Top 10 States for PAs to Own a Practice

The rankings other “best states for PAs” lists miss.

THE PA POSSIBILITY · FREE 2026 REPORT

A cash-based practice is one of the clearest paths an experienced PA has to earning more, working fewer hours, and taking back control of the schedule.

But where you practice decides what you’re allowed to build — and that’s two separate questions, not one.

Can you practice? That’s your state’s practice act: whether you need a supervision or collaboration agreement, and whether your years of experience can lift it.

Can you own it? That’s a different body of law entirely —professional entity statutes and corporate practice of medicine. It decides whether you can hold equity in the business that bills for your care, or only work inside one.

Nearly every “best states for PAs” list answers the first question. This report answers both.

All fifty states and the District of Columbia were read against their own statutes, board rules, and current legislative record, then scored on 100 points across five categories. Two states reached an A. Nine fell below 50. Inside: the ten strongest states with the statute behind each one, and the three states that top the autonomy rankings and fall short on ownership.

And if your state isn’t in the top ten — most aren’t — the report says what that actually changes about how you build. You don’t need to move to do this.

51 jurisdictions reviewed. 100-point PA Entrepreneur Score. Primary statute, board rules, and current legislative record

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

In 2015, I started a cash-based aesthetic practice out of a single room, a few hours a week, alongside my clinical role. I didn't have a perfect plan. I had a starting point. I kept building — slowly, deliberately, based on real demand. That same practice now runs on 10 to 11 days a month.

What I needed in that first year wasn't encouragement. It was an answer to a question nobody seemed to be asking: not "can I practice," but "can I own this." So I read all fifty states and the District of Columbia against their own statutes. This report is what came out of that.

I created The PA Possibility because I know what it costs to stay on the treadmill — and what becomes possible when you step off. My goal is to give experienced PAs a clear, strategic path to build a cash-based practice of their own — without quitting their job, without unnecessary risk, and without figuring it out alone.