Finding a Collaborating Physician in New York
As a nurse practitioner (NP), finding a collaborating physician in New York may seem like a challenge, but don’t worry! Zivian is here to guide you through the process.
New York regulations require nurse practitioners to form a collaborative agreement with a physician until the NP has 3,600 hours of experience.
Whether it’s understanding the legal requirements and NP autonomy in New York to identifying physicians who align with your professional goals, this post explores regulations and key considerations for finding a collaborating physician in the Empire State.
The Importance of NP-Physician Collaborations in New York
New York, characterized by its cultural diversity and population density, demands a collaborative approach to healthcare delivery.
NPs, equipped with advanced clinical training, bring a unique set of skills that, when combined with a physician's expertise, form a dynamic healthcare team. This collaboration not only enhances the scope of practice for both professionals but also ensures a holistic and integrated approach to patient care.
The significance of NP-Physician collaboration in New York is underscored by the state's regulations, which mandate a collaborative agreement for NPs to practice autonomously. This legal framework not only safeguards patient welfare but also fosters a collaborative environment where healthcare providers can leverage each other's strengths for optimal outcomes.
What Is the State Practice Environment for NPs in New York?
In which category does the state fall: NP independent practice, transition to independence, or collaboration required?
The New York State Education Department (NYSED) states the following:
“According to New York State Education Law §6902, a nurse practitioner (NP) diagnoses illnesses and physical conditions and performs therapeutic and corrective measures within the specialty area of practice in which the NP is certified. New York certifies NPs to practice in the following specialty areas: Acute Care, Adult Health; College Health; Community Health; Family Health; Gerontology; Holistic Care; Neonatology; Obstetrics; Oncology; Palliative Care; Pediatrics; Perinatology; Psychiatry; School Health; and Women's Health.
New York State Education Law holds nurse practitioners (NPs) independently responsible for the diagnosis and treatment of their patients and does not require an NP to practice under physician supervision.
Nurse practitioners, however, must practice in accordance with written practice protocols and a written practice agreement with a collaborating physician unless and until the NP has completed 3,600 hours of experience. This experience must consist of practicing as a licensed or certified NP as follows:
in accordance with the laws of New York or another state, or
while employed by the United States veteran's administration, the United States armed forces or the Unites States public health service.
Thereafter, the NP may practice independently.”
Delegation Authority & Process
Is an agreement required?
Yes, protocols and practice agreements are required.
What form of agreement is required and what are the requirements for the substance of the agreement?
To learn all the required components of a collaboration agreement in New York, contact our team today!
Where must the agreement be stored?
Practice agreements and practice protocols shall be maintained in the practice setting of the nurse practitioner and collaborating physician.
Does the agreement need to be filed with the state?
Agreement itself does not need to be filed, but there is a document “Form 4NP” that needs to be filed with the state within 90 days after beginning professional practice.
The department in its discretion or upon request of an NP or collaborating physician may review practice protocols for the purpose of insuring that they are in conformance with accepted medical and nursing practice and with the statutes and regulations governing the practice of medicine, nursing, and the prescribing of drugs, and may render an opinion which shall be binding upon the parties to the protocol.
Are there requirements to file the agreement after the initial filing (e.g., for updates or on a specified frequency)
No requirement.
Who must sign the agreement?
No requirement, but sample has both NP and collaborating physician.
How often must the agreement be reviewed/reauthorized?
Each practice agreement shall provide for patient records review by the collaborating physician in a timely fashion but in no event less often than every three months.
What are the qualifications for the collaborating provider (licensure, same scope, active practice in state, etc.)?
The NP must collaborate with a physician who is qualified to collaborate in the NP’s specialty area of practice.
What are the qualifications for the NP?
Please refer to NYSED’s list of necessary qualifications: https://www.op.nysed.gov/professions/nurse-practitioners/certification-requirements.
Is an alternate collaborating physician required?
No requirement.
Collaboration Requirements
Are there ratios/limits on the number of NPs that a collaborator may supervise or enter into collaboration agreements?
No physician shall enter into practice agreements with more than four nurse practitioners who are not located on the same physical premises as the collaborating physician.
Is there an express requirement to review a certain number/percentage of charts?
Each practice agreement shall provide for patient records review by the collaborating physician in a timely fashion but in no event less often than every three months.
