PA · Puerto Rico
Collaborative Practice Agreement for Physician Assistants in Puerto Rico
Yes, a written physician agreement is required. Puerto Rico does not name a specific instrument.
No independent-practice pathway exists or could exist under this credential — Art. 12 (20 L.P.R.A. §141j) requires supervision to be 'continua' and expressly not 'incidental' for as long as the Médico Asistente practices. This role is structurally a supervised bridge credential, chiefly for physicians who have not yet passed PR medical licensure, not an independent midlevel profession.
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
Available remotely (no on-site requirement)
Art. 12 requires supervision to be continuous and not incidental, but does not specify physical presence, a mile/minute radius, or a telecommunication standard. Whether the Junta de Licenciamiento y Disciplina Médica expects on-site presence in practice is an open question not resolved by the statute's text — verify before relying on this for compliance.
Supervision ratio
Up to 2 at a time
Art. 12 (20 L.P.R.A. §141j): 'Ningún Médico Supervisor podrá tener bajo su cargo y supervisión más de dos (2) Médicos Asistentes' — no supervising physician may have more than 2 PAs at once. A PA who practices in multiple medical disciplines may have one supervisor per discipline (not a combined multi-discipline cap).
Chart review
Percentage set by agreement · As needed · countersignature required
Not a periodic sampled review — Art. 11 (20 L.P.R.A. §141i) requires EVERY progress note the PA writes to be signed by both the PA and the Médico Supervisor, with the Junta empowered to set a maximum time between drafting and countersignature. Medical orders likewise require the supervisor's signature except in defined emergencies.
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Covered by the practice agreement · no controlled-substance authority
Art. 11 (20 L.P.R.A. §141i): 'Los Médicos Asistentes no tendrán autoridad para recetar medicamentos en Puerto Rico' — PAs have NO prescriptive authority of any kind, controlled or otherwise. They may write medical orders, but only when countersigned by the supervising physician (or, in an emergency where life/health is at risk and the supervisor is unavailable, by another physician).
Written agreement
Required
Not a written 'practice agreement' in the NC/VA sense — Ley 71-2017 conditions practice on an ongoing supervisory relationship with a specific licensed M.D./D.O. ('Médico Supervisor'), reported to the Junta, rather than a negotiated contract document.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Art. 7 (20 L.P.R.A. §141e) affirmatively bars a Médico Asistente from associating with any other person or entity to form a 'corporación profesional' under Ley 164-2009 (Cap. 238) for the purpose of grouping licensed PAs — unlike the other provider types in this dataset, PAs have NO independent-ownership pathway of any kind and must practice as employees/contractors of a physician-owned entity.
Stricter than every other provider type here: this is a categorical prohibition on PA-only or PA-inclusive professional corporations, not merely a non-licensee-ownership restriction.
What a collaborating physician costs here
Typical monthly cost in Puerto Rico
$550 – $850
Estimate for one Physician Assistant. This state's rules add a restrictive-tier premium.
About Puerto Rico's rules
PR's 'Médico Asistente' (PA) credential is NOT the mainland PA profession — it is a bridge pathway mainly for internationally-trained physicians awaiting PR licensure (Ley 71-2017), capped at 2 per supervising physician with zero prescriptive authority. APRNs (NP/CNM/CRNA/CNS) need patient-level collaborative protocols with a physician for nearly all diagnostic/prescriptive functions (Ley 254-2015) despite AANP rating PR 'Reduced Practice.' No dedicated esthetician license currently exists.
Other clinicians in Puerto Rico: see the state overview.