30-60-90 day plan for physician assistants
On this page
- What makes a physician assistant's first 90 days different?
- What has to be in place before a full schedule?
- What does the 30-60-90 day plan look like?
- Which numbers should a new PA and the practice track?
- How should the hiring manager use the plan in the final interview?
- What should each check-in cover?
- A filled example
- What does the practice owe the new PA?
- Common mistakes
- How do you adapt the plan?
- Questions people ask
A 30-60-90 day plan for a new physician assistant should get the practice agreement or supervision document, license, DEA registration, payer enrollment and hospital privileges in place first, then build the schedule in stages with chart review by the supervising physician, and reach a full schedule with independent judgment the team trusts by day 90. As of October 2026, Medicare covers PA services performed under the state's own scope of practice rules and pays 85 percent of the physician fee schedule amount, and PAs can bill Medicare directly, so enrollment is part of week one, not an afterthought.
This plan is for the medical director, supervising or collaborating physician, or advanced practice provider lead hiring a PA for a clinic, hospital service or surgical team. Nurse practitioners follow a similar arc with different licensing rules; see the 30-60-90 day plan for nurse practitioners. The general structure is in the 30-60-90 day plan template for new hires.
What makes a physician assistant's first 90 days different?
A PA's scope is set by three documents at once: the state's PA law and practice agreement or supervision rules, the employer's privileges or delegation, and the payer rules that decide what can be billed and under whose name. A new PA can be clinically ready on day one and still not be allowed to see a given patient, prescribe a given drug or bill a given service until each document is in place. The first month therefore runs two tracks: credentialing that someone in the practice owns, and a clinical ramp the supervising physician owns.
The second difference is the working relationship. Under most state laws the PA practices with a named physician or group, and the quality of that relationship (how quickly questions get answered, how chart review feeds back) decides how fast the PA can safely take a full schedule.
What has to be in place before a full schedule?
The items below are current as of October 2026 and are not legal advice. Practice agreement and supervision rules differ by state; check your state's PA board.
| Item | What applies | Source |
|---|---|---|
| Certification | PA-C maintained with 100 CME credits every two-year cycle and the PANRE or PANRE-LA passed by the end of the tenth year of the certification maintenance cycle | NCCPA |
| State license and practice document | State-specific. Example: in California a written practice agreement developed by one or more physicians and the PA defines the services the PA may perform; it replaced the delegation of services agreement | Physician Assistant Board of California, SB 697 bulletin |
| Medicare coverage | Services must be performed under state law and the state's scope of practice rules; where the state has no explicit supervision rule, supervision is documented at the practice level; employer billing applied before January 1, 2022 | 42 CFR 410.74 |
| Medicare payment | 85 percent of the physician fee schedule amount, including assistant-at-surgery services | 42 CFR 414.52(d) |
| Controlled substances | State authority to dispense first, then a separate DEA registration in each state where the PA practices | DEA registration FAQ |
| Hospital privileges | PAs are credentialed and privileged under the Medical Staff chapter; focused professional practice evaluation is required for all new privileges and starts when privileges are granted | Joint Commission FAQs on PAs and APRNs and FPPE |
Commercial payer credentialing often takes longer than Medicare enrollment. Ask the credentialing team for a dated list on day one and schedule the PA's early patients around what is approved.
What does the 30-60-90 day plan look like?
30-60-90 day plan — [Name], PA-C, [practice / service]
Supervising or collaborating physician(s): [names] Start date: [date]
Specialty: [ ] Settings: [clinic / inpatient / OR / ED]
Credentialing owner: [name] Payers pending: [list]
DAYS 1-30 — Documents in place; learn the practice
Goals:
- Practice agreement or supervision document signed and filed as
the state requires; scope and prescribing limits written down
- License, DEA (for this state), payer enrollment and privileges
tracked on one dated list with the credentialing owner
- Shadow each supervising physician for at least [3] sessions
- Learn order sets, protocols, referral patterns, the EHR inbox
and the practice's escalation rules (when to call, when to transfer)
- Reduced schedule (example: half the template), every note reviewed
the same day
Deliverables by day 30:
- All documents in place, or a dated plan for the rest
- Written list of conditions and procedures the PA manages alone,
with the physician, or refers
Check-in: day 30, with the supervising physician and practice lead
DAYS 31-60 — Staged schedule; chart review narrows
Goals:
- Schedule raised (example: three quarters of the template)
- Chart review moves from every note to a sample plus all
high-risk encounters agreed in the practice agreement
- Hospital: FPPE cases completed per the medical staff plan
- Own the inbox: results, refills, messages within the practice's
standard
Deliverables by day 60:
- Chart review findings trending down; no open documentation issues
- FPPE on schedule (hospital settings)
Check-in: day 60
DAYS 61-90 — Full schedule and own panel
Goals:
- Full template; own panel or service list
- Take part in one quality measure or protocol the practice tracks
- Agree the ongoing review pattern (OPPE, peer review, sampling)
Deliverables by day 90:
- Full schedule held for two weeks with notes closed on time
- Ongoing review pattern written down
Check-in: day 90 — full reviewWhich numbers should a new PA and the practice track?
