Physician duties · NP · Missouri
Signing for a Nurse Practitioner in Missouri: what the physician takes on
The agreement is mandatory for the clinician, which makes its duties mandatory for you. Missouri calls the instrument a Collaborative Practice Arrangement (CPA).
Missouri has no full-independent-practice tier for APRNs — a written collaborative practice arrangement is mandatory for as long as the NP practices (§ 334.104). The often-cited '1,000 hours' figure only gates a controlled-substance prescriptive-authority certificate — it does not end collaboration.
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
Available remotely (no on-site requirement)
§ 334.104 requires the collaborating physician and APRN to 'maintain geographic proximity,' with no numeric mileage in the current statutory text (a pre-2024 75-mile rule was reportedly rescinded — secondary-sourced, verify before relying on it). A statutory correctional-center exception permits 200 miles by road, but that carve-out's sunset date (August 28, 2025) has already passed as of this writing — its current status is unconfirmed. Rural health clinics may waive proximity up to 28 days/year; telehealth arrangements in shortage areas reportedly waive it further (secondary-sourced).
Supervision ratio
Up to 6 at a time (combined across provider types)
Shares the same 6-FTE combined cap (APRNs/PAs/assistant physicians together) as the `pa` entry (§ 334.104).
Chart review
10% of charts · As needed (every 14 days)
10% of all charts, every 14 days (§ 334.104); 20% for controlled-substance charts.
Meeting cadence
As needed
Physician presence at least once every 2 weeks for chart review/medical direction (§ 334.104). Separately, a new APRN must complete a minimum one-month period of practice with the collaborating physician continuously present before working with reduced/periodic presence — this is an onboarding step, not a path to full independence; the biweekly-presence and chart-review rules continue indefinitely afterward.
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Same Schedule III/IV/V plus Schedule II hydrocodone framework as `pa`, 120-hour cap (30 days for buprenorphine). Requires ≥1,000 hours of practice in the applicable APRN category (secondary-sourced figure, not independently re-verified against current rule text) before applying for the controlled-substance certificate — this threshold gates the Rx certificate only, not exit from the collaborative practice arrangement itself.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Same traditional corporate-practice-of-medicine framework as the `pa` entry (RSMo Chapter 356 professional corporations) — exact section numbers for APRN-specific ownership eligibility were not confirmed this research pass; treat as an open item.
Not independently verified against primary source this research pass.
Legal sources for these rules (4)
What physicians charge for this role
Typical monthly compensation in Missouri
$500 – $700
Estimate for one Nurse Practitioner. This state's rules add a restrictive-tier 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.