Your Collaborating Physician's Monthly Fee: What It Should Buy

Is $1,500 a month normal?

Nobody can tell you, because no agency or professional body publishes what collaborating physicians charge. State boards regulate what the agreement must contain and what the physician must do under it; none of them sets or reports a price. So a quoted $1,500 a month is neither normal nor excessive on any published benchmark. It is priceable only against the work your own state's rule assigns to that physician.

That work is not the same in every state. Georgia's Composite Medical Board writes a record-review schedule with percentages and deadlines into its nurse protocol rules 1Ref 1Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia's record-review schedule the Board calls minimum accepted standards (100% of controlled-substance records at least quarterly, 100% of adverse-outcome records within 30 days, 10% of all other records at least annually), its definition of immediate consultation as availability for direct communication or by telephone or other telecommunications, and the designated-physician role for absence coverage.. Ohio's Board of Nursing writes a chart-review cadence into its quality-assurance rule that names no percentage at all 2Ref 2Ohio Board of Nursing (2026).Rule 4723-8-05 | Quality assurance standards..Ohio's quality-assurance content: periodic random chart review including prescribing patterns and schedule II prescribing where indicated, at a minimum annually, and the absence of any chart percentage in the rule.. Two physicians charging the same monthly figure in those two states are selling different amounts of their own time.

Find your own floor before you negotiate against it. The rule sits in your state's administrative code, in the board chapter that names the agreement: a standard care arrangement in Ohio, a nurse protocol agreement in Georgia. Read that chapter rather than a summary of it, because summaries drop the cadences, and the cadences are what the money is for.

What your state's rule already obliges the physician to do

Read your state's chapter and the fee turns into a list of tasks with cadences attached. Georgia's rule counts records and sets deadlines against them. Ohio's rules list required contents for the arrangement and an annual floor for random chart review, without naming a percentage. Both describe the same three products: review, availability, coverage.

In Georgia the duties are counted in records, and the board has determined that minimum accepted standards of medical practice require the schedule in the table below 1Ref 1Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia's record-review schedule the Board calls minimum accepted standards (100% of controlled-substance records at least quarterly, 100% of adverse-outcome records within 30 days, 10% of all other records at least annually), its definition of immediate consultation as availability for direct communication or by telephone or other telecommunications, and the designated-physician role for absence coverage.. The tightest cadence sits on controlled substances, which is also where a state is most likely to add conditions of its own. Whether yours layers extra requirements onto buprenorphine prescribing with required physician involvement is a separate lookup in the same chapter. Between reviews, immediate consultation means the delegating physician is available for direct communication or by telephone or other telecommunications, which is availability rather than presence 1Ref 1Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia's record-review schedule the Board calls minimum accepted standards (100% of controlled-substance records at least quarterly, 100% of adverse-outcome records within 30 days, 10% of all other records at least annually), its definition of immediate consultation as availability for direct communication or by telephone or other telecommunications, and the designated-physician role for absence coverage..

In Ohio the duties are written as required contents instead. The standard care arrangement must itself contain criteria for referral to the collaborating physician, a process for obtaining consultation, a process for resolving disagreements about patient management, and provisions for obtaining and reviewing OARRS reports 3Ref 3Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio's mandatory contents of a standard care arrangement: the coverage plan for emergency or planned absences, criteria for referral, a process for obtaining consultation, a process for resolving disagreements about patient management, and provisions for obtaining and reviewing OARRS reports, with the rule effective 2026-03-26.. The quality-assurance rule adds periodic random chart review, including prescribing patterns and schedule II prescribing where indicated, at a minimum annually 2Ref 2Ohio Board of Nursing (2026).Rule 4723-8-05 | Quality assurance standards..Ohio's quality-assurance content: periodic random chart review including prescribing patterns and schedule II prescribing where indicated, at a minimum annually, and the absence of any chart percentage in the rule.. Both rule texts took effect on March 26, 2026.

Neither board says what any of that is worth.

Turning the fee into hours and dollars per visit

Two arithmetic moves make a monthly number comparable to something. Divide it by the price of an hour of physician time, and divide it by your own monthly visits. The Bureau of Labor Statistics puts the median annual wage for physicians and surgeons at $275,930 in May 2025, listed in its Quick Facts as $132.66 per hour 4Ref 4U.S. Bureau of Labor Statistics (2026).Physicians and Surgeons : Occupational Outlook Handbook.The price of an hour of physician time used to convert a monthly fee into hours: the median annual wage of $275,930 for physicians and surgeons in May 2025 and the $132.66 hourly figure in Quick Facts, cited with the caveat that it is a national median across all physicians and surgeons rather than a collaboration rate.. At that median, $1,500 a month is roughly eleven hours of physician time.

But that median is a blunt instrument. It is a national figure across all physicians and surgeons, specific to no specialty, no state and no collaboration 4Ref 4U.S. Bureau of Labor Statistics (2026).Physicians and Surgeons : Occupational Outlook Handbook.The price of an hour of physician time used to convert a monthly fee into hours: the median annual wage of $275,930 for physicians and surgeons in May 2025 and the $132.66 hourly figure in Quick Facts, cited with the caveat that it is a national median across all physicians and surgeons rather than a collaboration rate.. No board rule states how many hours a month a collaboration takes, so the hours side is your own estimate, built from your state's review percentages and your chart volume. Eleven hours is what the fee implies. Nobody has measured what the work costs.

The second move is per visit. A flat monthly collaborator fee behaves like rent: it does not move with volume, so it lands in the same line as any other fixed cost, whether you bill fee-for-service or run the membership panel that the DPC equation describes. Divide the fee by the visits you billed last month, then divide it again by half that number. The visit volume for collaborator fees is worth computing at both, because the second figure is what a slow quarter costs you.