Is there a requirement to meet and, if so, how often and how?
No restriction.
Are there proximity requirements (e.g., between the NP/collaborator or practice site)?
No restriction.
Are there location-specific requirements? (e.g., that collaborator must go to practice site at some frequency)
No restriction.
Is remote supervision allowed/are there limitations on remote supervision?
No restriction.
Physician and NP Filing Requirements
Outside of filing the collab agreement, must the physician and/or NP file any separate forms (e.g., notice of delegation of prescriptive authority, notice of collaboration, notice to PDMP, etc.)?
According to the NYSED, the Nurse Practitioner Form NP-CR: Collaborative Relationships Attestation Form needs to be filed by NPs with more than 3600 hours of qualifying NP experience who choose to practice and have collaborative relationships, instead of practicing in accordance with a written practice agreement.
Prescription Requirements and Controlled Substance Prescribing
What are the prescription requirements?
Please see prescription requirements identified by the NYSED: https://www.op.nysed.gov/professions/nurse-practitioners/professional-practice/prescription-privileges-and-electronic-prescribing.
For NPs practicing under practice agreement, in addition to the requirements of section 6810 of the Education Law, prescription forms used by nurse practitioners shall be printed with the name, nurse practitioner certificate number, office address, and office telephone number of the nurse practitioner.
There are specific requirements for orders to dispense HIV prevention drugs. A certified NP may issue a written patient specific order or prescription to a licensed pharmacist to dispense HIV post-exposure prophylaxis drugs pursuant to applicable law. A certified NP may issue a written non-patient specific order and protocol for a licensed pharmacist to dispense up to a seven day supply of HIV post-exposure prophylaxis drugs to prevent HIV infection in persons who have potentially been exposed to HIV, provided:
Order and protocol.
(i) The non-patient specific order shall include, at a minimum, the following:
(a) the name, license number and signature of the certified nurse practitioner who issues the non-patient specific order and protocol;
(b) the name and dose of the specific drug(s) to be dispensed;
(c) a protocol for dispensing the drug(s) or a specific reference to a separate written protocol for dispensing the drug(s), which shall meet the requirements of subparagraph (ii) of this paragraph;
(d) the period of time that the order is effective, including the beginning and ending dates;
(e) a description of the group(s) of persons who may receive the dispensed drugs, provided that the group(s) of persons are located in New York State; and
(f) the name and license number of each licensed pharmacist authorized to execute the non-patient specific order and protocol or the name and address of the New York State licensed pharmacy that employs or contracts with the licensed pharmacist(s) to execute the non-patient specific order and protocol.
(ii) The written protocol, incorporated into the order prescribed in subparagraph (i) of this paragraph, shall, at a minimum, require the licensed pharmacist to:
(a) screen each potential recipient, pursuant to criteria in the protocol, for conditions that would qualify or preclude the potential recipient from receiving the dispensed drugs;
(b) offer counseling regarding the need for follow-up care pursuant to criteria in the protocol and provide the counseling if the recipient consents;
(c) offer or provide in writing, the names and addresses of hospitals or other health providers that offer follow-up care, which shall be identified in the protocol; and
(d) document the pharmacy services provided, including the offer or provision of counseling and referral information described in this subparagraph, and maintain the documentation in accordance with section 29.2(a)(3), section 63.6(b)(7) and section 63.6(b)(8) of Title 8 NYCRR.
What are the requirements for controlled substance prescribing?
No rescrictions other than compliance with general prescribing requirements.
See prescribing requirements outlined by the NYSED here: Prescription Privileges and Electronic Prescribing.
Sources
“New York State Education Department. “NYS Nursing: Laws, Rules & Regulations: Article 139.” www.op.nysed.gov, www.op.nysed.gov/professions/registered-professional-nursing/laws-rules-regulations/article-139.
“NYS Nursing: Laws, Rules & Regulations: Part 64.” www.op.nysed.gov, www.op.nysed.gov/professions/registered-professional-nursing/laws-rules-regulations/part-64.
“NYS Nursing: Practice Information: Practice Requirements for Nurse Practitioners.” Www.op.nysed.gov, www.op.nysed.gov/professions/nurse-practitioners/professional-practice/practice-requirements.
