Physician Collaboration Requirements by State

Q: Are physician collaboration rules determined by medical boards or nursing boards?

Physician collaboration rules are typically shaped by both medical boards and nursing boards, along with state statutes. Nursing boards often define NP scope of practice, while medical boards regulate physician oversight, delegation, and supervision.

Q: Can one physician collaborate across multiple states?

Yes, but only if the physician is properly licensed in each state where collaboration occurs and meets that state’s specific collaboration requirements. Multi-state collaboration is common, but compliance must be assessed state by state.

A 50-State Guide

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Understanding Physician Collaboration Requirements

Physician collaboration refers to the legal requirement that certain healthcare providers—most commonly Nurse Practitioners (NPs) and Physician Assistants (PAs)—maintain a formal relationship with a licensed physician in order to practice or prescribe.

These requirements vary widely by state and are shaped by scope-of-practice laws, medical and nursing board rules, and workforce access considerations. Some states require ongoing collaboration or supervision, while others allow full independent practice with no physician involvement.

This guide provides a clear, state-by-state breakdown of physician collaboration rules, including who needs a collaborating physician, what type of agreement is required, prescribing limitations, telehealth considerations, and compliance risks—so clinics, providers, and healthcare organizations can scale safely and compliantly.

Key Takeaways

Physician collaboration requirements vary by state. Some states require ongoing collaboration or supervision, while others allow independent practice.
Rules are set at the state level. Collaboration requirements are defined by state statutes, nursing boards, and medical boards.
Written agreements and ratios often apply. Many states require formal collaboration or delegation agreements and impose physician-to-provider ratio limits.
Prescriptive authority is tied to collaboration. Medication and controlled-substance prescribing rules depend on physician involvement under state law.
Telehealth follows the patient’s location. Virtual care does not bypass collaboration requirements, and loss of a collaborating physician can halt practice.

What Is Physician Collaboration?

Physician collaboration is a legal or regulatory arrangement that requires a non-physician provider to maintain a defined professional relationship with a physician. Depending on the state, this relationship may involve:

Written collaborative practice agreements
Delegation or supervisory arrangements
Chart or case review requirements
Prescribing oversight
Availability for consultation or referral

Who Physician Collaboration Applies To

Physician collaboration laws most commonly apply to:

Nurse Practitioners (NPs / APRNs)
Physician Assistants (PAs)
Certain APRN specialties (e.g., CNS, CNM)
Clinics employing mid-level providers
Telehealth and virtual care organizations

Physician Collaboration vs Supervision vs Medical Direction

These terms are often used interchangeably—but they are not the same from a compliance perspective.

Physician Collaboration

Shared responsibility model
Often requires a written agreement
Common for NPs and APRNs
Physician is available for consultation, not daily oversight

Physician Supervision

Physician maintains higher level of oversight and control
Often includes chart review, on-site visits, or ratio limits
More common for PAs
Greater liability exposure for physicians

Medical Direction

Broader clinical oversight role
Common in medspas, IV therapy, and specialty clinics
May include protocol approval, staff training, and quality assurance
Often layered on top of collaboration or delegation requirements

Why Physician Collaboration Laws Vary by State

The same clinic model can be fully legal in one state and non-compliant in another without adjustments.

State-level variation is driven by several factors:

Medical boards regulating physician practice
Nursing boards defining NP/APRN scope
State scope-of-practice statutes
Access-to-care concerns, especially in rural areas
Workforce shortages and public health policy priorities

Do you need a collaborating physician?

Finding the right collaborating physician is one of the most important steps in building a compliant, scalable NP-led practice. GuardianMD makes the process simple, fast, and fully compliant.

