This is not legal advice. Foundry PC is not a law firm.
Nurse practitioner-led companies are the fastest-growing segment of new telehealth practices we see. They also arrive with the most confusion about which physician they need. Here's a clean breakdown.
Role 1: The professional entity owner
In corporate practice of medicine states, the entity that delivers medical care must be owned by a licensed physician. If your practice is NP-led and operates in a state where NPs cannot own a medical practice, or where the entity must be a medical PC, you need a physician to own it.
What they do: Hold the entity, approve clinical policies, sign credentialing, sit in governance.
When you need one: If you operate in CPOM states and your NPs can't own the entity there.
When you don't: In full-practice-authority states where NPs can own their own professional entity (a growing list, but check each state), or if your company operates only in non-CPOM states with an NP-owned entity.
Role 2: The collaborating or supervising physician
Separate from ownership, many states require NPs to have a collaborative practice agreement or supervision arrangement with a physician in order to practice, prescribe, or both. The specifics vary widely: some states require chart review percentages, some require periodic meetings, some limit the number of NPs one physician can collaborate with, some have none of this.
What they do: Sign the collaborative practice agreement, perform required chart reviews, be available for consultation, meet the state's documentation requirements.
When you need one: In reduced- and restricted-practice states for NPs. Roughly half the states still require some form of collaboration or supervision for NPs.
When you don't: In full-practice-authority states, after any transition-to-practice period.
The collaborating physician must typically be licensed in the state where the NP practices. For a multi-state NP practice, that can mean multiple collaborating physicians or one physician with many licenses.
Role 3: The medical director
A medical director provides clinical leadership: protocols, quality review, escalation, and often payer- or accreditation-required oversight. This role is not always legally required, but many payers, pharmacies, and accreditation bodies expect one, and it's frequently written into MSO-PC governance.
What they do: Own clinical quality, write and update protocols, handle complex escalations, represent the practice clinically to payers and regulators.
When you need one: When payers or accreditors require it, when you prescribe controlled substances, when you're scaling past a handful of providers.
When you don't: Very early stage, single-state, few providers, no payer contracts.
Can one physician do all three?
Often, yes, and it's efficient. A single physician who owns the PC, collaborates with the NPs, and serves as medical director is a common configuration. But the roles should be documented separately, with separate duties and separate compensation lines, because they carry different legal obligations and different fair-market-value analyses. A flat PC owner stipend does not cover chart review for eight NPs.
Splitting the roles across two physicians also has advantages: it reduces single-point-of-failure risk, and it can make the physician owner's independence clearer to regulators.
Pricing logic
- PC owner: flat monthly stipend, stepped by state count and specialty.
- Collaborating physician: typically priced per NP supervised, per month, reflecting the chart review and availability burden. Some states' requirements are heavy enough to justify higher rates.
- Medical director: flat monthly retainer based on scope, often with an hourly component for projects.
Ask any provider quoting you a single number what's included. A $2,500 per month "physician" line that's supposed to cover PC ownership plus collaboration for six NPs plus medical directorship is underpriced for the work, which usually means one of the roles isn't really being performed.
State variability is the whole problem
NP practice authority, physician collaboration rules, and CPOM ownership rules are three separate state-by-state overlays. A state can be full practice authority for NPs and still require a physician-owned PC for the entity. Another can allow NP entity ownership but require collaboration for prescribing. The only reliable approach is a state-by-state matrix built by counsel before you form anything.
How Foundry PC handles it
Foundry matches NP-led practices with physicians for any or all three roles, documents them separately, and prices them transparently: a stepped PC owner stipend, a per-provider collaborating physician line, and a medical director retainer where needed. Our matched physicians hold multi-state licenses so a growing NP practice doesn't outgrow them.
Book a 20-minute call with your state list and your NP count and we'll tell you which roles you actually need.