What does a collaborating physician agree to do?

For PAs practicing under a written collaborative agreement, the collaborating physician and PA establish an agreement that:

• Describes the general categories of care, treatment, and procedures the PA will provide.

• Reflects services within the physician's area of clinical practice and the PA's education, training, experience, and competence.

• Identifies any procedures for which the physician's physical presence is required.

• Establishes a method for the PA to obtain physician consultation when needed, including by telephone, telecommunications, or electronic communication.

• Includes joint development or approval of appropriate orders or clinical guidelines and periodic review of the services provided under them.

• Provides for consultation between the PA and collaborating physician at least monthly.

The agreement is intended to support—not replace—the PA's exercise of professional clinical judgment.

Does the physician have to be physically present?

No. Illinois law specifically provides that collaboration does not require the physician's personal presence at the location where the PA is practicing, provided appropriate methods of communication and consultation are available.

Does the physician have to review every patient or sign every PA note?

No general Illinois requirement mandates review or co-signature of every PA encounter. The law requires periodic review and appropriate consultation. Individual employers, hospitals, credentialing bodies, or payers may establish additional requirements.

Is the collaborating physician automatically liable for everything the PA does?

No. Illinois law provides that a physician is not liable for the acts or omissions of a PA solely because the physician entered into a collaborative agreement or authorized the PA to perform an act. This protection does not extend to circumstances in which the physician has reason to believe the PA lacks competency to perform the authorized activity or the physician engages in willful and wanton misconduct.

PAs remain licensed healthcare professionals who are accountable for their own professional practice.

What about prescribing?

A collaborating physician may, but is not required to, delegate prescriptive authority. If prescribing authority is delegated, additional Illinois requirements apply, particularly for controlled substances, including appropriate IDFPR notification and licensure.

Is there a limit on the number of PAs?

Generally, a physician may collaborate with up to seven full-time-equivalent PAs. Certain practice settings and designated shortage areas are exempt from or have exceptions to this limitation.

Important exception: hospital and facility-based practice

PAs practicing in an Illinois hospital, certain hospital affiliates, federally qualified health centers, or ambulatory surgical treatment centers may practice without an individual written collaborative agreement when practicing under the credentialing, privileging, and oversight structures established by the facility.

Bottom Line

Being a collaborating physician does not mean being physically present with the PA, reviewing every patient, or assuming automatic liability for the PA's practice.

It means establishing an appropriate scope of practice, remaining available for consultation, periodically reviewing the collaborative practice, and supporting a PA in delivering care consistent with their education, training, experience, and competence.

Key Illinois authorities: Physician Assistant Practice Act of 1987, 225 ILCS 95/7, 7.5 and 7.7; Medical Practice Act of 1987, 225 ILCS 60/54.5; 68 Ill. Admin. Code Part 1350.

This information is intended as a general educational resource and does not constitute legal advice. Requirements may also be affected by employer policies, credentialing requirements, payer rules, and the specific practice setting.

Current as of August 2026.