Ask a vendor how much of their medical director’s time you are buying and you will usually get an adjective. Alabama replaced the adjective with a percentage.
Under Alabama Board of Medical Examiners Administrative Code Rule 540-X-8-.08, the collaborating physician must be present for not less than ten percent of the CRNP’s scheduled hours in an approved practice site, where that CRNP has less than two years or 4,000 hours of collaborative practice experience — measured either since initial certification or within the collaborating physician’s practice specialty.
The arithmetic nobody runs before signing
| CRNP scheduled hours | Required physician presence, per week |
|---|---|
| 20 hours | 2 hours |
| 32 hours | 3.2 hours |
| 40 hours | 4 hours |
| Two CRNPs at 40 hours | 8 hours |
Eight hours a week of on-site physician time is a full working day. It is not what a low monthly directorship fee is priced to deliver, and the gap between the fee and the obligation is where these arrangements fail.
What changes after the two-year mark
Once the CRNP has more than two years or 4,000 hours of collaborative practice experience, the presence requirement gives way to a meeting requirement: the physician must meet with the CRNP no less than quarterly.
Separately, the physician must visit remote practice sites no less than twice annually. If you run more than one location, that obligation is per site.
The exclusions tell you the intent
Certain settings are excluded from the minimum presence hours: patient homes, facilities licensed by the Alabama Department of Public Health, facilities certified by the Alabama Department of Mental Health, and practice under specified limited protocols.
An aesthetic clinic is not on that list. The exclusions are aimed at settings with their own oversight structures, which is a useful signal about how the rule is meant to be read.
Practical consequences for hiring
- A newly certified CRNP is materially more expensive to supervise than an experienced one, and the difference is measured in physician hours.
- The two-year clock can run within the collaborating physician’s specialty, so changing collaborating physicians may restart the analysis.
- Scale your physician coverage to total CRNP hours, not to headcount.
- Record the presence. A requirement expressed as a percentage is a requirement someone can audit.
Ownership is the easy part here
Alabama does not apply a strict corporate practice prohibition in the way California or New York do, and non-physician ownership is common. The constraint is presence, not equity — which is the reverse of most states in this market.
Related reading
Frequently asked questions
How much on-site time does Alabama require?
Not less than 10% of the CRNP’s scheduled hours, where the CRNP has less than two years or 4,000 hours of collaborative practice experience.
What happens after two years or 4,000 hours?
The physician must meet with the CRNP no less than quarterly.
How often must remote sites be visited?
No less than twice annually.
Which settings are excluded from the presence minimum?
Patient homes, ADPH-licensed facilities, ADMH-certified facilities, and practice under specified limited protocols. Aesthetic clinics are not among them.
General information about Alabama collaborative practice requirements, not legal advice. Board rules change. Confirm your obligations with healthcare counsel licensed in Alabama.