Collaborating physicians for NPs: the 2027 guide by state
To find a collaborating physician as a nurse practitioner, confirm whether your state requires a written agreement, then choose a physician who matches your specialty and prescribing scope. Psychiatric NPs usually need a psychiatrist comfortable with controlled substances and telehealth. See our guide to finding a collaborating psychiatrist as a PMHNP. Cosign matches you, prepares the agreement and tracks chart reviews.
What is a collaborating physician for a nurse practitioner?
A collaborating physician is a licensed MD or DO who enters a written agreement with a nurse practitioner to provide the oversight, consultation or supervision that state law requires. Whether you need one, and what the agreement must include, depends on the state where you practice.
Which NPs need a collaborating physician?
States fall into three broad groups:
- Full practice states let NPs evaluate, diagnose and prescribe without a physician agreement, sometimes after a transition period.
- Reduced practice states require a collaborative agreement for at least one element of practice, often prescribing.
- Restricted practice states require supervision, delegation or team management for NPs to provide care.
The American Association of Nurse Practitioners publishes a state practice environment map, which is a good starting point. Always confirm with your board of nursing. Data patterns cited below were checked against public sources as of October 2026; verify current rules before you sign.
What does the agreement usually include?
Use our collaborative practice agreement template and checklist alongside the list below.
- Scope of practice and which services the NP provides
- Prescriptive authority, including any limits on controlled substances
- How and how often the physician is available for consultation
- Chart review requirements, if any
- Meeting frequency and documentation
- How the agreement is ended and what happens to patients during a transition
How many NPs can one physician collaborate with?
Many states cap it. Publicly reported limits include four NPs per physician in California, six in South Carolina, and seven in Tennessee and Texas. Caps are one reason good collaborating physicians are hard to find. Confirm the current ratio with your board before you plan capacity.
How much does a collaborating physician cost?
Collaborating physician fees commonly fall between a few hundred and a few thousand dollars a month, with many arrangements between $500 and $1,200. Price rises with chart review volume, controlled-substance prescribing, specialty and the number of states involved.
Why do psychiatric NPs need a different search?
Psychiatric NPs often prescribe controlled substances, manage complex medication regimens and work through telehealth across state lines. A primary care physician may not be comfortable with that risk. Look for:
- A psychiatrist or physician with psychiatric prescribing experience
- Comfort with controlled-substance oversight and your state's monitoring program
- Licenses in each state where you will practice, if your state requires the physician to be licensed there
- Clear availability for urgent consults
How do you find a collaborating physician?
- Start with your network: former preceptors, colleagues and local practices.
- Ask your state NP association; many keep referral lists.
- Use a matching service that vets physicians and handles agreements.
- Interview at least two physicians before you sign.
- Put everything in writing, including what happens if either side ends the agreement.
What should you ask before you sign?
- How often will we meet, and how will you review charts?
- How quickly can you respond to an urgent question?
- Are you covered by malpractice insurance for this role?
- How many other NPs do you collaborate with?
- What notice will you give if you need to end the agreement?
Checked October 2026. Sources: AANP State Practice Environment map; state boards of nursing and medicine. Confirm current rules with your board. General information only, not legal advice.
Frequently asked questions
Do NPs in full practice states ever need a collaborating physician?
Sometimes, during a transition period before independent practice or for specific employers or payers.
Can my collaborating physician be in another state?
Some states allow it and some require in-state licensure or presence. Check your state's rules.
What happens if my collaborating physician quits?
You may have to stop the services that require collaboration until a new agreement is in place, so plan a backup in advance.
How Cosign helps
Cosign matches NPs, especially psychiatric NPs, with vetted physicians in their specialty, prepares the state-specific agreement and tracks chart reviews. Tell us where you practice and we will introduce a physician who fits.
General information only, not legal advice.