What’s Happening in Lansing: Understanding the NP Bill and What It Means for PAs

This week, House Bill 4399 and identical Senate Bill 268 were introduced in the Michigan Legislature that would grant full practice authority to Nurse Practitioners (NPs) upon graduation. This proposal would allow NPs to diagnose and treat patients independently, without the need for post-graduate experience or formal collaboration with a physician.

The Michigan Academy of PAs (MAPA) convened an urgent meeting to review the implications of this bill for the Physician Associate (PA) profession. The discussion emphasized the importance of understanding the policy, its context, and its potential impact—not only on providers, but on patients and public safety as well.

What Does the Bill Do?

• Grants full practice authority to Nurse Practitioners upon graduation, eliminating the need for any collaborative agreement or post-graduate experience.

• NPs own practices today, but may not currently diagnose and treat (practice medicine) independently. This bill would change that—allowing NPs to both own and operate independent practices without physician involvement.

• NPs in Michigan may already practice outside the specialty for which they were educated and trained. This bill does not address or restrict that practice, even in cases of complete specialty misalignment.

• The bill does not require any form of postgraduate clinical experience (such as a residency or supervised hours) before NPs can practice independently in a specialty. In contrast, physicians must complete years of specialty-specific postgraduate training in their residency.

• The Michigan Board of Nursing—which is almost entirely made up of professionals without medical education or authority to diagnose or treat (RNs, LPNs and public members)—would be responsible for defining and enforcing the rules by which NPs diagnose and treat patients.
   View Board Composition

How Do PAs Compare?

A recent comparison of education, clinical training, and scope of practice between PAs, NPs, and physicians illustrates important distinctions:

• PAs complete over 2,000 clinical hours across multiple specialties; most NP programs require only 500 hours in a single specialty.

• PA education follows the medical model, while NP education follows a nursing model.

• PAs must recertify with a national board exam every 10 years and complete 50 hours of CME annually, while NPs do not recertify after their initial board exam and complete 20 hours of CE annually. 

(See: PA-MD-NP Comparison)

These differences show some of the unique differences among different providers and reflect different preparation models and scopes. It is essential that policymakers and patients understand these differences so that each role can be properly integrated into Michigan’s healthcare workforce.

Why This Matters

Michigan PAs currently practice medicine under a practice agreement model, meaning the agreement must include a participating physician, even after years of clinical experience. As NPs move toward full practice authority, there is growing concern that PAs could be left behind in terms of autonomy and employment competitiveness due to the higher administrative burden of employing PAs. 

Participants in the MAPA meeting referenced similar dynamics in other states, most notably Florida—where NPs gained independence and PAs were later excluded from similar reforms. This also has impacted national employers who find it more difficult to hire PAs in States where NPs are independent due to the administrative burden has affected PA hiring and parity in clinical teams.

MAPA’s Approach: Facts Over Fear

MAPA is not opposing the NP independence bill. In fact, MAPA has never opposed NP independence. Instead, we have historically used the conversation as an opportunity to:

1. Ensure that policymakers understand the clear distinctions in education, training, and clinical preparation between PAs and NPs.

2. Advocate for relative parity between PAs and NPs in Michigan law—so that both professions can be empowered to serve patients to the full extent of their training.

If concerns raised in the current legislation are addressed—particularly those related to patient safety, specialty training, and oversight—and if PAs are granted a pathway to comparable professional autonomy, then expanding NPs' practice ability may improve access to care

Team-based care thrives when every provider is practicing at the top of their license—and when their roles are understood, respected, and equitably supported in law.

What MAPA Is Doing

MAPA has already taken action by advancing legislation for Michigan to join the PA Licensure Compact, which facilitates multi-state practice. This bill has bipartisan support and is moving through the legislative process.

At the same time, MAPA has been working with legal counsel to draft a PA Modernization Bill. This bill would:

• Clarify delegation authority.

• Update the professional title to “Physician Associate,” aligning with national trends.

MAPA emphasized that the Compact and the modernization bill are distinct and complementary, and that advancing both is essential to securing a fair and functional future for Michigan’s PA workforce.