TAPA is aware of proposed rules by the Texas Medical Board, as published in the Texas Register on January 25, 2019.  Please go to http://www.tmb.state.tx.us/page/proposed-rule-changes
then look under Board Rule Changes Proposed (Physician Assistant Board) - January 25, 2019. 

In short, Section 193.21(d) states that there are certain acts that cannot be delegated to a "mid-level provider" (their words): The reading and interpreting of radiological studies, and rendering a diagnosis based upon radiological studies".  TAPA is very concerned about the implications of this language and the possible detriment to the practice of all Texas PAs and ultimately the patients they care for.  PAs have ordered, read, interpreted and rendered treatment to patients based upon radiologic studies for years, in accordance with practice agreements with physicians.  

TAPA is currently crafting a response to the Texas Medical Board and will continue to pursue this issue.  

The Texas Medical Board is currently soliciting public comment on these proposed rules and have provided an email address for contact.  We encourage our membership to express concerns regarding these rules at the following address, as provided by the Texas Medical Board: rules.development@tmb.state.tx.us.  You can also send a formal letter to the following address:

Texas Medical Board
ATTN: Rita Chapin
PO Box 2018
Austin, TX 78768-2018

Thank you to members who have contacted us; please know that we are working diligently on this issue and will provide more information as it becomes available.

You can also reach out to TAPA to express concerns here: tapatxinfo@gmail.com

A template letter for PAs to edit and send to the Texas Medical Board is located here.Template

The Texas Academy of Physician Assistants (TAPA) is extremely concerned about the proposed rule regarding the reading and interpreting of radiologic studies, as outlined in TAC 193.21(d), on page 403 of the Texas Register published on January 25, 2019.

It is unfortunate that TAPA, an important stakeholder, was not included in this process as we were for the input regarding the proposed rules on the performance of radiologic procedures under TAC 185.32.  TAPA collaborated with the Texas PA Board and the Texas Medical Board on language that maintains delegation at the practice site.

TAPA represents close to 10,000 practicing Physician Assistants in the state of Texas.  There is zero evidence that the “reading and interpreting of radiological studies” and then “rendering a diagnosis based on the radiological studies” by a physician assistant who is acting in accordance with a practice agreement with a physician is in any way harmful to patients.  In fact, thousands of physician assistants in Texas daily order radiologic studies, interpret these studies, render a diagnosis and then a proper treatment for patients, in accordance with the practice agreement with a physician.  

Section 204.202 of the Physician Assistant Practice Act clearly outlines the scope of practice of physician assistants in Texas.  In this statute, it does not restrict the ordering, reading, interpreting or rendering a diagnosis based upon radiologic studies.  

Section 204.204 of the Physician Assistant Practice Act also clearly outlines the supervision requirements for a physician assistant by a physician.  This statute states that “the supervision does not require the constant physical presence of the supervising physician where physician assistant services are being performed, but, if a supervising physician is not present, the supervising physician and the physician assistant must be, or must be able to easily be, in contact with one another by radio, telephone, or another telecommunication device”.  

In accordance with these statutes, physician assistants frequently work in a clinic or hospital setting autonomously where they must be able to care for patients by ordering and interpreting diagnostic tests and then treat a patient, including radiologic studies.  Restricting a physician’s ability to delegate this to the PA will cause a severe disruption in patient care for all Texans who are being cared for by physician assistants. Thus, will lead to decreased utilization of physician assistants by physicians and healthcare entities.  This is a step backwards in the physician-PA partnership, especially as physician assistants have safely cared for millions of Texans based upon the ordering, interpreting and rendering diagnoses and treatments purely from radiologic studies for over 50 years.

The language in this proposed rule is unnecessarily stark and restrictive; it will endanger patients.  Imposing arbitrary and punitive regulatory restrictions on the physicians who supervise PAs and at the same time restricting the PA role on the health care team will disrupt the lives of thousands of the very patients we all seek to serve.

Finally, the use of the term “mid-level provider” in the proposed rule is not defined in statute and does not have a recognized legal definition in Texas. This term does not differentiate between physician assistants and advanced practice registered nurses.  TAPA is concerned why this particular wording was chosen, when in all other areas of law and rule the specific professions are expressly defined.

TAPA asks the Texas Medical Board to reject Rule 193.21(d) of the Texas Administrative Code for the sake of all Texas patients and the physician assistants who care for them every day.


Eva J. Montes, MCG, MPAS, PA-C
President, Texas Academy of Physician Assistants

We have learned that the Texas Medical Board will be postponing the adoption of rule 193.21 until at least the late Spring or early Summer.

This rule would have removed the ability for a physician to delegate the reading, interpretation and diagnosis of medical conditions based on radiologic studies- thereby making a significantly negative impact on the practice of PAs across the state.

There will be a stakeholder meeting later this Spring regarding this rule, and you can be assured that TAPA will be present to make sure PA practice is protected.

Thank you to everyone who has contacted the Texas Medical Board about this rule so far! You can continue to contact them at the address they have provided- rules.development@tmb.state.tx.us.

We’ll continue to monitor this situation closely, and will provide more information as it becomes available.