Learn More

Overview of Physician Collaboration Laws by State (NPs)

State	Collaboration Required?	Agreement Required?	Prescriptive Authority	Physician-to-NP Ratio	Path to Independence (Hours/Time-Based?)
Alabama	Yes	Yes (CPA)	Restricted	Yes	No
Alaska	No	No	Independent	No	N/A
Arizona	No	No	Independent	No	N/A
Arkansas	Yes	Yes	Restricted	Yes	Yes
California	Yes	Conditional	Conditional	Conditional	Yes
Colorado	No	No	Independent	No	N/A
Connecticut	Yes	Yes	Conditional	No	Yes
Delaware	Yes	Yes	Conditional	No	Yes
Florida	Yes	Yes	Restricted	Yes	No
Georgia	Yes	Yes	Restricted	Yes	No
Hawaii	No	No	Independent	No	N/A
Idaho	No	No	Independent	No	N/A
Illinois	Yes	Yes	Conditional	No	Yes
Indiana	Yes	Yes	Restricted	Yes	No
Iowa	No	No	Independent	No	N/A
Kansas	Yes	Yes	Restricted	Yes	No
Kentucky	Yes	Yes	Restricted	Yes	No
Louisiana	Yes	Yes	Restricted	Yes	No
Maine	No	No	Independent	No	N/A
Maryland	Yes	Yes	Conditional	No	Yes
Massachusetts	Yes	Yes	Conditional	No	Yes
Michigan	Yes	Yes	Restricted	Yes	No
Minnesota	No	No	Independent	No	N/A
Mississippi	Yes	Yes	Restricted	Yes	No
Missouri	Yes	Yes	Restricted	Yes	No
Montana	No	No	Independent	No	N/A
Nebraska	Yes	Yes	Conditional	No	Yes
Nevada	No	No	Independent	No	N/A
New Hampshire	Yes	Yes	Conditional	No	Yes
New Jersey	Yes	Yes	Conditional	No	Yes
New Mexico	No	No	Independent	No	N/A
New York	Yes	Yes	Conditional	No	Yes
North Carolina	Yes	Yes	Restricted	Yes	No
North Dakota	No	No	Independent	No	N/A
Ohio	Yes	Yes	Restricted	Yes	No
Oklahoma	Yes	Yes	Restricted	Yes	No
Oregon	No	No	Independent	No	N/A
Pennsylvania	Yes	Yes	Restricted	Yes	No
Rhode Island	Yes	Yes	Conditional	No	Yes
South Carolina	Yes	Yes	Restricted	Yes	No
South Dakota	No	No	Independent	No	N/A
Tennessee	Yes	Yes	Restricted	Yes	No
Texas	Yes	Yes (Delegation)	Conditional	Yes	No
Utah	No	No	Independent	No	N/A
Vermont	Yes	Yes	Conditional	No	Yes
Virginia	Yes	Yes	Conditional	No	Yes
Washington	No	No	Independent	No	N/A
West Virginia	Yes	Yes	Restricted	Yes	No
Wisconsin	Yes	Yes	Restricted	Yes	No
Wyoming	No	No	Independent	No	N/A

Physician Collaboration Requirements by State

Alabama Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes (CPA)
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

Alabama requires ongoing physician collaboration with written agreements and ratio limits. There is no hours-based path to independent NP practice.

Alaska Physician Collaboration Requirements

Collaboration required: No
Path to independence: N/A
Agreement required: No
Physician-to-NP ratio: No
Prescriptive authority: Independent

Alaska grants full practice authority to NPs with no physician collaboration required.

Arizona Physician Collaboration Requirements

Collaboration required: No
Path to independence: N/A
Agreement required: No
Physician-to-NP ratio: No
Prescriptive authority: Independent

Arizona allows NPs to practice and prescribe independently without physician involvement.

Arkansas Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: Yes (hours-based)
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

Arkansas requires physician collaboration initially, with a defined experience-based pathway toward independence.

California Physician Collaboration Requirements

Collaboration required: Conditional
Path to independence: Yes (transitional)
Agreement required: Conditional
Physician-to-NP ratio: Conditional
Prescriptive authority: Conditional

California uses a transition-to-practice model where some NPs may practice independently after meeting statutory requirements.

Colorado Physician Collaboration Requirements

Collaboration required: No
Path to independence: N/A
Agreement required: No
Physician-to-NP ratio: No
Prescriptive authority: Independent

Colorado grants full practice authority with no physician collaboration required.

Connecticut Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: Yes (hours-based)
Agreement required: Yes
Physician-to-NP ratio: No
Prescriptive authority: Conditional

Connecticut requires collaboration during an initial transition period before allowing independent practice.

Delaware Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: Yes
Agreement required: Yes
Physician-to-NP ratio: No
Prescriptive authority: Conditional

Delaware permits independent NP practice after meeting experience requirements.

