Legal Requirements for Physicians Supervising Nurse Practitioners and Physician Assistants: FAQ
Why physicians should know about legal requirements
Physicians have a responsibility to ensure that non-physician clinicians (NPCs) they supervise provide quality care and comply with state laws. Each state defines scope of practice for non-physician clinicians and, if applicable, sets supervision guidelines. Failing to understand and follow state laws and regulations can put you at risk for malpractice lawsuits and medical board investigations.
When supervising an NPC, ensure that your scope of practice and their scope of practice are congruent. For example, if you are a geriatrician, it is not advisable to supervise an NPC who will be providing mainly pediatric care in your practice or doing procedures that you do not perform.
Common legal questions
- Where can I learn about legal requirements in my state?
- What is the legal scope of practice for non-physician clinicians?
- How can I understand my contractual obligations for working with a non-physician clinician?
- Is there a legal limit to how many non-physician clinicians I can supervise?
- How many non-physician clinicians should I supervise?
- What are my responsibilities when a non-physician clinician I supervise makes a mistake?
- What do I do if I believe a non-physician clinician I work with is cognitively impaired?
- How can I learn about legal cases or disciplinary actions involving non-physician clinicians?
Where can I learn about legal requirements in my state?
Regulations that govern the role of NPCs and outline physician responsibilities can be found on the state regulatory agency websites. The regulatory agency that governs Physician Assistants (PAs) is generally the state medical board, although some states have their own PA board2. For Nurse Practitioners (NPs) and nurse midwives, the regulatory agency is the state nursing board. These state boards will be able to provide information on the most up-to-date statutes, regulations, and policies pertaining to NPC practice and physician responsibilities related to the supervision of, or collaboration with, NPCs.
Physicians should pay particular attention to the language used in state statutes and regulations related to supervision versus collaboration with NPCs. In recent years, many states have updated their laws to reflect a transition to a collaborative working environment between physicians and NPCs. States that require supervision of NPCs will define what supervision entails at the practice level in state code and/or regulations. These regulations may address any or all of the following: physician availability, regular review, delegation of tasks, and frequency of direct supervision.
In addition to these state resources, many AAFP chapters can provide additional state-specific resources and guidance for family physicians seeking information on supervision or collaboration with NPCs.
Find Your State to Learn More
Nurse Practitioner Scope and Requirements
Practice Environment:
- Reduced Practice Authority (NPs can perform some of their scope of practice without a supervising physician, however, restrictions apply. Restrictions vary by state but may include prescribing certain medications or operating their own independent practice. As a result, NPs are often in collaborative agreements with physicians.)
Physician Supervision/Collaboration:
- Collaborative practice agreement required.
State Resources:
- Advanced Practice - Alabama Board of Nursing
- Alabama Board of Medical Examiners & Medical Licensure Commission
Physician Assistant Scope and Requirements
Practice Environment:
- Reduced (State statute and/or regulation limits PA practice in at least one area and requires physician supervision or limited delegated authority.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A - NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- Collaboration required including monthly contact between PA and collaborating physician.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A - NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Moderate (State statute and/or regulation includes additional administrative requirements, limiting PA flexibility in practice.)
Physician Supervision/Collaboration:
- Physician supervision required including weekly meetings between PA and supervising physician.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Reduced Practice Authority (NPs can perform some of their scope of practice without a supervising physician, however, restrictions apply. Restrictions vary by state but may include prescribing certain medications or operating their own independent practice. As a result, NPs are often in collaborative agreements with physicians.)
Physician Supervision/Collaboration:
- Collaborative practice agreement required.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Restricted Practice Authority (NPs cannot perform their scope of practice without a supervising physician. State law requires that NPs are supervised by a physician.)
