Finding a Collaborating Physician When Your Employer's Won't Sign
Summary
Finding a collaborating physician for your own nurse practitioner practice starts with your state's rule, because the document you need, and whether you need one at all, is set by state law rather than by any national standard. Work outward from there. The candidates are physicians whose state cap, if there is one, has room; who will take on the recurring chart review the rule assigns them; and who will sit down at the state portal, because in some states the filing cannot be completed without them.
By Gale Editorial · Updated 2026-09-01. Every figure cited to a dated source. How we write.
Does your state require a collaborating physician at all?
Whether your state requires a collaborating physician depends on its practice-authority class, so check the class before you look for anybody. The American Association of Nurse Practitioners sorts state law into three groups, and only two of them send you looking: reduced-practice law requires a career-long regulated collaborative agreement with an outside health discipline, and restricted-practice law requires career-long supervision, delegation or team management 1Ref 1American Association of Nurse Practitioners (2026).State Practice Environment.AANP's national classification frame: that reduced-practice law requires a career-long regulated collaborative agreement and restricted-practice law requires career-long supervision, delegation or team management, used here only as the map of which states force the search.. Full-practice law asks for no such document.
The class is the map. Which form you are chasing depends on what your state calls the document, a collaborative agreement or protocol, a standard care arrangement or a written practice agreement, since almost every state that requires one uses a different name.
Some requirements also expire. New York sets a threshold: an NP with more than 3,600 hours of qualifying practice experience practices without a written practice agreement, and an NP at or below that count enters one with a collaborating physician in order to keep practicing 2Ref 2New York State Education Department, Office of the Professions (2026).Practice Information for Nurse Practitioners.New York only: the 3,600-hour threshold above which an NP practices without a written practice agreement, the resource person covering a collaborating physician's prolonged absence, and the rule that the agreement is no longer valid once the collaborating physician dies.. That is New York's rule and nobody else's.
Start at your board's practice page for nurse practitioners, then read the statute or rule it links to. While you are there, check the neighboring rules you will also need in the first month: physician co-signature on NP notes, required not-a-physician signage, and the prescribing limits that attach to your certification.
What the agreement has to contain, state by state
Read the contents rule before you draft anything, because the state has already written most of the document for you. Ohio's rule names the parts a standard care arrangement must contain; Georgia's rules set a record-review schedule the board calls its minimum accepted standards; Pennsylvania's application collects the terms as mandatory data fields. The four states below show the range, and none of them is the national rule.
| State | What the rule pins down | Who has to act |
|---|---|---|
| Georgia | 100 percent of controlled-substance patient records reviewed at least quarterly, 100 percent of adverse-outcome records within 30 days, and 10 percent of all other records at least annually 3Ref 3Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia only: the record-review schedule the Board calls its minimum accepted standards, the annual direct onsite observation and quarterly medical-record review, the combined-equivalent-of-eight cap on one delegating physician, and the bar on a delegating physician being the APRN's employee. | The delegating physician submits the protocol registration; filing costs $150 and all fees are non-refundable 4Ref 4Georgia Composite Medical Board (2026).APRN Protocol Registration.Georgia only: that the APRN protocol agreement application is submittable online by delegating physicians through Gateway, with access since opened to APRNs holding an active protocol number, the $150 non-refundable filing fee, and the board's currently stated processing average of 30 business days as of 2026-09-01. |
| Ohio | Signatures of each nurse and each collaborating physician, referral criteria, a consultation process, a chart-review process, a plan for coverage during emergency or planned absences, and a dispute-resolution process 5Ref 5Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio only: the mandatory contents of a standard care arrangement, including signatures, referral and consultation criteria, the chart-review process, the coverage plan for emergency or planned absences and the dispute-resolution process, plus three-year retention of superseded arrangements. | Both parties sign, and the nurse keeps superseded arrangements for three years 5Ref 5Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio only: the mandatory contents of a standard care arrangement, including signatures, referral and consultation criteria, the chart-review process, the coverage plan for emergency or planned absences and the dispute-resolution process, plus three-year retention of superseded arrangements. |
