TL;DR: How to Become a Collaborating Physician
- A collaborating physician (CP) is a licensed MD or DO who partners with NPs to meet state oversight requirements like chart review, protocols, and availability.
- State laws vary: Some require CPs permanently, others only until NPs log a certain number of hours (e.g., NY: 3,600 hrs, WI: 3,840 hrs, CA: 4,600 hrs, IL: 4,000 hrs + CE, VT: 2,400 hrs).
- CP responsibilities may include: drafting agreements, reviewing charts, conducting site visits, supervising prescribing, and filing forms with the board.
- Physicians can become CPs by: (1) learning their state rules, (2) finding NP/clinic opportunities, (3) drafting agreements, and (4) maintaining documentation.
- Options: Do it yourself (DIY), join a matchmaking service, or use a compliance platform.
- GuardianMD provides a compliance hub, regulatory updates, chart review tools, and board inquiry support — making CP work safer and more manageable.
- TL;DR: How to Become a Collaborating Physician
- Why Become a Collaborating Physician?
- What is a Collaborating Physician?
- Why Do States Require Collaborating Physicians?
- What Are the Responsibilities of a Collaborating Physician?
- How Do You Become a Collaborating Physician?
- Why Consider Working with GuardianMD as a Collaborating Physician?
- Conclusion
Why Become a Collaborating Physician?
Becoming a collaborating physician (CP) can be a rewarding way to expand your professional impact while supporting nurse practitioners (NPs) and ensuring safe, compliant patient care. But it’s also a role that carries legal and regulatory responsibility.
In my experience helping hundreds of physicians and NPs set up these agreements, I’ve seen just how confusing the patchwork of state rules can be. This guide is designed to cut through that confusion and give you a clear roadmap.
What is a Collaborating Physician?
A collaborating physician is a licensed physician legally required in some states to oversee nurse practitioners. This oversight can include chart review, protocols, and availability for consults.
Many clinic owners confuse a collaborating physician with a medical director, but the roles are different — if you’re exploring oversight options, here’s a guide on how to find a medical director in 2025.
Depending on the state, a CP may need to:
- Sign and maintain a written collaborative practice agreement
- Review a percentage of charts or meet quarterly review requirements
- Be available for consultation (in person or remotely)
- Establish protocols for prescribing, referrals, and emergencies
- Register the relationship with the state board
In Short:
Being a collaborating physician is much more than signing a form — it’s an ongoing commitment to compliance, documentation, and patient safety.
The National Council of State Boards of Nursing (NCSBN) outlines national standards for APRN regulation and collaboration, which many states adapt into their own laws.
Why Do States Require Collaborating Physicians?
When NPs first entered the workforce, many states required physician collaboration to ensure patient safety and clinical backup. Today, the landscape is shifting:
- Full Practice Authority (FPA): About 30 states allow NPs to practice independently.
- Reduced Practice: Some states grant autonomy with limitations (e.g., controlled substances).
- Restricted Practice: Many states still require CPs for broad oversight.
Recent Changes and Examples
- New York: NPs must complete 3,600 hours of qualifying experience before practicing without a CP agreement.
- Wisconsin (2024 law): APRNs must log 3,840 hours under physician or dentist oversight before independent practice.
- California (AB 890): NPs must complete a transition-to-practice of 4,600 hours (three years) before being eligible for independent practice in the new 103/104 license categories.
- Illinois: NPs can gain FPA after 4,000 hours of clinical experience and 250 hours of continuing education; until then, a CP agreement is required.
- Florida: To register as an autonomous APRN, an NP must have 3,000 hours of supervised practice within the past five years and meet additional board requirements.
- Vermont: NPs must complete 2,400 hours and 24 months in a collaborative provider agreement before achieving full practice authority.
By contrast, in states like Texas or Georgia, collaboration is required indefinitely — no matter how much experience an NP has.
Even in autonomy states, CPs remain essential until those transition requirements are met — and in restricted states, collaboration is a career-long necessity. These rules often overlap with corporate practice of medicine laws, which govern how medical services can be structured and who can own a clinic.
For a current overview of which states grant full practice authority, reduced practice, or restricted practice, see the AANP state practice environment map.
What Are the Responsibilities of a Collaborating Physician?
The role of a CP varies by state, but common responsibilities include:
- Drafting and maintaining a compliant collaborative agreement
- Reviewing NP charts (monthly, quarterly, or by percentage)
- Establishing and updating practice protocols
- Being available for consults and emergencies
- Ensuring all filings and registrations are submitted
- Documenting oversight for board audits or inquiries
This is where many physicians underestimate the workload — it’s not just signing off once in a while, it’s ongoing documentation and oversight.