Physician Supervision/Collaboration:
- Physician supervision required
State Resources:
- California Board of Nursing
- California Laws and Regulations for Nurse Practitioners
- California Nurse Practitioner Practice
Physician Assistant Scope and Requirements
Practice Environment:
- Moderate (State statute and/or regulation includes additional administrative requirements, limiting PA flexibility in practice.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A – NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Reduced (State statute and/or regulation limits PA practice in at least one area and requires physician supervision or limited delegated authority.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- NPs must practice in collaboration with a physician who is licensed in Connecticut for at least three years to gain full practice authority.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- Collaborative relationship with the supervising physician.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A – NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- Written collaborative agreement with physician required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A – NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Moderate (State statute and/or regulation includes additional administrative requirements, limiting PA flexibility in practice.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- NPs must complete 3,000 practice hours under a physician’s supervision to gain full practice authority.
State Resources:
- Florida Board of Nursing
- Florida Advanced Practice Registered Nurse (APRN) FAQ
- Florida Nursing Statutes for APRNs
Physician Assistant Scope and Requirements
Practice Environment:
- Reduced (State statute and/or regulation limits PA practice in at least one area and requires physician supervision or limited delegated authority.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Restricted Practice Authority (NPs cannot perform their scope of practice without a supervising physician. State law requires that NPs are supervised by a physician.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Reduced (State statute and/or regulation limits PA practice in at least one area and requires physician supervision or limited delegated authority.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A – NPs can practice independently.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A – NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Reduced (State statute and/or regulation limits PA practice in at least one area and requires physician supervision or limited delegated authority.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A – NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Moderate (State statute and/or regulation includes additional administrative requirements, limiting PA flexibility in practice.)
Physician Supervision/Collaboration:
- Written collaborative agreement with physician required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Reduced Practice Authority (NPs can perform some of their scope of practice without a supervising physician, however, restrictions apply. Restrictions vary by state but may include prescribing certain medications or operating their own independent practice. As a result, NPs are often in collaborative agreements with physicians.)
Physician Supervision/Collaboration:
- Collaborative agreement required, except for:
- APRNs that practice in a hospital, hospital affiliate, or ambulatory surgical treatment center
- APRNs who are granted full practice authority
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- Collaboration required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Reduced Practice Authority (NPs can perform some of their scope of practice without a supervising physician, however, restrictions apply. Restrictions vary by state but may include prescribing certain medications or operating their own independent practice. As a result, NPs are often in collaborative agreements with physicians.)
Physician Supervision/Collaboration:
- Collaborative practice agreement required.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Moderate (State statute and/or regulation includes additional administrative requirements, limiting PA flexibility in practice.)
Physician Supervision/Collaboration:
- Written collaborative agreement with physician required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A – NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Moderate (State statute and/or regulation includes additional administrative requirements, limiting PA flexibility in practice.)
Physician Supervision/Collaboration:
- Physician supervision required including a written supervisory agreement.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A – NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Reduced (State statute and/or regulation limits PA practice in at least one area and requires physician supervision or limited delegated authority.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Reduced Practice Authority (NPs can perform some of their scope of practice without a supervising physician, however, restrictions apply. Restrictions vary by state but may include prescribing certain medications or operating their own independent practice. As a result, NPs are often in collaborative agreements with physicians.)
Physician Supervision/Collaboration:
- Collaborative agreement required for prescribing controlled substance and other specified drugs.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Reduced (State statute and/or regulation limits PA practice in at least one area and requires physician supervision or limited delegated authority.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Reduced Practice Authority (NPs can perform some of their scope of practice without a supervising physician, however, restrictions apply. Restrictions vary by state but may include prescribing certain medications or operating their own independent practice. As a result, NPs are often in collaborative agreements with physicians.)
Physician Supervision/Collaboration:
- Collaborative practice agreement required.
State Resources:
- Louisiana Board of Nursing
- Louisiana Nursing Professional Standards
- Louisiana Guidelines for Interpreting Scope of Practice for APRNs
Physician Assistant Scope and Requirements
Practice Environment:
- Reduced (State statute and/or regulation limits PA practice in at least one area and requires physician supervision or limited delegated authority.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A – NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- Collaborative agreement required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A – NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Reduced (State statute and/or regulation limits PA practice in at least one area and requires physician supervision or limited delegated authority.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A – NPs can practice independently.
