Obtaining a Physician Assistant (PA) license is more than just a bureaucratic step—it is a legally mandated process that determines whether you can practice, prescribe medications, and work within a defined scope in your chosen state. While physician assistant education and national certification follow a standardized pathway, licensure is state-specific, with every medical board imposing its own regulatory hurdles, fees, and procedural requirements.

For new PA graduates, the licensing process can be overwhelming, given the sheer number of documents, exams, and approvals required before being granted full practice rights. Similarly, for PAs relocating to a different state, navigating the complexities of license transfer, supervision agreements, and controlled substance registration can be a time-consuming endeavor. The process becomes even more intricate for internationally trained PAs, who must undergo credential verification and additional examinations before they can practice in the U.S.

This guide is written for professionals who already understand the role of a PA but need a technical, in-depth roadmap on securing licensure. Whether you are entering the profession for the first time, seeking multi-state licensure, or reinstating a lapsed license, this guide will walk you through every aspect of the PA licensing process, from prerequisites to renewal compliance.

Unlike certification, which is nationally standardized through the National Commission on Certification of Physician Assistants (NCCPA), PA licensure is controlled at the state level. Each state medical board sets its own requirements, renewal timelines, and regulations regarding supervision, prescriptive authority, and scope of practice.

The following regulatory bodies play a key role in the licensure and oversight of PAs in the U.S.:

• State Medical and Licensing Boards – The primary regulators responsible for issuing licenses and enforcing state-specific PA practice laws.
• National Commission on Certification of Physician Assistants – The organization that administers the Physician Assistant National Certifying Examination (PANCE), which is required for initial licensure in every state.
• Federation of State Medical Boards (FSMB) – A national body that helps standardize licensing processes, maintains disciplinary records, and facilitates license verification for those moving between states.

While all states require PANCE certification, not all states have identical licensure rules. Understanding state-specific requirements is crucial, especially when moving between jurisdictions.

Before applying for licensure, several fundamental prerequisites must be met. These requirements are consistent across all 50 states, though some variations exist in additional coursework, background checks, and jurisprudence exams.

To be eligible for licensure, a candidate must complete a physician assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). Accreditation ensures the program meets national standards for medical education, clinical training, and competency assessment.

Graduating from a non-accredited program may render you ineligible for both PANCE registration and state licensure, making program selection critical for long-term career viability.

The PANCE is the nationally recognized certification exam for PAs and is required for initial licensure in all 50 states.

Exam Overview

• Consists of 300 multiple-choice questions
• Divided into five 60-question blocks
• Covers major organ systems, diagnostic tests, and clinical management
• Administered by the NCCPA

Exam Registration & Fees

• Registration is completed through NCCPA’s online portal
• The cost of the exam is $550
• Candidates must wait 90 days post-graduation before sitting for the exam

If a candidate fails the PANCE, they can retake it up to 6 times within 6 years before having to restart the certification process.

Once a physician assistant has met all prerequisites, the next stage is navigating the state-specific licensure process. This phase requires submitting applications, completing background checks, fulfilling documentation requirements, and—depending on the state—passing additional exams or securing a supervision agreement. Because licensure is regulated at the state level, specific requirements and processing times vary. However, the general process follows a structured pathway that ensures compliance with medical board regulations. Below is a step-by-step breakdown of what to expect during this critical stage.

Before submitting an application, a PA must ensure that they have compiled all necessary documentation to avoid delays in processing. Missing or incomplete paperwork is one of the most common reasons for delays and rejections. Most state medical boards require the following:

• Official transcripts from an ARC-PA accredited program – These must be sent directly from the educational institution to the licensing board.
• PANCE certification verification from NCCPA – States require direct confirmation from the NCCPA that the PA has passed the national certification exam.
• State-specific jurisprudence exam results (if applicable) – Certain states mandate a jurisprudence exam to assess knowledge of state medical laws, ethical standards, and practice regulations.
• FBI fingerprinting and background check clearance – This is a required step in all states to confirm that the applicant has no disqualifying criminal history.
• Proof of completion of required state-specific coursework – Some states require additional coursework, such as:
  ○ Opioid prescribing training
  ○ HIV/AIDS education
  ○ Medical ethics coursework

Pro Tip: Some state boards provide an online application checklist that helps applicants track their progress. It is crucial to review the state’s specific requirements before submission, as failing to include even one document can significantly extend the approval timeline.

