Regulations

How Many NPs Can a Physician Supervise? 50 State Guide

Chris Turitzin
June 16, 2026
12 mins
Updated:
June 16, 2026

TABLE OF CONTENTS

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Example H2

Most states do not tell physicians exactly how many NPs they can supervise. But the absence of a numeric cap does not remove the physician's actual obligation: availability, chart review, prescribing oversight, meetings, documentation, and clinical judgment when something gets complicated.

In the states that do set limits, the rules can change the economics of collaboration quickly. A four-NP cap, a seven-FTE cap, or a location-based rule can make physician capacity scarce. The state-by-state breakdown below shows where no numeric limit exists, where a fixed cap applies, and what physicians should think about before adding another NP collaboration.

Key Highlights
  • Most states do not set a numeric NP/APRN supervision ratio. Single Aim's state-by-state review classifies 39 jurisdictions as no numeric limit.
  • When states do set limits, the structure varies. Some states count individual clinicians, some use FTE or weekly-hour formulas, and Florida uses an office-location rule.
  • Ratio caps increase collaborating physician fees. In a selected-state comparison from Single Aim's physician pay analysis, five ratio-limit states averaged about $636/month, compared with about $464/month across five no-limit states.
  • No numeric limit does not mean no oversight. Agreements, prescribing rules, chart review, meetings, site visits, and specialty alignment may still matter.

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What Is An NP Supervision Ratio Limit?

A supervision ratio limit is a state rule that restricts how many NPs or APRNs one physician may supervise or collaborate with, or support for prescriptive authority. In some states, the rule is a simple headcount: one physician may work with up to a set number of NPs or APRNs. In other states, the rule is based on full-time equivalents or weekly hours, which means part-time clinicians may be counted differently from full-time clinicians.

The details matter. Some states count only NPs or APRNs. Others count APRNs and PAs together, which means a physician's PA relationships can reduce the remaining capacity for NP collaborations. A few states regulate a narrower piece of the relationship, such as prescribing collaboration, instead of setting a broad supervision cap.

Many states do not set a numeric limit at all. In those states, the practical limit is often the physician's own capacity and judgment: how many NP/APRN relationships can the physician support while still meeting the required collaboration, review, availability, and documentation duties?

Why Ratio Rules Matter Operationally

Ratio limits matter because they turn collaboration into a capacity question. If a state allows a physician to collaborate with only four NPs, or seven FTEs, every additional agreement uses part of a finite regulatory allowance. That can affect whether a physician can accept another relationship, how carefully they track existing agreements, and how much each available collaboration slot is worth.

That shows up in physician fees. In a selected-state comparison from Single Aim's physician pay analysis, five states with ratio or location limits averaged about $636/month: California, Texas, Oklahoma, Ohio, and Florida. Five no-limit comparison states averaged about $464/month: Pennsylvania, Michigan, Massachusetts, Indiana, and New Jersey. Other requirements can also modify pricing, including proximity, chart review, and meeting rules. But the pattern is clear: ratio caps restrict physician supply, and restricted physician supply increases the value of each available collaboration slot.

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We see this most often with multi-state groups. A clinic may have internal physicians who can support NP collaborations in some states, but those same physicians can max out quickly in states with strict ratio rules. California, Texas, and Georgia are common examples. By the time a group comes to Single Aim, the problem is often not that they lack physicians entirely. It is that their existing physicians are already at capacity in the states where capacity matters most.

Why Do States Set NP Supervision Limits?

Direct explanations for ratio caps are rare. Most statutes state the number without explaining why that number was chosen. South Carolina is the closest capped-state example: its joint Board of Nursing and Board of Medical Examiners FAQ says the physician's key responsibility is to ensure that quality of clinical care and patient safety are maintained, and the same FAQ explains the state's two ratio rules: up to 6 FTE APRN practice agreements and no more than 6 APRNs or PAs in clinical practice at one time.3

Illinois shows the same capacity concern from the enforcement side. The state does not set a numeric cap, and a physician may collaborate with multiple APRNs. But entering into an excessive number of collaborative agreements can create medical-board discipline if it impairs adequate collaboration.1

West Virginia's Board of Medicine frames the same capacity concern as guidance rather than a hard cap. In guidance for physicians entering APRN prescriptive-authority collaborations, the Board ties these relationships to the physician's standard of practice and says its policy was adopted because it was "reasonable, necessary and in the public interest." The same guidance strongly recommends that a physician not participate in more than 3 APRN collaborations or FTEs, or 4 in a hospital, free clinic, or FQHC setting. The Board also says that recommendation is guidance, not a mandatory legal cap.2

These sources do not prove why every state chose its exact number. But they do show the regulatory concern behind the rule structure: can the physician actually do the work the agreement says they will do?