Florida Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

Florida maintains ongoing collaboration requirements with limited prescribing authority.

Georgia Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

Georgia requires permanent physician collaboration and enforces ratio limits.

Hawaii Physician Collaboration Requirements

Collaboration required: No
Path to independence: N/A
Agreement required: No
Physician-to-NP ratio: No
Prescriptive authority: Independent

Hawaii grants full practice authority to Nurse Practitioners.

Idaho Physician Collaboration Requirements

Collaboration required: No
Path to independence: N/A
Agreement required: No
Physician-to-NP ratio: No
Prescriptive authority: Independent

Idaho allows independent NP practice without physician collaboration.

Illinois Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: Yes (hours-based)
Agreement required: Yes
Physician-to-NP ratio: No
Prescriptive authority: Conditional

Illinois requires collaboration during a defined transition period.

Indiana Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

Indiana requires ongoing physician collaboration with ratio limits.

Iowa Physician Collaboration Requirements

Collaboration required: No
Path to independence: N/A
Agreement required: No
Physician-to-NP ratio: No
Prescriptive authority: Independent

Iowa grants full practice authority to NPs

Kansas Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

Kentucky Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

Kentucky maintains permanent collaboration requirements for NPs.

Louisiana Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

Louisiana requires ongoing physician collaboration with limited prescribing authority.

Maine CPOM Laws

Collaboration required: No
Path to independence: N/A
Agreement required: No
Physician-to-NP ratio: No
Prescriptive authority: Independent

Maine allows independent NP practice.

Maryland Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: Yes
Agreement required: Yes
Physician-to-NP ratio: No
Prescriptive authority: Conditional

Maryland permits independent practice after experience requirements are met.

Massachusetts Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: Yes
Agreement required: Yes
Physician-to-NP ratio: No
Prescriptive authority: Conditional

Massachusetts uses a transition-to-practice framework.

Michigan Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

Michigan requires permanent physician collaboration.

Minnesota Physician Collaboration Requirements

Collaboration required: No
Path to independence: N/A
Agreement required: No
Physician-to-NP ratio: No
Prescriptive authority: Independent

Minnesota grants full practice authority.

Mississippi Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

Mississippi maintains strict collaboration requirements.

Missouri Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

Missouri requires permanent collaboration.

Montana Physician Collaboration Requirements

Collaboration required: No
Path to independence: N/A
Agreement required: No
Physician-to-NP ratio: No
Prescriptive authority: Independent

Montana allows independent NP practice.

Nebraska Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: Yes
Agreement required: Yes
Physician-to-NP ratio: No
Prescriptive authority: Conditional

Nebraska permits independence after experience requirements.

Nevada Physician Collaboration Requirements

Collaboration required: No
Path to independence: N/A
Agreement required: No
Physician-to-NP ratio: No
Prescriptive authority: Independent

Nevada grants full practice authority.

New Hampshire Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: Yes
Agreement required: Yes
Physician-to-NP ratio: No
Prescriptive authority: Conditional

New Jersey Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: Yes
Agreement required: Yes
Physician-to-NP ratio: No
Prescriptive authority: Conditional

New Jersey uses a transition-to-practice model.

New Mexico Physician Collaboration Requirements

Collaboration required: No
Path to independence: N/A
Agreement required: No
Physician-to-NP ratio: No
Prescriptive authority: Independent

New Mexico allows nurse practitioners (NPs) to practice independently under full practice authority.

New York Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: Yes
Agreement required: Yes
Physician-to-NP ratio: No
Prescriptive authority: Conditional

New York allows independence after experience thresholds.

North Carolina Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

North Carolina requires permanent physician supervision.

North Dakota Physician Collaboration Requirements

Collaboration required: No
Path to independence: N/A
Agreement required: No
Physician-to-NP ratio: No
Prescriptive authority: Independent

North Dakota grants full practice authority.

Ohio Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

Ohio requires ongoing physician collaboration.

Oklahoma Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

Oregon Physician Collaboration Requirements

Collaboration required: No
Path to independence: N/A
Agreement required: No
Physician-to-NP ratio: No
Prescriptive authority: Independent

Oregon allows independent NP practice.

Pennsylvania Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

Pennsylvania maintains permanent collaboration requirements.

Rhode Island Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: Yes
Agreement required: Yes
Physician-to-NP ratio: No
Prescriptive authority: Conditional

New York allows independence after experience thresholds.