| Pennsylvania | One collaborating physician per agreement with substitute physicians named separately, professional liability insurance, and the circumstances and frequency of the physician personally seeing the patient 6Ref 6Pennsylvania Department of State, Bureau of Professional and Occupational Affairs, State Board of Nursing (2021).User Guide for Certified Registered Nurse Practitioner (CRNP) Prescriptive Authority Collaborative Agreement Application.Pennsylvania only: that both the CRNP and the primary collaborating physician complete portions of the prescriptive-authority collaborative agreement application in their own licensing accounts, the physician's reject-and-return step, one collaborating physician per agreement with substitutes named separately, the insurance and patient-contact data fields, and the $95/$45 application fees as listed in the 2021 guide. | Both the CRNP and the primary collaborating physician complete their own portions of the application 6Ref 6Pennsylvania Department of State, Bureau of Professional and Occupational Affairs, State Board of Nursing (2021).User Guide for Certified Registered Nurse Practitioner (CRNP) Prescriptive Authority Collaborative Agreement Application.Pennsylvania only: that both the CRNP and the primary collaborating physician complete portions of the prescriptive-authority collaborative agreement application in their own licensing accounts, the physician's reject-and-return step, one collaborating physician per agreement with substitutes named separately, the insurance and patient-contact data fields, and the $95/$45 application fees as listed in the 2021 guide. |
| New York | A written practice agreement until the NP passes 3,600 hours of qualifying practice experience 2Ref 2New York State Education Department, Office of the Professions (2026).Practice Information for Nurse Practitioners.New York only: the 3,600-hour threshold above which an NP practices without a written practice agreement, the resource person covering a collaborating physician's prolonged absence, and the rule that the agreement is no longer valid once the collaborating physician dies. | The NP and the collaborating physician sign it, and the physician may designate a resource person during an extended absence 2Ref 2New York State Education Department, Office of the Professions (2026).Practice Information for Nurse Practitioners.New York only: the 3,600-hour threshold above which an NP practices without a written practice agreement, the resource person covering a collaborating physician's prolonged absence, and the rule that the agreement is no longer valid once the collaborating physician dies. |
Bring that list to the first conversation. A physician who has never signed one is being asked for an open-ended obligation, and a printed contents rule with dates and percentages is a smaller thing to agree to.
A willing physician can still be barred from signing
A physician can want to sign and still be barred from it, because some states cap how many practitioners one physician may cover. Georgia, unless a specific statutory exemption applies, bars a delegating physician from holding nurse protocol agreements or job descriptions with more than the combined equivalent of eight advanced practice registered nurses or physician assistants at any one time 3Ref 3Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia only: the record-review schedule the Board calls its minimum accepted standards, the annual direct onsite observation and quarterly medical-record review, the combined-equivalent-of-eight cap on one delegating physician, and the bar on a delegating physician being the APRN's employee..
Ask for the current count in the first conversation, since the no you get may be arithmetic, and ask your board whether your own state sets a limit at all. Both questions take a minute, and they decide whether the rest of the conversation is worth having.
The cap also shapes where to look. A physician with room on the roster is worth more of your time than a well-known collaborator without any, which points the search toward solo and small-practice physicians, part-time and semi-retired clinicians, and specialists whose patient mix matches the one you plan to see.
What signing commits the physician to every quarter
Signing commits a physician to recurring work, and that is what decides the answer you get. Georgia's rules require the delegating physician to document direct onsite observation of the APRN's practice at least once annually and to review medical records quarterly. They set that review at 100 percent of controlled-substance patient records at least quarterly, 100 percent of adverse-outcome records within 30 days, and 10 percent of all other records at least annually 3Ref 3Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia only: the record-review schedule the Board calls its minimum accepted standards, the annual direct onsite observation and quarterly medical-record review, the combined-equivalent-of-eight cap on one delegating physician, and the bar on a delegating physician being the APRN's employee..
