Introduction
Let me tell you about the most stressful three months of my professional life. I'd done everything right—found the perfect location for my practice, lined up financing, built my business plan. Then came the part nobody prepared me for: finding a collaborating physician.
I must have sent forty emails. I made awkward phone calls to physicians I barely knew. I showed up at medical society meetings where I knew exactly zero people, trying to strike up conversations about collaboration without sounding desperate. Most of the physicians I approached either didn't understand what I was asking, weren't interested, or quoted fees that would have eaten half my projected revenue.
The thing is, finding a collaborating physician doesn't have to be that painful. I eventually figured out what works—and more importantly, what doesn't. Since then, I've helped dozens of PAs navigate this exact challenge, and I've learned that the difference between a frustrating six-month search and finding a great collaborator in a few weeks often comes down to knowing where to look, how to approach, and what to offer.
If you're in a state that requires collaboration (most still do), this is arguably the most important relationship you'll establish for your practice. The wrong collaborator can make your life miserable—I've seen arrangements fall apart because of poor fit, leading to practice interruptions that cost PAs thousands in lost revenue. The right collaborator becomes a genuine asset, someone who makes you a better clinician while requiring minimal day-to-day involvement.
In this guide, I'm going to share everything I've learned about finding, approaching, and building successful collaboration relationships. These aren't theoretical strategies—they're tactics I've used personally and have seen work for the PAs I advise.
Related: For comprehensive practice ownership guidance, see our Complete Guide to PA Practice Ownership.
Understanding Your State's Requirements
Before you start emailing every physician you've ever worked with, take a step back. I've watched PAs waste weeks pursuing collaboration arrangements they didn't actually need—or pursuing the wrong type of arrangement for their state.
The terminology alone can trip you up. When I first started exploring practice ownership, I used "supervising physician" and "collaborating physician" interchangeably. A physician I was talking to got noticeably uncomfortable. Turns out, in his state, "supervision" implied a much more hands-on relationship with liability implications he wasn't comfortable with. The actual requirement was collaboration, which is much more consultative.
Here's how to think about the different relationships states require. Traditional supervision states still exist, though they're becoming rarer—these typically require direct physician oversight, regular chart review, and sometimes even on-site physician presence. Most states have moved to collaborative models, where the physician serves more as a consultant who's available for questions and provides periodic oversight. Then there are the optimal authority states like Arizona and Colorado, where PAs can practice independently with little to no required physician involvement.
The first question to ask yourself is whether you even need a collaborating physician. It sounds basic, but I've talked to PAs who spent months searching for collaborators only to discover their state had eliminated that requirement. Check your state's current regulations—and I mean current, because these laws are changing rapidly. Our PA State Requirements Database is a good starting point.
Assuming you do need a collaborator, you need to understand exactly what your state requires. Does the physician need to be on-site at any point? How often must they review charts, and what percentage? Are there specific ratios of PAs to physicians? Must the physician be in the same specialty as your practice? Some states are strict about specialty matching, while others allow any MD or DO.
One question that surprises many PAs: Can your collaborator be in a different state? The short answer is usually no—most states require your collaborating physician to hold an active license in the state where you practice. However, some states now allow telemedicine-based collaboration arrangements with specific rules. This opened up my search considerably when I realized I didn't need someone local—I just needed someone licensed in my state who was willing to collaborate remotely.
Resource: PA State Requirements Database
Where to Find Collaborating Physicians
After struggling through my own search, I've identified eight reliable sources for finding collaborating physicians. Some of these seem obvious, but the devil is in the details of how you approach them.
Start with people who already know you. Your former employers and colleagues should be your first calls. These physicians have seen your work firsthand—they know your clinical judgment, your communication style, your professionalism. That existing trust is invaluable because you're essentially asking someone to attach their license to your practice. The pitch is straightforward: "Dr. Smith, I'm opening my own primary care practice and am looking for a collaborating physician. Given our history working together at [Previous Practice], I wanted to ask if you'd be interested in discussing this." Don't overthink it. Many physicians are open to collaboration arrangements even if they couldn't supervise you full-time—the time commitment is usually much less than people assume.
