TL;DR: In Texas, a physician assistant (PA) provides medical services that a supervising physician delegates and that are within the PA's education, training and experience. That can include taking your history and examining you, ordering tests, making a working diagnosis, building and adjusting a treatment plan, prescribing under the delegation rules, and referring you on. The supervising physician oversees the PA's work and accepts responsibility for it. A PA is not a physician, and care outside what has been delegated goes to a physician. At Innovare Tx, primary care is with Charles Ortega, PA-C, MPAS, supervised by Dr. Nathan V. Nguyen, MD.
What a physician assistant can do in Texas
The Texas Physician Assistant Licensing Act describes a PA's practice as medical services delegated by a supervising physician that are within the PA's education, training and experience (Texas Occupations Code §204.202). The law lists services a PA may provide, including:
- Taking patient histories and doing physical examinations.
- Ordering or performing diagnostic and therapeutic procedures.
- Making a working diagnosis.
- Developing and carrying out a treatment plan, and checking whether it is working.
- Counseling and education.
- Prescribing or ordering a drug or device under the delegation rules in chapter 157.
- Making appropriate referrals.
For primary care, that covers most of what a first visit involves: your history, an exam, lab work, a plan for an ongoing condition such as high blood pressure or diabetes, and a referral when you need one.
How supervision works
Every PA in Texas has at least one supervising physician, who oversees the PA's activities and accepts responsibility for the medical services the PA provides (§204.204). Supervision must be continuous. It does not require the physician to be physically present all the time, but the physician and the PA must be in contact, or able to be in contact easily, by phone or another telecommunication device. For delegated services within the PA's scope and set out in the physician's protocols or practice guidelines, the PA acts as the supervising physician's agent (§204.202(e)).
What goes to a physician or a specialist instead
A PA works inside two limits: what the supervising physician has delegated, and the PA's own education, training and experience. Care outside those limits is not the PA's to give. In practice that means:
- Specialist care. When a condition needs a specialist, such as a cardiologist or a surgeon, the PA refers you. Making appropriate referrals is part of the job the law describes.
- Programs that require a “physician.” Some programs define physician narrowly. Federal workers' compensation is one: its definition (5 U.S.C. §8101(2)) does not include physician assistants. That is why, at Innovare Tx, Dr. Nathan V. Nguyen, MD is the treating physician on federal workers' comp (OWCP) cases.
- Emergencies. For a medical emergency, call 911 or go to the nearest emergency room.
Questions worth asking any PA-led practice
- Who is the supervising physician?
- When would you refer me to a physician or a specialist, and to whom?
- How do I reach the practice with a question between visits?
- Does my health plan let me list this practice as my primary care provider? This depends on your plan, so ask your insurer, especially if you have an HMO.
A good practice will answer all of these plainly. You can ask us the same questions at (214) 233-3094.
Primary care at Innovare Tx
Primary care here is with Charles Ortega, PA-C, MPAS, a physician assistant with 27+ years of experience who has been NCCPA certified since 1998 and speaks English and Spanish. He practices under the supervision of Dr. Nathan V. Nguyen, MD. We offer preventive care, care for ongoing conditions, and same-day sick visits when available. We do not give immunizations. Read more about Charles.
Next step · Decide
Becoming a new primary care patient
Who you see, what we offer and don't, what to bring, and how preventive visits are covered.
Is a physician assistant a doctor?
No. A physician assistant is a licensed medical provider who practices under a supervising physician. In Texas the PA provides the medical services the supervising physician delegates, within the PA's education, training and experience.
Can a physician assistant prescribe medication in Texas?
Yes, within limits. Texas law lets a PA prescribe or order a drug or device under the delegation rules in chapter 157 of the Occupations Code, as delegated by the supervising physician.
Does the supervising physician have to be in the clinic?
Not at all times. Texas requires supervision to be continuous, but the physician and the PA may be in contact by phone or another telecommunication device when the physician is not present (§204.204).