Ohio fixes what the document itself must promise: referral criteria, a consultation process, a quality-assurance chart review, a plan for covering patients during emergency or planned absences, and a process for resolving a disagreement between the two of you 5Ref 5Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio only: the mandatory contents of a standard care arrangement, including signatures, referral and consultation criteria, the chart-review process, the coverage plan for emergency or planned absences and the dispute-resolution process, plus three-year retention of superseded arrangements.. Those clauses are the physician's job description for the next year.
Quantify the load before you ask. Three figures turn an open-ended favor into a number of chart reviews per quarter: your projected weekly visits, the share of them that will involve controlled substances, and, if it is part of the practice, your plan for buprenorphine prescribing with required physician involvement. A physician who can see that number can price it and calendar it.
In some states the filing needs the physician's own login
Budget for the physician's own time inside the state licensing system, because in more than one state the filing cannot be completed without them. Georgia's APRN protocol agreement applications are only accessible and submittable online by delegating physicians, through the physician's own Gateway account 4Ref 4Georgia Composite Medical Board (2026).APRN Protocol Registration.Georgia only: that the APRN protocol agreement application is submittable online by delegating physicians through Gateway, with access since opened to APRNs holding an active protocol number, the $150 non-refundable filing fee, and the board's currently stated processing average of 30 business days as of 2026-09-01.. Pennsylvania's guide is explicit that both the CRNP and the primary collaborating physician log into their own licensing accounts to complete specific portions of the application 6Ref 6Pennsylvania Department of State, Bureau of Professional and Occupational Affairs, State Board of Nursing (2021).User Guide for Certified Registered Nurse Practitioner (CRNP) Prescriptive Authority Collaborative Agreement Application.Pennsylvania only: that both the CRNP and the primary collaborating physician complete portions of the prescriptive-authority collaborative agreement application in their own licensing accounts, the physician's reject-and-return step, one collaborating physician per agreement with substitutes named separately, the insurance and patient-contact data fields, and the $95/$45 application fees as listed in the 2021 guide..
That changes the ask. You are asking someone to create or use a state account, answer questions inside it, and finish on a schedule that suits your opening date. Georgia's board has since opened online access to APRNs who already hold an active protocol number, which does not help a first filing 4Ref 4Georgia Composite Medical Board (2026).APRN Protocol Registration.Georgia only: that the APRN protocol agreement application is submittable online by delegating physicians through Gateway, with access since opened to APRNs holding an active protocol number, the $150 non-refundable filing fee, and the board's currently stated processing average of 30 business days as of 2026-09-01..
Pennsylvania's system gives the named physician a reject button that sends the application back to the CRNP to make changes, so an incomplete field costs a round trip 6Ref 6Pennsylvania Department of State, Bureau of Professional and Occupational Affairs, State Board of Nursing (2021).User Guide for Certified Registered Nurse Practitioner (CRNP) Prescriptive Authority Collaborative Agreement Application.Pennsylvania only: that both the CRNP and the primary collaborating physician complete portions of the prescriptive-authority collaborative agreement application in their own licensing accounts, the physician's reject-and-return step, one collaborating physician per agreement with substitutes named separately, the insurance and patient-contact data fields, and the $95/$45 application fees as listed in the 2021 guide.. The 2021 guide lists the CRNP-side application fee as $95 for a first agreement and $45 for later ones, and fee amounts change, so confirm the current figure on the board's own fee page before you file 6Ref 6Pennsylvania Department of State, Bureau of Professional and Occupational Affairs, State Board of Nursing (2021).User Guide for Certified Registered Nurse Practitioner (CRNP) Prescriptive Authority Collaborative Agreement Application.Pennsylvania only: that both the CRNP and the primary collaborating physician complete portions of the prescriptive-authority collaborative agreement application in their own licensing accounts, the physician's reject-and-return step, one collaborating physician per agreement with substitutes named separately, the insurance and patient-contact data fields, and the $95/$45 application fees as listed in the 2021 guide..
