Summary
Session Law 2025-37/HB 67, Healthcare Workforce Reforms, was signed into law by Governor Josh Stein on July 1, 2025.
The new law paves the way for new licensure pathways for physicians and PAs and will waive supervision for certain PAs for the first time in North Carolina history. Most changes authorized by Session Law 2025-37 (SL 2025-37) will not be in effect until 2026. Check each section below for applicable effective dates and additional details.
Interstate Medical Licensure Compact (IMLC)
Part I of SL 2025-37 passes the Interstate Medical Licensure Compact (IMLC). By joining the IMLC, there will now be an additional pathway for licensure in NC as well as a pathway for NC licensees to obtain licenses in other compact member states. The compact license is optional and only available to candidates meeting all the eligibility requirements. The traditional application process will still be in place once the IMLC is implemented. This provision of SL 2025-37 goes into effect January 1, 2026. For general information about the IMLC as well as eligibility requirements, click here.
Visit the Board's dedicated IMLC Information Page.
Internationally-Trained Physician Employee (ITPE) License
Part II of SL 2025-37 sets up a pathway to licensure for individuals who have obtained medical education and post graduate training outside the United States. This license is only available to applicants who have been offered full-time employment at an NC licensed hospital or a medical practice in certain rural counties where an NC licensed physician is physically practicing on-site. The applicant will also need to provide information to the Board, including proof of licensure in good standing from another country within the last five years, 130 weeks of medical education from certain designated schools, two years of postgraduate training or active practice for at least 10 years, and demonstration of competency through examination. The applicant must also have no disciplinary actions or pending investigations in any jurisdiction, no criminal convictions, and be legally authorized to work in the United States.
The scope of this license is limited to practicing at NC licensed hospitals or rural medical practice where an NC licensed physician is physically present. After four years of licensure, the international physician license holder is eligible to apply for a full license.
Visit the Board's dedicated ITPE Information Page.
Physician Assistant Interstate Licensure Compact (PA Compact)
Part IV of SL 2025-37 passes the Physician Assistant Interstate Licensure Compact (PA Compact). The PA Compact will offer an additional optional pathway for eligible physician assistants to obtain the privilege to practice in NC. The traditional pathway for licensure will still be available to all physician assistants. The PA Compact is not yet operational, and the effective date of this part of SL 2025-37 is deferred for nine months. For general information about the PA Compact, click here.
Additional information specific to NC implementation of the PA Compact will be available at a later date.
Physician Assistant Team Based Practice
Part VI of SL 2025-37 establishes a team-based practice physician assistant. Team-based practice physician assistants must practice in team-based settings, which include certain health care facilities and certain physician-owned medical practices. They must have more than 4,000 hours of clinical practice experience as a licensed physician assistant and more than 1,000 hours of clinical experience within their medical specialty. Physician assistants must apply to NCMB for team-based status. Approved team-based physicians assistants are not required to file an intent to practice with NCMB, however, team-based physician assistants are still expected to collaborate and consult with other members of the health care team as necessary.
NCMB will provide more information upon the adoption of rules; this provision does not go into effect until NCMB adopts rules or June 30, 2026, whichever occurs first.
FAQs
Team Based Practice
What is a team-based setting or team-based practice?
A team-based setting or team-based practice must be either:
- A medical practice that meets all of the following:
- The majority of the practice is owned collectively by one or more licensed physicians.
- An owner who (1) is an NC licensed physician and (2) has consistent and meaningful participation in the design and implementation of health services to patients.
- The physician and team-based physician assistant that provide services at the medical practice must work in the same clinical practice area.
- A hospital, clinic, nursing home, or other health facility with active credentialing and quality programs where physicians have consistent and meaningful participation in the design and implementation of health services to patients.
Are all PAs eligible for team-based practice?
- No. Team-based practice is only available to physician assistants that meet all of the following:
- More than 4,000 hours of clinical practice experience as a physician assistant AND more than 1,000 hours of clinical practice experience within the specific medical specialty of practice with a physician in that specialty.
- Practices at a team-based setting or team-based practice.
- Physician assistants, who are not eligible for team-based practice, must practice in accordance with all current NCMB rules pertaining to supervision.
Can out of state practice experience count toward the clinical hours experience requirement?
Yes.
Is team-based practice mandatory?
