PA · Alabama
Collaborative Drug Therapy Management for Physician Assistants in Alabama
Yes, a written agreement with a physician is required before you prescribe and adjust drug therapy. Alabama calls it a Supervisory Practice Agreement.
Ala. Admin. Code r. 540-X-7-.23: 'There shall be no independent, unsupervised practice by physician assistants.' No experience threshold ever removes the supervision requirement.
What the physician relationship must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
PA with <2 years (4,000 hours) of experience, remote/satellite site: On-site presence required
Supervising physician must be physically present at the approved practice site for not less than 10% of the PA's scheduled hours (Ala. Admin. Code r. 540-X-7-.23).
PA with ≥2 years (4,000 hours) of experience, remote/satellite site: Available remotely (no on-site requirement)
The on-site presence requirement does not apply; instead the physician must visit the remote site at least twice a year and meet with the PA at least quarterly. No mileage or radius figure appears in the rule text.
Supervision ratio
Up to 9 at a time (combined across provider types)
A physician may not collaborate with/supervise any combination of CRNPs, CNMs, and PAs exceeding 360 hours/week (i.e., 9 FTE positions total, combined across all three provider types) — a shared cap, not a per-type cap (Ala. Admin. Code r. 540-X-8-.08, cross-referenced for PAs).
Chart review
Percentage set by agreement · Quarterly · countersignature required
Quarterly quality-assurance review of 'a meaningful sample of medical records plus all adverse outcomes' — no specific percentage codified. Countersignature required 'pursuant to established policy and/or applicable legal regulations and accreditation standards,' also with no fixed percentage (Ala. Admin. Code r. 540-X-7-.23, -.24). Records retained for duration of practice plus 3 years after termination.
Meeting cadence
Quarterly
Minimum quarterly meeting cadence; modality not specified as exclusively in-person or telehealth.
Prescriptive authority
Covered by the practice agreement · controlled substances permitted
PAs prescribe legend drugs under the supervising physician's authority. Controlled-substance prescribing appears to run through the supervising physician's own DEA and Alabama Controlled Substances Certificate rather than a PA-specific certificate (the QACSC chapter covers only CRNPs and CNMs); confirm against the controlled-substances section of Ala. Admin. Code 540-X-7.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — PC or PLLC with licensed shareholders (Title 10A)
Alabama has no strict corporate-practice-of-medicine doctrine barring corporate ownership generally, but PAs cannot own/operate an independent practice outside a registered supervising-physician relationship.
Sources for the supervision rules (3)
- Ala. Code § 34-24-290 et seq. — Assistants to Physicians
- Ala. Admin. Code r. 540-X-7-.23, -.24 — Physician Assistant Supervision Requirements
- Ala. Admin. Code r. 540-X-8-.08 — Combined CRNP/CNM/PA Supervision Ratio (cross-referenced)
What a collaborating physician costs here
Typical monthly cost in Alabama
$650 – $950
Estimate for one Physician Assistant. This state's rules add a restrictive-tier premium.
About Alabama's rules
Alabama is a restrictive state: PA/CRNP/CNM all require an indefinite collaborative agreement with no independence pathway, and share a combined 360 hours/week (9 FTE) supervision cap per physician. CRNA's status is a genuine ambiguity — statute requires an 'immediately available' physician/dentist/podiatrist, but no filed agreement or ratio regime exists like CRNP/CNM's; flagged for legal review.
Other clinicians in Alabama: see the state overview.