If you practice in a restricted or reduced-practice state, a collaborative practice agreement (CPA) isn’t optional — it’s the legal foundation of your ability to see patients. That means the physician across the table isn’t just a formality. They are, in the regulatory sense, your practice partner. A well-negotiated CPA gives you the structure to run a sustainable practice. A poorly structured one can cap your income, limit your scope, tie you to a non-compete, and leave you exposed if a board complaint arises.
This guide is for NPs evaluating an existing or proposed CPA: what good terms look like, what red flags to identify, how to assess the physician relationship, and what to do when things go wrong.
For context on which states still require CPAs and which have moved to full practice authority, see the NP independent practice states guide.
Quick read: CPA decision framework
| Situation | Recommended action |
|---|---|
| First CPA, new practice, unfamiliar terms | Attorney review before signing — not after |
| Offered revenue share (% of collections) | Get legal counsel; some states prohibit this; evaluate perverse incentive risk |
| Non-compete clause included | Assess geographic radius, duration, and specialty restrictions before signing |
| Physician has board actions, expired credentials, or is in a different specialty | Decline — board scrutiny of the agreement will reflect on you |
| Relationship sours while CPA is active | Check termination clause first; 30-day written notice is standard minimum |
| Practicing in a full-practice authority state | No CPA required — verify your state's current status with your BON |
What a CPA actually does
A collaborative practice agreement is a written document that defines the formal supervisory or collaborative relationship between an NP and a physician. The specific requirements vary by state — some states mandate it for all NPs, some only for certain practice settings or prescribing, and a growing number have eliminated the requirement entirely.
In states that require a CPA, the document typically specifies: the scope of practice the NP is authorized to perform, the mechanism for physician oversight (chart review percentages, consultation protocols, availability requirements), the procedures for handling situations outside the NP’s scope, and the terms of the financial arrangement.
What a CPA is not: it is not a general employment agreement, and it does not govern compensation, hours, benefits, or most day-to-day working conditions unless those terms are written into it explicitly. Conflating the CPA with an employment contract is a common mistake that leads to expensive renegotiations later.
Evaluating the physician
The quality of the collaborating physician matters as much as the contract terms. A CPA is only as useful as the physician’s actual availability and clinical relevance to your practice.
Credential check. Before signing anything, verify the physician’s license is current, unrestricted, and in good standing. Your state medical board has a public verification tool. Look for any history of board sanctions, malpractice settlements, or restrictions — not because any single data point is disqualifying, but because a physician with a problematic regulatory history is a riskier partner if your agreement ever draws board scrutiny.
Specialty alignment. A CPA between a family NP and a family physician who practices in the same specialty area is standard. A CPA between a psychiatric-mental health NP and an orthopedic surgeon is harder to defend to a board. The collaborating physician should have genuine clinical expertise in the area you’re practicing in. If the physician cannot meaningfully review your charts or consult on clinical questions in your specialty, the agreement is nominal rather than substantive — and boards know this.
Availability. Ask directly: how quickly can you reach the physician by phone during practice hours? What happens if they’re unavailable for a week? What is their chart review turnaround? An agreement that looks fine on paper collapses in practice if your collaborator is consistently unavailable. Get specifics, in writing.
Number of other collaborations. Some physicians collaborate with multiple NPs across several practices simultaneously. There’s no universal limit, but if a physician is collecting collaboration fees from 10–15 NPs, their availability and actual oversight are legitimately in question.
Key terms to evaluate (and red flags)
| Term | What good looks like | Red flag |
|---|---|---|
| Compensation structure | Flat monthly retainer for oversight services | Percentage of your collections or revenue share |
| Chart review requirement | Clear percentage (e.g., 10–25% of charts monthly), defined turnaround | No specified percentage, no documentation protocol |
| Termination clause | 30-day written notice by either party; no-cause termination allowed | Long notice periods (90+ days), cause-only termination for NP |
| Indemnification | Each party responsible for their own acts and omissions | NP indemnifies physician for all claims arising from NP's practice |
| Non-compete | Absent, or narrowly scoped (limited geography, short duration) | Broad radius (50+ miles), long duration (2+ years), specialty restrictions |
| Scope definition | Consistent with your state BON scope; references current state law | Scope narrower than state law permits without clinical justification |
| Prescribing authority | Full authority for your scope; DEA registration handled clearly | Physician controls which medications you can prescribe beyond state requirements |
Revenue share: the fee-splitting problem
Some collaborating physicians charge a percentage of the NP’s revenue rather than a flat fee. This arrangement creates two problems. First, several states prohibit fee-splitting arrangements that tie physician compensation to NP patient volume or revenue — a percentage-based arrangement may be illegal depending on your state. Second, even where legal, the structure creates a perverse incentive: the physician benefits financially from the NP seeing more patients, which can blur the boundary between legitimate oversight and pressure to increase volume.
