Resources & Information

No. However, you may not commence practice until you receive notification that your Intent to Practice (ITP) form has been processed by the Board.

Intent to Practice forms are processed instantaneously on the Board’s website. You may access the ITP form and check the status of your current and past supervisory relationships by logging into your Licensure Gateway.

You must see “active” under your name and the primary supervising physician’s name along with the date on the website in order to begin practicing. An email acknowledging receipt of the ITP will be sent to the PA and the supervising physician. The Board no longer sends a letter via mail. A copy of the emailed ITP acknowledgment should be kept at all practice sites.

No. You can verify your Intent to Practice was received by utilizing the Board’s Licensee Search tool. If you look up your name on the website and can see your name as active with the primary supervising physician’s name as active along with the date, you can begin practicing. The Intent to Practice acknowledgement letter is emailed to the physician assistant and to the primary supervising physician once the ITP is completed online. PAs and their primary supervising physician(s) should keep a copy of the Intent to Practice acknowledgment letter at all practice sites. The Board provides copies of Intent to Practice letters in the PAs Licensure Gateway.

No. The primary supervising physician must ensure that the PA’s scope of practice is clearly identified and that the delegation of the medical tasks is appropriate to the skills and competencies of both the supervising physician and the PA. See Board rules 21 NCAC 32 .0201(10) and .0213.

A PA’s scope of practice includes those medical acts, tasks or functions, including prescribing and dispensing of drugs and medical devices, that are delegated by the supervising physician in his or her individualized supervisory arrangement.

A supervisory arrangement is a written statement that describes medical acts, tasks and functions (including prescriptive authority instructions) delegated to the PA by the primary supervising physician appropriate to the PA’s qualification, training, skill and competence. The primary supervising physician and the PA must sign and date the supervisory arrangement, keep it on file at all practice sites and make it available to the Board if requested.

If there is a back-up supervising physician, they are required to complete the back-up supervising physician form. This form must be signed and dated by the back-up supervising physician, primary supervising physician and the PA.  This form must be kept onsite as a part of the supervisory arrangement.

See Board rules 21 NCAC 32S .0201(9), .0212, and .0213.

Yes, the supervising physician is accountable to the Board for the physician assistant’s medical activities and professional conduct at all times, whether the physician personally is providing supervision or the supervision is being provided by a Back-up Supervising Physician. See Board rule 21 NCAC 32S .0201(10).

For the first six months of any new supervisory arrangement: The primary supervising physician and the PA in a new practice arrangement must meet monthly for first six months to discuss relevant clinical problems and quality improvement measures.

After the first six months: The primary supervising physician and PA must meet at least every six months to discuss relevant clinical problems and quality improvement measures.

A record of all of these meetings must be signed and dated by both primary supervising physician and PA and be available for NCMB representative inspection.

See Board rule 21 NCAC 32S .0213(e).

No. The Board accepts electronic communication between a PA and his or her primary supervising physician as valid quality improvement meetings as long as the spirit of Rule 21 NCAC 32S.0213 (e) Supervision of Physician Assistants is satisfied.

The physician assistant and his or her Primary Supervising Physician should document a discussion of relevant clinical issues. The meeting and its documentation can take a variety of forms. Some PA/physician teams perform a medical record review while others structure the meeting as a journal club or choose a specific clinical topic for review. As long as the meetings occur, are documented and signed, and include a substantive discussion or review of relevant clinical issues, then the documentation requirement for meetings is likely to meet Board expectations.

The Board has an emergency policy to cover these situations. It involves notifying the Board within two days of the loss of supervisor and securing a new primary while practicing during a 30-day grace period.

The federal government may employ a PA to work in a federal facility in North Carolina without requiring the PA to hold a NC license. However, many PAs employed by the federal government and working in federal facilities do hold an active NC license.