NP/APRN Supervision Ratio Requirements By State

Use this table to scan each state's NP/APRN supervision and collaboration ratio rule. The four categories are no numeric limit, clinician limit, FTE limit, and office-location limit.

NP/APRN supervision ratio requirements by state
State Category NP limit Notes
Alabama FTE limit 9 FTEs or 360 hours/week including out-of-state agreements4 Counts CRNP, CNM, and PA supervision/collaboration hours, including agreements in other states. Joint Committee approval may allow additional CRNP positions.
Alaska No numeric limit No numeric limit5  
Arizona No numeric limit No numeric limit6  
Arkansas No numeric limit No numeric limit7 APRNs may qualify for full independent practice after 6,240 practice hours and board certification.
California Clinician limit 4 NPs per physician8 Supervision does not require physical presence, but standardized procedures must address supervision. Full California summary.
Colorado No numeric limit No numeric limit9 Full Colorado summary.
Connecticut No numeric limit No numeric limit10 Initial APRNs may need a written collaborative agreement for the first 3 years and 2,000 hours. Full Connecticut summary.
Delaware No numeric limit No numeric limit11  
District of Columbia No numeric limit No numeric limit12  
Florida Office-location limit 4 primary-care offices; 2 specialist offices13 This is an office-location limit, not an APRN headcount cap. Dermatology/skin-care practices have special location and distance rules. Full Florida summary.
Georgia Clinician limit 4 APRNs per physician14 Georgia also references a broader 8 mid-level practitioner cap for APRNs and PAs combined, with limited exceptions. Full Georgia summary.
Hawaii No numeric limit No numeric limit15  
Idaho No numeric limit No numeric limit16  
Illinois No numeric limit No numeric limit1 Excessive agreements that impair adequate collaboration can create disciplinary risk. Full Illinois summary.
Indiana No numeric limit No numeric limit17 Collaborative practice documents must address proximity and weekly random review of at least 5% of charts/medications. Full Indiana summary.
Iowa No numeric limit No numeric limit18  
Kansas No numeric limit No numeric limit19  
Kentucky No numeric limit No numeric limit20 Collaboration can still apply through CAPA-NS and CAPA-CS requirements. Full Kentucky summary.
Louisiana No numeric limit No numeric limit21 A practice-site rule limiting collaborating physicians is separate from any physician-to-APRN ratio.
Maine No numeric limit No numeric limit22 NPs may need 24 months of supervised practice before independent practice.
Maryland No numeric limit No numeric limit23  
Massachusetts No numeric limit No numeric limit24 Physicians should sign prescriptive practice guidelines only when able to provide appropriate supervision.
Michigan No numeric limit No numeric limit25 Physicians must provide continuous access for communication and regular review/consultation under protocols. Full Michigan summary.
Minnesota No numeric limit No numeric limit26 CNPs and CNSs beginning after July 1, 2014 must complete 2,080 hours of collaborative management before independent practice.
Mississippi No numeric limit No numeric limit27  
Missouri FTE limit 6 FTEs combined28 The cap does not apply to hospital employees providing inpatient care or population-based public health services.
Montana No numeric limit No numeric limit29  
Nebraska No numeric limit No numeric limit30 Transition-to-practice requirements may apply, but no numeric cap was identified.
Nevada Clinician limit 3 APRNs/PAs combined31 A physician may petition the medical board for approval to exceed the limit.
New Hampshire No numeric limit No numeric limit32  
New Jersey No numeric limit No numeric limit33 Prescribing requires a written joint protocol, kept at each site and reviewed annually. Full New Jersey summary.
New Mexico No numeric limit No numeric limit34  
New York Clinician limit 4 off-site NPs per physician35 No numeric cap applies to same-premises NPs or NPs exempt from written practice agreements after qualifying experience. Full New York summary.
North Carolina No numeric limit No numeric limit36 Appropriate supervision is case-specific; number of supervisees is one factor. Full North Carolina summary.
North Dakota No numeric limit No numeric limit37  
Ohio Clinician limit 5 prescribing APRNs per physician38 No general standard-care-arrangement cap identified; this cap applies to prescribing collaboration. Full Ohio summary.
Oklahoma Clinician limit 6 prescribing APRNs/PAs combined39 The Board of Medicine may grant an exception. APRNs may seek independent prescriptive authority after 6,240 supervised clinical practice hours.
Oregon No numeric limit No numeric limit40  
Pennsylvania No numeric limit No numeric limit41 Physician must be immediately available; prescriptive-authority agreements require protocols, chart review, notice, and review. Full Pennsylvania summary.
Rhode Island No numeric limit No numeric limit42  
South Carolina FTE limit 6 FTEs and no more than 6 clinicians at once3 More than six part-time clinicians may be possible only if total FTE does not exceed 6 and no more than six provide clinical services at the same time. Full South Carolina summary.
South Dakota No numeric limit No numeric limit43 CNPs/CNMs may need a collaborative agreement for initial practice hours.
Tennessee No numeric limit No numeric limit44 Physician must still be able to meet required supervision duties, including availability, chart review, and remote-site visits where required. Full Tennessee summary.
Texas FTE limit 7 FTEs combined45 The cap does not apply in qualifying facility-based hospital practices or medically underserved population practices. Full Texas summary.
Utah No numeric limit No numeric limit46 Early APRNs may need a mentor for Schedule II authority, but no mentor ratio was identified.
Vermont No numeric limit No numeric limit47 A collaborative provider agreement may apply during the initial or additional role/focus transition period.
Virginia Clinician limit 6 APRNs; 10 psychiatric-mental health APRNs48 APRNs authorized for autonomous practice after the required clinical experience do not need a practice agreement, so the cap does not apply to them. Full Virginia summary.
Washington No numeric limit No numeric limit49  
West Virginia No numeric limit No mandatory maximum; 3 FTEs recommended, or 4 in hospital/free clinic/FQHC settings2 The Board policy says this recommendation is guidance, not mandatory and not required by law. APRNs may qualify for limited prescriptive authority without a collaborative agreement after 3 documented collaborative years.
Wisconsin No numeric limit No numeric limit50 Full Wisconsin summary.
Wyoming No numeric limit No numeric limit51  

