In an otherwise restricted, patient-care-team state, an NP applies jointly to the Boards of Medicine and Nursing, which issue a new license bearing an autonomous-practice designation authorizing practice without a practice agreement.
Virginia is otherwise a restricted, patient-care-team state; its autonomy is an earned upgrade delivered as an actual re-licensing. An NP with the equivalent of at least three years of full-time clinical experience — as determined by the Boards, documented by attestation — applies jointly to the Boards of Medicine and Nursing, which issue a new license bearing the autonomous-practice designation. HB 971, signed April 4, 2024, cut the wait from five years to three.
The requirement
Equivalent of at least 3 years of full-time clinical experience (as determined by the Boards), documented by attestation from a patient care team physician or an attesting nurse practitioner
The moment it attaches
Joint issuance by the Boards of Medicine and Nursing of a new license with the autonomous-practice designation
The timeline
Original 5-year pathway effective July 1, 2018; reduced to 3 years for applications received on or after July 1, 2024 (HB 971, signed April 4, 2024)
Virginia's autonomy is an earned upgrade in a restricted state, delivered as an actual re-licensing: the Boards of Medicine and Nursing jointly issue a brand-new license stamped with the autonomous designation — and HB 971 (signed April 4, 2024) cut the wait from five years to three.
Va. Code §54.1-2957
Scope and carve-outs
The grant and the strings, at equal weight
Practice without a written or electronic practice agreement in the practice category of the NP's certification and licensure — full scope within that category, with statutory duties to practice within their training and experience, consult other providers per clinical need, and maintain referral protocols for complex cases. NPs without the designation still require a patient care team physician.
The watch
Pending in Virginia
Statutes move, boards write rules, sunsets arrive. This watch is checked against primary sources on a standing cadence — last verified 11 August 2026 — and every item links the source it was read from.
Nothing pending in Virginia that we can pin to a primary source. Quiet is a finding too — it means the ground your practice stands on is not moving this season.
Superbills for the patient who wants to claim out-of-network benefits.
The Fee Schedule — the one Gale document that states the fee.
Your practice page, in the public directory compiled from the NPPES registry.
Your credentials in one place — every license, DEA registration, board certification and plan enrollment you already hold, with reminders at 90, 60 and 30 days before one expires. Gale checks your NPI against the national registry and marks what it checked. It does not file applications; a credentialing service can.
Referrals from colleagues through your own link, acknowledged and booked in one place, and a view of which referral sources send you patients and which have gone quiet.
Practice notes on your public page, and your own notes on Gale’s health articles in the content library — credited to you, and nothing is public until you publish it.
An activity and access log that records who opened, changed or exported a patient’s chart, and when.
Connect Claude to set up your services, rates and hours by talking to it. It cannot open a patient record, move money or sign anything.
Opening with the founding cohort
Concierge memberships — a monthly plan your practice sells on its own terms. Not sellable yet: enrollment fails closed behind a legal switch until counsel clears it. No countdown — when it clears, it clears.
The loop tracker — every referral, lab, and question a visible loop with an owner, a state, and a promised window. Closing one requires an outcome note; nothing silently expires.
The guided founding sequence — practice setup walked step by step with the first cohort: entity, posted prices, the practice page, the first visit.
Currents — the regulatory watch for your state and the latest evidence for your specialty, dated, sourced, and re-verified on a standing cadence. Quiet weeks say so.
Built, on sample data for now
Insurance billing — a billing console, coding you review and attest, and every claim followed from draft to paid. Today a claim is checked by Gale’s own test system: nothing reaches a payer and no money moves.
Outreach — check-ins for patients who have drifted, drafted overnight for you to approve. Approving sends nothing yet; patient contact stays off until it opens.
Your panel, sorted so the patients who are due or slipping out of care come first — a sort order, not a prediction — with show rates and between-visit activity counted beside it.
Practice health — whether notes get signed and Good Faith Estimates go out on time.
Guidance monitoring — the between-visit guidance a patient chooses to share with you, with anything off track listed first. It fills as patients share.
Workbooks — your charts, claims, referral pipeline, compliance records and clinician roster as tables you can edit. New accounts start on a sample practice.
A desktop bridge and scheduled agents, for work that runs while you are away. A scheduled agent can never send a message, move money or sign anything.
The economics
The designation retires the supervising relationship and whatever it cost to keep. What Gale adds is built to stay just as legible.
Gale’s side of the ledger is deliberately short. The software is free, and Gale earns one flat all-in fee on a transaction — charged only when your practice is actually paid, never as a subscription, never with per-feature line items, never a spread on your rate. The number itself lives in exactly one document, on purpose, so it can never quietly say two different things in two places: the Fee Schedule states it.
The playbook
The deepest state cluster we have built is California’s — eight guides on the 103/104 ladder, cited to the statute and the board’s own filings. They are California’s rules, not Virginia’s; the same treatment is coming state by state. Until then, they show the depth of homework to expect from us.
A patient care team physician — or, since the recent amendments, an attesting nurse practitioner. The Boards of Medicine and Nursing jointly determine what counts as the equivalent of three years of full-time clinical experience; this page deliberately prints no hours figure, because the statute states the requirement in years, not hours.
Practice without a written or electronic practice agreement, in the practice category of your certification and licensure. The statutory duties that remain are clinical: practice within your training and experience, consult per clinical need, and maintain referral protocols for complex cases. NPs without the designation still require a patient care team physician.
Where to start
Your page may already exist
Gale publishes a public directory compiled from the NPPES registry. Find your listing, claim it, and see how you rank for your own name — that page is the front door your independent practice will be found through.