The Benefits of Cross-Licensing as a PA: Practicing in Multiple States with Greater Autonomy

One license can no longer contain a PA’s potential. Cross-licensing – obtaining physician associate licenses in multiple states – has become a game-changer for career flexibility and autonomy. Whether you’re eyeing telemedicine work across state lines or seeking the most PA-friendly practice laws, holding multiple licenses opens doors. In this article, we’ll discuss why cross-licensing is beneficial, highlight states where PAs enjoy greater autonomy (with less oversight), and note important regulations and developments like the new PA Licensure Compact.

Why Cross-Licensing Matters

Traditionally, PAs are licensed state by state, which limited practice to one location. But today’s healthcare environment is more fluid. Telehealth allows PAs to treat patients anywhere – as long as they have a license for the patient’s state. Cross-licensing simply means maintaining active licenses in several states. Here’s why it’s worth considering:

• Telemedicine Expansion: If you want to work for national telemedicine services (see our remote PA jobs article), you’ll likely need licenses in multiple states. More licenses = more eligible patients you can see. This makes you a more competitive candidate for telehealth positions.

• Locum Tenens and Travel PAs: Enjoy working short stints in different places? Having licenses in a few key states lets you take temporary or part-time jobs without weeks of delay for new licensure. Cross-licensing thus fuels a “traveler PA” lifestyle, where you can go where demand is highest (or where you want to explore living).

• Job Market Flexibility: Economic or personal factors may require relocating or telecommuting across state lines. A second (or third) license in your back pocket means you can quickly respond to opportunities. You’re not tied down if one state’s market saturates – you can cast a wider net.

• Emergency Readiness: As seen in the COVID-19 pandemic, having licensure mobility is valuable. States with emergency compacts allowed faster deployment of providers across borders. PAs with multiple licenses were able to volunteer or be hired swiftly where the need was greatest.

• Maximizing Autonomy: Importantly, not all states treat PAs the same. Some states grant much broader scope and independence. By cross-licensing in those “PA-friendly” states, you might practice with less red tape. For example, a PA living in a restrictive state might also get licensed in a more autonomous state and conduct telemedicine for patients there under that state’s more liberal rules.

States with Greater PA Autonomy (“Optimal Practice” States)

One motivation to cross-license is to practice in states that offer greater PA autonomy. In some states, PAs face heavy administrative burdens and must have specific supervising physician agreements. In others, laws have modernized to allow PAs to practice more independently (while still collaborating as needed). According to the AAPA’s grading, seven states currently offer “Optimal” practice environments for PAs – meaning PAs can practice to the full extent of their training with minimal. These are:

• Iowa

• Arizona

• Montana

• New Hampshire

• North Dakota

• Utah

• Wyoming

In fact, in recent years these states eliminated the legal requirement for a specific relationship between a PA and a physician (with only minor exceptions). In other words, PAs in these states no longer need a formal supervising physician agreement by law. This doesn’t imply practicing in isolation – PAs still consult and collaborate – but it removes an outdated mandatory tether. The result is more flexibility in how PAs can work, own practices, and respond to patient needs. These six states are often cited as the most “PA-friendly” in terms of scope of practice.

Regulation example: In 2023, Montana updated its PA practice law. PAs with over 8,000 hours of experience became exempt from any collaboration agreement requirement (while those with fewer hours practice in collaboration with a physician or experienced PA). This effectively means an experienced PA in Montana can practice without a formal supervising physician contract – a landmark for PA autonomy. Other states like North Dakota, Utah, and Iowa have implemented similar statutes empowering experienced PAs.

For PAs interested in opening their own practice, these optimal-practice states are fertile ground. Owning a clinic as a PA is considerably easier when the law doesn’t mandate a physician partner on paper. It’s noted that PAs are “more likely to find success in states that have ‘Optimal’ scope of practice” if they want to open a practice. Cross-licensing can enable an entrepreneurial PA to set up telemedicine services or even a physical clinic in one of these states to take advantage of the favorable regulations.

The PA Licensure Compact: Easier Multi-State Practice

A huge development making cross-licensing easier is the upcoming PA Licensure Compact. This interstate compact, once operational, will allow a PA licensed in one member state to obtain a multi-state privilege to practice in other compact states – streamlining the licensing process significantly. Here are key points:

• As of mid-2025, 19 states have enacted the PA Compact legislation. While not operational yet (the Compact Commission is still finalizing rules as of 2025), it’s expected that within 1–2 years, PAs will be able to apply for a compact privilege. The AAPA estimates 18–24 months from activation (April 2024) to get the system running.

• States in the compact span the country – e.g. Colorado, Iowa, Minnesota, Ohio, Virginia, West Virginia, Utah, Wisconsin and more are on board. (The list is growing as additional states consider bills each year.)

• Benefit: If you hold a license in one compact state, you can quickly obtain a privilege to practice in other compact states without full traditional applications. This removes a huge barrier and cost when wanting to work across states. It will especially help PAs in telehealth and locum tenens roles to hop between states with far less paperwork. Keep in mind, the compact doesn’t override state scope of practice laws – when practicing in a state via the compact, you must follow that state’s PA practice regulations. But it does eliminate needing separate licenses and fees for each state.

The PA Compact mirrors what physicians (IMLC) and nurses (NLC) have had for years. Its passage is a positive step to “decreasing the barriers PAs face when they travel and practice. In the near future, cross-licensing might not be a painstaking process at all, but rather a quick privilege activation if you’re in the compact.

Things to Consider When Cross-Licensing

Before you rush to apply for multiple licenses, a few practical considerations:

• Cost and Maintenance: Each state license comes with fees and renewal requirements (CME, background checks, etc.). Ensure you can keep up with multiple renewals. The compact will help reduce duplication, but until it’s live, cross-licensing can be costly. However, think of it as an investment in broader job prospects.

• Practice Laws Differences: Research what each state allows PAs to do. For example, some states might have physician-to-PA ratio limits, chart co-signature rules, or prescriptive differences. When you practice under that license, you are bound by that state’s rules. Our earlier mention of autonomy means you might choose to focus work in a state with more freedom, but you must still respect any nuances of each license.

• Malpractice Coverage: Make sure your malpractice insurance covers you in all states you practice (often it does, but the carrier should be aware of your multi-state work). Different states have different malpractice climates and requirements – something to be mindful of (see our malpractice for PAs article for more on coverage).

• Collaboration and Network: If you plan to cross-license to practice independently (e.g., telemed in an Optimal state), remember to still build physician relationships or specialist contacts for referral as needed. Autonomy doesn’t mean isolation – quality care often involves teamwork, even if not legally mandated.

• Stay Current: Licensure compacts, state laws, and regulations can change. For instance, other states are considering granting PAs more autonomy or joining the compact. Keep an eye on AAPA advocacy updates or state PA chapter news so you can take advantage of new opportunities (or comply with new rules).

In conclusion, cross-licensing empowers PAs to break out of single-state limitations, expand their patient reach, and even maximize their professional independence. It’s about being agile in your career. With key states removing supervision mandates (Iowa, Montana, and others leading the way) and the licensure compact on the horizon, multi-state practice is becoming the norm for ambitious PAs. If you’re willing to manage a bit of extra paperwork now, the payoff can be huge in flexibility, opportunities, and personal satisfaction – truly practicing on your own terms.

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