Your state PA association is criminally underutilized. I say this from experience—I didn't even think to contact my state association until months into my search. Many state PA associations maintain informal collaboration boards or can directly connect PAs with physicians who've expressed interest. Some even have formal matching services. Join your state association if you haven't already, attend their networking events, and don't be shy about posting in member forums. This is exactly what those networks exist for.
Retiring physicians are often your best prospects. Think about it from their perspective: they've spent decades practicing medicine, they're not ready to completely step away, but they don't want the demands of full-time patient care. A collaboration arrangement is perfect—they stay intellectually engaged, maintain their connection to medicine, generate some supplemental income, and mentor the next generation of clinicians. I've worked with PAs who found ideal collaborators by networking at local medical society meetings frequented by senior physicians, checking with hospital medical staff offices, or even doing targeted LinkedIn searches for recently retired physicians in their specialty.
Don't overlook physicians in different practice settings. Some of my best collaboration matches have involved hospitalists. Think about it: a hospitalist doesn't compete with your outpatient practice, they're often hungry for additional income streams, and their schedule (typically a week on, week off) often gives them flexibility. Academic physicians, physicians in unrelated specialties, and part-time practitioners can all be excellent candidates for similar reasons—they have expertise to offer without conflicts of interest.
Locum tenens networks are an underappreciated resource. Locum physicians are already accustomed to flexible, non-traditional arrangements. They understand that collaboration doesn't require daily oversight. Contact locum tenens agencies directly—some maintain lists of physicians interested in collaboration opportunities—and network at medical conferences where locum physicians tend to gather.
Telemedicine has expanded your options significantly. If your state allows remote collaboration (and many now do), physicians who practice primarily through telemedicine platforms may be interested in collaboration opportunities. Just make sure you verify they're licensed in your state and establish crystal-clear communication protocols. The distance can work in your favor—it often means lower fees and more flexibility—but only if you have systems in place to make the collaboration functional.
Never underestimate face-to-face networking. I know, nobody wants to hear this in 2026. But some of my most successful collaboration arrangements started with in-person conversations at state PA conferences, local medical society meetings, and even hospital grand rounds. There's something about meeting someone face-to-face that builds trust faster than any email chain.
Finally, explore online platforms. LinkedIn physician groups, Doximity, healthcare-specific job boards, and PA practice ownership forums are all worth exploring. These are less personal than other approaches, but they can significantly expand your reach. I've seen successful collaboration arrangements start as cold messages on Doximity.
What Physicians Want in a Collaboration
Here's something that took me embarrassingly long to figure out: if you want to successfully recruit a collaborating physician, you need to understand what's in it for them. Early in my search, I was so focused on my own needs—I need a collaborator, here's what the state requires, here's what I can pay—that I never stopped to consider the physician's perspective. No wonder most of my early pitches fell flat.
Money matters, but not as much as you'd think. Yes, additional income is a motivator. Most collaboration arrangements pay somewhere between $500 and $2,500 per month, depending on time commitment, chart review volume, availability requirements, and state liability considerations. But here's what surprised me: I've had physicians turn down $2,000/month offers, and I've had others accept $750/month enthusiastically. The difference usually wasn't about money.
Time is the real currency. Busy physicians are already stretched thin. They're looking at your proposal and thinking: "How much of my life is this going to consume?" If your pitch immediately screams "time sink," you've lost them. The arrangements that work best are the ones physicians can accommodate without disrupting their primary work—a brief weekly call or check-in, quarterly chart reviews that take an hour or two, availability for consultation that rarely actually gets used, and telemedicine options whenever possible.
Liability is the elephant in the room. This is often the biggest barrier, and it's legitimate. The physician is attaching their license to your practice—if something goes wrong, they're potentially exposed. Every physician I've successfully recruited has asked hard questions about liability, and the ones I failed to recruit were often stuck on this concern. What puts them at ease: clear agreement terms that define exactly what they're responsible for, adequate malpractice coverage (and documentation that you have it), and reasonable chart review processes that let them verify quality without consuming their life.
