PA · Maryland
Collaborative Drug Therapy Management for Physician Assistants in Maryland
Yes, a written agreement with a physician is required before you prescribe and adjust drug therapy. Maryland calls it a Collaboration Agreement.
No independent-practice or experience-based autonomy pathway exists for PAs in Maryland — a delegation agreement with a supervising physician and 'continuous supervision' are required for as long as the PA practices (Health Occ. § 15-302; COMAR 10.32.03).
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
Available remotely (no on-site requirement)
COMAR 10.32.03.05 requires the delegation agreement to describe 'continuous physician supervision mechanisms reasonable and appropriate to the practice setting' and the physician to attest to responding to the PA 'in a timely manner'; there is no on-site or mile or minute radius standard.
Supervision ratio
Up to 4 at a time
A primary (or alternate) supervising physician may not supervise more than 4 PAs at any one time, except in hospitals, correctional/detention facilities, or public health facilities, where this cap does not apply (COMAR 10.32.03.07).
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Schedule II-III: 30-day supply max per single filling (7-day max for institutionalized patients' Schedule II). A patient-care-team physician may delegate prescribing/dispensing of Schedules II-V, provided the PA holds both a Maryland CDS registration and a federal DEA registration; the delegation agreement must attest to compliance with applicable state/federal law. PAs may not delegate dispensing of drug samples/starter dosages.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional corporation; Maryland does not recognize PLLCs, and medical-services PCs are described as issuing stock only to licensed physicians (secondary summary)
This ownership question is legally distinct from the clinical delegation agreement above.
Sources for the supervision rules (4)
What a collaborating physician costs here
Typical monthly cost in Maryland
$500 – $600
Estimate for one Physician Assistant. This state's proximity rules add a small premium.
About Maryland's rules
Maryland's APRN categories are not uniform: CRNPs and CNMs gained full practice authority in 2015 (after an 18-month new-graduate mentorship), CRNAs remain fully supervised with no prescriptive authority at all (Maryland is one of about 11 states granting CRNAs none), and only the psychiatric-mental-health population focus of CNS practice is independent. Maryland does not recognize PLLCs; professional entities use physician-only professional corporations, so multi-disciplinary ownership questions remain open.
Other clinicians in Maryland: see the state overview.