2013 2020 and still, more than half the states require Nurse Practitioners and other advanced practice nurses (APN’s) to have a formal collaborative (and in some states supervisory) relationship with a physician. While the Future of Nursing Report recommends removing barriers to full practice, it’s likely to be slow going. Thus, finding and working with one or more collaborating physicians is a reality for many of us. However, the “political” climate and regulations in many states make it challenging to do so.
In a state where NPs must have collaboration in order to practice in either an employed or self-employed situation, the lack of a collaborator impedes the NPs ability to provide patient care and has forced the closure of more than one NP owned practice. Collaboration is not only short-sighted; it’s also costly and reduces a patient’s access to care.
Because of these challenges, NPs have many questions regarding collaborating physicians (CP) including:
· When do I need a collaborating physician?
· What are they responsible for?
· How can I find a collaborating physician?
· Do I need to pay for collaboration and if so, how much?
· Do I have to pay for their malpractice insurance?
· Should I have a written contract or agreement?
Let’s take a look at each of these questions:
Do I need a collaborating physician? In order to answer this question, it’s imperative that you read and thoroughly understand what is required in your state. You will need to look at rules and regulations from the board of nursing, the board of medicine, and any business or corporate laws regarding collaboration or hiring of physicians.
Often, I receive a question from someone who asks if they really need a CP if they are not prescribing, or if they are functioning as a health coach vs NP, or something similar. The answer is in your practice act and with your board. Some practice acts will delineate specific tasks and functions that require collaboration, others will be more generic. This is why it is imperative that you read and understand exactly what it required of you.
But don’t stop there. If you are required to have a CP, then I recommend you also read the BOM practice act to understand the rules and regulations regarding physician collaboration with NPs and other APN’s. You’ll want to be clear on what is expected of the physician and any restrictions that may be in place (chart sign-offs, distance, physical requirements in your practice space, the number of NPs that one can collaborate with, and the like).
You’ll also want to take a look at any business/corporation restrictions that may be placed on physicians. In some cases, they cannot be hired by non-physicians and thus cannot be compensated in the form of cash.
What are they responsible for? Physicians are not always aware of what is required when they are approached by an NP regarding collaboration. Thus, it is your responsibility to find out and be able to communicate this information clearly. You will not be able to move forward this obtaining a CP until you are both clear about the required responsibilities.
Some states require collaboration for all areas of practice and others for just parts of practice such as prescribing legend medications and/or controlled substances. You may be required to have written protocols, reference textbooks, or just be required to reach out when necessary.
Furthermore, practice acts (both BOM and BON) may require any of the following: physical presence in the practice X number of hours per month; a distance of X miles from the NP practice; X number of charts signed off each month/quarter; face-to-face collaboration (in some cases Skype, Facetime or other video conferencing may be acceptable); other methods and time requirements for communication or even just “as needed” communication with the method (phone, email, etc) being documented.
That’s it for this time. We will pick up with finding a collaborating physician, paying the CP (as well as malpractice coverage) and agreements next time.
Looking for Part II?
Collaborating Physicians: The Basics, Part 2
Tell us below, what your challenges are regarding collaboration. How has it affected your practice, your ability to provide patient care?
Barbara C Phillips, ARNP, FNP-BC, FAANP is a professional speaker, author, clinician, and business owner who provides business education, resources, and support to Nurse Practitioners, Physician Assistants and other Advance Practice Clinicians – both for the employed and self-employed clinician. Additional information about Ms. Phillips is available at ClinicianBusinessInstitute.
Article updated August 2020.