Some physicians genuinely want to help. This surprised me at first, but it's true. There are physicians who view collaboration as a chance to support PA professional growth, expand access to healthcare in underserved areas, give back to their profession, or stay connected to clinical medicine even as they wind down their primary practice. When you find these physicians, compensation negotiations tend to be much easier—they're motivated by purpose, not just money.
Alignment matters more than you might expect. Physicians want to collaborate with PAs who share their clinical philosophy, practice evidence-based medicine, communicate professionally, and have good reputations. They're going to do some due diligence on you, just as you should on them. One physician told me he turned down a collaboration offer because the PA's social media presence seemed unprofessional. First impressions matter, and your reputation precedes you.
How to Approach Potential Collaborators
The approach matters more than you think. I've seen PAs torpedo promising opportunities with poorly crafted outreach, and I've seen others land collaborators with physicians who initially seemed like long shots. The difference is almost always in the approach.
Be professional, concise, and specific. Physicians are busy. They don't have time to decode vague requests or wade through rambling emails. Tell them exactly who you are, what you're asking, and why you're asking them specifically. Generic mass emails almost never work—I can count on one hand the number of PAs I know who landed collaborators through copy-paste email blasts. The personal touch matters.
Lead with the relationship, not the transaction. One mistake I made early on was leading with compensation. It came across as transactional—like I was trying to buy their license. Better approach: build rapport first, establish your credibility, let them see you as a colleague they'd want to work with. Compensation details can come later, once there's mutual interest.
Don't be desperate. Physicians can smell desperation, and it makes them uncomfortable. If you're following up three times a week or pressuring for quick decisions, you're pushing them away. Follow up once after a week, maybe once more after two weeks, then let it go. There are other physicians out there.
When you're ready to reach out, here's an email structure that's worked well for me and the PAs I advise:
Start with a clear subject line: "PA Collaboration Opportunity - [Your Specialty]." In the body, introduce yourself with your name, credentials, years of experience, and specialty. State what you're looking for: opening your own practice in [city] and seeking a collaborating physician. Explain specifically why you're reaching out to them—this is crucial. Did you work together? Did a mutual contact refer you? Did you read about their work? The more specific and personal, the better.
Give them a quick picture of what you're asking for: the type of collaboration your state requires, estimated time commitment, and (if appropriate at this stage) a compensation range. Share your relevant background briefly—board certifications, current role, relevant experience. Close by asking for a 15-20 minute call or coffee at their convenience.
That's it. Don't write a novel. Don't attach your full CV unless they ask. Make it easy for them to say yes to a conversation.
The first meeting is where deals are won or lost. Come prepared with your CV and credentials, a summary of your business plan, your state's specific collaboration requirements, a proposed agreement outline, and your malpractice insurance information. Cover your background and clinical experience, your practice vision and patient population, what your state requires, your proposed time commitment and responsibilities, and be ready to discuss compensation if they're interested.
But here's the part most people miss: listen more than you talk. Pay attention to their concerns about liability. Note their preferences around time commitment and communication style. Listen for any deal-breakers. The information you gather in this meeting is as valuable as the information you provide—it tells you whether this is a relationship worth pursuing and how to structure an arrangement that works for both of you.
Negotiating Terms
Let's talk money. This is where a lot of collaboration arrangements either come together or fall apart, and I've seen both outcomes hinge on how the negotiation is handled.
There's no single right way to structure compensation. The most common model is a flat monthly fee, which works well when expectations are clear and relatively consistent. I've seen these range from $500 to $2,500 per month depending on what's involved. Hourly arrangements (typically $150-300/hour) make sense when your needs will vary significantly—some months you might need substantial input, other months very little. Per-chart review fees ($25-75 per chart) work when chart review is your primary requirement. And hybrid models—a base fee plus hourly for anything beyond baseline expectations—can be the fairest approach when requirements are unpredictable.
What drives compensation up? Time-intensive requirements, obviously—if you need significant oversight, you should expect to pay more. States with higher liability exposure for collaborating physicians tend to command higher fees. Specialist physicians often charge more than generalists. In regions where collaborating physicians are scarce, supply and demand push prices up. And any arrangement requiring on-site presence will cost significantly more than remote collaboration.
