Not all states require that nurse practitioners “collaborate with” or are “supervised by” physicians. While 33 states and DC allow nurse practitioners to diagnose and treat patients autonomously, 18 states still require physician oversight for nurse practitioners to engage in patient care. In addition to this overarching oversight requirement, most states include a handful of additional stipulations as to what this oversight looks like. One of these limitations can be the number of nurse practitioners that a physician is allowed to supervise or collaborate with at one time. 

So, just how many nurse practitioners can a physician supervise? Most states don’t designate a specific NP to MD ratio. Of the ten states that do specify the number of physicians that a single MD can supervise or collaborate with, the number ranges from two to eight. States may also place additional terms to guide these relationships. For example, in Georgia, a physician may enter into a supervisory agreement with up to eight NPs, but only actively supervise four NPs at any given time. Other states may enact terms that depend on if the supervised NPs practice on a full or part time basis. 

Laws limiting the number of NPs a single physician can oversee may seem trivial however, these regulations can have significant applications. NPs looking for jobs in states with such supervisory limits may face a tough job market to name one effect. There may be fewer employment opportunities for nurse practitioners as these are limited by the number of MDs a facility is able to employ. If an employer can’t find a physician to fill an open position, for example, the facility in turn won’t be able to accommodate additional NPs.

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Does your state limit the number of nurse practitioners that a physician can supervise? What implications has this had for your practice? 


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2 thoughts on “How Many Nurse Practitioners Can a Physician Supervise?”

  1. Paula Brooks, DNP

    In South Carolina the law was changed on July 1, 2018. It was never unlimited ratios. The MD could supervise 3 APRNs at one given time. As of July 1, 2018, the Physician can collaborate with 6 APRNs at any one time. It is no longer a supervisory relationship, rather a collaborative one. No delegated medical acts – One step away from independent practice.

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