Frequently Asked Questions

How many NPs can one physician supervise?

It depends on the state. Most states do not set a general numeric maximum. The states that do set limits use different structures: California uses a clinician count, Texas and Missouri use FTE limits, South Carolina uses both an FTE limit and a simultaneous-clinician limit, and Florida uses an office-location rule instead of an NP headcount cap.

What is the difference between a clinician limit and an FTE limit?

A clinician limit counts people. If the cap is 4 NPs, each NP in the covered collaboration counts toward that cap. An FTE limit counts workload. In an FTE limit state, part-time clinicians may count as less than one full-time equivalent, but the exact calculation depends on the state language.

Does no numeric limit mean no collaborating physician is required?

No. A physician-to-NP cap and a collaboration requirement are separate questions. A state may decline to set a fixed maximum while still requiring a collaborative agreement, prescriptive authority agreement, protocol, chart review process, meeting cadence, board filing, or other oversight duty.

Do PAs count toward NP/APRN ratio requirements?

In some states, yes. PA-only rules are separate, but several states use a combined cap that can make PA relationships count against the same physician capacity used for NPs or APRNs. Examples include Alabama4, Missouri28, Nevada31, Oklahoma39, South Carolina3, and Texas45. Georgia also has a broader mid-level practitioner cap that can matter for APRN and PA relationships.14

What should physicians check before adding another NP?

