Supervision Agreement · PA
North Carolina Supervisory Practice Agreement for Physician Assistants
Required. The Supervisory Practice Agreement is the written instrument North Carolina law names for a Physician Assistant working with a physician. Below: the board that governs it, what it must contain, and the terms it has to carry.
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 North Carolina Supervisory Practice Agreement must contain
Each numbered item is a statutory requirement the Supervisory Practice 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 Supervisory Practice Agreement also carries 1 scope, 1 education and 1 registration clauses, authored in the document itself.
Statutes and rules these clauses cite
- 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.
Terms it has to carry
Ratio, proximity, chart review, meeting and prescribing terms the Supervisory Practice Agreement has to carry, from North Carolina'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.
Sources for the supervision 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); North Carolina NPs have no independent-practice pathway. PA team-based practice (S.L. 2025-37, H.B. 67) is now in force: its June 30, 2026 trigger has passed, regardless of whether the Medical Board's conforming rules were finished by then. Several categories below (CRNA proximity, ratio and chart review; CNM proximity) have no codified numeric standard; confirm with the board rather than reading them as an absence of any requirement.
Other clinicians in North Carolina: see the state overview.