Finding a physician who is willing to collaborate with you is an important first step. Finding one who is actually a good fit for you and your practice is something different.

Depending on your state's requirements, a collaborating physician may become part of your professional life for years. Even when the required level of physician involvement is relatively limited, you still want someone you trust, can communicate with, and feel comfortable turning to when a question or unusual situation arises.

So before agreeing to a collaboration, it helps to look beyond whether a physician has the right license.

Start With the Requirements

Before considering fit, make sure the physician can actually meet the requirements for your practice.

Collaborative practice requirements vary considerably from state to state and may depend on your NP license, specialty, prescribing authority, practice setting, and other factors.

Depending on where you practice, you may need to consider things such as:

• Whether the physician must be licensed in your state
• Specialty or scope-of-practice requirements
• Geographic or proximity requirements
• Chart review or quality-assurance requirements
• Meeting or communication requirements
• Prescriptive authority and controlled-substance requirements
• Limits on how many NPs a physician may collaborate with

Ultimately, it is the responsibility of both the NP and physician to understand the rules that apply to their licenses and collaboration.

Once you've established that a physician can collaborate with you, you can start asking whether you actually want to work together.

Consider Clinical and Practice Fit

A physician doesn't necessarily need to have an identical practice to yours, but they should have enough familiarity with your patient population and scope of practice to be an appropriate collaborator.

An NP opening a primary care practice may be looking for something quite different from an NP practicing in psychiatry, women's health, weight management, aesthetics, or another specialty.

This is an important conversation to have early.

Tell the physician what your practice actually looks like. Discuss the types of patients you see, services you provide, medications you prescribe, procedures you perform, and any areas of your practice that might require greater physician involvement.

The goal isn't simply to find someone willing to sign an agreement. It's to find someone who understands what they're agreeing to.

Will Your Practice Involve Controlled Substances?

If controlled substances are part of your practice, this is something to discuss with a potential collaborating physician before entering into an agreement.

State laws regarding NP controlled-substance prescribing vary, and in some states the physician may need to play a more active role.

Texas is a good example. In most outpatient settings, APRNs cannot prescribe Schedule II controlled substances under delegated prescriptive authority. If a patient needs a Schedule II medication, the collaborating physician may need to issue the prescription.

That can be particularly important in specialties such as psychiatry, where Schedule II medications may be routinely used in the treatment of conditions such as ADHD.

An NP whose practice involves Schedule II medications therefore needs more than a physician who is simply willing to collaborate. They need a physician who is comfortable with that patient population, willing to participate in Schedule II prescribing when clinically appropriate, and clear about how that process will work.

This also creates additional work and responsibility for the physician. As a result, physicians who provide this additional level of involvement may charge a higher collaboration fee than those whose collaborations do not involve physician prescribing of Schedule II medications.

Before agreeing to work together, discuss:

• Whether your practice involves controlled substances
• Which schedules and medications you commonly prescribe
• What the physician is and is not comfortable prescribing
• How prescriptions requiring physician involvement will be handled
• Expected turnaround time
• Whether additional physician involvement affects the collaboration fee

This is an area where practice fit matters considerably. A physician can otherwise be an excellent collaborator and simply not be the right collaborator for a practice that routinely requires Schedule II prescribing.

Talk About How You Each View Collaboration

“Collaborating physician” can mean very different things to different people.

One physician may expect to have regular conversations and be closely involved in clinical decision-making. Another may be comfortable allowing an experienced NP considerable independence while remaining available when consultation is needed.

Likewise, a new NP starting a practice may want more access to a physician than an NP who has practiced independently for many years.

Neither approach is necessarily better.

What matters is whether your expectations match.

Before entering a collaboration, talk about what each of you expects the relationship to look like in actual practice.

Communication Matters

This is one of those things that's easy to overlook until you need someone.

How will you communicate if a clinical question comes up?

Does the physician prefer text, phone, email, or a scheduled meeting? How quickly can you reasonably expect a response? What constitutes an urgent issue? What happens if the physician is traveling or unavailable?

You don't need to plan for every possible scenario, but you should have a general understanding of how communication will work.

A collaboration is much easier when neither person is guessing about how or when to contact the other.

Discuss the Practical Details Up Front

Money and logistics shouldn't be awkward topics that get addressed after you've already decided to work together.

Talk openly about:

• The physician's collaboration fee
• What is included in that fee
• How and when payment will occur
• Any required chart reviews
• Scheduled meetings or check-ins
• Documentation expectations
• Availability for consultation
• Malpractice coverage or other insurance considerations
• How either party can end the collaboration

There may also be additional requirements specific to your state or practice.

A written collaborative agreement should ultimately reflect the requirements that apply to you and the expectations you've established together.

Don't Discount Personality and Working Style

Sometimes two people meet all the requirements on paper and simply aren't a great professional fit.

That's okay.

You may prefer someone who is highly communicative and enjoys discussing cases. Someone else may want a physician who is available when needed but otherwise takes a hands-off approach.

You may value a physician who has experience working with independent NP-owned practices. Or perhaps having someone familiar with your particular specialty matters most.

There isn't one ideal collaborating physician for every NP.

There is an ideal type of collaboration for you.

Have a Conversation Before You Commit

A profile, résumé, referral, or introduction can tell you whether a physician looks promising. A conversation tells you much more.

Ask questions. Tell them about your practice. Explain what you're looking for. Give the physician an opportunity to ask questions about you as well.

Remember that this decision goes both ways.

A good collaboration isn't an NP hiring a name for an agreement or a physician simply adding another NP to a roster. It's a professional relationship that both people should feel comfortable entering.

Finding Someone Is Only the First Step

This was one of the ideas behind Collab-MD.

NPs need collaborating physicians. There are also physicians who are interested in working with NPs.

The challenge is often simply finding each other.

Collab-MD was created to make that part easier. NPs can explore physicians who are interested in collaboration and decide who they'd like to contact. Physicians can describe their experience, preferences, state licenses, and the types of collaborations they're interested in.

From there, you talk.

You decide whether you're a good fit.

And if you are, you decide what happens next.