Before signing another agreement, the physician should confirm the state's category of limit, who counts toward the cap, whether part-time clinicians are counted by FTE, whether existing APRN or PA agreements already use capacity, and whether any practice-setting exception applies. In states without a fixed numeric cap, the physician should still ask the practical question: can I meet the required availability, review, prescribing, meeting, and documentation duties across all active relationships?

Find A Collaborating Physician Who Understands Capacity Limits

Knowing the ratio rule is only useful if the agreement is built around it. In capped states, the physician needs to have available capacity under the state rule before the collaboration begins; in states without a fixed cap, the physician still needs enough time and structure to meet the actual oversight duties.

Single Aim helps NPs and healthcare groups connect with collaborating physicians who understand state-specific capacity limits, agreement requirements, chart review, meetings, and prescribing oversight from the start. That matters most in states where physician capacity is scarce, but it also matters anywhere the collaboration has to hold up beyond the signature.

If you are opening a new practice, expanding into a ratio-capped state, or replacing a physician who has reached capacity, build the collaboration around the state's requirements from day one.

Find a physician who understands NP supervision limits

Single Aim helps NPs and healthcare groups connect with collaborating physicians and clarify state-specific capacity, agreement, and oversight expectations before the relationship starts.

Get matched with a collaborating physician

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Citations

  1. 225 ILCS 60/22(42); 68 Ill. Admin. Code 1285.335(b)(1)-(3).
  2. W. Va. Code 30-7-15b; W. Va. Bd. of Med., Policy Statement Regarding Minimum Requirements and Guidelines for Physicians in Collaborative Relationships for Prescriptive Authority with APRNs para. 13 (modified May 7, 2018).
  3. S.C. Code 40-47-195(D)(1)(c); South Carolina Board of Nursing and Board of Medical Examiners, Frequently Asked Questions Regarding Implementation of New Law Governing APRN Practice, questions 8, 11, 16 (Sept. 2019).
  4. Ala. Admin. Code r. 610-X-5-.05(1), (1)(b), (4), (6).
  5. Alaska Stat. 08.68.850; 12 AAC 44.400-44.445.
  6. A.A.C. R4-19-508(A); Arizona Board of Nursing Scope of Practice Nurse Practitioner/APRN FAQs, updated May 2024.
  7. Ark. Code Ann. 17-87-310, 17-87-314; 17 CAR 123-603.
  8. Cal. Bus. & Prof. Code 2836.1; Cal. Code Regs. tit. 16, 1474.
  9. 3 CCR 716-1 Rule 1.14(C)(9), (C)(13)-(15), (G)(2)(a)-(b); C.R.S. 12-255-112(4)(b)(I)(A)-(D).
  10. Conn. Gen. Stat. 20-87a(b)(2), (b)(3).
  11. 24 Del. C. 1902(g), 1935(a)-(c); 24 Del. Admin. Code 8.4, 8.6.
  12. D.C. Code 3-1201.02, 3-1206.03; 17 DCMR ch. 59.
  13. Fla. Stat. 458.348(1)(a)-(b), (3), (3)(a)-(c).
  14. Ga. Comp. R. & Regs. 410-11-.14(3); O.C.G.A. 43-34-26.3; Georgia BON FAQs on NPs and Protocol Agreements, revised July 2015.
  15. Haw. Rev. Stat. 457-8.5, 457-8.6.
  16. Idaho Code tit. 54, ch. 14; IDAPA 24.34.01.
  17. 848 IAC 5-1-1(a)(7)(D), (F), (G).
  18. Iowa Code 152.1(6); Iowa Admin. Code r. 655-7.2(1), 7.3, 7.4.
  19. K.S.A. 65-1130.
  20. 201 KAR 20:057 sec. 1(1); KRS 314.042(12)(a), (15)(a), (15)(l)(2)-(3).
  21. La. Admin. Code tit. 46, pt. XLVII, 4505, 4513(D); La. Rev. Stat. 37:913.