What makes lower compensation reasonable? Minimal time requirements, remote/telemedicine arrangements, physicians who are motivated by engagement or teaching rather than income, and states with lower liability exposure for collaborating physicians.
Here's my honest assessment of what's fair for typical arrangements. For basic collaboration—consultation availability, quarterly chart review, brief weekly check-ins—I'd expect $500-$1,000 per month. For moderate requirements with more regular involvement, $1,000-$1,500 per month is reasonable. For intensive supervision arrangements with significant time commitment, $1,500-$2,500 per month is typical.
One thing I've learned: some physicians care about things other than money. I worked with a retiring physician who took below-market compensation because she valued the flexible scheduling—she wanted to be able to travel without being tied down. Another valued the teaching opportunity and found satisfaction in mentoring a new practice owner. Don't assume money is the only lever you have to work with.
Collaboration Agreement Essentials
I'm going to be direct about this: you need a written collaboration agreement, and you need a healthcare attorney to either draft it or review it. I know attorneys are expensive. I know it feels like an unnecessary formality when you've got a great rapport with your collaborator and you both trust each other. But I've seen handshake deals turn ugly when expectations weren't spelled out, and I've seen friendships destroyed by misunderstandings that a good agreement would have prevented.
The agreement protects both parties. It sets clear expectations so neither of you is surprised. And if things ever do go wrong—a malpractice claim, a regulatory inquiry, a parting of ways—you'll be grateful you have documentation.
Your agreement needs to clearly identify both parties with full legal names, license numbers, and practice addresses. This sounds basic, but I've seen agreements with errors in this section that created problems down the line.
Define the scope of collaboration precisely. What services will you provide? What patient populations will you serve? What procedures will you perform? Are there any limitations on your practice? Vagueness here is dangerous—if you expand your practice into areas not covered by the agreement, you could be practicing without adequate collaboration.
Spell out the collaboration requirements in detail. How often will the physician be available for consultation? What communication methods will you use? What's the chart review frequency and process? What are the response time expectations? The more specific you are here, the fewer arguments you'll have later.
Address prescriptive authority explicitly. If you'll be prescribing controlled substances, document how that will work. List any prescription protocols. Note any medication restrictions. This section has regulatory implications, so don't skip it.
Get compensation terms in writing. Document the amount, payment schedule, term of agreement, and any provisions for adjustment. I've seen physicians claim they were promised more than the PA thought they'd agreed to—written terms prevent that dispute.
Liability and insurance sections are non-negotiable. Specify malpractice requirements for both parties, any indemnification provisions, and who covers what. Both parties need adequate coverage, and both parties need to verify the other's coverage.
Be thoughtful about term and termination provisions. How long does the agreement last? How does it renew? How much notice is required to terminate? What happens to your practice if the collaboration ends? I recommend at least 60-90 days notice for termination—that gives you time to find another collaborator without interrupting your practice.
Finally, address regulatory compliance. Make sure you're documenting everything your state board requires, noting any reporting obligations, and maintaining all required documentation.
I've included a basic agreement outline below to give you a sense of structure. But please—use this as a starting point for a conversation with your healthcare attorney, not as a fill-in-the-blank document. Your specific situation needs specific legal attention.
COLLABORATIVE PRACTICE AGREEMENT
PARTIES: [PA Name], PA-C, License # [Number] and [Physician Name], MD, License # [Number]
RECITALS: PA intends to operate [Practice Name]. Physician agrees to serve as collaborating physician. Both parties intend to comply with [State] law.
ARTICLE 1 - SCOPE: PA shall provide [specific services], PA shall not [any limitations], Patient population shall include [description]
ARTICLE 2 - COLLABORATION: Physician availability [frequency/method], Chart review [number/percentage/frequency], Meeting schedule [frequency]
ARTICLE 3 - PRESCRIPTIVE AUTHORITY: PA prescribing scope [list or protocols], Controlled substance compliance [requirements]
ARTICLE 4 - COMPENSATION: Amount [$/period], Payment schedule [timing]
ARTICLE 5 - INSURANCE: PA coverage [minimum amount], Physician coverage [minimum amount]
ARTICLE 6 - TERM AND TERMINATION: Start date, duration, notice requirements, transition provisions
ARTICLE 7 - GENERAL PROVISIONS: [Standard legal provisions per attorney guidance]
SIGNATURES: [Both parties with dates]
Red Flags to Watch For
I wish someone had given me this list before I started my collaborator search. I made some rookie mistakes and nearly entered into arrangements that would have been disasters. Here are the warning signs I've learned to watch for—both in physicians and in the arrangements themselves.
