Bill Name: Senate Bill 47 (SB 47)

Primary Sponsor: Senators Joyce Krawiec, Jim Burgin, & Kevin Corbin

Status: 2/27/2023 passed House and sent to Senate

AmSpa’s Take: Reducing the amount of regulation and paperwork with which advanced practitioners such as physician assistants (PAs) and nurse practitioners (NPs) need to comply to practice frees up time and resources that can be better spent seeing patients, improving their skills and developing their practices.

Outlook: This bill is in the first steps of the process but, based on the sponsor’s past records, it has a higher likelihood of passing. Some of the sponsors hold leadership positions on the committee where this bill was assigned.

Analysis: Currently, North Carolina physician assistants (PAs) practice under the supervision of a physician. This supervising physician delegates the health care tasks that the PA may perform. The relationship is formalized using a written supervision agreement, which lays out what tasks and medications are authorized. Under SB 47, PAs would be able to practice without a written agreement in certain practice settings.

This new practice relationship is termed “team-based practice.” Team-based settings are defined as: 

1. Hospitals and other facilities with credentialing where physicians have consistent participation in providing services; or
2. Practices that are majority physician-owned, where physicians actively practice and participate alongside the PAs. 

  In these qualifying facilities, PAs can practice without written agreements or supervision by collaborating, referring and consulting with appropriate members of the health care team. PAs in these situations would be responsible for the services they provide. In order to qualify for this new practice, the PA must:

1. Have more than 4,000 hours of clinical practice experience;
2. Have at least 1,000 hours in their current specialty;
3. Submit proof of these requirements to the board; and
4. Practice in an eligible team-based setting.

While SB 47 certainly would increase the practice autonomy of PAs, the limitations on setting and the high entry requirements would have limited application in an aesthetic medical or medical spa-type practice. The majority of states allow nurse practitioners to practice independently; more recently, many states have been giving more freedom and autonomy to PAs, as well. SB 47 is squarely within this trend. If you would like additional information, to read the language of the bill or to contact the sponsors or committee, you can find the information you need through this link.