State Resources:
- Massachusetts Board of Registration in Nursing
- Massachusetts Nursing Laws and Regulations
- 244 CMR 4.00: Advanced Practice Registered Nursing
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Restricted Practice Authority (NPs cannot perform their scope of practice without a supervising physician. State law requires that NPs are supervised by a physician.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- Collaboration through a written practice agreement required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- NPs must complete at least 2,080 hours within the context of a collaborative management setting to gain full practice authority.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- Collaboration through a practice agreement required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Reduced Practice Authority (NPs can perform some of their scope of practice without a supervising physician, however, restrictions apply. Restrictions vary by state but may include prescribing certain medications or operating their own independent practice. As a result, NPs are often in collaborative agreements with physicians.)
Physician Supervision/Collaboration:
- Collaborative agreement required.
State Resources:
- Mississippi Board of Nursing
- Mississippi Statutes and Regulations for APRNs
- Mississippi Board of Nursing Decision Making Model
Physician Assistant Scope and Requirements
Practice Environment:
- Reduced (State statute and/or regulation limits PA practice in at least one area and requires physician supervision or limited delegated authority.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Restricted Practice Authority (NPs cannot perform their scope of practice without a supervising physician. State law requires that NPs are supervised by a physician.)
Physician Supervision/Collaboration:
- Collaborative practice agreement and physician supervision required.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Reduced (State statute and/or regulation limits PA practice in at least one area and requires physician supervision or limited delegated authority.)
Physician Supervision/Collaboration:
- Collaboration according to the terms of a written practice agreement.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A – NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Reduced (State statute and/or regulation limits PA practice in at least one area and requires physician supervision or limited delegated authority.)
Physician Supervision/Collaboration:
- Physician supervision required including monthly face-to-face meetings between the PA and physician.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- NPs must complete at least 2,000 practice hours with a supervising physician under a transition-to-practice agreement to gain full practice authority.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Moderate (State statute and/or regulation includes additional administrative requirements, limiting PA flexibility in practice.)
Physician Supervision/Collaboration:
- Physician supervision and collaborative agreement required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- NPs must complete at least 2 years or 2,000 practice hours before they can prescribe controlled substances without a collaborating physician.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Reduced (State statute and/or regulation limits PA practice in at least one area and requires physician supervision or limited delegated authority.)
Physician Supervision/Collaboration:
- Physician supervision required including in-person supervision at least once a month.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A – NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- Written collaboration agreement required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Reduced Practice Authority (NPs can perform some of their scope of practice without a supervising physician, however, restrictions apply. Restrictions vary by state but may include prescribing certain medications or operating their own independent practice. As a result, NPs are often in collaborative agreements with physicians.)
Physician Supervision/Collaboration:
- Joint protocol with collaborating physician required.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Moderate (State statute and/or regulation includes additional administrative requirements, limiting PA flexibility in practice.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A – NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- PAs must practice under supervision of physician for three years before they can transition to a collaborative relationship.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- NPs must complete at least 3,600 practice hours with a collaborating physician under a written practice agreement to gain full practice authority.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Moderate (State statute and/or regulation includes additional administrative requirements, limiting PA flexibility in practice.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Restricted Practice Authority (NPs cannot perform their scope of practice without a supervising physician. State law requires that NPs are supervised by a physician.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- Physician supervision required including monthly meetings between PA and physician in the first six months.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A – NPs can practice independently.
State Resources:
- North Dakota Board of Nursing
- North Dakota Advanced Practice FAQ
- North Dakota Administrative Code for APRNs
Physician Assistant Scope and Requirements
Practice Environment:
- Full (State statute and/or regulation does not limit PA practice; PAs may practice to the full extent of their medical education, training, and experience under collaboration with a physician. Healthcare teams or employers may set guidelines for collaboration.)
Physician Supervision/Collaboration:
- Collaboration under a written collaboration agreement is required for PAs with less than 4,000 practice hours.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Reduced Practice Authority (NPs can perform some of their scope of practice without a supervising physician, however, restrictions apply. Restrictions vary by state but may include prescribing certain medications or operating their own independent practice. As a result, NPs are often in collaborative agreements with physicians.)