Federally employed PAs are governed by federal rules and regulations in regard to how they practice while working within federal facilities. However, a federally employed PA who holds a NC license and wants to maintain the license must comply with NC rules that pertain to maintaining an active license (i.e., annual renewal, CME and payment of fees). Also, any PA who carries a NC license is expected to practice competently, act professionally and be of requisite good character no matter where, or for whom, he or she works. PAs employed by federal facilities are not required to submit an ITP form with the Board prior to beginning their practice at the federal facility.

Yes. Board rules 21 NCAC 32S.0213 (d) and (e) require signatures by the physician assistant, primary supervising physicians, and if applicable, back-up supervising physicians for supervisory arrangements and quality improvement meetings. Rule 21 NCAC 32S .0215 requires a current list of signatures from the physician assistant, primary supervising physician, and all backup supervising physicians. For these documents, an electronic signature is acceptable.

Yes. There is no exception for QI meetings in the rules for physician assistants working part time or locum tenens positions. Physician assistants in any new practice arrangement are expected to meet monthly with their primary supervising physician for six months, then every six months thereafter. Physician assistants must make and maintain a written record of these meetings as required by board rule, 21 NCAC 32S .0213(e).

No. A physician in a resident training program must be supervised by a fully licensed physician.

A PA is only required to have one primary supervising physician. The primary supervising physician is the physician who accepts full responsibility and liability for the PA’s medical activities and professional conduct at all times, whether the physician personally is providing supervision or supervision is being provided by a back-up supervising physician.

A physician assistant is not required to have a back-up supervising physician. However, a PA is not authorized to practice if their supervising physician is unavailable and therefore it is prudent to have a back-up supervising physician during these times. The back-up supervising physician is the physician who accepts responsibility for supervision of PA’s activities in absence of the primary supervising physician. The back-up supervising physician is responsible and liable for PA’s activities ONLY when providing supervision. See: Back-up Supervising Physician(s) Form

All supervising physicians must be licensed by the Board and not prohibited from supervising PAs. Primary and back-up supervising physicians must ensure PA has adequate back-up for any procedure performed by PA in any practice location (office, home, hospital, etc.).

See Board rules 21 NCAC 32S .0201(10), .0213, and .0215.

Yes. It is the responsibility of the PA to submit an online Intent to Practice (ITP) form via the Board’s website to remove a primary supervising physician. Login to your Licensure Gateway account and select Intent to Practice from the options. Physicians are not able to remove former supervisees on their own.

Yes. A licensed physician assistant may form their own practice to render the professional service they are licensed to provide. For more information, read this article.

Yes. PAs and physicians may jointly own stock in professional corporations. There is no requirement that shares of stock be allotted in a certain manner.

No. Practices owned solely by PAs may not hire or contract with physicians to practice medicine on behalf of the PA owned practices.

No, NC General Statute 55B-14 (a) and (c) do not allow for PA licensees of the NC Medical Board and NP licensees of the NC Board of Nursing to own a professional entity together.

• 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.

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.

Yes. In order to submit your registration, you must confirm that your practice or facility has chosen to engage in team-based practice and that you have been hired or promoted to practice as a team-based physician assistant.

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.

• 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.

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 when rules are finalized. 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.

Register by visiting http://www.ncmedboard.org and logging in to the Licensure Gateway. Find the registration link on the main page next to links related to Intent to Practice. Complete and submit the form.

Physician assistants must provide their team-based practice address, identify their team-based practice specialty, attest that they meet all the requirements for team-based practice, and acknowledge that they understand any limitations as required by the law.

There is no notarization requirement or requirement to upload any supporting documentation. 

Registering for team-based practice does not nullify any current intent to practice forms filed with NCMB. If a PA will no longer practice in any settings where a primary supervising physician is required, the PA will need to update their intent to practice form. To update this information, login to the Licensure Gateway, navigate to the Intent to Practice form and remove any sites or supervisors that are no longer applicable.

Yes.

• 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.

Yes. Employers are free to impose any additional requirements on their employees, including quality improvement meetings.

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.

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.

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.