PA · North Carolina
Collaborative Practice Agreement for Physician Assistants in North Carolina
Yes, a written physician agreement is required. North Carolina does not name a specific instrument.
Team-based practice created by S.L. 2025-37 (H.B. 67) is now LIVE — its June 30, 2026 statutory trigger has passed. Exempts qualifying PAs from filing supervising-physician/intent-to-practice notices. Perioperative, surgical, anesthesia-related, and pain-management settings remain supervised_only regardless of experience. No numeric ratio cap or chart-review percentage is codified — NCMB evaluates 'adequate supervision' qualitatively (Position Statement 9.1.1).
Independent practice requires: ≥4,000 total hours of clinical PA experience; ≥1,000 hours in the PA's specific medical specialty; practicing in a qualifying team-based setting (physician-majority-owned practice, or a hospital/clinic with meaningful physician participation).
What the collaboration must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
No proximity requirement
Supervision must be continuous but is not construed as requiring the physical presence of the supervising physician at the time and place services are rendered (21 NCAC 32S .0213(b)). No mile/minute radius is codified.
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
new supervisory arrangement, first 6 months (non-team-based PA): Monthly
Signed, dated written record of each meeting (clinical issues discussed, QI measures taken) required and must be produced to the Board on request (21 NCAC 32S .0213(e)).
ongoing, after first 6 months (non-team-based PA): Every 6 months
At least every 6 months thereafter, same documentation requirement.
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Team-based PAs (S.L. 2025-37) may prescribe without physician authorization; non-team-based PAs need written supervisory authorization (21 NCAC 32S .0212).
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional Corporation (PC) or PLLC — a PA may wholly own a PA-only entity, or co-own with a physician (N.C. Gen. Stat. § 55B-14); non-licensees may not hold equity.
A PA-owned entity may NOT itself employ or contract a physician to practice medicine (that flips back into CPOM), and a PA may not jointly co-own an entity with an NP under § 55B-14's ownership-combination limits. This ownership rule is legally distinct from the clinical supervisory arrangement above — the supervising physician does not need to own the entity the PA practices through.
Legal sources for these rules (5)
- N.C. Gen. Stat. § 90-18.1
- 21 N.C. Admin. Code 32S .0213 — Physician Supervision of Physician Assistantssecondary
- 21 N.C. Admin. Code 32S .0212 — Prescriptive Authority
- S.L. 2025-37 (H.B. 67) — Healthcare Workforce Reformssecondary
- NC Medical Board Position Statement 9.1.1 — Physician Supervision of Other Licensed Health Care Practitionerssecondary
What a collaborating physician costs here
Typical monthly cost in North Carolina
$500 – $700
Estimate for one Physician Assistant. Standard-tier state.
About North Carolina's rules
The NP 'SAVE Act' (full practice authority) has failed every session since 2021, most recently as S.B. 966 (2026) — NC NPs have no independent-practice pathway. PA 'team-based practice' (S.L. 2025-37/H.B. 67) is now LIVE: its June 30, 2026 trigger has passed, regardless of whether NCMB's conforming rules were finished by then. Several categories below (CRNA proximity/ratio/chart-review, CNM proximity) have no codified numeric standard — treat as open items to verify with the board, not an absence of one.
Other clinicians in North Carolina: see the state overview.