Practice Protocol
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Protocol · PA · Washington

Practice Protocol for Physician Assistants in Washington

Required. Washington law names the instrument a Collaboration Relationship, 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.

Practice authorityConditional independence
Written agreementAgreement required
What Washington calls itCollaboration Relationship
Governing boardWashington Medical Commission and the Washington State Pharmacy Quality Assurance Commission
Agreement familySupervising Physician + Collaborative Practice
Research date2026-09-03 · clauses 2026-09-03

HB 2041 (eff. Jan. 1, 2025) replaced WA's prior supervision-only model with a two-tier system: below the hours threshold, a 'participating physician' supervises per RCW 18.71A.030; above it, the relationship becomes 'collaboration' — consult/refer as indicated, no supervision requirement. Even post-threshold, a filed practice agreement is still required.

Independent practice requires: ≥4,000 hours of postgraduate clinical practice, including ≥2,000 hours in the PA's chosen specialty (a PA changing specialties must complete the first 2,000 hours in the new specialty back under supervision).

What a Washington Collaboration Relationship must contain

Governed by the Washington Medical Commission and the Washington State Pharmacy Quality Assurance Commission. Each numbered item is a statutory requirement the Collaboration Relationship must satisfy.

  1. If the Physician Assistant ("PA") has fewer than four thousand (4,000) postgraduate clinical practice hours, the Physician Assistant shall practice under the supervision of the Physician. If the Physician Assistant has at least four thousand (4,000) postgraduate clinical practice hours in total and at least two thousand (2,000) hours in the Physician Assistant's chosen specialty, the Physician Assistant shall instead practice under a collaboration relationship with the Physician, a less prescriptive arrangement than supervision, as provided under RCW 18.71A.

  2. The supervision or collaboration agreement shall include a plan scaled to the Physician Assistant's completed hours, a communication protocol (in person, electronic, or by phone), a designated backup physician if the Physician is the only physician named, the Physician Assistant's signed attestation of postgraduate hours, and a termination clause requiring thirty (30) days' written notice, or immediate termination for a good-faith concern regarding unprofessional conduct, as required by RCW 18.71A.120. Washington law does not fix a numerical limit on the number of Physician Assistants with whom a physician may enter into such an agreement. The agreement shall be kept at the Physician Assistant's primary practice site and produced to the Washington Medical Commission upon request; it need not be filed with the Commission in advance.

  3. The Collaboration Relationship 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 Collaboration Relationship has to carry, from Washington's supervision rules.

Proximity

below the 4,000-hour supervision tier: Available remotely (no on-site requirement)

The participating physician need not be physically present but must remain 'accessible and involved in the oversight structure' (secondary-sourced characterization of RCW 18.71A.030/.120 — no fixed mile/minute radius located in the statute itself).

Supervision ratio

Not codified — no cap on file

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

Prescribing must fall within the scope of the participating/collaborating physician's own clinical practice, as set out in the filed practice agreement (RCW 18.71A.120). No schedule-specific numeric limit was located in statute.

Written agreement

Required

Practice ownership (corporate practice of medicine)

Licensee-only ownership required — Professional Service Corporation under RCW 18.100 — Washington courts have affirmatively adhered to a corporate-practice-of-medicine doctrine (WA Supreme Court, 2010), but RCW 18.100.050(5)(a) permits a single multi-discipline PSC co-owned across 12 enumerated health professions including physicians, and RCW 18.71A.120(8) explicitly authorizes a licensed PA to independently own a healthcare clinic — a materially more permissive PA-ownership rule than most CPOM states on file.

Ownership eligibility (RCW 18.100) is legally distinct from the clinical supervision/collaboration tier above.

Sources for the supervision rules (5)
How the relationship works day to day
Who has to be where, how often you meet, and what the physician costs: Physician Assistant in Washington on collaborativeagreement.com.

About Washington's rules

Washington is a full-independence state for ALL FOUR ARNP roles (NP, CRNA, CNM, CNS) under RCW 18.79, not just NPs — confirmed current via WAC 246-840-300/420 and Board of Nursing guidance. PAs are separate: HB 2041 (eff. Jan. 1, 2025) replaced supervision-only with a 4,000-hour supervision→collaboration tier (RCW 18.71A.120) with no numeric ratio cap.

Other clinicians in Washington: see the state overview.