Common Questions

About the report, your state's guide, the training — and the thing I haven't built yet.

First, the distinction everything else rests on

"Can I practice?" and "Can I own it?" aren't the same question. What's the difference?

They're answered by two different bodies of law, and they don't move together.

Can you practice? is your state practice act — supervision, collaboration or delegation, and whether documented experience hours lift those requirements. This is what every "best states for PAs" list measures.

Can you own it? is a different question entirely: professional entity statutes and corporate practice of medicine doctrine. Whether you may hold equity in the entity that bills for the care.

I expected corporate practice of medicine doctrine to be the deciding factor. It isn't. What decides it is usually much plainer — the list in your state's professional entity statute of which licensed professions may organize a professional corporation. Where PAs are named, ownership is achievable. Where the list omits them, ownership is unsettled or barred — sometimes in states with no CPOM doctrine at all.

A state can let you practice with no physician agreement and still leave who owns the practice an open question. If you only research the first question, you can build a plan on an answer that doesn't apply to what you're trying to build.

About the 2026 Report

What is the Top States Report and who is it for?

Top 10 States for PAs to Own a Practice is a free 2026 report. It ranks states on a 100-point PA Entrepreneur Score built across five categories: practice autonomy (30), ownership flexibility (25), CPOM environment (20), ease of business formation (15), and overall business friendliness (10).

All 50 states and the District of Columbia were reviewed against primary statute, board rules, and the current legislative record. Ten are profiled in the report, with score, grade, statutory basis, and the real constraint named alongside the win.

It's for experienced PAs who want to know what their state actually permits before they file an entity, sign a lease, or build a plan around an assumption.

Do I need to live in a top-ten state to build a cash-based practice?

No. And most readers won't — eight of the ten are small-population states.

The scores describe how much regulatory friction you're working with, not whether the door is open. Two states reach the A range. Twelve sit in the 70s and thirteen in the 80s, and that middle is the interesting part: for most PAs it isn't a yes or a no, it's a structure — which entity type, which agreement, which threshold.

Nine states score below 50, and in a small number the ownership question is genuinely unresolved rather than simply harder. Those are named in the report, along with what each of them does well.

You don't need to move to build this. You need to know which of a few specific things your state requires.

Doesn't the AAPA already publish a list of the best states for PAs?

It does, and it's useful — for a different question. Those rankings are built primarily on practice autonomy. This report scores something narrower and more relevant if you intend to own the business: whether you may hold equity in the entity that bills for the care.

The two don't always agree. An earlier version of this report leaned on the autonomy tiers and got three states wrong as a result. It was rebuilt on its own methodology, and the current version scores all 51 jurisdictions directly.

How current is the research?

Reviewed August 2026 against primary statute, board rules, and the legislative record as it then stood. Where a change is recent, the report says so — Maine's LD 2088, for instance, is an April 2026 emergency law and is described as current as reviewed.

Reform is moving faster on scope of practice than on ownership. That gap is the reason this report exists, and the reason it gets re-reviewed rather than written once.

What is the Top 4 Specialties guide?

A companion piece covering four cash-pay niches available to experienced PAs: Aesthetic Medicine, Weight & Lifestyle Management, BHRT, and Direct Primary Care.

Start with the report. Your regulatory environment shapes what's worth building — there's no sense choosing a niche before you know which structures your state recognizes.

About Your State's Guide — $27

What is the Individual PA Entrepreneur State Guide?

The report tells you how ten states scored and why the ownership question is the one to ask. Your state's guide answers that question for your jurisdiction.

Each guide covers the practice act and current supervision or collaboration requirements; any experience-hour thresholds and what clearing them changes; the professional entity statute and whether PAs are named in it; the corporate practice of medicine position; which entity structures are available; formation mechanics; and the specific questions to put to a healthcare attorney in that state.

Get your state's guide — $27 → [PENDING]

What's the difference between the free report and the paid guide?

Breadth versus depth.

The report is ten states and a method — how they were scored, what separates autonomy from ownership, and why most "PA-friendly state" advice answers the wrong question. It's the orientation.

The guide is one jurisdiction in full. Statute, structure, thresholds, and the questions to ask counsel. It's what you actually work from.

Read the report first. If your state isn't one of the ten — and for most people it won't be — the guide is where that answer lives.

Is my state covered?

Yes. All 50 states and the District of Columbia. You choose yours at checkout.

Is this legal advice?

No, and it isn't a substitute for counsel.

The purpose is narrower and, I'd argue, more useful: to make you an informed entrepreneur before you meet with an attorney. Statutes change, board interpretations differ, and individual circumstances differ. Verify anything you intend to rely on with a healthcare attorney licensed in your state.