  22. 02-380 C.M.R. ch. 8 sec. 2(2)(A)-(D); Me. Rev. Stat. tit. 32, 2102(2-A).
  23. Md. Code, Health Occ. 8-302; COMAR 10.27.07.
  24. 243 CMR 2.10(4)(a)-(b); 244 CMR 4.07.
  25. Mich. Admin. Code R. 338.2411(1)-(2); MCL 333.16109(2)(a)-(c).
  26. Minn. Stat. 148.171, 148.235; Minnesota BON APRN Licensure General Information.
  27. 30 Miss. Admin. Code Pt. 2840, R. 1.3.
  28. Mo. Rev. Stat. 334.104.8; 20 CSR 2200-4.200.
  29. Mont. Code Ann. 37-8-202, 37-8-409; ARM 24.159.1406 et seq.
  30. Neb. Rev. Stat. 38-2315, 38-2322; 172 NAC 101.
  31. NAC 630.495(1)-(2); NAC 630.490.
  32. N.H. Rev. Stat. Ann. 326-B:11; N.H. Code Admin. R. Nur 600.
  33. N.J. Admin. Code 13:37-8.1(a)-(c); N.J. Stat. 45:11-49(b)(1).
  34. N.M. Stat. Ann. 61-3-23.2; N.M. Admin. Code 16.12.2.
  35. N.Y. Educ. Law 6902(3)(a)(v), 6902(3)(b).
  36. 21 NCAC 36 .0810(1); NC Medical Board Position Statement 9.1.1.
  37. N.D. Cent. Code 43-12.1; N.D. Admin. Code 54-05-03.1.
  38. Ohio Rev. Code 4723.431(A)(1), 4723.01(L)(1); Ohio Admin. Code 4723-8-04(H)-(I).
  39. OAC 435:10-13-2(a)(4); Okla. Stat. tit. 59, 567.4a, 567.4c.
  40. ORS 678.010, 678.390; OAR 851-055-0000, 851-055-0010, 851-055-0070, 851-055-0078.
  41. 49 Pa. Code 21.251, 21.282a(a), 21.285(a)-(b); Pennsylvania Advanced Practice Clinician Guidance.
  42. R.I. Gen. Laws 5-34-3, 5-34-44; 216-RICR-40-05-3.
  43. S.D. Codified Laws 36-9A-12.1, 36-9A-13; S.D. Admin. R. 20:62.
  44. Tennessee BME FAQ, Physician Supervision of PAs and APNs, Oct. 2016; Tenn. Comp. R. & Regs. 0880-06-.02(2), (8), (9).
  45. Tex. Occ. Code 157.051, 157.0512; Texas BON Prescriptive Authority FAQs.
  46. Utah Code 58-31b-102(11), 58-31b-803(3)-(4); Utah Admin. Code R156-31b-703b.
  47. 26 V.S.A. 1613(a)(1)-(4); Vermont BON Administrative Rules 9-8, 9-9, 9-10, 9-17.
  48. Va. Code 54.1-2957.01(E)(2); Va. Code 54.1-2957(I); 18VAC90-30-86.
  49. RCW 18.79.250; WAC 246-840-300, 246-840-302.
  50. Wis. Admin. Code N 8.10(7).
  51. Wyo. Stat. 33-21-120; 054.0002.2 Wyo. Code R. ch. 2.

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Chris Turitzin
Chris, founded Single Aim Health in 2024 to provide clinicians, especially NPs and PAs, with essential services for launching and growing their practices. A Stanford graduate in Product Design, Chris co-founded Momentus Media, which was acquired by Facebook, and worked as a Product Manager there. He later gained expertise in digital health through leadership roles at Bicycle Health, Virta Health, and founding Wink Health. Now, he is using his experience to help clinicians through Single Aim Health.
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Disclaimer: The regulatory research, summaries, and tools provided by Single Aim, LLC are for informational and educational purposes only and do not constitute legal advice. While we strive to ensure accuracy, healthcare laws vary by state and may change over time. You should always consult a licensed attorney familiar with healthcare regulations in your specific state before making decisions related to you clinical and operational needs for compliance. Single Aim is not a law firm and does not provide legal representation. Use of our materials does not create an attorney-client relationship.

Need legal guidance? We recommend contacting a licensed healthcare attorney in your state or using professional associations such as the American Health Law Association (AHLA) or your state’s medical or nursing board for referrals.