No. Team-based practice is not mandatory and whether you can be hired as a team-based physician assistant is up to your employer. If team-based practice is not adopted, then you must follow all current NCMB rules pertaining to supervision.
Will I still need a supervising physician if I practice in a team-based setting?
- PAs who are registered as team-based practice PAs do not need to file an intent to practice or have a supervisory arrangement with a physician. However, team-based practice physician assistants must work in team-based settings alongside licensed physicians who have consistent and meaningful participation in the practice. Physician assistants are required to consult, collaborate and refer with physicians as determined by the team.
- In addition, team-based practice physician assistants are limited to practicing in their registered team-based setting and designated area of practice. If their employment or area of practice changes, they must either file an intent to practice or register with the NCMB if the setting qualifies as a team-based practice.
- While NC laws and rules do not require team-based physician assistants to have supervising physicians, the law does not restrict or limit an employer’s ability impose additional requirements on employees, including supervision. Whether a physician assistant is hired or promoted as a team-based physician assistant is up to the employer. When employers choose not to participate in team-based practice, all physician assistants must comply with current supervision requirements under NCMB rules.
- Physician assistants, who are not eligible for team-based practice, must practice in accordance with all current NCMB rules pertaining to supervision.
Are there any limitations on team-based physician assistants?
- Physician assistants working in perioperative settings will need to be supervised by a physician as determined by NCMB rules. More details will be available in the Spring.
- Physician assistants cannot provide final interpretations of diagnostic imaging. However, they may provide final interpretations of x-rays if they have a supervising physician as determined by NCMB rules. More details will be available in the Spring.
- All physician assistants who compound must be supervised by an NC licensed physician and are subject to traditional supervision rules, including filing an intent to practice, having supervisory arrangements, and quality improvement meetings.
Can an employer require a registered team-based physician assistant to conduct quality improvement meetings even though it is not required by NCMB rules of team-based physician assistants?
Yes. Employers are free to impose any additional requirements on their employees, including quality improvement meetings.
Will I be required to register with the NCMB in order to qualify for team-based practice?
Yes. Any PA who is eligible for team-based practice and working in an appropriate team-based setting is required to submit proof to the NCMB of team-based practice qualifications. Physician assistants cannot commence practice as a team-based practice until they receive authorization from the NCMB. The process is still being developed. More details will be available in the Spring. Until a physician assistant is registered as a team-based physician assistant with the NCMB, all supervision requirements under NCMB’s current rules must be satisfied.
When will I be able to apply for team-based practice status?
PAs will be able to apply for team-based practice status either after the NCMB adopts rules or June 30, 2026, whichever takes place first. Until then, all supervision requirements under NCMB’s current rules must be satisfied.
What if I don’t qualify for team-based practice?
PAs that do not qualify for team-based practice are subject to traditional NCMB rules requiring the PA to complete an intent to practice listing a NC licensed supervising physician, having a supervisory arrangement that includes the PA’s prescriptive authority, and meeting with the supervising physician for the purposes of quality improvement.
I am a PA who owns my own practice. Do I qualify for team-based practice?
No. Team-based practice only applies to team-based settings where a majority of the practice is owned by licensed physicians. A physician owner must have consistent and meaningful participation in the design and implementation of health services to patients in order to qualify. These practices are subject to the current NCMB rules pertaining to supervision.
I work in a practice that specializes in pain management. Do I qualify for team-based practice?
No. A team-based setting or team-based practice does not include medical practices that specialize in pain management. Physician assistants working in practices that specialize in pain management must follow all rules pertaining to supervision, including maintaining a supervisory arrangement with a supervising physician and having quality improvement meetings. Physician assistants must consult with their supervising physician prior to prescribing targeted controlled substances if the therapeutic use of the targeted controlled substance will or is expected to exceed a period of 30 days.
Clinical Pharmacists Practitioners
Part VII of SL 2025-37 updates the provisions of the Medical Practice Act regarding Clinical Pharmacists Providers (CPPs) allowing them to provide health care services, or medical tasks, acts, and functions delegated by a physician within a collaborative practice agreement for the purpose of providing drug therapy, disease, or population health management for patients. CPPs will be required to have a site-specific supervising physician who conducts periodic reviews and evaluations of the delegated health care services provided by the CPP. These changes went into effect October 1, 2025.