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Pennsylvania Nurse Practitioner Practice Ownership 

Nurse practitioners can and do own practices in Pennsylvania.  Although they do not enjoy full practice authority, they nonetheless are permitted to create health care business entities with or without a physician co-owner.  See, e.g., 49 Pa. Code, Ch. 21, § 21.6 (PA Board of Nursing allowing nurses to "form a professional corporation with other registered nurses or other health care practitioners who treat human ailments and conditions, and who are licensed to provide health care services in this Commonwealth without receiving a referral or supervision from another health care practitioner.").  The PA Board of Medicine has a similar rule applicable to physicians.  See 49 Pa. Code, Ch. 16, § 16.21.  The LLC is an available choice, but it comes with its own limitations and considerations that must be addressed at the outset of forming the business.  

Regardless of the business entity choice or whether there is a physician co-owner, the nurse practitioner must always comply with the Collaborative Agreement and Prescriptive Authority Collaborative Agreement and corresponding regulations.  The failure to do so would make the business unlawful and could constitute the unauthorized practice of medicine. 

Corporate Practice of Medicine Doctrine 

Another consideration that nurse practitioner entrepreneurs must keep in mind is the corporate practice of medicine (CPOM) doctrine.  CPOM doctrine prohibits corporations and other non-physician entities from practicing medicine or employing practicing physicians.  This long-standing but often misunderstood doctrine ensures that medical decisions are made solely based on patient care and are not influenced by corporate interests.  Neill v. Gimbel Bros., Inc., 330 Pa. 213, 199 A. 178 (1938).  Nurse practitioner practice ownership is consistent with the principles described in Neill because the policy behind CPOM is about ensuring that trained and licensed professionals maintain an "immediate and unbroken relationship" between themselves and their patients.  Id.  CPOM doctrine is concerned with corporate interests in health care decision-making, and it applies to other health professions beyond medicine such as optometry and dentistry.  Id.  

However, a nurse practitioner should not employ a physician.  Id. ("The position of a physician normally is not that of a servant of anyone...."); ("a licensed practitioner of a profession may not lawfully practise his profession among the public as the servant of an unlicensed person or a corporation; and that, if he does so, the unlicensed person or corporation employing him is guilty of practising that profession without a license.").

If a nurse practitioner enters into a management services agreement (MSA) with a management services organization (MSO), the agreement must be structured in a way that does not violate the CPOM doctrine.  For example, the nurse practitioner practice owner must maintain absolute control over the clinical side of the practice, again, with collaborating physician oversight.  The MSO cannot influence clinical decisions. 

Governor Shapiro is a vocal supporter of full practice authority, and we are unlikely to reverse course on this issue.  Owning a practice as a nurse practitioner in a reduced practice state like Pennsylvania comes with its own unique set of challenges.  Therefore, it is crucial to work with other nurse practitioner entrepreneurs and a health care law attorney to ensure compliance and success.  Reach out to McCluan Law for more information about how to lawfully create and operate a nurse practitioner practice with collaborating physician oversight.