Georgia charges $150, and all of its fees are non-refundable. As of September 1, 2026 the board's page says it is currently experiencing processing times averaging 30 business days, depending on the complexity of the agreement 4Ref 4Georgia Composite Medical Board (2026).APRN Protocol Registration.Georgia only: that the APRN protocol agreement application is submittable online by delegating physicians through Gateway, with access since opened to APRNs holding an active protocol number, the $150 non-refundable filing fee, and the board's currently stated processing average of 30 business days as of 2026-09-01.. Plan your opening date around that window.
Paying a collaborator without creating a kickback problem
Set the money in the written contract before the first patient. The personal services and management contracts safe harbor at 42 CFR 1001.952 protects an arrangement that is written and signed, covers all of the services, runs for a term of not less than one year, and sets the compensation methodology 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 referrals 7Ref 7Office of the Federal Register (2026).42 CFR 1001.952 — Exceptions (Anti-Kickback Safe Harbors).The structural standards of the personal services and management contracts safe harbor: written and signed, covering all services, a term of not less than one year, and compensation set in advance at fair market value that does not take into account the volume or value of referrals..
Each of those elements has a quiet way of failing. A month-to-month handshake misses the one-year term, and a fee that moves with how many patients you send toward the physician's own practice misses the referral clause.
This page carries no monthly figure, because no authority in this set publishes one. Collaborating physician fees are quoted privately and travel by word of mouth, so treat a number you are given as one offer and price it against the review load the state rule puts on the signer.
Georgia adds a structural limit worth knowing before you improvise: its rules bar a delegating physician who delegates to or supervises an APRN from being that APRN's employee, with narrow exceptions for specific practice settings 3Ref 3Georgia Composite Medical Board (2026).Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25.Georgia only: the record-review schedule the Board calls its minimum accepted standards, the annual direct onsite observation and quarterly medical-record review, the combined-equivalent-of-eight cap on one delegating physician, and the bar on a delegating physician being the APRN's employee.. Whether a particular fee is fair market value is a valuation question, and the contract is one to paper with a health care attorney licensed in your state.
Plan for the day your collaborator leaves
Write the replacement plan into the agreement while you still have one. New York states that if the collaborating physician dies, the written practice agreement signed by the nurse practitioner and physician is no longer valid. An NP at or below the 3,600-hour threshold then needs an agreement with another collaborating physician to keep practicing 2Ref 2New York State Education Department, Office of the Professions (2026).Practice Information for Nurse Practitioners.New York only: the 3,600-hour threshold above which an NP practices without a written practice agreement, the resource person covering a collaborating physician's prolonged absence, and the rule that the agreement is no longer valid once the collaborating physician dies.. Ohio requires the arrangement itself to carry a plan for covering patients during emergency or planned absences 5Ref 5Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio only: the mandatory contents of a standard care arrangement, including signatures, referral and consultation criteria, the chart-review process, the coverage plan for emergency or planned absences and the dispute-resolution process, plus three-year retention of superseded arrangements..
Two mechanics from the sourced states are worth borrowing wherever you practice. New York lets a collaborating physician designate a resource person to be available during an extended absence, and Pennsylvania's agreement names substitute physicians alongside the single primary collaborator 2Ref 2New York State Education Department, Office of the Professions (2026).Practice Information for Nurse Practitioners.New York only: the 3,600-hour threshold above which an NP practices without a written practice agreement, the resource person covering a collaborating physician's prolonged absence, and the rule that the agreement is no longer valid once the collaborating physician dies.6Ref 6Pennsylvania Department of State, Bureau of Professional and Occupational Affairs, State Board of Nursing (2021).User Guide for Certified Registered Nurse Practitioner (CRNP) Prescriptive Authority Collaborative Agreement Application.Pennsylvania only: that both the CRNP and the primary collaborating physician complete portions of the prescriptive-authority collaborative agreement application in their own licensing accounts, the physician's reject-and-return step, one collaborating physician per agreement with substitutes named separately, the insurance and patient-contact data fields, and the $95/$45 application fees as listed in the 2021 guide.. Name your substitute at the same time you name your collaborator, while the goodwill of the first conversation is still available.
