Washington PA Collaboration Requirements Summary

Washington requires every PA to have a collaboration agreement with at least one participating physician, and the nature of that relationship changes at 4,000 hours. A PA with fewer than 4,000 hours of postgraduate clinical practice must work under supervision, following a supervision plan written into the agreement and worked out at the practice site. Past 4,000 hours, with at least 2,000 of them supervised in the PA’s chosen specialty, the PA works in collaboration instead. Nothing is filed with the state — the Washington Medical Commission no longer collects PA practice agreements — and the agreement is kept at the PA’s primary practice location instead. Washington is explicit that the PA retains responsibility for their own acts that constitute the practice of medicine. This page covers Washington’s rules on the collaborative relationship, the collaboration agreement, board filing, ongoing compliance, prescribing, and specialty and telehealth requirements.

Source: RCW 18.71A.030(2)

Type of Collaborative Relationship

Washington requires a collaboration agreement with one or more participating physicians, with the depth of oversight tied to the PA’s hours. Below 4,000 hours of postgraduate clinical practice, a PA works under supervision as described in the agreement and determined at the practice site. At 4,000 hours, provided 2,000 or more of those hours were supervised in the PA’s chosen specialty, the PA moves to collaboration, and physician involvement drops. Washington states plainly that the PA retains responsibility for any act constituting the practice of medicine when the PA performs it. There is no route to practicing without an agreement.

Source: RCW 18.71A.030(3)(b)

What is a PA’s scope of practice in Washington?

PAs in Washington may practice in any area of medicine or surgery, so long as the practice is not beyond the scope of expertise and clinical practice of the participating physician or physicians, or of the group of physicians within the department or specialty area where the PA practices. The collaboration agreement may only include acts, tasks, or functions the PA is qualified to perform by education, training, or experience.

Do PAs need a collaborating physician in Washington?

Yes. A PA must have a collaboration agreement identifying at least one participating physician, and if a termination leaves no participating physician designated, a new one must be added for the agreement to remain valid.

Can PAs practice independently in Washington?

No, a collaboration agreement with a participating physician is always required. What changes at 4,000 hours is that supervision gives way to collaboration and physician involvement drops substantially.

How many PAs can a physician collaborate with in Washington?

Washington sets no limit on the number of PAs a physician may collaborate with.

Who can be a collaborating physician in Washington?

A physician licensed in Washington whose scope of expertise and clinical practice covers what the PA is doing — or a physician in the group practicing within that department or specialty area. Experienced PAs get an exception: a PA with at least 10 years or 20,000 hours of postgraduate clinical experience in a specialty may continue providing those specialty services even when employed in a setting where those services fall outside the participating physician’s specialty.

Are there proximity or in-person requirements in Washington?

No, Washington sets no distance, travel, or on-site presence requirement, and no standard for how quickly the participating physician must be reachable. The collaboration agreement must set out a process for communication, availability, and decision making, and those communications may happen in person, electronically, by telephone, or by another method.

Collaboration Agreement Requirements

Washington’s written agreement is called a collaboration agreement, and the state provides a template. It must cover seven things, from the parties’ duties through a termination provision. The PA signs it along with the participating physician or physicians, or the employer. It must be available either electronically or on paper at the PA’s primary practice location and produced to the commission on request. Washington sets no review or renewal schedule.

Source: RCW 18.71A.120(2)

What must be included in a PA collaborative agreement in Washington?

Seven things: the duties and responsibilities of the PA and the participating physician or physicians, including the supervision or collaboration requirements for specified procedures or areas of practice based on the PA’s hours; a process for communication, availability, and decision making, including during an unforeseen health care crisis; a protocol for designating another participating physician for consultation if only one is named; the signature of the PA plus the participating physician or physicians or employer; a plan for how the PA will be supervised, if the PA is working under supervision; the PA’s attestation of postgraduate clinical practice hours completed, including hours in a chosen specialty; and a termination provision. Washington provides a state template.

What is the collaborative agreement called in Washington?

It is called a collaboration agreement. Washington refers to the physicians named on it as participating physicians.

Who has to sign the collaborative agreement in Washington?

The PA, plus the participating physician or physicians, or the employer.

How often must the agreement be reviewed or renewed in Washington?

Washington sets no review or renewal schedule for the collaboration agreement. The PA’s attestation of hours is made at the time the PA signs the agreement.

Is a backup physician required in Washington?

No standing backup physician is required, but if the agreement names only one participating physician, it must include a protocol for designating another participating physician for consultation when that physician is unavailable.

Board Filing Requirements

Washington requires no board filing for the collaborative relationship. The Washington Medical Commission no longer collects PA practice agreements; instead the collaboration agreement must be available electronically or on paper at the PA’s primary practice location and produced to the commission on request. No additional documents are required, there is no recurring filing, and no notice goes to the board when a relationship ends.

Source: RCW 18.71A.120(1)(f)

Do you have to file the collaborative agreement with the board in Washington?