The standards below are examples only; set them with the practice's own templates and history. Productivity follows the schedule template, so judge the ramp on safety and completeness first.
| Measure | Why it matters | Example standard (example only) |
|---|---|---|
| Credentialing items open | Unbillable or unscheduled patients | All approved, or dated, by day 30 |
| Chart review findings per week | Shows whether review can safely narrow | Falling each week; none repeated |
| Notes closed within the practice's standard | Billing, handoffs and audits depend on it | Same standard as physicians by day 60 |
| Inbox turnaround | Patient safety on results and refills | Within the practice's standard from day 45 |
| Patients seen against the template | Access and the business case for the role | Matches the staged template at each step |
| FPPE cases completed (hospital) | Required before privileges are confirmed | On the medical staff's schedule |
How should the hiring manager use the plan in the final interview?
Ask finalists for a short plan built from a brief that names the specialty, the setting, the supervising physicians and the state. Use the rubric in how to evaluate a 30-60-90 day plan in an interview. A strong plan mentions the practice agreement, DEA and enrollment before the schedule, and stages the schedule against chart review. Follow-up questions:
- "Your DEA registration for this state is not through on day 10 and a patient needs a controlled substance. What do you do?"
- "Which presentations in this specialty would you always discuss with the physician in your first month?"
- "Your chart review shows the same documentation gap three weeks running. How do you fix it?"
- "A patient asks to see 'a real doctor.' How do you handle it?"
Earlier rounds are covered in the physician assistant screening questions, which test certification, license, supervision rules and DEA status.
What should each check-in cover?
| Checkpoint | Questions to ask | On track | Worth a direct conversation |
|---|---|---|---|
| Day 30 | "What can you do alone, what with us, and what do you refer?" | Documents in place or dated; written scope list; chart review shows sound judgment | Seeing patients the payer has not approved; no written scope; questions going unanswered for hours |
| Day 60 | "What did chart review catch this month?" | Findings falling; inbox handled; FPPE on schedule | Same findings repeating; notes left open; inbox backed up |
| Day 90 | "What review pattern do we keep from here?" | Full template held; ongoing review agreed | Schedule raised without the chart review to support it |
A filled example
Physician assistant: Daniel Ortiz (invented), PA-C with four years in emergency medicine, joining a three-surgeon orthopedic practice that covers clinic and the operating room.
Day 30: His practice agreement was signed in week one, but one commercial payer had not approved him, so the scheduler booked only Medicare and approved-payer patients. He shadowed each surgeon, wrote a scope list (fracture follow-up, post-op visits, joint injections under protocol) and had every note reviewed the same day.
Day 60: On three quarters of the template. Chart review found incomplete neurovascular exams documented on some post-op visits; he added a template prompt and the finding stopped. Hospital FPPE cases for first-assist privileges were on schedule.
Day 90: Full clinic template on two days a week and first assist on two. Chart review moved to a weekly sample plus all new fractures. The practice agreed a quarterly review with the lead surgeon.
What does the practice owe the new PA?
- A named credentialing owner with a dated list of every license, registration, enrollment and privilege.
- Protected time from the supervising physician for same-day chart review in the first month.
- A staged schedule template agreed before day one, so schedulers do not book a full day in week two.
- Clear escalation rules: who to call, how fast an answer comes, and what goes to the physician automatically.
Common mistakes
- Booking a full schedule before enrollment. The visits happen, but some cannot be billed or are billed under the wrong rules.
- Copying the practice agreement from another state. Supervision and prescribing rules are state law; the document has to match the state where the PA practices.
- Chart review that never narrows or never stops. Review should follow the findings: tight at first, then a sample plus agreed high-risk cases.
- Treating the PA as overflow. A PA with no defined panel or service ends up with the leftover patients and no way to show progress.
How do you adapt the plan?
- New graduate: extend same-day review of every note to day 60, add structured teaching sessions and lengthen shadowing.
- Surgical PA: add privileges for first assist and procedures, operating room orientation and the surgeon's preferences, and track FPPE by procedure.
- Emergency or hospitalist PA: replace panel building with shift-based supervision, sign-out practice and the department's transfer and admission rules.
- Practice building an advanced practice team: the 30-60-90 day plan for practice managers covers enrollment and revenue cycle work that decides how quickly a new PA can be scheduled.
If the seat is still open, the physician assistant job description template sets the certification, license, practice agreement and DEA lines this plan depends on.
Questions people ask
What should a new physician assistant do in the first 30 days?
Get the paperwork that allows them to practice and bill in place before seeing a full schedule: state license, the practice agreement or supervision document the state requires, DEA registration for that state if they will prescribe controlled substances, payer enrollment and hospital privileges. Clinically, they should see a reduced schedule with same-day chart review by the supervising or collaborating physician and learn the practice's protocols, order sets and referral patterns.
How does Medicare pay for physician assistant services?
As of October 2026, 42 CFR 410.74 covers PA services performed in line with state law and the state's scope of practice rules, and limits billing by the PA's employer to services before January 1, 2022, so PAs can now bill Medicare directly. Under 42 CFR 414.52 the allowed amount is 85 percent of the physician fee schedule amount, including for assistant-at-surgery services. Check the practice's billing setup with its billing team; this is not billing or legal advice.
Does a new PA in a hospital need focused professional practice evaluation?
In a Joint Commission accredited hospital, yes. The Joint Commission's standards FAQs say a period of focused professional practice evaluation is required for all new privileges, begins when privileges are granted, and applies to PAs, who are credentialed and privileged under the Medical Staff chapter like other practitioners.
How long does it take a new PA to reach a full schedule?
Many practices stage it over about 90 days, but the right pace depends on the specialty and the PA's experience. A new graduate in a specialty clinic needs longer chart review and more shadowing than an experienced PA moving within the same specialty. Raise the schedule when chart review shows safe, complete notes, not on a fixed date alone.