Finding a Collaborating Physician in Florida
If you’re a nurse practitioner (NP) or physician assistant (PA) in Florida, you may be required to have a collaborating physician in order to practice. But what is a collaborating physician, and how do you find one?
In this article, we’ll define the role of a collaborating physician and provide tips on how to find one in Florida. We'll also outline specific requirements and regulations for collaborative practice agreements between NPs and physicians in the Sunshine State.
Note: State regulations and requirements are subject to change. Always check with your state medical or nursing board to confirm the most up-to-date information.
What Is a Collaborating Physician?
A collaborating physician is a licensed physician who works with a nurse practitioner or physician assistant to provide medical care to patients. This collaboration is often required by state laws and regulations, and the specific requirements may vary from state to state.
In Florida, NPs and PAs are required to have a collaborating physician in order to practice. This means that the physician must be available for consultation and must review and approve the NP or PA’s medical decisions.
Why Is a Collaborating Physician Required?
Collaborating physicians are required in order to ensure the safety and quality of patient care. By working together, NPs, PAs, and physicians can combine their knowledge and skills to provide the best possible care for patients.
Additionally, collaborating physicians can provide guidance and support to NPs and PAs, especially in areas where they may have less experience or expertise. For nurse practitioners in Florida, establishing a collaborative relationship with a physician is a crucial step in delivering quality care and maintaining compliance.
NP-Physician Collaboration in Florida
Florida allows nurse practitioners to work autonomously within their scope of practice but mandates a formal collaboration with a physician.
The Florida Board of Nursing and the Florida Board of Medicine jointly regulate the collaborative practice requirements. This collaboration involves regular consultations, case reviews, and communication between the nurse practitioner and the collaborating physician. Becoming familiar with these regulations is an essential part of maintaining a compliant working relationship.
What Is the State Practice Environment for NPs in Florida?
A collaboration is required for NPs practicing in Florida, but a path to independent practice exists for APRNs engaged in primary care practice.
APRNs engaged in “primary care practice” can practice autonomously if they have 3,000 hours of qualifying experience within prior 5 years.
“Primary care practice – includes physical and mental health promotion, assessment, evaluation, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses, inclusive of behavioral and mental health conditions.”
NP must submit an Autonomous NP Registration with Financial Responsibility and get approved by the Florida Board of Nursing.
Delegation Authority & Process
Is a collaboration agreement required?
Yes, an agreement known as a “supervisory protocol” is required.
What form of agreement is required and what are the requirements for the substance of the agreement (is use of a state template required?)
There is no specific requirement for the form of collaborative agreement. However, below is a list of recommendations for what should be included.
A description of the duties of the ARNP.
A description of the duties of the physician or dentist (which shall include consultant and supervisory arrangements in case the physician or dentist is unavailable).
The management areas for which the ARNP is responsible, including:
The conditions for which therapies may be initiated.
The treatments that may be initiated by the ARNP, depending on patient condition and judgment of the ARNP.
The drug therapies that the ARNP may prescribe, initiate, monitor, alter, or order.
A provision for annual review by the parties.
Specific conditions and a procedure for identifying conditions that require direct evaluation or specific consultation by the physician or dentist. These can be found here.
Collaboration Requirements
Below is a list of important questions regarding collaboration requirements for nurse practitioners in Florida.
Are there ratios or limits on the number of NPs that a collaborator may supervise or enter into collaboration agreements with?
A ratio of 1 supervisor for 2 or 4 “offices,” depending on the specialty, in addition to physician’s primary office location as stated on state website. More detail on remote supervision is provided below.
Is there an express requirement to review a certain number/percentage of charts?
There is no express requirement. However, if a physician receives a referral and plans to utilize an NP within their practice, upon initial referral of a patient by another practitioner, the physician receiving the referral must ensure that the patient is informed of the type of license held by the physician and the type of license held by any other practitioner who will be providing services to the patient.
When scheduling the initial examination or consultation following such a referral, the patient may decide to see the physician or any other licensed practitioner supervised by the physician and, before the initial examination or consultation, shall sign a form indicating the patient’s choice of practitioner. The supervising physician must review the medical record of the initial examination or consultation and ensure that a written report of the initial examination or consultation is furnished to the referring practitioner within 10 business days following the completion of the initial examination or consultation.
Is there a requirement for the nurse practitioner and collaborating physician to meet? If so, how often?
See below for remote supervision requirements.
Are there proximity requirements between the NP-collaborator and/or practice site?
No, there are no requirements.
Are there any location-specific requirements (e.g., that collaborator must go to practice site at some frequency)?
No, there are no requirements.
Remote Supervision Requirements
Is remote supervision allowed? Are there limitations on remote supervision?
Remote supervision is permitted as long as the NP is able to contact their collaborating physician “when needed for consultation and advice either in person or by communication devices.” See below for additional details pertaining to specialty.
A physician who supervises an advanced practice registered nurse or physician assistant at a medical office other than the physician’s primary practice location (a physician’s “primary practice location” means the address reflected on the physician’s profile published pursuant to s. 456.041.), where the advanced practice registered nurse is not under the onsite supervision of a supervising physician, must comply with the standards set forth below:
A physician who is engaged in providing primary health care services may not supervise more than four offices in addition to the physician’s primary practice location. For the purpose of this subsection, “primary health care” means health care services that are commonly provided to patients without referral from another practitioner, including obstetrical and gynecological services, and excludes practices providing primarily dermatologic and skin care services, which include aesthetic skin care services.
A physician who is engaged in providing specialty health care services may not supervise more than two offices in addition to the physician’s primary practice location. For the purpose of this subsection, “specialty health care” means health care services that are commonly provided to patients with a referral from another practitioner and excludes practices providing primarily dermatologic and skin care services, which include aesthetic skin care services.