No. The Washington Medical Commission no longer collects PA practice agreements. The agreement is kept at the PA’s primary practice location, electronically or on paper, and made available to the commission on request.

Can a PA start practicing as soon as they file in Washington?

There is nothing to file for the collaborative relationship, so no waiting period applies. A PA needs a Washington license and a signed collaboration agreement available at their primary practice location. Moving from supervision to collaboration at 4,000 hours also requires no board submission — the PA is responsible for tracking their own hours.

What are the termination and notice requirements in Washington?

No notice goes to the board, but the collaboration agreement itself must contain a termination provision with a 30-day written notice requirement. Either the PA or a participating physician may terminate immediately instead where there are good-faith concerns about unprofessional conduct or failure to practice medicine with reasonable skill and safety. A PA or physician may also end the agreement as to one participating physician without ending it for the others, though if that leaves no participating physician designated, a new one must be added for the agreement to stay valid.

Collaboration Compliance

Washington sets no fixed ongoing compliance numbers — no chart review, no meeting cadence, no chart co-signature, no availability standard, no supervision documentation, and no records retention period. For a PA with fewer than 4,000 hours, the agreement’s supervision plan is what governs, and how supervision actually works is determined at the practice site. The PA is responsible for tracking their own postgraduate clinical hours, including hours in a chosen specialty.

Source: RCW 18.71A.120(2)(e)

How many charts must a collaborating physician review in Washington?

None — Washington requires no chart review. There is no chart co-signature requirement either. A PA working under supervision must have a plan in the collaboration agreement for how that supervision will work, and that plan may address record review if the parties choose.

How often must a PA and collaborating physician meet in Washington?

Washington sets no required meeting cadence. The collaboration agreement must establish a process for communication, availability, and decision making when providing treatment or during an unforeseen crisis, and those communications may be in person, electronic, by telephone, or by another method.

How long must collaboration records be kept in Washington?

Washington sets no retention period for collaboration records and requires no supervision documentation. The collaboration agreement itself must remain available at the PA’s primary practice location, and the PA must track their own postgraduate clinical hours.

Prescribing Rules

Washington’s master regulatory data records no additional state prescribing requirements for PAs. There is no state controlled-substance registration, no additional credential for prescriptive authority, no heightened oversight tied to controlled substances, and no prescription form requirements. Washington does maintain detailed rules governing the treatment of pain, which apply to prescribing in that context.

Source: WAC 246-918-800 through WAC 246-918-935

Can a PA prescribe controlled substances in Washington?

Washington’s master regulatory data sets no additional state requirements for PA controlled-substance prescribing. There is no extra credential, no state registration, and no heightened supervision requirement tied to controlled substances. Washington’s pain treatment rules do apply where relevant.

Can a PA prescribe Schedule II drugs in Washington?

Washington’s master regulatory data does not address drug schedules individually for PAs. Prescribing follows from the acts, tasks, and functions included in the collaboration agreement, which must be within the PA’s qualifications and within the participating physician’s scope of expertise and clinical practice.

What schedule drugs can a PA prescribe in Washington?

Washington’s master regulatory data sets no schedule-by-schedule limits on PA prescribing. The collaboration agreement defines what the PA may do, bounded by the PA’s education, training, and experience and by the participating physician’s scope of expertise and clinical practice.

Does a PA need a DEA license in Washington?

Washington imposes no state controlled-substance registration requirement on PAs. Federal DEA registration requirements apply independently of state law and are not addressed in Washington’s rules. Washington sets no prescription form or prescription pad requirements.

Can a PA prescribe independently (without physician sign-off) in Washington?

Washington requires no physician sign-off, co-signature, or prescription-level review. Prescribing must stay within what the collaboration agreement authorizes, and a PA working under supervision is also bound by the supervision plan in that agreement.

Specialty & Telehealth Requirements

Washington’s master regulatory data does not address telehealth-specific or specialty-specific requirements for PAs. Specialty does shape the relationship elsewhere in Washington’s rules, through the hours a PA needs in a chosen specialty and through the matching between the PA’s practice and the participating physician’s expertise.

Are there telehealth or telemedicine requirements for PAs in Washington?

Washington sets no telehealth-specific requirement for PAs in the master regulatory data. Washington also sets no in-person or proximity requirement that telehealth would need an exemption from, and it expressly allows the required communication between a PA and a participating physician to happen electronically or by telephone.

Are there specialty-specific requirements for PAs in Washington?

Washington sets no specialty-specific practice requirements for PAs in the master regulatory data, but specialty drives the transition rules. A PA needs 2,000 supervised hours in their chosen specialty as part of the 4,000-hour threshold, and a PA who changes specialties after 4,000 hours must complete the first 2,000 hours in the new specialty under supervision. A PA with 10 years or 20,000 hours in a specialty may keep providing those services outside the participating physician’s specialty.