Watch out for physicians who want ownership or excessive control. This is a big one. Your collaborating physician should be a collaborator, not a business partner or boss. If a physician starts pushing for an ownership stake or wants control over business decisions beyond clinical matters, run. I've seen these arrangements go badly—what starts as "I just want to make sure things are done right" becomes interference in every aspect of your practice.
Unavailability and unresponsiveness are major warning signs. If a physician takes days to return your messages during the courtship phase, imagine how they'll be when you actually need clinical input. I talked to a PA whose collaborator routinely took 48 hours to respond to urgent questions—that's not collaboration, that's liability waiting to happen. If they're frequently canceling meetings or difficult to reach, find someone else.
Be wary of physicians demanding excessive fees. Yes, you should expect to pay fair market rate. But if someone wants significantly above-market compensation and can't justify it, that's a red flag. Some physicians see PA collaboration as a cash cow and will squeeze you for as much as possible. Know the market rates in your area and don't be afraid to walk away from unreasonable demands.
Physicians who are uncomfortable with PA independence will make your life miserable. If during your conversations they want to micromanage every clinical decision, question your competence, or seem fundamentally uneasy with the idea of a PA practicing with any autonomy, this won't work. You need a collaborator who respects your training and trusts your judgment—someone who's there for genuine consultation, not constant oversight.
No interest in understanding your practice is surprisingly common—and concerning. I've had physicians offer to collaborate without asking a single question about my training, experience, patient population, or clinical approach. That tells me they're treating this as a transaction, not a professional relationship. If something goes wrong, they'll claim they didn't know what I was doing. A good collaborator wants to understand your practice.
Always, always check for legal or licensing issues. This should go without saying, but verify that any potential collaborator has a clean record. Malpractice history, board discipline, licensing problems—any of these should give you pause. Your state medical board's website is a good starting point for this research.
On the arrangement side, be cautious of any physician who refuses to put terms in writing. No written agreement means no clarity on expectations, no protection if things go wrong, and potentially no documentation to satisfy regulatory requirements.
"We'll figure it out as we go" is not a plan. Vague responsibilities sound flexible and easy, but they create confusion and conflict. If a physician can't articulate what they're committing to, they probably haven't thought it through.
Ironically, "I'll sign whatever you need" is also a red flag. This signals a physician who's treating collaboration as a rubber stamp arrangement without any real engagement. That might sound appealing at first—minimal interference!—but it creates problems. If they're not actually reviewing your work, they can't provide meaningful oversight, and if something goes wrong, they'll claim they were just a figurehead.
Finally, be wary of pressure to rush. Good collaboration arrangements take time to structure properly. If a physician is pushing you to finalize quickly without proper legal review, something's wrong. Either they're not taking the relationship seriously, or they're trying to lock you in before you can think clearly about the terms.
Maintaining the Relationship
Finding a collaborator is just the start. I've seen PAs put enormous effort into landing a collaborating physician, then let the relationship atrophy through neglect. Don't make that mistake. A collaboration relationship is like any other professional relationship—it requires ongoing attention and effort.
Communication is everything. Schedule regular check-ins, whether that's weekly or bi-weekly depending on your arrangement. Keep these focused and brief—respect their time. Come with specific questions rather than vague "how am I doing?" conversations. Share interesting cases. Most physicians got into medicine because they find the clinical work fascinating; letting them participate in interesting cases, even at a distance, keeps them engaged.
When you do need to consult on cases, develop good habits. Learn when to ask versus when to figure it out yourself—bothering them with every minor decision undermines trust, but failing to consult on genuinely tricky situations creates liability. When you do reach out, provide relevant information concisely. Document their input in the chart. And follow up on outcomes—they want to know what happened with that complex case, and keeping them in the loop strengthens the relationship.