State-by-State Examples of Responsibilities
Here are examples of how responsibilities differ across states.
| Regulatory Aspect | Example States | Typical Requirement |
| Hours before autonomy | New York: 3,600 hrs; Wisconsin: 3,840 hrs; California: 4,600 hrs (AB 890); Illinois: 4,000 hrs + 250 CE; Vermont: 2,400 hrs + 24 months | CP required until threshold hours are met |
| Chart review | New York: NP records must be reviewed every 3 months; Texas: CP must review a percentage of charts for each delegated NP; Georgia: regular chart reviews required by law | Frequency may be fixed (quarterly) or percentage-based |
| Filing agreements | New York: Form 4NP must be filed within 90 days of starting practice; Florida: NPs applying for autonomous practice must register with the Board of Nursing; Illinois: transition-to-practice documentation required | Some states require filings with the board, others only onsite documentation |
| Specialty match | New York: CP must be qualified in the same specialty as the NP; Kentucky: CP must have prescribing authority in the same drug schedule; Ohio: CPs must be practicing in a field consistent with NP services | Varies from strict specialty alignment to general physician oversight |
| Prescriptive authority | Florida: CPs must oversee prescribing until APRN is autonomous; Texas: strict limits on controlled substance prescribing, with delegated authority defined in CPA; Kentucky: CP oversight required for Schedule II–V prescribing | Restrictions common in reduced and restricted states |
| Supervision / site visits | Alabama: CP required to conduct regular site visits for some NP practice settings; Missouri: CP must be on-site periodically depending on the practice arrangement | Not universal, but mandated in several restricted states |
Why this matters:
Even if two states have similar “reduced practice” laws, their actual CP duties differ drastically — from chart review frequency to filing requirements to whether site visits are mandated. For physicians, this means oversight is never “one-size-fits-all.”
How Do You Become a Collaborating Physician?
There are two main paths to becoming a collaborating physician: manage the process yourself or work through a platform. Both start with confirming that you’re eligible in your state, but the steps that follow look very different.
Option 1: Do It Yourself (DIY Approach)
If you only plan to support one or two NPs and like having control, DIY might work. But be ready for the admin load.
Physicians who go the DIY route are responsible for every step:
- Learning state laws — Knowing whether your state requires ongoing collaboration (like Texas or Georgia) or has transition-to-practice hours (like New York, Illinois, or California).
- Finding opportunities — Networking with NPs, scanning job boards, or connecting through NP associations. Many physicians first meet NPs who are looking to start an IV hydration business, one of the fastest-growing models requiring compliant oversight.
- Drafting and maintaining agreements — Creating written protocols that define chart review frequency, prescribing rules, emergency coverage, and more. In some states, these agreements must also be filed with the board.
- Building a documentation system — Tracking chart reviews, consultations, and compliance records to be audit-ready. This includes confirming your malpractice policy covers CP duties.
Pro/Con Table:
| DIY Approach | Pros | Cons |
| You control the relation-ship | Flexible, direct connection with NPs | Full compliance burden on you |
| Potentially higher pay | No middleman | Risk if documentation isn’t main-tained |
| Works for small scale | One or two NPs manageable | Hard to scale, high admin lift |
Option 2: Use a Platform
Platforms exist to make the process easier, but not all are the same. Broadly, there are two types:
Matchmaking services
Their primary function is to connect NPs and CPs.
- Once paired, the physician and NP are left to manage agreements, documentation, and compliance themselves.
- These services can help you find opportunities but provide little protection if a board ever comes knocking.
Compliance platforms (e.g., GuardianMD)
- Go beyond introductions by managing the full oversight lifecycle.
- Provide state-compliant agreements and templates.
- Track chart reviews, license expirations, and deadlines automatically.
- Monitor state law changes so you don’t have to.
- Offer support during board inquiries, ensuring you have the documentation and protocols ready.
For physicians, the difference is peace of mind. Matchmaking may get you started, but compliance platforms let you practice as a CP confidently, knowing your oversight duties are being met and tracked.
How Do I Know If a Company Is a Matchmaking Service or a True Compliance Platform?
If you’re considering working with a company to help you become a CP, it’s worth asking a few key questions:
- Do you provide state-specific agreements and protocols, or just connect me to an NP?
- How do you track chart reviews, license expirations, and compliance deadlines?
- What happens if my name comes up in a board inquiry — will you support me, or am I on my own?
- Do you actively monitor state law changes and update requirements for me?
If the answer to these is “no” or vague, it’s likely a matchmaking service rather than a true compliance platform. A real platform should give you the tools, documentation, and support you need to protect your license — not just make an introduction.
Bottom line:
Becoming a collaborating physician is possible either way, but the decision comes down to how much risk and administrative responsibility you’re willing to assume. DIY means full control but also full liability. Matchmaking services get you connected but leave compliance in your lap. Compliance platforms like GuardianMD give you both opportunity and protection, making it easier to focus on patient care and professional collaboration.
Why Consider Working with GuardianMD as a Collaborating Physician?
This is why I built GuardianMD — to give physicians the same level of protection and structure I wished I had when I first started in oversight roles.
GuardianMD was built to protect both NPs and CPs. As a physician, you’ll benefit from:
- Compliance Hub: Manage agreements, reviews, and protocols in one place
- Regulatory Updates: Automatic monitoring of state law changes
- Board Inquiry Support: Documentation and advocacy if your name comes up in an investigation
- Scalable Oversight: Tools to safely oversee multiple NPs across different states
This lets you focus on clinical leadership instead of chasing paperwork.
Frequently Asked Questions (Collaborating Physicians & NPs)
Conclusion
Becoming a collaborating physician is both an opportunity and a responsibility. Done right, it allows physicians to extend their expertise, support NP colleagues, and improve access to care. But it also requires careful attention to state laws, compliance, and documentation.
If you’re thinking about becoming a CP, my advice is simple: don’t treat it as a casual side gig. Whether you do it yourself or through GuardianMD, set it up the right way from the start so you protect your license and your NP colleagues.
