PA · Missouri
Supervision Agreement for Physician Assistants in Missouri
Yes, a written supervising-physician agreement is required. Missouri calls it a Collaborative Practice Arrangement.
Missouri has no independent-practice pathway for PAs — a written collaborative practice arrangement with a physician is mandatory for as long as the PA practices, regardless of experience (§ 334.735).
What the supervision must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
Available remotely (no on-site requirement)
§ 334.735 requires the collaborating physician and PA to 'maintain geographic proximity,' with no numeric mileage in the current statutory text. A pre-2024 75-mile rule was reportedly rescinded by board action (secondary-sourced — not independently confirmed against current rule text; verify before relying on this for compliance decisions). PAs also generally practice 'within the same office facility' as the supervising physician per the statutory definition of supervision, with exceptions for hospital/nursing-home/correctional-facility follow-up exams if reviewed and countersigned.
Supervision ratio
Up to 6 at a time (combined across provider types)
No physician may hold collaborative practice arrangements/supervision agreements with more than 6 full-time-equivalent APRNs, PAs, and/or assistant physicians in any combination concurrently (§§ 334.104, 334.735). Exceptions exist for hospital inpatient care and population-based public health services.
Chart review
10% of charts · As needed (every 14 days)
10% of all charts documenting the PA's care, reviewed at least every 14 days (§ 334.735). Rises to 20% for charts in which the PA prescribed a controlled substance — see prescriptiveAuthority notes.
Meeting cadence
As needed
The collaborating physician (or another physician named in the arrangement) must be present for sufficient periods of time at least once every 2 weeks to conduct chart review and provide medical direction, except in documented extraordinary circumstances (§ 334.735). No MEETING_FREQUENCIES value maps exactly to 'biweekly' — treat this as the closest available approximation, not a monthly cadence.
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Controlled-substance delegation requires the collaborating physician hold an unrestricted federal DEA registration; separate written delegation within the collaborative practice arrangement (§ 334.735).
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Missouri follows the traditional corporate-practice-of-medicine doctrine — professional corporations under RSMo Chapter 356 generally require shareholders to be licensed in the relevant profession. This research pass could not confirm exact section numbers for PA-specific ownership eligibility (search budget exhausted) — treat as an open item pending direct citation of Chapter 356 and the § 334 fee-splitting provisions.
Not independently verified against primary source this research pass — flag for confirmation before relying on it for an ownership-structuring decision.
Legal sources for these rules (2)
What a supervising physician costs here
Typical monthly cost in Missouri
$500 – $650
Estimate for one Physician Assistant. This state's proximity rules add a small premium.
About Missouri's rules
PA/APRN collaboration is governed by nearly-identical §§ 334.104/334.735: a 6-FTE combined ratio cap, 10%/20% chart-review every 14 days, biweekly physician presence, and a 120-hour controlled-substance Rx cap. A pre-2024 numeric 75-mile proximity rule was reportedly rescinded by both boards — current text uses an undefined 'geographic proximity' standard; verify with counsel before relying on any specific mileage figure.
Other clinicians in Missouri: see the state overview.