South Carolina Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

South Carolina requires strict physician oversight.

South Dakota Physician Collaboration Requirements

Collaboration required: No
Path to independence: N/A
Agreement required: No
Physician-to-NP ratio: No
Prescriptive authority: Independent

South Dakota grants full practice authority.

Tennessee Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

Tennessee requires permanent collaboration.

Texas Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes (delegation)
Physician-to-NP ratio: Yes
Prescriptive authority: Conditional

Texas uses a delegation model with strict oversight and limited prescribing authority.

Utah Physician Collaboration Requirements

Collaboration required: No
Path to independence: N/A
Agreement required: No
Physician-to-NP ratio: No
Prescriptive authority: Independent

Utah allows independent NP practice.

Virginia Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: Yes
Agreement required: Yes
Physician-to-NP ratio: No
Prescriptive authority: Conditional

Virginia permits independence after experience requirements.

Washington Physician Collaboration Requirements

Collaboration required: No
Path to independence: N/A
Agreement required: No
Physician-to-NP ratio: No
Prescriptive authority: Independent

Washington grants full practice authority.

West Virginia Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

West Virginia requires permanent physician collaboration.

Wisconsin Physician Collaboration Requirements

Collaboration required: Yes
Path to independence: No
Agreement required: Yes
Physician-to-NP ratio: Yes
Prescriptive authority: Restricted

Wisconsin maintains strict collaboration requirements.

Wyoming Physician Collaboration Requirements

Collaboration required: No
Path to independence: N/A
Agreement required: No
Physician-to-NP ratio: No
Prescriptive authority: Independent

Wyoming allows independent NP practice.

States With the Strictest Physician Collaboration Laws (NPs)

These states impose ongoing physician collaboration or supervision, often with no path to independence, strict ratio caps, prescribing limitations, and heightened enforcement risk.

Highest-Risk / Most Restrictive States

Texas
Delegation-based model with strict physician oversight, ratio limits, and prescriptive authority constraints. One of the most complex states operationally, especially for multi-site and telehealth models.
California
Transitional independence exists, but enforcement is nuanced. Physician involvement, standardized procedures, and setting-specific rules make compliance complex—particularly for corporate-backed clinics.
Florida
Physician collaboration remains required for many NPs. Prescribing authority is limited, ratios apply, and enforcement risk is higher for wellness, IV therapy, and telehealth clinics.
Alabama
Requires formal collaborative practice agreements with ratio limits and prescribing restrictions. No clear path to independence for most NPs.
Mississippi
Ongoing collaboration required, strict physician oversight expectations, and limited flexibility for scaling without expanding physician coverage.

Other Highly Restrictive Collaboration States

These states also warrant caution due to permanent collaboration requirements, ratio caps, or limited prescribing authority:

Georgia
South Carolina
Tennessee
Missouri
Oklahoma
Pennsylvania
Wisconsin

Common Compliance Mistakes Across States

Using outdated or expired agreements
Exceeding physician-to-provider ratios
Assuming telehealth rules are more lenient
Missing required documentation or renewals

Confusing collaboration with CPOM compliance

How Organizations Manage Multi-State Physician Collaboration

Scaling across states requires:

State-specific agreement management
Centralized physician oversight tracking
Automated license and ratio monitoring
Clear separation between clinical and administrative control

This is where most growing organizations struggle—and where purpose-built infrastructure matters.

Get Help With Physician Collaboration & Compliance

GuardianMD helps clinics, franchises, and healthcare organizations manage physician collaboration across all 50 states with:

Vetted collaborating physicians
State-specific agreement templates
License, ratio, and compliance monitoring
Telehealth-ready collaboration models
Audit-ready documentation

Whether you’re opening a single clinic or scaling nationally, we help you stay compliant—without slowing growth.

Do you need a collaborating physician?

Finding the right collaborating physician is one of the most important steps in building a compliant, scalable NP-led practice. GuardianMD makes the process simple, fast, and fully compliant.

Learn More

Frequently Asked Questions

Do NPs need a collaborating physician in every state?

No. Nurse Practitioner collaboration requirements vary by state. Some states require ongoing physician collaboration, some require collaboration only during an initial transition period, and others allow full independent practice with no physician involvement.

