Supervising & Collaborating Physicians in Pennsylvania: What NPs and PAs Actually Need

For Nurse Practitioners: The Pennsylvania Process, Step by Step

Pennsylvania runs CRNP prescriptive authority through the PALS portal, and — importantly — you initiate it, not your physician.

1. Line up a substitute physician first. Before anything else, identify at least one backup physician holding an active Pennsylvania license. Doing this first saves you from getting three steps into the process and stalling.
2. Start the agreement in PALS. Log into your PALS account and complete the Prescriptive Authority Collaborative Agreement.
3. Sign and send. Electronically sign and route it to your collaborating physician through PALS.
4. Your physician approves. They log into their own PALS account, review, and electronically approve. Nothing moves until they do — so if your physician is slow with administrative tasks, this is where you'll find out.
5. Complete and submit. Answer the legal questions, pay the fee, and submit to the Board of Nursing.
6. Wait for your number. The Board reviews and issues a prescriptive authority number. Do not prescribe until you have it.
7. Keep the original on site. The original agreement stays at your primary practice location. A copy is filed automatically with the Bureau of Professional and Occupational Affairs — you don't need to file it separately.
8. Report changes. If the agreement is updated or terminated, notify the Board and file a Change form.
9. Renew every two years. Review and renew the agreement at least every 24 months.

What Pennsylvania does not require of CRNPs

Worth stating plainly, because people assume otherwise: no geographic restriction, no mandated chart review, no state-specific DEA registration, and no cap on how many CRNPs one physician may collaborate with.

And on prescribing: you write controlled substances yourself. Once your prescriptive authority is issued, controlled substance prescriptions come from you under your own authority — your collaborating physician doesn't need to write them on your behalf. This surprises NPs coming from states where every controlled substance runs through the physician.

Pennsylvania remains one of the more restrictive states in the Northeast for NP practice overall — but the specific burdens are the backup physician requirement and the wait for board approval, not proximity or chart review.

For Physician Assistants: What Pennsylvania Requires

A written agreement, filed before you start.

Your supervising physician's written agreement form must be filed with the board, and you need an active Pennsylvania license, before you begin practicing.

Six per physician.

Pennsylvania caps a physician at six PAs. What's useful about the way this is structured: the cap applies to primary supervision, and a physician can serve as an alternate supervisor for others. So a physician at their primary limit may still legitimately be your backup — which matters when you're arranging coverage rather than a primary relationship.

Countersignature during your first year.

100% of your records countersigned within ten days, during your first 12 months after graduation and again during your first 12 months in a new specialty. Both boards apply this. It's a real, recurring commitment for your supervising physician — and one they should understand before agreeing, not discover in month three.

MD or DO matters.

The two boards set different satellite-office and patient-visit requirements. If you practice at a satellite location, confirm which board governs your physician before you sign.

Fifteen days to report changes.

Any change or termination must be reported by both parties within 15 days. Missing that window is independently a disciplinary matter.

What a Collaborating Physician Costs in Pennsylvania

Pennsylvania has a cost structure most states don't: you're paying two physicians. Your primary collaborator commands the main fee; your substitute physician typically charges a smaller separate amount. Budget for both.

Beyond that, rates depend on credential, specialty, prescribing scope, and patient volume. For PAs, the first-year countersignature obligation is real physician work and is usually priced accordingly.

At MD-Match, pricing is tailored to your practice rather than flat-rated. For Pennsylvania NPs, we also source your backup physician and work to keep that second fee as low as possible — it's part of the match, not an extra you're left to solve alone. The match fee is $50, one time, and rematching is free, always.

Mistakes I Actually See in Pennsylvania Arrangements

Prescribing before the number arrives.

The most consequential one. Everything is filed, it feels finished, and the NP starts writing. But authority begins when the Board issues your prescriptive authority number — not when you submit. Anything written before that is written without authority.

No backup physician lined up.

People discover the substitute requirement mid-process, then stall while they scramble to find a second physician — often paying more than they needed to because they're in a hurry.

The physician who never approves in PALS.

You initiate, they approve. If your collaborating physician is slow with paperwork, your entire authorization sits frozen and there's nothing you can do but chase them. This is a good reason to ask, before signing, how quickly they handle administrative requests.

The countersignature that quietly stops (PAs).

It works for six weeks, slips to two weeks, then a month — and now there's a documented compliance gap.

Letting the two-year renewal lapse.

Nothing prompts you. The agreement quietly expires and nobody notices until something else surfaces it.

Not knowing whether your physician is MD or DO (PAs).

Different boards, different satellite rules.

Every physician in the MD-Match network is background-checked and license-verified for Pennsylvania. For NPs we identify your substitute physician as part of the match, track the PALS steps with you, and set renewal reminders so the two-year deadline doesn't arrive unannounced.

How MD-Match Works in Pennsylvania

1. Complete the free intake form — credential, specialty, practice setting, timeline. First step takes about two minutes.
2. Get a personalized quote. I review every Pennsylvania submission myself, including what your backup physician arrangement will realistically cost.
3. Pay the one-time $50 match fee and get matched — collaborating physician and substitute physician, both Pennsylvania-licensed and specialty-aligned.
4. We walk the PALS process with you and set the renewal reminder. If a match ever stops working, rematching is free.