Short answer: yes — both PAs and NPs need a physician relationship in Texas, and the requirements differ.
Physician assistants practice under a supervising physician. Nurse practitioners who prescribe need a prescriptive authority agreement (PAA) with a delegating physician. Both must be registered with the Texas Medical Board before the PA or NP begins working under them.
Tell us about your practice — credential, specialty, setting, timeline. Takes about 2 minutes.
Start the Free Intake Form →The supervising physician oversees the PA's activities and accepts responsibility for the medical services provided. You can have multiple supervising physicians; this matters if you work across settings or need coverage.
This is the requirement most often misunderstood. Texas does not ask your supervising physician to be in the building. It asks that you can reach each other readily by phone or another telecommunication device. A physician three counties away who answers the phone is compliant. A physician down the hall who never picks up is not.
This trips people up because the process has two halves and neither party always knows whose move it is. You log into your own TMB account and submit the request naming your supervising physician. They then log into theirs, review it, and approve. Only once both steps are done are you registered — and it must be done before you begin working. Your physician needs a full, active, unrestricted Texas license to complete their side. Changes get updated within 30 days.
The practical implication: after you submit your request, follow up until you've confirmed the approval went through. Don't assume silence means done.
Seven FTEs works out to 280 supervised hours per week, counting APRNs and PAs together, everywhere that physician supervises — not just your practice. Two things follow. First, headcount alone tells you nothing: a physician supervising nine part-timers may have plenty of room, while one supervising seven full-timers has none. Second, if you practice in a medically underserved area, your hours don't count toward their total at all — which can make you easier to place.
So the question worth asking a prospective supervisor isn't "how many people do you supervise?" It's "how many supervised hours per week do you currently carry?"
Texas is a restricted-practice state. To prescribe drugs or devices, an APRN needs a written prescriptive authority agreement with a delegating physician, registered with the TMB before the first prescription.
and contain, at minimum: names, addresses, and license numbers of both parties; the nature and locations of the practice; the categories of drugs and devices that may be prescribed; a plan for consultation, referral, and patient emergencies; a designated alternate physician for coverage; and a quality assurance and improvement plan. It must be reviewed and re-signed annually, and retained for two years after it ends.
Texas prescribes no fixed percentage — you and your physician set the cadence in the agreement. That flexibility is a feature and a trap: "we'll figure it out" is not a plan, and boards expect documentation showing reviews actually happened at whatever frequency your agreement states.
(SB 406), so remote collaboration is permitted.
Since September 1, 2019, all prescriptive authority agreements require meetings at least monthly — regardless of how long the physician and delegate have worked together. Prior rules varied by experience; that variation is gone.
The meetings do not require being in the same room. Telephone or video conferencing is explicitly permitted. But each meeting must be documented. As far as a board audit is concerned, an undocumented meeting didn't happen.
Texas rates depend on your credential, specialty, prescribing scope (Schedule II authority in particular), patient volume, and how much support is bundled in. Most Texas NPs and PAs pay somewhere between a few hundred and over a thousand dollars per month in private arrangements. Psychiatric and aesthetics practices generally price higher than primary care, because the sign-off burden and risk profile are different.
At MD-Match, pricing is tailored to your practice rather than flat-rated, and it's comparable to what you'd pay arranging it privately — with vetting, compliance tracking, and TMB registration support included rather than left to you. The match fee is $50, one time, and rematching is free, always.
Dr. Wasef reviews every Texas submission personally and gives you an honest read on your situation.
Get My Free Texas Quote →After years on the physician side of these agreements, the failures are rarely exotic. The same patterns repeat:
This is the most common one I see, and it's a direct consequence of the two-step process. The NP or PA submits their TMB request, assumes that's the end of it, and starts working. The physician never logs in to approve — too busy, didn't see the notification, didn't realize a second step existed. Everyone believes it's handled. Nobody is registered. Months later it surfaces during credentialing, an audit, or a malpractice application.
If you take one thing from this page: submit your request, then confirm the approval actually happened.
Texas asks for reachability, which sounds like a low bar until your physician stops answering. The statute's standard is that you can easily be in contact. A collaborator who takes three days to return a call fails that test, and it's your practice carrying the risk.
A physician already carrying close to 280 supervised hours a week across all their arrangements. Because the cap is measured in hours, not headcount, neither party always realizes how close they are — a physician who "only supervises five people" may be at the ceiling if all five are full-time. You'd never know unless you asked in hours.
A chart review clause vague enough to mean nothing, with no documentation trail. Compliant on paper the day it was signed; indefensible the day it's examined.
Monthly is the floor, documented is the requirement. Most arrangements start well and drift by the second quarter.
Every physician in the MD-Match network is background-checked, license-verified for Texas, and capacity-checked against the 1:7 rule before matching. Monthly check-ins are structured and documented as part of the service, not left to goodwill.