Are physician collaboration rules determined by medical boards or nursing boards?

Physician collaboration rules are typically shaped by both medical boards and nursing boards, along with state statutes. Nursing boards often define NP scope of practice, while medical boards regulate physician oversight, delegation, and supervision.

Can one physician collaborate across multiple states?

Yes, but only if the physician is properly licensed in each state where collaboration occurs and meets that state’s specific collaboration requirements. Multi-state collaboration is common, but compliance must be assessed state by state.

Which states allow full practice authority without physician collaboration?

Several states grant Nurse Practitioners full practice authority, allowing them to practice and prescribe independently without a collaborating physician. Examples include Arizona, Colorado, Oregon, Washington, and Wyoming.

Can physician collaboration requirements change over time?

Yes. Collaboration laws evolve through legislative changes, board rulemaking, and enforcement shifts. States have increasingly moved toward transitional or independent practice models, making regular compliance reviews essential.

Can clinics share collaborating physicians across locations?

Sometimes. Many states allow physicians to collaborate with providers across multiple locations, but ratio limits, geographic rules, and supervision expectations may restrict how widely a single physician can be shared.

Can newly licensed providers have different collaboration requirements?

Yes. Many states impose stricter collaboration or supervision requirements on newly licensed Nurse Practitioners, with reduced requirements after completing a defined number of practice hours or years.

Can a physician collaborate with providers in different specialties?

In some states, yes — but others require physicians to collaborate only within their scope of training or specialty. Specialty alignment is especially important in areas like psychiatry, aesthetics, IV therapy, and specialty prescribing.

Do collaboration requirements differ for primary care vs specialty care?

They can. Certain specialties may have additional oversight requirements, prescribing limitations, or documentation rules that go beyond general primary care collaboration standards.

What is a Collaborative Practice Agreement (CPA)?

A Collaborative Practice Agreement (CPA) is a formal written agreement that outlines the relationship between a physician and a Nurse Practitioner, including scope of practice, prescribing authority, consultation requirements, and quality oversight.

How often do agreements need to be updated?

Update requirements vary by state. Some states require updates annually or upon license renewal, while others require updates only when material changes occur, such as staffing, scope of practice, or practice location.

Is a written physician collaboration agreement always required?

No. In full practice authority states, written collaboration agreements are not required. In collaboration or transitional states, written agreements are often mandatory and must meet specific statutory or board requirements.

Do collaboration agreements need to be filed with the state?

Some states require collaboration agreements to be filed or made available upon request, while others require clinics to retain agreements internally for audit purposes only.

How often must physician collaboration agreements be updated?

Agreements should be reviewed and updated whenever there is a material change, such as provider turnover, scope expansion, prescribing changes, or regulatory updates — even if the state does not mandate a fixed update interval.

Can a collaboration agreement be terminated early?

Yes. Most collaboration agreements can be terminated early, but states may require notice periods, transition plans, or immediate cessation of certain services if no replacement collaboration is in place.

Are collaboration agreements subject to audit?

Yes. State boards and regulatory agencies may audit collaboration agreements during investigations, complaints, license renewals, payer audits, or corporate transactions.

Can providers prescribe independently under a collaboration agreement?

Sometimes. Prescriptive authority under a collaboration agreement depends on state law and the terms of the agreement. Many states limit controlled substance prescribing or require additional oversight.

Can collaborating physicians restrict what medications a provider can prescribe?

Yes. Collaboration agreements often define or limit prescribing authority beyond what state law requires, especially for controlled substances or specialty medications.

Does physician collaboration impact DEA registration?

It can. DEA registration must align with state scope-of-practice rules and collaboration requirements. Improper collaboration arrangements can create DEA compliance risks.

Who is responsible for ensuring collaboration compliance — the provider or the organization?

Both. Individual providers are responsible for practicing within their legal scope, while clinics and organizations are responsible for structuring compliant collaboration, documentation, and oversight systems.

What happens if collaboration requirements aren’t met?

Failure to comply can result in license discipline, fines, prescribing restrictions, payer clawbacks, contract termination, or forced clinic closure, depending on severity and state enforcement posture.

Who enforces physician collaboration laws?

Enforcement typically involves state nursing boards, medical boards, and sometimes departments of health or attorneys general, depending on the issue.