A percentage-of-collections structure moves with revenue instead of standing still, which changes every number above. Flat fee versus percentage collaborator pay is its own comparison.

What the written agreement has to say for the money to hold up

A safe harbor is the yardstick a paid collaboration agreement gets measured against. The federal personal services and management contracts provision, at 42 CFR 1001.952(d), asks for a writing signed by both parties that specifies all the services, a term of not less than one year, and a compensation methodology set in advance, consistent with fair market value in arm's-length transactions and not determined in a manner that takes into account the volume or value of any referrals 5Ref 5Office of the Federal Register (2026).42 CFR 1001.952 — Exceptions (Anti-Kickback Safe Harbors).The personal services and management contracts safe-harbor standards a written collaboration agreement can be measured against: a signed writing specifying all services, a term of not less than one year, compensation set in advance at fair market value and not determined by the volume or value of referrals, and services not exceeding what is reasonably necessary, together with the fact that the safe harbor is voluntary..

A safe harbor is voluntary. Falling outside one is not itself a violation, and that regulation says nothing about whether any particular collaboration fee is lawful 5Ref 5Office of the Federal Register (2026).42 CFR 1001.952 — Exceptions (Anti-Kickback Safe Harbors).The personal services and management contracts safe-harbor standards a written collaboration agreement can be measured against: a signed writing specifying all services, a term of not less than one year, compensation set in advance at fair market value and not determined by the volume or value of referrals, and services not exceeding what is reasonably necessary, together with the fact that the safe harbor is voluntary.. What it gives a solo practice is a checklist to hold a draft against before signing: is the term at least a year, is the number fixed in advance, is every service written down, and does anything in the compensation move with referrals.

One element is easy to miss and it cuts in your favor. The same standard asks that the aggregate services contracted for do not exceed those which are reasonably necessary to accomplish the commercially reasonable business purpose of the services 5Ref 5Office of the Federal Register (2026).42 CFR 1001.952 — Exceptions (Anti-Kickback Safe Harbors).The personal services and management contracts safe-harbor standards a written collaboration agreement can be measured against: a signed writing specifying all services, a term of not less than one year, compensation set in advance at fair market value and not determined by the volume or value of referrals, and services not exceeding what is reasonably necessary, together with the fact that the safe harbor is voluntary.. A collaborator proposing to bill for oversight your state's rule does not require is proposing something that standard has a view about, and it is a question for a health care attorney before signing.

What the fee does not buy

The fee buys the physician's time under the agreement and nothing automatically beyond it. It does not settle malpractice coverage for your care, it does not include co-signature work unless the contract says so, and it is not the state filing fee. Each is a separate arrangement with its own paperwork and its own price, worth settling in writing before the first payment leaves your account.

The filing is the cheapest of them and the easiest to forget. In Georgia, filing an APRN protocol agreement costs $150, the fees are non-refundable, and only the delegating physician can submit the application online, with the board reporting an average of 30 business days as its page stated in September 2026 6Ref 6Georgia Composite Medical Board (2026).APRN Protocol Registration.Georgia's $150 non-refundable filing fee for an APRN protocol agreement, the fact that only the delegating physician can submit the application online, and the board's stated average processing time of 30 business days as of September 2026.. Your start date depends on somebody else logging in, and the $150 belongs in the negotiation alongside the monthly number.

Malpractice is the item to settle on paper, with each carrier's answer in hand. No board rule and no federal regulation cited here says whether a collaborating physician's policy covers a nurse practitioner's care, or what a collaboration does to that physician's premium. Ask both carriers, in writing, whether the arrangement is covered and whether it has to be disclosed, and file the replies with the agreement. Liability theories are a question for a health care attorney where you practice.

Two more items sit with you, outside the fee. Whether physician co-signature on NP notes is required at all is a question for your board's rule; whether your collaborator will do it, and how fast, is a question for the contract. Required not-a-physician signage, if your state has such a rule, obliges the practice rather than the collaborator.

Price the exit before you sign the entry

Price the exit before you sign, because the arrangement is only as durable as one person's continued participation. In New York, if the collaborating physician dies, the written practice agreement signed by the nurse practitioner and physician is no longer valid, and a nurse practitioner with 3,600 or fewer hours of qualifying practice must enter into a written practice agreement with another collaborating physician to keep practicing 7Ref 7New York State Education Department, Office of the Professions (2026).Practice Information for Nurse Practitioners.New York's rule that a written practice agreement is no longer valid if the collaborating physician dies, the 3,600-hour threshold above which an NP practices without a written practice agreement, and the fact that the page does not address retirement or voluntary termination.. Retirement and voluntary termination are not addressed on that page.

That is New York's rule and it belongs to New York. What generalizes is the shape of the exposure: a monthly fee buys a relationship that can end on somebody else's schedule, and where an agreement is required in order to practice, the end of the relationship is the end of your prescribing until a replacement signs one.

Georgia's rule supplies the model for half the fix, by requiring that the backup be a designated physician who agreed in writing to consult in the delegating physician's absence 1Ref 1Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia's record-review schedule the Board calls minimum accepted standards (100% of controlled-substance records at least quarterly, 100% of adverse-outcome records within 30 days, 10% of all other records at least annually), its definition of immediate consultation as availability for direct communication or by telephone or other telecommunications, and the designated-physician role for absence coverage.. Name that person in your own agreement. Then add a notice period for termination on either side, a rule for the fee in a partial month, and a line about who files the paperwork when the arrangement ends.

Those four terms cost nothing to ask for while the monthly number is still under negotiation.