Documentation matters for legal and regulatory reasons. Keep records of all consultations. Document when chart reviews are completed. Maintain communication logs. Save written correspondence. If you ever face a regulatory inquiry or malpractice claim, this documentation will be essential.
Treat your collaborator like the professional they are. Pay on time, every time. Acknowledge their contribution—a brief thank you when they provide helpful input goes a long way. If appropriate, send occasional referrals their way. Keep them updated on your practice's success. These courtesies cost you nothing but build goodwill that strengthens the relationship.
When disagreements arise—and they will—address them early. Don't let small issues fester into big problems. Focus on solutions rather than blame. Refer back to your written agreement if there's ambiguity about expectations. Be willing to compromise when reasonable. And know when it's time to accept that the relationship isn't working and start looking for someone new.
Sometimes collaboration arrangements need to end. If your collaborator becomes consistently unavailable, has licensing problems or malpractice issues, fundamentally disagrees with your clinical approach, makes excessive demands, violates boundaries, or simply wants out—it may be time to move on. Give proper notice as specified in your agreement and ensure a smooth transition for patient care. The relationship ending doesn't have to be acrimonious, and how you handle the transition will affect your reputation in the medical community.
Frequently Asked Questions
How much should I pay a collaborating physician?
I hear this question constantly, and the honest answer is: it depends. Most arrangements fall between $500 and $2,500 per month, with the exact amount driven by time commitment, your state's specific requirements, the physician's specialty, and local market conditions. I'd start by researching what's typical in your area—your state PA association may have data on this—and then negotiate based on what your specific arrangement actually requires.
Can my collaborating physician be in a different state?
The short answer for most situations is no. Most states require your collaborating physician to hold an active license in the state where you practice. That said, some states have carved out exceptions for telemedicine-based collaboration, so check your state's specific rules. I've seen PAs in rural areas benefit from these provisions when local physicians weren't available.
What if I can't find a collaborating physician?
This is frustrating, and I won't pretend it's always easy. If you're struggling, make sure you've really exhausted the sources I outlined above—former colleagues, state PA associations, retiring physicians, hospitalists, locum networks. Consider whether you're offering competitive compensation. Sometimes the search gets easier if you're willing to consider practice locations where collaborators are more available. Your state PA association may be able to help directly, and there are healthcare consultants who specialize in making these matches.
Can a family member serve as my collaborating physician?
Legally, yes, in most cases—assuming they meet all your state's requirements. But I'd caution against it. This creates obvious conflict-of-interest concerns, and I've seen it complicate credentialing with insurance companies who aren't thrilled about the arrangement. An arm's-length professional relationship is almost always better. If your spouse or parent is genuinely the best option, consult with a healthcare attorney about how to structure it properly.
What happens if my collaborating physician leaves suddenly?
This is exactly why your written agreement needs robust termination provisions. Standard notice requirements are 30-90 days, which gives you time to find a replacement without interrupting patient care. I'd recommend having a backup plan in place even when your current arrangement is going well—maintain relationships with other potential collaborators so you're not starting from scratch if you need to make a change. Some states allow temporary solo practice during transition periods, but don't count on that—know your state's rules before you need them.
Do I need to pay for their malpractice insurance?
Usually not. The standard arrangement is for each party to maintain their own coverage. Your policy should explicitly cover your collaborative practice arrangement, and you should verify that theirs covers their role as your collaborator. This is worth a direct conversation with both insurance providers to make sure there are no gaps.
Related Articles
Practice Ownership: - Complete Guide to PA Practice Ownership - Can PAs Own Their Own Practice? - Corporate Practice of Medicine Doctrine
Requirements: - PA Practice Authority Levels Explained - PA State Requirements Database
Getting Started: - PA Practice Startup Costs - Credentialing & Insurance Guide
Resources
This guide was written by Robert Byron, PA-C, founder of Elite Medical Marketing. The agreement templates provided are for educational purposes only. Consult a healthcare attorney in your state to draft legally compliant documents.
Last updated: January 2026