PA · North Dakota
Supervision Agreement for Physician Assistants in North Dakota
Not unconditionally. North Dakota does not name a specific instrument.
A PA practicing outside a qualifying facility may seek independent-practice approval only if the site is in a board-designated rural/medically underserved area AND a ND-licensed physician performs periodic chart reviews (N.D. Admin. Code § 50-03-01-03.2(2)). Otherwise, no agreement is required at all once the 4,000-hour/qualifying-facility conditions are met (§ 43-17-02.1(3)).
Independent practice requires: ≥4,000 hours of board-approved practice (below this, a written collaborative agreement with a physician is required — N.D. Cent. Code § 43-17-02.1(6)); practicing at a licensed health care facility, a facility with a credentialing/privileging system, a physician-owned facility/practice, or a board-approved facility/practice (§ 43-17-02.1(5)) — a PA outside such a setting seeking full independent practice must instead qualify via the rural/underserved pathway below.
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
PA below 4,000 practice hours, or outside a qualifying facility: No proximity requirement
No mile/minute radius or on-site requirement is codified. The only geographic element in ND law is the 'rural, medically underserved area' designation required for the independent-practice pathway (NDAC § 50-03-01-03.2(2)(a)) — a designation-based, not mileage-based, condition.
Supervision ratio
Not codified — no cap on file
Chart review
PA in the rural/underserved independent-practice pathway: Percentage set by agreement · As needed
NDAC § 50-03-01-03.2(2)(b) requires 'chart reviews at periodic intervals as required by the board' with no percentage or fixed interval specified in the rule text. Former ND ratio-cap rules (NDAC §§ 50-03-01-09, -09.1, -09.2) and the countersignature-adjacent § 50-03-01-04 were all repealed by 2020.
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Covered by the practice agreement · controlled substances permitted
May prescribe/dispense Schedule II-V substances and all legend drugs (§ 43-17-02.1(4)(c)); individual DEA registration required, no separate agreement needed beyond DEA compliance (§ 43-17-02.1(4)(f)). Dispensing itself is restricted to cases where pharmacy services aren't reasonably available, dispensing is in the patient's best interest, or an emergency exists (§ 43-17-02.1(4)(d)).
Written agreement
Not required
False reflects the default/most-common case (≥4,000 hours at a qualifying facility, where 'a written agreement...is not required,' § 43-17-02.1(3)) — but a PA below 4,000 hours, or practicing outside a qualifying facility, DOES need a written collaborative agreement (§ 43-17-02.1(6)) or board-approved rural/underserved arrangement with periodic chart review (NDAC § 50-03-01-03.2(2)).
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional corporation under N.D. Cent. Code ch. 10-31 (Professional Organizations Act) — shareholders must be individuals licensed to render the same professional service as the corporation. Whether a PA may independently own a practice (as opposed to practicing at a 'physician-owned facility or practice,' § 43-17-02.1(5)) was not confirmed in the plain statutory text this research pass — secondary sources describing H.B. 1175 suggest a board-approval ownership pathway exists, but this was not independently verified.
Treat PA independent ownership as an open item pending direct confirmation with the ND Board of Medicine, not a settled fact.
Legal sources for these rules (4)
- N.D. Cent. Code § 43-17-02.1 — Physician assistant practice
- N.D. Admin. Code § 50-03-01-03.2 — Independent practice (rural/underserved pathway)
- N.D. Admin. Code §§ 50-03-01-09, -09.1, -09.2 (repealed eff. Jan. 1, 2020) — former ratio caps
- H.B. 1175 (2019 session) — repeal of PA supervision-contract model, eff. Jan. 1, 2020
What a supervising physician costs here
Typical monthly cost in North Dakota
$500 – $600
Estimate for one Physician Assistant. Standard-tier state.
About North Dakota's rules
H.B. 1175 (2019, eff. 2020) and a 2022 rule amendment repealed ND's old PA supervision-contract/ratio/countersignature model — PAs are now CONDITIONAL only below 4,000 practice hours or outside a qualifying facility. All four APRN roles (NP, CRNA, CNM, CNS) are FULL independent practice with no collaboration agreement of any kind.
Other clinicians in North Dakota: see the state overview.