NP and Dr.

Understanding Collaborating Physician for Nurse Practitioners

As a nurse practitioner (NP), you are in high demand – and for good reason. With the ever-growing shortage of primary care physicians, nurse practitioners are filling gaps in patient care and playing an increasingly prominent role in healthcare. This is good news for patients, who have increased access to quality, holistic care. But for services that are outside of your scope of practice, you may find yourself required to seek a candidate for physician collaboration with nurse practitioners. 

What is a Collaborating Physician for Nurse Practitioners and Why Do I Need One? 

As an independent nurse practitioner, you are an expert in patient care. In some states, a collaborating physician is a necessary part of a nurse practitioner’s team due to state laws governing independent NP practices. This is because in many states, NPs are required to have a collaborative practice agreement with a physician.  

A collaborative practice agreement is a contract between an NP and a physician that outlines the rights and responsibilities for each. While agreements vary by state, they usually specify activities that fall within the NP’s scope of practice. According to the American Academy of Nurse Entrepreneurs (AANE), common examples of types of services that can be rendered include: 

  • Types of medical conditions that can be treated, with or without physician consultation 
  • Whether or not a procedure requires direct or indirect supervision 
  • Ordering, performing, and interpreting lab tests 
  • Ordering and interpreting ancillary studies, such as x-rays or EKGs 
  • Prescribing and managing medications 
  • Performing specific procedures 
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To illustrate, in a state where NPs cannot practice autonomously, they are required to have a collaborative agreement with a physician to sign off on care delivered to patients. However, with the collaborative agreement in place, NPs can expand the services they offer, like prescribing medications or ordering physical therapy. 

In contrast, NPs in full practice authority states have fewer restrictions on care they are enabled to provide. That means they are authorized to assess, diagnose, and treat the patient independently without having a collaborative agreement with a physician.  

Keep in mind that states have different – and evolving – requirements. Be sure to investigate your state requirements and consult with the local nursing organizations, the American Assocation of Nurse Practitioners (AANP), and/or an attorney specializing in healthcare law before entering any agreement. 

Benefits of a NP Working with a Collaborating Physician 

For many independent nurse practitioners, working with a collaborating physician means they will have an opportunity for a level of autonomy they may not have otherwise. By partnering with a collaborating physician, NPs can provide personalized patient care and make organizational decisions, but still have a physician’s guidance when it is required.  

Through collaboration with physician partners, you can gain access to additional medical networks and specialized training opportunities you may not have access to on your own. Collaborating physicians also can assist with coordinating referrals to specialty care providers and overseeing shared patients. In addition, physician collaborators can provide networking opportunities with other healthcare professionals in your area. 

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Budget Considerations for Physician Collaboration in an Independent NP Practice  

As a business owner, independent nurse practitioners often have a budget top of mind. From purchasing an EHR system to social media expenses, you have many factors that have an impact on your bottom line – including a collaborating physician for nurse practitioner cost. According to, NPs can choose either an hourly rate or from the following pricing options for collaborating physicians: 

  • Flat Rate – An agreed upon rate of compensation that is paid regardless of the hours of involvement.  
  • Percentage – Collaborative physicians are compensated based on the number of patients that are seen.  
  • Exchange for Services – NPs work a predetermined number of hours in a physician’s practice in exchange for their services.  

One of the potential downsides of collaborative practice agreements is that they take away time which physicians could use to see their own patients. Another is that physicians can cancel agreements at any time which could deter NPs from investing in new practices. In these instances, it is patient care that suffers most. 

Keep in mind that rules around pricing agreements also vary geographically. Again, make sure that you understand the laws in your state before entering into a collaborative agreement between physician and nurse practitioner. 

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How do NPs Find a Physician Collaborator?  

While it may take some effort, it is possible to integrate a collaborating physician into your practice. Tap into local professional networks and keep your criteria in mind as you vet prospects. What skills, or specialties would you prefer your collaborating physician partner to have? Also, ask your colleagues to refer you to doctors who may be the right fit for your independent practice. 

To avoid common physician collaboration issues with nurse practitioners, ensure you have a good rapport and share the same practice philosophy when considering a long-term partnership. In addition to agreeing upon responsibilities, it is also important to establish guidelines for processes, such as chart review, to ensure you each are on the same page.  

With careful consideration and effort, you can confidently select a collaborating physician who will bring value to your practice as you still maintain your independence.  

NP Advantage Can Help 

According to an article published in the journal Health Services Research, “patients reassigned to NPs experienced similar outcomes and incurred less utilization at comparable cost relative to MD patients.” In a healthcare landscape facing a massive primary care shortage, NPs are an invaluable patient resource.  

The NP Advantage team understands the integral role you play in healthcare and will stay by your side along the journey to independence. Our team of business and healthcare consultants have the experience and expertise needed to support the launch and growth of independent NP practices and, if needed, we can help you connect with resources in your search for a collaborating physician.