Physician Supervision/Collaboration:
- Standard care arrangement with collaborating physician required.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Moderate (State statute and/or regulation includes additional administrative requirements, limiting PA flexibility in practice.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Restricted Practice Authority (NPs cannot perform their scope of practice without a supervising physician. State law requires that NPs are supervised by a physician.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Moderate (State statute and/or regulation includes additional administrative requirements, limiting PA flexibility in practice.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A - NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- Collaborative agreement required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Reduced Practice Authority (NPs can perform some of their scope of practice without a supervising physician, however, restrictions apply. Restrictions vary by state but may include prescribing certain medications or operating their own independent practice. As a result, NPs are often in collaborative agreements with physicians.)
Physician Supervision/Collaboration:
- Collaborative agreement required.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Reduced (State statute and/or regulation limits PA practice in at least one area and requires physician supervision or limited delegated authority.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Reduced Practice Authority (NPs can perform some of their scope of practice without a supervising physician, however, restrictions apply. Restrictions vary by state but may include prescribing certain medications or operating their own independent practice. As a result, NPs are often in collaborative agreements with physicians.)
Physician Supervision/Collaboration:
- Collaborative agreement required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A - NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- Collaboration required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Restricted Practice Authority (NPs cannot perform their scope of practice without a supervising physician. State law requires that NPs are supervised by a physician.)
Physician Supervision/Collaboration:
- Written practice agreement required.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Reduced (State statute and/or regulation limits PA practice in at least one area and requires physician supervision or limited delegated authority.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A - NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Moderate (State statute and/or regulation includes additional administrative requirements, limiting PA flexibility in practice.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Restricted Practice Authority (NPs cannot perform their scope of practice without a supervising physician. State law requires that NPs are supervised by a physician.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Moderate (State statute and/or regulation includes additional administrative requirements, limiting PA flexibility in practice.)
Physician Supervision/Collaboration:
- Collaboration required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Restricted Practice Authority (NPs cannot perform their scope of practice without a supervising physician. State law requires that NPs are supervised by a physician.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Moderate (State statute and/or regulation includes additional administrative requirements, limiting PA flexibility in practice.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Reduced Practice Authority (NPs can perform some of their scope of practice without a supervising physician, however, restrictions apply. Restrictions vary by state but may include prescribing certain medications or operating their own independent practice. As a result, NPs are often in collaborative agreements with physicians.)
Physician Supervision/Collaboration:
- Collaborative agreement required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A – NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Full (State statute and/or regulation does not limit PA practice; PAs may practice to the full extent of their medical education, training, and experience under collaboration with a physician. Healthcare teams or employers may set guidelines for collaboration.)
Physician Supervision/Collaboration:
- Collaboration required, although degree of required collaboration varies based on the number of practice hours accrued.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- NPs must complete 1,600 practice hours under a physician’s supervision to gain full practice authority.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- Collaboration through practice agreement required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Restricted Practice Authority (NPs cannot perform their scope of practice without a supervising physician. State law requires that NPs are supervised by a physician.)
Physician Supervision/Collaboration:
- Practice agreement required, except for NPs who have completed at least five years of clinical practice experience under a physician’s supervision.
State Resources:
- Virginia Board of Nursing
- Virginia Regulations for Nurse Practitioners
- Virginia Code for Licensure and Practice of APRNs
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- Collaboration through practice agreement required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A - NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Reduced (State statute and/or regulation limits PA practice in at least one area and requires physician supervision or limited delegated authority.)
Physician Supervision/Collaboration:
- Physician supervision required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Reduced Practice Authority (NPs can perform some of their scope of practice without a supervising physician, however, restrictions apply. Restrictions vary by state but may include prescribing certain medications or operating their own independent practice. As a result, NPs are often in collaborative agreements with physicians.)
Physician Supervision/Collaboration:
- Collaborative agreement required.
