If your state requires a nurse practitioner or physician assistant to practice under a collaborating or supervising physician, MDside supplies that physician: a licensed MD or DO in your state who signs the agreement, files it where the state requires filing, and does the work the agreement describes. Chart review, availability and protocol approval happen on a schedule, not on request.
The agreement is the easy part. The exposure sits in what happens after it is signed: a chart review cadence nobody keeps, a physician who cannot be reached when a patient has a complication, a protocol that predates the current menu. Boards discipline the physician for that, and the clinic loses its prescriber in the same week.
What the physician does
- Signs and files the collaborative or supervisory agreement your state requires, and keeps it current when the practice, the menu or the NP changes. Pennsylvania files it with the State Board of Medicine; other states keep it on site.
- Reviews charts at the frequency your state sets, and documents the review.
- Meets the availability rule your state actually uses: on site, within a set distance, or immediately reachable by phone or video.
- Approves the protocols the NP or PA practices under, written against the treatments you offer today.
- Handles adverse events with you, including any report your state requires.
The rules vary more than most clinics expect
- Some states give nurse practitioners full practice authority, so no collaborator is required for the NP’s own scope. Arizona is one. Many operators there still use a physician for delegation to RNs and for structure.
- Some states cap how many NPs one physician may collaborate with, or require the physician to be present for part of a newer NP’s hours. Alabama sets both kinds of limits.
- Physician assistants practice under their own state rules, which differ from the NP rules in the same state.
The state-by-state medical director pages carry the citation for each state. We start every engagement by reading the rule that applies to you.
Who this is for
- Nurse practitioners opening or running their own aesthetics, weight-loss, hormone or IV practice.
- Clinics adding an NP or PA who needs a collaborator in their state.
- Practices whose current collaborating physician is leaving and who need a transition that keeps prescribing lawful on the day the old agreement ends.
Frequently asked questions
Is a collaborating physician the same as a medical director?
Not always. The collaborating or supervising physician is the one named in the NP’s or PA’s practice agreement. A medical director oversees the clinic’s medical program, protocols and delegation to staff such as RNs. In a small practice one physician often holds both roles, and the agreements should say so.
Does the physician have to be on site?
It depends on the state and sometimes on the procedure. Some states accept availability by phone or video, some set a distance limit, and some require the physician to be present for a share of a newer NP’s hours or for certain procedures. We match the arrangement to the rule that applies to you.
What happens when the collaborating physician leaves?
The NP may lose the ability to prescribe until a new agreement is in place, and in filing states the change has to be recorded. Plan the transition before the departure date. We take over existing practices and handle the handoff.
Can one physician collaborate with NPs in more than one state?
Only where the physician holds a license in each state, and subject to each state’s limits on the number of NPs per physician. We assign a physician licensed where your patients are.
Book a call and tell us your state, who is on your team, and what you offer.
General information, not legal or medical advice. Requirements differ by state and change often. Confirm your obligations with counsel licensed where you operate.