A flat monthly retainer (typically $300–$800/month depending on specialty, caseload, and state) aligns the physician’s compensation with oversight services rather than revenue. This is the structure most attorneys recommend and the one that best withstands board scrutiny.
If you’re paying your collaborating physician more than 10–15% of your practice revenue in a percentage-based arrangement, that is a significant financial burden worth quantifying carefully before signing. Run the numbers at your expected volume.
Non-compete clauses
A non-compete in a CPA creates a specific risk that doesn’t exist in standard employment non-competes: if the CPA terminates and you can’t practice within the restricted geography, you may be unable to satisfy your own regulatory requirement to have a collaborating physician — effectively forcing you to shut down your practice.
Evaluate any non-compete on: geographic radius (10-mile radius in a rural area is very different from 10 miles in a dense urban market), duration (12 months is more negotiable than 24), and whether it restricts you from any practice in the area or only from competing directly with the physician’s own practice.
Get attorney review of any non-compete before signing, particularly if you’re starting a practice you intend to build over several years. The cost of an hour of attorney time is small relative to the cost of discovering, mid-practice, that a termination forces you to stop seeing patients.
Indemnification clauses
Watch for language that makes you responsible for indemnifying the physician against claims arising from your practice. The standard in a properly balanced agreement is mutual indemnification — each party covers their own acts and omissions. Clauses that shift liability to the NP beyond that standard deserve careful attorney review before signing.
What to do if the relationship sours
CPA relationships can deteriorate for several reasons: the physician becomes less available, the financial terms feel increasingly unfair, personality conflicts develop, or the physician’s own practice situation changes.
First, check the termination clause. Most agreements allow either party to terminate with 30–60 days written notice without cause. If yours does, you have a clear exit path — begin searching for a new collaborating physician before terminating, so you have continuity of your ability to practice.
If the termination clause is restrictive, you may need to negotiate a mutual agreement to exit. This is where having an attorney who reviewed the original agreement is valuable.
If the physician is making clinical demands that exceed their authority under the agreement or your state’s scope-of-practice laws, document those interactions in writing and consult your state NPA (nurse practitioner association) for guidance. Most states have resources specifically for NPs navigating difficult collaboration relationships.
One financial caution: if the agreement includes malpractice tail coverage provisions — where the departing party owes a tail premium — understand who is responsible before triggering termination. Tail coverage for NPs can run thousands of dollars, and that obligation should factor into your exit planning.
Physician-finding services
In states with large NP populations and a shortage of willing collaborating physicians, a market for physician-collaboration services has emerged. Services like Collaborating Docs, MD Collaborate, and National Nurse Practitioner Mentorship Group connect NPs with physicians offering collaboration agreements — typically on a flat-fee basis.
These services can solve the “can’t find a physician” problem, but apply the same evaluative criteria: verify credentials, confirm specialty alignment, ask about availability and chart review processes, and have an attorney review the agreement before signing.
Questions to ask before deciding
- Is this physician licensed, in good standing, and practicing in a specialty relevant to my patient population?
- What does chart review actually look like — how often, what turnaround, and what documentation do we create?
- Is the compensation structure a flat fee or revenue-based? If revenue-based, what does that cost me at projected volume?
- What does the termination clause say, and do I have a clear, timely exit if needed?
- Does the non-compete, if present, restrict me in a way that could force me to shut down or relocate?
- Has an attorney reviewed this agreement — not just read it, but specifically flagged the indemnification, non-compete, and termination provisions?
Bottom line
A CPA is a regulatory requirement in restricted-practice states, but it’s also a professional and financial relationship. The terms you sign now shape your practice for as long as the agreement is active.
If the compensation structure is flat-fee and reasonable, the physician has relevant credentials and genuine availability, the termination clause gives you a clean exit, and no onerous non-compete is attached, the agreement is likely workable. If you’re being asked to share revenue, sign a broad non-compete, or accept one-sided liability language, those are material problems worth negotiating — or walking away from.
The cost of attorney review before signing is almost always less than the cost of a dispute, a board inquiry, or a non-compete that constrains where you can practice for the next two years.
For context on NP career decisions more broadly, see the FNP vs AGPCNP vs PMHNP comparison and NP school while working.