State Resources:
- West Virginia Nursing Board
- West Virginia Nursing Statutes and Regulations
- West Virginia Nursing Scope of Practice
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- Collaboration required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Reduced Practice Authority (NPs can perform some of their scope of practice without a supervising physician, however, restrictions apply. Restrictions vary by state but may include prescribing certain medications or operating their own independent practice. As a result, NPs are often in collaborative agreements with physicians.)
Physician Supervision/Collaboration:
- Collaborative agreement required.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Advanced (State statute and/or regulation allows PAs to practice to the full extent of their medical education, training, and experience, but are subject to state administrative requirements.)
Physician Supervision/Collaboration:
- Collaboration through written collaborative agreement required.
State Resources:
Nurse Practitioner Scope and Requirements
Practice Environment:
- Full Practice Authority (NPs can perform the full scope of practice without a supervising or collaborating physician. NPs can evaluate patients; diagnose, order, and interpret diagnostic tests; initiate and manage treatments, including prescribing medications; and operate their own independent practices.)
Physician Supervision/Collaboration:
- N/A - NPs can practice independently.
State Resources:
Physician Assistant Scope and Requirements
Practice Environment:
- Full (State statute and/or regulation does not limit PA practice; PAs may practice to the full extent of their medical education, training, and experience under collaboration with a physician. Healthcare teams or employers may set guidelines for collaboration.)
Physician Supervision/Collaboration:
- Degree of collaboration is determined at the practice level.
State Resources:
What is the legal scope of practice for non-physician clinicians?
The scope of practice for NPCs is determined by state statutes and regulations. Consult state regulatory agency webpages for the most up-to-date statutes, regulations, and policies pertaining to NPC scope of practice. Physicians can also look to state boards for interpretative statements of regulation that can serve as guidelines for proper implementation.
Nearly all states require PAs to have some level of supervision or collaboration with a physician; however, the details of these arrangements vary by state. NPs have more variation across states in their practice authority which ranges from full practice authority with the ability to operate independent practices, to restricted practice authority in which NPs must be supervised by a physician.
While state statutes and regulations govern the scope of practice for NPCs, health systems and other employers may develop additional guidelines, policies, or procedures related to how NPCs practice within that environment.
Below is a list of credible resources for understanding current scope of practice regulations by state.
- Vivian’s 2023 State by State Scope of Practice for PAs
- AMA’s PA Scope of Practice Resource
- AAPA’s Guide to PA Regulations and Compliance
- AAPA’s List of Licensing Boards for PAs
- AANP’s Standards of Practice for NPs
- AANP’s Scope of Practice for NPs
- AANP’s NP State Practice Environment Overview
- Nursing Process’ NP Scope of Practice by State - 2023
How can I understand my contractual obligations for working with a non-physician clinician?
Thoroughly review your physician employment contract and ask questions about your employer’s expectations related to supervision/collaboration with NPCs. If you are employed, your employer’s expectations for supervision should be laid out in writing in your employment contract. Supervision requirements are sometimes addressed in contract addendums, these should be carefully reviewed before signing.
When specific contracting questions or concerns arise, physicians should engage with a health care attorney with experience in physician employment contracts. See Employment Contracting | AAFP for tips on negotiating contracts.
Be familiar with state legal requirements. You may also look to your state medical board to understand what contract language is typical and appropriate when outlining physician supervision/collaboration responsibilities. The AAFP supports appropriate compensation for physicians’ supervision of NPCs in addition to their core compensation. See Physician Compensation for Nurse Practitioner and Physician Assistant Oversight | AAFP
Considerations in your contract review:
- How many NPCs will I be expected to supervise/collaborate with?
- What are the expectations for supervision/collaboration at this organization?
- Does my contract ensure that I will have time to follow the legal responsibilities required by my state?
- Will my liability change because of my supervision/collaboration with NPCs?
- What support (e.g., in-house legal counsel) is available to me if I have questions regarding my supervision/collaboration role?
- Am I being appropriately compensated for supervision/collaboration?