Once all documentation has been compiled, the next step is submitting the application to the respective state medical board. This can typically be done online, though some states still permit paper applications.

Key factors to consider when submitting the application:

• Submission Method: Many states strongly recommend using their online licensure portal for faster processing. Paper applications may experience longer review times.
• Application Fees: The cost of licensure applications varies by state, ranging from $150 to $600. Additional processing fees may apply for background checks, jurisprudence exams, and controlled substance registrations.
• Processing Timeframes: Applications can take anywhere from 4 to 12 weeks for approval. Delays may occur if:
  ○ The board requests additional documentation
  ○ There is a backlog of applications
  ○ The applicant has a prior disciplinary history requiring further review

Pro Tip: To track your application status, check whether the state board offers an online status portal. Some states allow real-time updates so applicants can see what documents are pending or under review.

Every state requires criminal background checks as part of the licensure process. These checks are conducted at both the state and federal levels and are designed to ensure patient safety and professional integrity.

The process typically involves:

• FBI Fingerprinting – Applicants must submit biometric fingerprints via an approved vendor. Some states offer live-scan fingerprinting, which speeds up processing, while others require mailed ink fingerprint cards.
• National Practitioner Data Bank (NPDB) Screening – The NPDB is a repository of disciplinary actions taken against healthcare providers. State boards use this to verify whether the applicant has had prior sanctions, malpractice claims, or disciplinary actions in any jurisdiction.
• Verification of Prior Disciplinary Actions – If the PA has ever held a medical license in another state, that board may need to submit a formal report regarding any history of complaints, disciplinary measures, or legal actions.

For PAs with prior legal or disciplinary issues, it is often beneficial to include a written explanation and supporting documentation when applying, rather than waiting for the board to request clarification. Failure to disclose past issues can result in automatic application denial.

Pro Tip: Background check processing times vary, with some states completing them within days, while others may take several weeks. It’s best to initiate fingerprinting and background checks as soon as the application is submitted to prevent unnecessary delays.

While the trend toward Optimal Team Practice (OTP) is reducing the requirement for mandatory physician supervision, many states still require a formal supervision or collaboration agreement as part of the PA licensure process.

What Is a PA Supervision or Collaboration Agreement?

A collaboration or supervision agreement is a legally binding document that outlines:

• The physician assistant’s scope of practice
• Prescriptive authority (particularly for controlled substances)
• Supervising physician’s responsibilities
• Methods of communication and oversight

Which States Require Supervision Agreements?

While some states allow PAs to practice independently, others mandate a written agreement with a supervising physician before granting a full license. States with stricter supervision requirements may include:

• Texas
• Florida
• North Carolina
• Alabama

However, some states—such as New Mexico and North Dakota—have adopted OTP models, allowing experienced PAs to practice without physician supervision.

For PAs who need to secure a collaborating physician, services like Collaborating Docs provide pre-vetted physician matches, ensuring that agreements meet state compliance standards.

Pro Tip: Ensure that the agreement is reviewed by legal counsel or a compliance expert, as improperly structured agreements can lead to disciplinary action if found noncompliant.

Several states require a PA jurisprudence exam as a condition of licensure. This exam evaluates an applicant’s knowledge of state-specific laws, professional ethics, and medical practice regulations.

