Maryland modernized physician assistant practice. Now, lawmakers should finish the job

I care for roughly 1,400 primary care patients on Maryland’s Eastern Shore. If the physician listed on my collaboration agreement retired tomorrow and no other physician remained on that agreement, Maryland law could force me to stop seeing those patients. My education, license and competence would not change. Only the paperwork would.

That is not a hypothetical. Under current Maryland law, a physician assistant may practice only after notifying the State Board of Physicians that an executed collaboration agreement exists. If the physician suddenly leaves, becomes incapacitated, dies or can no longer legally practice, and no other physician remains listed, the PA cannot continue practicing until a new agreement is executed.

Maryland calls this collaboration. In practice, it is legal dependency.

I have practiced as a PA since 2012 and co-own an independent primary care practice serving Wicomico and Dorchester counties. I collaborate every day, consulting physicians, specialists, pharmacists and other PAs, because good medicine requires teamwork. What I question is the idea that teamwork exists only when the state requires another clinician’s name on my paperwork.

Maryland has made real progress: The 2024 Physician Assistant Modernization Act replaced delegation agreements with collaboration agreements, and the 2026 Physician Assistant Parity Act, effective Oct. 1, extends PA authority into areas already open to other health professionals. As a former legislative director for the Maryland Academy of Physician Associates, I worked with Sen. Mary Beth Carozza and members of the General Assembly on earlier versions of that effort. Neither law addressed the central problem: A PA’s ability to practice still depends on a physician remaining listed on the agreement.

That dependency is most dangerous where care is hardest to find. Maryland’s Rural Health Transformation Program identifies recruiting and retaining rural clinicians as a state priority. On the Eastern Shore, losing one clinician means longer waits, farther drives and more reliance on emergency rooms.

The evidence supports relying more on PAs: A 2018 study of 368,481 veterans with diabetes found no clinically significant differences in diabetes control among patients managed by physicians, PAs or nurse practitioners, and a 2019 study of 47,236 medically complex patients found that PA- and nurse practitioner-led care was associated with 6% to 7% lower adjusted costs and less emergency and inpatient use.

Removing the mandatory agreement would not remove accountability. PAs would remain licensed, subject to discipline and accountable to applicable professional, facility, and credentialing standards, just as we are now. What would change is the basis of legal authority to practice: a PA’s own licensure, education, and training, not whether a physician remains listed on the agreement.

Patients, clinicians, and health system leaders on the Eastern Shore should ask their state delegates and senators to support amending Maryland’s Health Occupations Article to end the mandatory collaboration agreement, while keeping consultation, referral and disciplinary oversight in place.

Maryland has already acknowledged its PA laws needed to change. Lawmakers should finish the job before an administrative agreement separates another patient from a clinician they already know and trust.