Resources:
- AAFP’s Guidelines on the Supervision of Non-Physician Clinicians (NPCs)
- AAFP’s Physician Compensation for Nurse Practitioner and Physician Assistant Oversight
- AAPA’s Guide to PA Regulations and Compliance
- AANP’s NP State Practice Environment Overview
Is there a legal limit to how many non-physician clinicians I can supervise?
In states where supervision or collaboration is required for NPCs, maximum physician-to-NPC ratios are determined at the state level through statutes and regulations or professional code. Details on state code and regulations can be found through state regulatory agency websites. These legal guidelines can serve as a starting point for conversations around how many NPCs a physician can reasonably expect to supervise.
How many non-physician clinicians should I supervise?
The precise supervision ratio that is right for one physician may not be right for another and will be influenced by practice size and experience level of both the physician and the NPCs.
Consider these factors when determining how many NPCs to supervise or collaborate with:
- Outside of minimum legal requirements, will the NPC need additional training and support to provide quality patient care?
- What is the culture of the practice environment? How can you build and maintain trust with the NPC?
- How will you establish feedback loops and ongoing communication?
- How much of your time will this take?
This may be directed by the organization or health system in which the physician is employed, and employed physicians should direct their questions accordingly.
What are my responsibilities when a non-physician clinician I supervise makes a mistake?
AAFP believes that patients should be informed about all aspects of their health care. This position is outlined in the AAFP Position Paper on Disclosing Unanticipated Clinical Outcomes. The Communication and Optimal Resolution (CANDOR) toolkit from the Agency for Healthcare Research and Quality (AHRQ) is intended to help health care institutions and clinicians use a patient-centered process to communicate in a timely, thorough, and just way when unexpected events cause patient harm.
Generally speaking, you should handle adverse and unwanted events involving an NPC the same way you would handle a similar situation with a physician colleague. The AAFP encourages physicians to be aware of current policies and procedures that affect their individual practice situation, including the policies of their employer, hospital, state medical board, and malpractice insurance carrier. In some cases, one or more of these entities may require physicians to report incidents prior to disclosure or in addition to disclosure. You may benefit from speaking with in-house legal counsel, consulting the human resources department or the medical director, reviewing your employer’s bylaws, and meeting with the head of NPCs, if the organization has one.
Failure to report may have negative consequences, including the potential for disciplinary action on the physician’s license or loss of malpractice coverage. Physicians should also be aware that resignation of clinical privileges during an investigation is reportable to the National Practitioner Data Bank.
What do I do if I believe a non-physician clinician I work with is cognitively impaired?
Approach a situation where you believe an NPC is cognitively impaired by following guidelines that would be utilized for a physician colleague. Consider contacting your state Physician Health Program (PHP). The Federation of State Physician Health Programs has contacts for each state’s program (with the exception of Maine, Nebraska, and Wisconsin). PHPs are confidential resources for physicians, other licensed healthcare professionals, and those in training suffering from addictive, psychiatric, medical, behavioral or other potentially impairing conditions. These programs coordinate evaluation, treatment, and continuing care of clinicians with these conditions. Most state websites contain FAQs that may help you determine appropriate action. They also allow for anonymous notification of suspected impairment of licensed clinicians.
In addition, review your organizational or institutional policies for required actions. Consult in-house legal counsel, human resources department, or the medical director, if necessary.
How can I learn about legal cases or disciplinary actions involving non-physician clinicians?
As you consider hiring an NPC or are assigned to supervise a new NPC, you may want to understand their past legal, malpractice, or licensure issues. Any concluded legal investigation, licensure disputes, or disciplinary actions for clinicians are recorded by the state licensing boards associated with their license. Contact state boards to get information on individual clinicians. In addition to state boards, the National Practitioner Data Bank and the Office of Inspector General’s List of Excluded Individuals/Entities has information on medical malpractice payments and adverse action reports against practitioners.
In large health systems, often a credentialing committee would handle this process. In a smaller practice environment, there should be a hiring policy in place that outlines the process for identifying any medical or legal cases candidates have been involved in.
FREE CME: Non-Physician Clinician Supervision
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