Common States Requiring a Jurisprudence Exam:

• Texas
• California
• Florida
• Ohio

Exam Format & Study Recommendations

• Most jurisprudence exams are administered online and open-book.
• Topics include scope of practice, supervision laws, disciplinary procedures, and controlled substance regulations.
• Many states provide official study guides or online modules to help applicants prepare.

Pro Tip: Even if a state does not mandate a jurisprudence exam, reviewing state laws and medical board regulations before practicing in a new state is highly recommended.

Once licensed, a PA must maintain their credentials by renewing their license and fulfilling continuing medical education (CME) requirements.

License Renewal Timelines

• Renewal periods range from 1 to 3 years, depending on the state.
• Many states allow online renewal, but some require paper submissions.

• PAs must complete 100 CME hours every two years to maintain NCCPA certification.
• Some states mandate additional opioid prescribing courses or patient safety training.

• If a PA prescribes Schedule II-V controlled substances, they must:
  ○ Obtain a DEA registration number
  ○ Apply for state-specific controlled substance permits

While the standard pathway to PA licensure follows a predictable trajectory, many PAs encounter unique situations that require additional steps, documentation, or examinations. These special circumstances include relocating to a new state, reinstating an expired license, returning to practice after an extended absence, and seeking U.S. licensure as an internationally trained PA. Each of these scenarios presents its own regulatory and logistical challenges.

Physician assistants who relocate or plan to practice in multiple states must navigate the complexities of obtaining a new license in a different jurisdiction. Unlike physicians who can use the Interstate Medical Licensure Compact (IMLC) to expedite multi-state licensure, PAs currently have no such standardized system—though the PA Licensure Compact is in development.

How to Transfer Licensure Between States

The process of obtaining a license in another state typically requires:

• Applying for a new state license: Even if a PA is licensed in one state, most states require a separate application and verification of credentials before granting a new license.
• Verification of prior licenses: Most state boards use the Federation Credentials Verification Service (FCVS) or require direct communication with previous licensing boards.
• Fulfilling new state-specific requirements: Some states require jurisprudence exams, opioid prescribing training, or additional background checks that were not part of the PA’s original licensing process.

States That Offer Expedited Licensure

Some states provide license reciprocity or expedited licensure for PAs already licensed in another state. These tend to have more streamlined application processes, reducing the time to licensure approval. However, there is currently no universal reciprocity system for PAs, unlike physicians in certain compact states.

The PA Licensure Compact, when implemented, will allow PAs to apply for a multi-state license, similar to the Nurse Licensure Compact (NLC). This will significantly reduce redundant applications and fees for PAs working across state lines, particularly in telemedicine and travel medicine roles.

A lapsed or suspended PA license can present significant barriers to re-entry into the profession. Each state imposes specific reinstatement procedures depending on how long the license has been inactive and whether the suspension was due to disciplinary action.

How Long Before a License Is Considered ‘Lapsed’?

• In most states, a PA license expires if not renewed within the designated period (typically 1–3 years).
• Some states allow a grace period, while others require full re-application if the license has been expired for a certain number of years (e.g., 5 years in California).

Steps for Reinstating an Expired PA License

• Submit a reinstatement application with the state medical board.
• Provide documentation of past licensure, including records of any disciplinary actions.
• Complete required CME hours: Some states mandate additional coursework to compensate for time away from practice.
• Retake the jurisprudence exam if required by the state.
• Pay reinstatement fees, which are often higher than standard renewal fees.

Implications of Practicing With a Lapsed License

Practicing medicine with an expired or suspended license is considered unlicensed medical practice, which can lead to:

• Hefty fines
• Potential criminal charges (in severe cases)
• Permanent disciplinary marks on a PA’s record

PAs who have been out of practice for several years (whether due to personal reasons, relocation, or career shifts) may face additional licensing hurdles when re-entering clinical medicine.

