Legal Differences Between APNs and Physician Assistants

(225 Illinois Compiled Statutes 95/ -- The Physician Assistant Practice)

In Illinois, the relationship between physicians and APNs is distinctly different from the relationship between physicians and physician assistants (PAs).  Physician assistants by law are supervised by physicians, whereas APNs collaborate with physicians. The different verbiage in the Physician Assistant Act and the Nursing Act is not an accident; rather it is a result of long hours of negotiation between APN leaders and representatives from physician associations.  Another major difference between the Physician Assistant Practice Act and the Nursing Act is the issue of "ratios.” A physician is allowed to supervise only two PAs, although PAs may have more than one supervisory physician (thus allowing a PA to have more than one employer).  Such ratios do not exist for APNs, as a result of intense political negotiations back in 1997 and 1998. 

Furthermore, the Physician Assistant Practice Act has specific language regarding reimbursement for services.

     A physician assistant shall not be allowed to bill patients or in any way charge for services.  Nothing in this Act, however, shall be so construed as to prevent the employer of a physician assistant from charging for services rendered by the physician assistant. Payment for services shall be made to his or her employer if the payor would have made payment had the services been provided by a physician licensed to practice medicine in all its branches (95/6, c).

The Nursing Act has no such restrictions regarding reimbursement; indeed, many APNs in Illinois have their own practices and receive payment directly from insurance companies and patients.

Finally, there is a difference in educational requirements of APNs versus PAs. A physician assistant is defined as a person "who has been certified as a physician assistant by the National Commission on the Certification of Physician Assistants or equivalent successor agency and performs procedures under the supervision of a physician as defined in this Act” (225 ILCS 95/4).  The act itself does not delineate any educational requirements, but it is known that the degrees that PAs programs award are varied, ranging from associate degrees to master’s degrees.

As discussed previously, with the exception of the extended grandfathering for the CRNA, APN education is required to be at the graduate level.