A physician who supervises an advanced practice registered nurse or physician assistant at a medical office other than the physician’s primary practice location, where the advanced practice registered nurse or physician assistant is not under the onsite supervision of a supervising physician and the services offered at the office are primarily dermatologic or skin care services, which include aesthetic skin care services other than plastic surgery, must comply with the standards listed below.
The physician shall submit to the board the addresses of all offices where he or she is supervising an advanced practice registered nurse or a physician assistant which are not the physician’s primary practice location.
The physician must be board certified or board eligible in dermatology or plastic surgery as recognized by the board pursuant to s. 458.3312.
All such offices that are not the physician’s primary place of practice must be within 25 miles of the physician’s primary place of practice or in a county that is contiguous to the county of the physician’s primary place of practice. However, the distance between any of the offices may not exceed 75 miles.
The physician may supervise only one office other than the physician’s primary place of practice.
All protocols relating to electrolysis or electrology using laser or light-based hair removal or reduction by persons other than physicians licensed in FL require the person performing this service to be appropriately trained and work only under the direct supervision and responsibility of a physician licensed in FL.
Physician and Nurse Practitioner Filing Requirements
Outside of filing the collaborative agreement, does the physician and/or NP need to file any separate forms?
The physician must inform the board of medicine of collaborating relationship and termination of relationship using this form: Board of Medicine APRN/EMT/Paramedic Protocol Form.
The notice must be filed within 30 days of entering into the relationship, orders, or protocol. Notice also shall be provided within 30 days after the physician has terminated any such relationship, orders, or protocol.
Prescription Requirements and Controlled Substance Prescribing
What are the prescription requirements?
If prescribing weight loss drugs is delegated to a nurse practitioner, the delegating physician must review the medical records prior to the issuance of an initial prescription, order, or dosage.
What are the requirements for controlled substance prescribing?
See below for a list of requirements regarding controlled substance prescribing in Florida.
An advanced practice registered nurse may prescribe or dispense a controlled substance as defined in s. 893.03 only if the advanced practice registered nurse has graduated from a program leading to a master’s or doctoral degree in a clinical nursing specialty area with training in specialized practitioner skills. Advanced practice registered nurses may only prescribe controlled substances pursuant to the individual's education, training, experience and protocol.
A Nurse Practitioner shall not prescribe Schedule II controlled substances via telemedicine except for treatment of a psychiatric disorder.
“Psychiatric nurse” means an advanced practice registered nurse licensed under Fla. Stat. Ann. 464.012 who has a master’s or doctoral degree in psychiatric nursing, holds a national advanced practice certification as a psychiatric mental health advanced practice nurse, and has 2 years of post-master’s clinical experience under the supervision of a physician.
Advanced practice registered nurses must restrict prescriptions of Schedule II controlled substances as listed in section 893.03, F.S., to a 7-day supply. This restriction does not apply to prescription of controlled substances that are psychiatric medication prescribed by a psychiatric nurse.
Only advanced practice registered nurses may prescribe psychiatric mental health controlled substances to children younger than 18 years of age.
The following is also prohibited in Florida for psychiatric nurses:
Prescribing for office use any medicinal drug appearing in Schedule II of s. 893.03.
Prescribing, ordering, dispensing, administering, supplying, selling, or giving a drug that is an amphetamine, a sympathomimetic amine drug, or a compound designated in s. 893.03(2) as a Schedule II controlled substance, to or for any person except for:
The treatment of narcolepsy; hyperkinesis; behavioral syndrome in children characterized by the developmentally inappropriate symptoms of moderate to severe distractibility, short attention span, hyperactivity, emotional lability, and impulsivity; or drug-induced brain dysfunction.
The differential diagnostic psychiatric evaluation of depression or the treatment of depression shown to be refractory to other therapeutic modalities.
The clinical investigation of the effects of such drugs or compounds when an investigative protocol is submitted to, reviewed by, and approved by the department before such investigation is begun.
The following is also prohibited in Florida:
Prescribing, ordering, dispensing, administering, supplying, selling, or giving a drug that is an amphetamine, a sympathomimetic amine drug, or a compound designated in s. 893.03(2) as a Schedule II controlled substance, to or for any person except for:
The treatment of narcolepsy; hyperkinesis; behavioral syndrome in children characterized by the developmentally inappropriate symptoms of moderate to severe distractibility, short attention span, hyperactivity, emotional lability, and impulsivity; or drug-induced brain dysfunction.
The differential diagnostic psychiatric evaluation of depression or the treatment of depression shown to be refractory to other therapeutic modalities.
The clinical investigation of the effects of such drugs or compounds when an investigative protocol is submitted to, reviewed by, and approved by the department before such investigation is begun.
Prescribing, ordering, dispensing, administering, supplying, selling, or giving growth hormones, testosterone or its analogs, human chorionic gonadotropin (HCG), or other hormones for the purpose of muscle building or to enhance athletic performance. As used in this subparagraph, the term “muscle building” does not include the treatment of injured muscle.
Prescribing, ordering, dispensing, administering, supplying, selling, or giving amygdalin (laetrile) to any person.
Find a Collaborating Physician in Florida with Zivian
Zivian Health helps nurse practitioners connect with physicians within their specialty in a secure online collaboration software. Our mission is to simplify and streamline compliant collaborations to empower NPs and expand access to health care.
We’ll match you with a collaborating physician in a matter of days. Plus, you’ll have a home base to track all of your state requirements, including meetings, chart reviews, and licensure.
Get started with Zivian today by contacting us here.
Sources
See below for a list of sources for this post.
Fla. Admin. Code Ann. r. 64B9-4.016
Fla. Admin. Code Ann. r. 64B9-4.020
