May 21, 2026
By: Matt Wilmot & Edgar Bueno, as published by The National Law Review
On May 7, 2026, the Georgia Composite Medical Board (GCMB) issued a new and important position statement (the “Position Statement”) that will undoubtedly impact medical practices shared by advanced practice practitioners (NPs and PAs) and physicians. Specifically, the Position Statement focuses on the Delegating Physician/Advanced Practice Registered Nurse (APRN) Relationship, the Supervising Physician/Physician Assistant (PA) Relationship, and IV Hydration/IV Therapy Requirements.
While the specific attention on IV hydration clinics is limited, the guidance issued with respect to employment relationships between PAs, APRNs (jointly, “APPs”), and their supervising or delegating physicians has the potential to significantly impact ownership and employment frameworks underpinning APP-owned medical practices and businesses such as medical clinics, wellness services, medical spas, and IV hydration businesses.
Most importantly, the Position Statement focuses on employment relationships between APPs and their physician partners and may arguably be interpreted to severely restrict employment arrangements between APP-owned or controlled businesses and physicians.
What Georgia Law Actually Prohibits
Many medical practices and businesses in Georgia are founded and owned by APPs. To comply with statutory requirements, APPs hire or contract with supervising physicians to provide services to the business. The statutory framework generally prohibited an APP from “employing” their supervising physician, but the statutes left open varying interpretations about how far this prohibition extended.
With respect to APRNs, the Position Statement clarifies that the GCMB’s position on the prohibition on physician “employment” is not dependent upon traditional employment (W2) versus independent contractor (1099) status. Rather, the GCMB has “generally interpreted the prohibition to include a physician receiving compensation of any kind, monetary or non-monetary, from an APRN or an APRN-owned company in exchange for serving as the supervising or delegating physician.”
With respect to PAs, the Position Statement unambiguously states: “a physician may not be an employee of the physician assistant whom he or she is required to supervise unless the arrangement was approved by the Board prior to July 1, 2009.”
As to both arrangements, the GCMB stated that the supervisory relationships must reflect “genuine clinical oversight” and cannot be structured in a manner that circumvents statutory supervision requirements or GCMB rules.
Finally, the GCMB clarified that payments made to third-party supervising physician matching services, such as “Collaborating MDs/DOs,” “APRNMatch,” or “NP Collaborator,” are prohibited if the company is being paid for access to or assignment of a delegating physician, and that physician is being compensated through that arrangement to supervise or delegate to an APRN.
What IV Hydration Clinic Owners Need to Know
The GCMB previously issued a position statement clarifying the supervision and medical documentation requirements for the provision of IV hydration therapy. The Position Statement updates that guidance to also clearly state that APPs must have a valid nurse protocol agreement (APRNs) or job description (PAs) with a supervising physician. A natural extension of the employment limitations described above is that APPs who own or operate IV hydration therapy businesses cannot employ or otherwise compensate a supervising physician for those services.
What To Do Now
The areas covered by the Position Statement are quickly evolving, and this guidance can be viewed as a “first step” in an ongoing review of the physician and APP relationship. Significant ambiguity remains, including around medical director arrangements, and there are strong indications that a broader review of the supervisory arrangement between APPs and physicians is underway.
On March 25, 2026, House Resolution 1891, titled “Creating the House Study Committee on Physicians’ Delegation Authority and Supervision of Georgia’s Advanced Practice Providers,” was introduced in the Georgia House of Representatives. The committee’s stated objectives include:
- Evaluating demand for physicians willing to enter into supervision arrangements
- Reviewing scope of practice and public policy changes affecting APPs
- Examining difficulties in implementing laws surrounding nurse protocol agreements
While the resolution did not advance out of the House during the spring legislative session, this nevertheless could be an indication that the Georgia General Assembly is hearing from APPs, as small business owners, about the challenges they face in the current environment. Thus, these issues may be ripe for future legislative efforts.
APPs who own or operate independent medical practices, and physicians participating in these arrangements, should review the Position Statement for its applicability to their business models. That review should include both corporate structure and employment relationships between practitioners.
Specifically, APPs should consider taking the following steps:
- Review all current supervision and collaboration agreements, including how the supervising or delegating physician is compensated.
- Audit the corporate structure of the business, including how physician partners or contractors are engaged.
- Evaluate any third-party matching service arrangements in light of the GCMB’s new guidance.
- Confirm that all required nurse protocol agreements or job descriptions are current and in place.
If the Position Statement implicates your business model, reach out to qualified legal counsel for guidance on next steps.