But no source here sets a general grace period for finding a replacement, and it is not safe to assume your state grants one.
Ask your board what happens to prescribing after a collaborator quits, ask it in writing, and file the answer with the agreement. Ohio's three-year retention rule for superseded arrangements is a sensible floor for your own file even where your state imposes nothing 5Ref 5Ohio Board of Nursing (2026).Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist..Ohio only: the mandatory contents of a standard care arrangement, including signatures, referral and consultation criteria, the chart-review process, the coverage plan for emergency or planned absences and the dispute-resolution process, plus three-year retention of superseded arrangements..
Common questions
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- 1.American Association of Nurse Practitioners (2026). State Practice Environment. American Association of Nurse Practitioners. link ✓AANP's national classification frame: that reduced-practice law requires a career-long regulated collaborative agreement and restricted-practice law requires career-long supervision, delegation or team management, used here only as the map of which states force the search.
- 2.New York State Education Department, Office of the Professions (2026). Practice Information for Nurse Practitioners. NYSED Office of the Professions (op.nysed.gov). link ✓New York only: the 3,600-hour threshold above which an NP practices without a written practice agreement, the resource person covering a collaborating physician's prolonged absence, and the rule that the agreement is no longer valid once the collaborating physician dies.
- 3.Georgia Composite Medical Board (2026). Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25. Georgia Rules and Regulations, Secretary of State (rules.sos.ga.gov). link ✓Georgia only: the record-review schedule the Board calls its minimum accepted standards, the annual direct onsite observation and quarterly medical-record review, the combined-equivalent-of-eight cap on one delegating physician, and the bar on a delegating physician being the APRN's employee.
- 4.Georgia Composite Medical Board (2026). APRN Protocol Registration. Georgia Composite Medical Board (medicalboard.georgia.gov). link ✓Georgia only: that the APRN protocol agreement application is submittable online by delegating physicians through Gateway, with access since opened to APRNs holding an active protocol number, the $150 non-refundable filing fee, and the board's currently stated processing average of 30 business days as of 2026-09-01.
- 5.Ohio Board of Nursing (2026). Rule 4723-8-04 | Standard care arrangement for a certified nurse-midwife, certified nurse practitioner, and clinical nurse specialist.. Ohio Administrative Code (codes.ohio.gov). link ✓Ohio only: the mandatory contents of a standard care arrangement, including signatures, referral and consultation criteria, the chart-review process, the coverage plan for emergency or planned absences and the dispute-resolution process, plus three-year retention of superseded arrangements.
- 6.Pennsylvania Department of State, Bureau of Professional and Occupational Affairs, State Board of Nursing (2021). User Guide for Certified Registered Nurse Practitioner (CRNP) Prescriptive Authority Collaborative Agreement Application. Commonwealth of Pennsylvania (pa.gov). link ✓Pennsylvania only: that both the CRNP and the primary collaborating physician complete portions of the prescriptive-authority collaborative agreement application in their own licensing accounts, the physician's reject-and-return step, one collaborating physician per agreement with substitutes named separately, the insurance and patient-contact data fields, and the $95/$45 application fees as listed in the 2021 guide.
- 7.Office of the Federal Register (2026). 42 CFR 1001.952 — Exceptions (Anti-Kickback Safe Harbors). eCFR. link ✓The structural standards of the personal services and management contracts safe harbor: written and signed, covering all services, a term of not less than one year, and compensation set in advance at fair market value that does not take into account the volume or value of referrals.
https://www.gale.care/for-providers/pq-find-collaborating-physician-none-will-sign · 7 sources. Competitor details are cited to dated public sources and maintained as they change; figures are estimates, not commitments. Synthetic demonstration.