Key Takeaways
- NY requires collaborative agreements for NPs with 3,600 or fewer qualifying practice hours.
These NPs must practice with a collaborating physician under a written practice agreement and written practice protocols.
- The 3,600-hour threshold changes an NP’s practice requirements.
Once an NP has more than 3,600 qualifying hours, the written agreement and protocol requirements no longer apply.
- Experienced NPs still have options.
When Does a New York NP Need a Collaborative Agreement?
New York takes a different approach to nurse practitioner collaboration than states that require physician collaboration for all NPs or states that allow broad independent practice from the beginning.
For New York nurse practitioners, the key question is often how much qualifying NP practice experience they have.
An NP with 3,600 or fewer hours of qualifying experience must practice in collaboration with a physician who is qualified in the NP’s specialty. The relationship must be documented through a written practice agreement and written practice protocols.
Once an NP has more than 3,600 qualifying hours, the rules change. The NP is no longer required to practice under a written practice agreement and written practice protocols with a collaborating physician.
That distinction matters for NPs moving from employment to private practice, changing employers, or deciding whether to continue an existing physician relationship.
What Must a New York NP Collaborative Agreement Include?
For NPs who are still within the 3,600-hour requirement, the collaborative agreement must address several aspects of the relationship.
Among other things, the agreement must provide for referral and consultation, coverage during an emergency absence, and a process for resolving disagreements between the NP and collaborating physician concerning diagnosis or treatment. It must also provide for patient record review by the collaborating physician at least every three months.
The practice protocols are separate from the agreement. They identify the area of practice the NP will perform in collaboration with the physician and must reflect current accepted medical and nursing practice. The protocols address case management, including diagnosis, treatment, and appropriate recordkeeping.
This means an NP should not treat the agreement as a standard form to sign without reviewing the details. The agreement and protocols define important parts of the working relationship and should match the NP’s actual practice.
Choosing a Collaborating Physician in New York
The collaborating physician must be qualified to collaborate in the specialty involved. This makes choosing a physician an important part of setting up an NP practice.
The relationship also carries responsibilities for the physician. New York law addresses how many NPs a physician may have under practice agreements when the NPs are not located on the same physical premises as the physician.
For an NP, the practical issue is finding a physician who is willing to sign an agreement and able to fulfill the responsibilities established by the agreement and applicable law.
The parties should also understand what happens when the relationship changes. If a collaborating physician becomes unavailable for an extended period, the agreement should address coverage. If the physician dies, the existing written practice agreement is no longer valid, and an NP with 3,600 or fewer qualifying hours must enter into a new agreement to continue practicing.
Address these issues when drafting the agreement, rather than waiting until a physician is suddenly unavailable.
If you are a New York nurse practitioner entering into a collaborative agreement, Jackson LLP can review or draft the agreement and assess how its terms affect your practice, responsibilities, and future options. Contact our team for a free consultation.
What Changes After 3,600 Hours?
The 3,600-hour threshold is one of the most important parts of New York’s NP practice rules because it can change the legal structure of the NP’s practice.
Once an NP has more than 3,600 qualifying hours, the NP is no longer required to maintain a written practice agreement and written practice protocols with a collaborating physician. The experience must qualify under New York law, which includes NP practice under New York or another state’s laws, as well as qualifying NP practice with the U.S. Veterans Administration, U.S. Armed Forces, or U.S. Public Health Service.
An experienced NP therefore has more than one option.
The NP may practice without the written agreement and protocol requirements. Alternatively, the NP may continue to maintain collaborative relationships with qualified physicians or a qualifying healthcare facility.
For an NP who has reached the threshold, the question is whether continuing a collaborative relationship makes sense for the practice.
Should an Experienced NP Keep a Collaborative Relationship?
Experienced NPs can continue consulting and collaborating with physicians when patient care requires it. New York’s rules recognize collaborative relationships as a way for NPs and physicians to exchange information, make referrals, and provide comprehensive patient care.
For some practices, maintaining a physician relationship may make practical sense even after the NP qualifies to practice independently. For others, continuing a formal contractual relationship may create unnecessary obligations.
The answer depends on the NP’s specialty, practice model, relationship with the physician, and the terms of any existing agreement.
An NP who is employed by a medical practice should also look beyond the collaborative agreement itself. An employment agreement may contain separate provisions governing compensation, termination, restrictive covenants, professional responsibilities, and other obligations.
Reaching the 3,600-hour threshold does not automatically mean that an NP should terminate a physician relationship or change an employment arrangement.
What Should New York NPs Review Before Changing Their Arrangement?
An NP considering a new collaborative agreement or moving toward independent practice should review the full arrangement.
Start with the NP’s qualifying practice hours. Confirm that the experience being counted meets New York’s requirements and determine when the 3,600-hour threshold was reached.
Next, review the existing practice agreement and protocols. Look at provisions addressing patient records, consultation, referrals, coverage, disagreements, termination, and other responsibilities.
Finally, consider the broader practice arrangement. If the NP is employed, the employment agreement may create obligations that are separate from New York’s collaboration requirements. If the NP is preparing to open an independent practice, consider entity formation, ownership, contracts, and regulatory requirements together.
How Our New York Healthcare Lawyers Can Help Nurse Practitioners in NY
Jackson LLP represents nurse practitioners and other advanced practice professionals in New York on collaborative agreements, employment agreements, practice formation, and other legal issues affecting independent healthcare practices. We offer a free 15-minute consultation and provide a written proposal before we begin work.
Free Attorney Consultation
Free Attorney Consultation
Frequently Asked Questions About New York Nurse Practitioner Collaborative Agreements
Do all New York nurse practitioners need a collaborative agreement?
No. NPs with 3,600 or fewer qualifying hours must practice with a collaborating physician under a written practice agreement and written practice protocols. NPs with more than 3,600 qualifying hours are not required to use that written agreement and protocol structure under current New York law.
What is the 3,600-hour rule for New York nurse practitioners?
New York uses 3,600 qualifying hours of NP practice as the threshold for independent practice. An NP who has more than 3,600 qualifying hours is not required to practice under the written collaborative agreement and protocol requirements that apply to less-experienced NPs.
What is the difference between a collaborative agreement and practice protocols?
The practice agreement establishes the relationship between the NP and collaborating physician and addresses matters such as consultation, referrals, coverage, disagreements, and patient record review. The practice protocols describe the area of practice and procedures the NP will perform and must reflect current accepted medical and nursing practice.
Can a New York NP practice independently after 3,600 hours?
Yes. Under current New York law, an NP with more than 3,600 qualifying hours is not required to practice under a written practice agreement and written practice protocols with a collaborating physician.
Can an experienced New York NP continue working with a collaborating physician?
Yes. An NP with more than 3,600 qualifying hours may continue to maintain collaborative relationships with qualified physicians or a qualifying healthcare facility. The relationship does not necessarily need to take the form of the written practice agreement and protocol arrangement required for NPs with 3,600 or fewer hours.
What happens if a New York NP’s collaborating physician dies?
If the collaborating physician dies, the existing written practice agreement is no longer valid. An NP with 3,600 or fewer qualifying hours must enter into a new written practice agreement with another qualified collaborating physician to continue practicing.
