Practice Agreement · PA
Physician Assistant Practice Agreement in North Carolina
North Carolina law does not require a Physician Assistant to hold a named agreement with a physician. Practices still use one to define the working relationship; here is what it covers and what the state does require.
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 a Physician Assistant practice agreement covers in North Carolina
Governed by the North Carolina Medical Board and the Board of Pharmacy. Each numbered item is a statutory requirement the agreement must satisfy.
The Physician Assistant ("PA") will be supervised by the Physician as defined by regulations of the North Carolina Medical Board. The Physician shall be available to the Physician Assistant for consultation. (See Title 21, Chapter 32S of the North Carolina Administrative Code.)
Source: 21 NCAC 32S .0213
The Physician and the Physician Assistant shall meet at a frequency consistent with the requirements set forth in 21 NCAC 32S .0213 and sufficient to address practice-relevant clinical problems, quality improvement measures, and compliance with applicable regulations. The Physician and the Physician Assistant shall also establish a process for the ongoing review of the care provided in each practice site, including a written plan for evaluating the quality of care for one or more frequently encountered clinical problems. This plan shall include a description of the identified clinical problems, an evaluation of current treatment interventions, and, where appropriate, a plan for improving outcomes within a specified timeframe. A written record of all required meetings shall be dated and signed by the Physician and the participating Physician Assistant and maintained for a period of five (5) years. Such records shall be available for inspection upon request by the North Carolina Medical Board, or their authorized agents. Both the Physician Assistant and the Physician shall retain copies of these records.
Source: 21 NCAC 32S .0213
If the Physician Assistant has accumulated four thousand (4,000) or more total hours of clinical practice as a Physician Assistant, including one thousand (1,000) or more hours working with a physician in the relevant specialty, and the North Carolina Medical Board has approved the Physician Assistant for team-based practice, the Physician Assistant may practice in that specialty without the cosignature and joint-meeting requirements described above, except in perioperative settings (surgery- or anesthesia-related services), where physician supervision continues to apply.
Source: N.C. Gen. Stat. § 90-18.1
- The agreement on file also carries 1 scope, 1 education, 1 registration clauses, generated in the document itself.
Statutes and rules cited
- 21 NCAC 32Mregulation
North Carolina Medical Board rules governing nurse practitioner approval to practice and the collaborative practice arrangement with a primary supervising physician.
- 21 NCAC 36 .0809, .0810regulation
Board of Nursing rules requiring documented joint meetings between the primary supervising physician and the nurse practitioner: monthly for the first 6 months of a new collaborative practice arrangement, then at least every 6 months thereafter.
- 21 NCAC 32S .0213regulation
North Carolina Medical Board rule requiring periodic joint meetings, a quality-improvement review process, and 5-year recordkeeping for physician assistant supervision.
- N.C. Gen. Stat. § 90-18.1statute
S.L. 2023-47 team-based practice pathway allowing an experienced physician assistant (4,000+ total hours and 1,000+ specialty hours, approved by the Medical Board) to practice without the traditional cosignature/supervision requirement outside perioperative settings.
- N.C. Gen. Stat. § 90-18.4statute
Clinical Pharmacist Practitioner (CPP) designation, requiring joint Medical Board / Board of Pharmacy approval and a written collaborative practice agreement with a supervising physician.
- 21 NCAC 46 .3101 et seq.regulation
Board of Pharmacy rules on CPP approval, scope (implementing predetermined drug therapy, modifying drug therapy, ordering laboratory tests), and physician countersignature of CPP orders.
- S.L. 2025-37 (Board of Pharmacy CPP guidance, effective October 1, 2025)board guidance
Board of Pharmacy guidance on new CPP authority to order/perform CLIA-waived tests and initiate treatment for influenza under statewide protocols.
- N.C. Gen. Stat. § 90-171 et seq.statute
North Carolina Nursing Practice Act.
- Board of Nursing continuing competence requirementsboard guidance
Board of Nursing guidance on the 30-contact-hour (or alternative) continuing competence requirement for RN license renewal every 2 years.
Terms it has to carry
Ratio, proximity, chart review, meeting and prescribing terms the agreement has to carry, from the state's supervision rules.
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
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.