What the guide does is make that conversation shorter and considerably cheaper. You'll arrive knowing which statute governs, which structures are plausible, and which three or four questions actually matter — instead of paying someone to explain your own state's practice act to you.

What if the guide isn't what I expected?

Email me at [email protected] and I'll refund it. It's a $27 digital document delivered instantly; I'd rather you have your money back than feel stuck with something that didn't fit.

My state's laws feel complicated. Where do I start?

In order: the free report, for the distinction between practicing and owning. Then your state's guide, for what your jurisdiction specifically requires. Then a healthcare attorney in your state, with the questions the guide gives you.

Most people skip the middle step and arrive at the third one paying hourly for an orientation they could have had for $27.

About The Profitable Part-Time PA — $97

What is it, and what will I learn?

A 45-minute paid training, on demand. It covers the three mistakes that keep experienced PAs stuck in the employee model, and the 6-step framework for building a cash-based practice alongside your clinical role: WHY, NICHE, SKILLS, STRUCTURE, START, OBSTACLES.

It also walks through a worked example of the model at one to two days a week — structure and sequence, not income projections.

Watch the training — $97 →https://thepapossibility.com/webinar

How long is it, and is it live?

45 minutes, on demand. Start it, stop it, come back to it. There's no scheduled date to make and no live Q&A — you'll have it as soon as you buy it..

Is it just a sales pitch for something else?

No. It's a paid training, which is rather the point — you've already bought it, so there's nothing to sell you inside it.

It ends by pointing you at your own state's guide, because the framework's STRUCTURE step is the one you can't complete without knowing what your jurisdiction permits. If you'd like a say in what I build after this, there's a research form you can fill in. Neither is a pitch.

I'm a new graduate. Is this right for me?

Not yet, and I'd rather say so.

This is built for PAs with four to five years of clinical experience who are confident in their skills and ready to use them differently. If you're still building your clinical foundation, the most valuable thing you can do is practice. Bookmark this for when you get there.

Will this work for my specialty?

The framework is built around four cash-pay niches: Aesthetic Medicine, Weight & Lifestyle Management, BHRT, and Direct Primary Care. If you have experience in one, or you're open to building competency there, it applies directly.

If your clinical work is deeply tied to hospital systems, surgical settings, or insurance-dependent care, a cash-pay model may not transfer, and that's worth knowing before you spend anything.

I don't have a niche yet. Is that a problem?

No — that's the normal starting point.

Choosing a niche without a framework is one of the more common reasons experienced PAs stay stuck for months: the options feel endless and the stakes feel high, so nothing gets decided. The NICHE step exists for exactly that. You compare the four on lifestyle fit, schedule, and what your regulatory environment actually supports, rather than trying to intuit the right answer.

Do I have to quit my job?

No, and the model is designed on the assumption that you won't.

One room, one day, one offer. Validate demand before you invest more. Building alongside your clinical role is what makes the risk survivable — and it means any decision about your employed position comes later, from a much better position than the one you'd make it from now.

About The Accelerator

Is there a program that takes me from "I want this" to an open practice?

Not yet. I haven't built it.

I'm asked a version of this question often enough that I'd rather answer it honestly than describe something that doesn't exist. There's no curriculum, no start date, no price, no cohort, and no waiting list. Nobody is going to invoice you.

What I am doing is deciding whether to build it, and what shape it should take — a self-paced course is a very different thing from a small group with live coaching, and they suit different people at different points. I'd rather ask than guess.

If you'd like to shape it: the form takes about three minutes and asks where you are, what stops you first, and which version would actually be useful. I read every response. If I build it, the people who answered hear from me first. If I decide not to, I'll tell them that too.

Tell me what you'd want built → [/accelerator]

About Stephanie & The PA Possibility

Who is Stephanie Gho?

I'm Stephanie Gho, MS, PA-C — a Physician Associate with more than 25 years of clinical experience and the founder of The PA Possibility.

In 2015 I started a cash-based aesthetics and hormone optimization practice in a single room, part-time, alongside my clinical role. I didn't have a complete plan. I had a starting point. It now runs on 10 to 11 days a month.

The research behind the report and the state guides is mine: I read all 51 jurisdictions against primary statute because nobody had done it for PAs who wanted to own the business rather than simply practice in it.

I built The PA Possibility because I spent years working out what no one had mapped for me. The framework, the tools, the regulatory navigation — all of it by trial and error. This exists so experienced PAs don't have to.

Is this program only for PAs in aesthetics?

No. Aesthetics is one of four niches, and it happens to be the one I built around.

The framework applies equally to Weight & Lifestyle Management, BHRT, and Direct Primary Care — and the regulatory research doesn't care which you choose. Start small, validate demand, build the structure correctly, grow on real results. That sequence doesn't change with the niche.