Common Barriers to Re-Entry

• State boards may require proof of clinical competency, which could include:
  ○ Supervised clinical training or re-entry programs
  ○ Refresher courses to update medical knowledge
  ○ Additional CME hours beyond the standard requirement
• If the PA’s NCCPA certification has lapsed, they must pass the Physician Assistant National Recertifying Examination (PANRE) before reapplying for a license.

Several institutions offer PA re-entry programs, including:

• The University of Texas Health Science Center at San Antonio
• The Society of Physician Assistants in Occupational Medicine (SPAOM)
• State medical boards may also provide temporary re-entry licenses under supervised conditions.

PAs who trained and practiced outside the U.S. must undergo additional steps to obtain U.S. licensure, as foreign PA credentials are not automatically recognized by U.S. medical boards.

Credential Evaluation & Verification

• International PAs must submit their educational credentials for evaluation through recognized agencies such as:
  ○ The Educational Commission for Foreign Medical Graduates (ECFMG)
  ○ The World Education Services (WES)
• They may need to complete supplementary coursework at an ARC-PA accredited PA program to meet licensing standards.

Examinations & Additional Training

• Foreign-trained PAs must pass the PANCE, just like U.S.-trained PAs.
• Some states require additional clinical rotations or bridging programs to assess competency.

The process is complex and state-dependent, making it crucial for international PAs to work closely with licensing boards early in the process.

The PA Licensure Compact, once enacted, will enable qualified PAs to obtain a multi-state license, allowing them to practice across participating states without needing separate applications.

• This will be particularly beneficial for:
  ○ PAs practicing telemedicine
  ○ Traveling or locum tenens PAs
  ○ Military and government-employed PAs

Legislation for the compact is currently in development, and multiple states are expected to adopt it in the coming years.

OTP is a movement advocating for greater PA autonomy, allowing direct licensure without mandatory physician supervision. States that have adopted or are considering OTP legislation are moving towards:

• Independent PA licensing
• Full prescriptive authority
• Elimination of mandated supervision agreements

Currently, some states still require physician delegation agreements, but the trend is shifting towards greater independence for experienced PAs.

Navigating the physician assistant licensure process is complex, but with careful planning, it is entirely manageable. Whether you are seeking initial licensure, moving to a new state, or reinstating an expired license, understanding the state-specific requirements, renewal timelines, and regulatory changes is critical.

For those seeking multi-state practice, staying informed about the PA Licensure Compact will be essential in the coming years. Similarly, keeping up with CME requirements, controlled substance regulations, and evolving state laws will ensure a smooth and uninterrupted career as a PA.

Ultimately, proactive compliance with licensure regulations not only protects your ability to practice but also enhances patient safety, professional credibility, and career flexibility in the rapidly evolving healthcare landscape.

Navigating the complexities of physician assistant licensure, especially in states that mandate collaborative agreements with supervising physicians, can be a daunting task. At Collaborating Docs, we specialize in simplifying this critical aspect of your professional journey.

Founded in 2020 by Dr. Annie DePasquale, a Board-Certified Family Medicine physician, Collaborating Docs was the first-to-market solution designed to help Nurse Practitioners (NPs) and Physician Assistants (PAs) secure the legally required physician collaborations they need to practice.

With a network of over 2,000 collaborating physicians, we go beyond just matching—we find the perfect fit for your specialty, practice needs, and compliance requirements. Our commitment to full compliance ensures that your collaboration meets and exceeds state regulations, keeping you legally protected.

Whether you’re a new graduate embarking on your career, a seasoned PA relocating to a new state, or an internationally trained PA seeking U.S. licensure, securing a compliant and supportive collaboration is paramount. Collaborating Docs guarantees a match within 14 days or less, with 97% of matches completed in under 7 days, allowing you to focus on patient care without administrative delays.

Don’t let the complexities of securing a collaborating physician hinder your practice. Partner with Collaborating Docs to ensure a seamless, compliant, and supportive collaboration. Contact us today to get your free quote and take the next step in your professional journey.