authorizing the Physician Assistant to practice without any practice agreement within that specialty or practice area, upon the Board's receipt of a qualifying attestation under Va. Code § 54.1-2952.01. Where the Physician Assistant holds that designation, this Agreement's practice-agreement terms as to the Physician Assistant are not themselves required by Virginia law as a condition of the Physician Assistant's authority to practice, and instead serve only to define the working relationship the Parties choose to maintain.
- The Practice Agreement also carries 2 scope, 1 education and 1 registration clauses, authored in the document itself.
Statutes and rules these clauses cite
- Va. Code §§ 54.1-2952, 54.1-2952.01statute
Six-physician-assistant-per-physician cap (§ 54.1-2952) and the autonomous-practice attestation pathway for physician assistants with three years/1,800 hours-per-year of full-time clinical experience (§ 54.1-2952.01).
Terms it has to carry
Ratio, proximity, chart review, meeting and prescribing terms the Practice Agreement has to carry, from Virginia's supervision rules.
Proximity
Available remotely (no on-site requirement)
No codified mile/minute radius. Practice agreement must address 'the nature of the physician's or podiatrist's availability in ensuring direct involvement at an early stage and regularly thereafter,' and may include periodic site visits when the PA practices at a location separate from the supervising physician (18VAC85-50-101).
Supervision ratio
Up to 6 at a time
No patient care team physician or podiatrist may collaborate/consult with more than 6 PAs at any one time (§ 54.1-2952). Not stated as combined with the separate NP cap.
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Practice agreement must specify which Schedule II–VI controlled substances/devices the PA is or is not authorized to prescribe; requires ≥35 hours of Board-approved pharmacology training (§ 54.1-2952.1).
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — No Virginia statute enumerates PAs as an eligible independent owner of a healing-arts professional corporation (§ 13.1-543) or PLLC (§ 13.1-1102); practice ownership likely requires a physician-owned entity (or an APRN-owned one, see the NP entry)
The 2026 PA autonomous-practice pathway (§ 54.1-2952.01) removes the clinical practice-agreement requirement once qualified, but does not itself amend Title 13.1's entity-ownership rules — confirm whether an autonomous PA gains an independent ownership pathway before relying on this.
Sources for the supervision rules (5)
About Virginia's rules
No provider type below has a codified chart-review percentage, countersignature rule, or numeric proximity radius — all are left to the practice agreement. CPOM (ownership) is governed by Title 13.1's PC/PLLC statutes, which explicitly list APRNs (NP/CRNA/CNM/CNS) as eligible independent owners but do not enumerate PAs — the PA ownership pathway is an inference from that omission, not a confirmed holding. Virginia has no independent corporate-practice-of-medicine common-law doctrine (a 1992 AG opinion, secondary-sourced only).
Other clinicians in Virginia: see the state overview.