PA Planning
More Physician Assistants are stepping into entrepreneurship by launching clinics, offering direct-to-patient services, or moving into niche care models like aesthetics, IV hydration, and wellness. But even with the right license and clinical experience, ownership and service delivery aren’t always straightforward. The rules around what you can do and who can do it vary widely by state and service type.
This gives insight into what’s actually allowed, what to check before moving forward, and how to avoid the most common legal and operational mistakes before making the jump.
Why Ownership Isn’t Always Straightforward
State laws decide whether you as a PA-C can own and operate a medical business. The most common limiting factor is the Corporate Practice of Medicine (CPOM) doctrine, which restricts non-physicians from owning or controlling medical practices in many states.
Even in states where ownership is possible, there are often restrictions around how the business is structured, who holds clinical decision-making authority, and what services can be offered. That’s especially true in fields like aesthetics, mental health, IV therapy, and wellness where scope of practice, prescriptive authority, and supervision rules often become more restrictive or ambiguous given PAs scopes vary state by state.
What to Know Before You Launch
Before forming an entity or offering services, confirm:
Whether your state allows PA ownership or co-ownership of a medical business
What business structure is allowed (PLLC, PC, or PA-specific entity)
Whether you’ll need a supervising or collaborating physician, and what that relationship must include
If you’re allowed to prescribe, delegate, or perform services like injectables, peptides, IV hydration, or hormone therapy under state board rules (and independency order the supplies needed for your operations to run successfully).
Whether your scope of practice covers the full range of services you plan to offer, or if you’ll need additional protocols, agreements, or oversight
Whether your model is insurance-based or cash-pay, and if that affects compliance with federal and state billing laws. It may require more hoops for you and your supervising physician to jump through, if looking to enroll in Medicaid or Commercial insurance payors.
These variables don’t only impact ownership, they could affect what you can do once you own and all have different cost and timing implications you should carefully consider.
States That Support PA-Led Businesses
States like Arizona, North Carolina, and Florida make it easier for PAs to operate independently or co-own a practice. Arizona stands out for allowing experienced PAs to practice autonomously and for its lack of a codified CPOM law. In North Carolina, PAs can fully own a PLLC or PC, as long as there’s a supervisory agreement in place. Florida allows full PA ownership, but requires a designated Medical Director if the clinic isn’t physician-owned, something that especially impacts aesthetics, IV services, and wellness clinics.
States like Washington and Colorado also permit ownership or co-ownership, but often require that physicians remain involved in governance or maintain majority ownership. For PAs offering regulated services, these governance rules directly affect how care must be delivered and by whom.
States Where It’s Possible, But Heavily Structured
California and Texas allow partial ownership through tightly controlled models. In California, PAs can form a Physician Assistant Corporation or own up to 49% of a professional medical corporation, but a physician collaborator is still required, and CPOM remains a real concern—particularly for practices delivering IV hydration or cosmetic procedures.
In Texas, PAs can only co-own with a physician (who must hold 51% ownership), and services like aesthetics or hormone therapy often require a detailed prescriptive delegation agreement. Depending on the service, there may also be restrictions on protocols, advertising, and physician involvement, which directly affects how your practice can operate day to day.
States Where Ownership Is Heavily Restricted
States like New York, New Jersey, Alabama, Kentucky, and South Carolina are far more restrictive. In these jurisdictions, PAs cannot fully own or control a medical practice, and all services must be provided under physician-owned entities or through contracting arrangements. In-person supervision may be required, and services such as injectables, IVs, and hormone therapy are often off-limits without direct physician involvement and ordering of supplies (which adds more layers and complexity).
Even if you plan to operate as a 1099 contractor, open a cash-pay clinic or accept insurance, these states often limit PAs’ ability to independently prescribe, delegate tasks to others, or prescribe, making full entrepreneurial control difficult without a physician lead. It is important to note that this doesn't just apply to physician assistants but globally to all non-physicians, so while there ar barriers, it still may be possible.
Entrepreneurship Requires More Than a License
Your clinical license is a start, but it’s not a green light to do whatever you want. Whether you’re offering primary care, mental health, peptides, microneedling, or weight loss, your ability to operate independently depends on:
How your state defines PA scope
Whether the service is considered medical treatment, which 99% are
If a protocol or supervising physician is required, and for PAs most states do require this and layer in additional requirements like in-person meetings or live supervision for a continuous timeframe.
Whether certain services (like Botox, IVs, mental health) are limited to specific license types
These details are where many first-time business owners get tripped up and where the Independent PA Collective offers real value. We don’t provide specific templates or cookie-cutter solutions but focus on helping you move past these nuances, discuss how others are building compliant models, and work through the gray areas together. Learn more at www.theindependentPAC.com
