Physician duties · CNS · Maryland
Signing for a Clinical Nurse Specialist in Maryland: what the physician takes on
The agreement is mandatory for the clinician, which makes its duties mandatory for you. Maryland does not name a specific instrument.
Maryland has granted full independent-practice authority ONLY to psychiatric-mental-health CNSs; other CNS population foci must consult or collaborate with a licensed physician per COMAR 10.27.27's scope-of-practice language — whether that collaboration must be under a written agreement (vs. an as-needed relationship like CNM's) was not confirmed in this pass.
Independent practice requires: practicing within the psychiatric-mental-health population focus — the only CNS population focus Maryland has granted independent practice authority; this is a scope/specialty fact, not an hours/experience threshold.
What you take on as the physician
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
non-psychiatric population focus: Available remotely (no on-site requirement)
COMAR 10.27.27 requires consulting/collaborating with a licensed physician; no on-site or fixed-radius standard was confirmed in this pass.
psychiatric-mental-health population focus: No proximity requirement
No physician availability/proximity standard applies to the independent psychiatric-mental-health population focus.
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Covered by the practice agreement · controlled substances permitted
A CNS may prescribe any drug or durable medical equipment within their education, training, certification, and population focus (recent COMAR update per NACNS tracking) — requires Maryland CDS and federal DEA registration; exact schedule-level limits not independently confirmed in this pass.
Written agreement
Required
Coded as required by default because most CNS population foci must consult/collaborate with a physician, but a CNS in the psychiatric-mental-health population focus practices independently — see conditions above. Whether the non-independent branch's 'collaboration' is a formal written agreement or an as-needed relationship (as with CNM) was not confirmed in this pass.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Same open item as the general `np` entry.
Applies regardless of the psychiatric/non-psychiatric independence branch above — entity ownership is a separate legal question from clinical collaboration status.
Legal sources for these rules (2)
What physicians charge for this role
Typical monthly compensation in Maryland
$500 – $600
Estimate for one Clinical Nurse Specialist. This state's proximity rules add a small premium.
About Maryland's rules
Maryland's APRN categories are NOT uniform: CRNPs/CNMs gained full practice authority in 2015 (after an 18-month new-graduate mentorship), but CRNAs remain fully supervised with NO prescriptive authority at all (Maryland is one of ~11 states granting CRNAs none), and only the psychiatric-mental-health population focus of CNS practice is independent. Maryland does not recognize PLLCs — professional entities use physician-only Professional Corporations, so multi-disciplinary PC ownership questions are open items below.
Other clinicians in Maryland: see the state overview.