A new lawsuit filed in Wake County Superior Court by a local nurse practitioner threatens to dismantle North Carolina’s collaborative care model, a foundational framework that protects patient safety by ensuring physicians remain central to medical decision-making.
Backed by the “Pacific Legal Foundation,” the legal challenge falsely frames mandatory “Collaborative Practice Agreements” as an unnecessary financial and administrative burden rather than what they truly are: a vital safety net for patients.
Organizations like ours and the North Carolina Medical Society maintain that physician-led teams are essential for high-quality, coordinated healthcare, as physicians undergo thousands of hours of rigorous clinical training that cannot be replicated in nursing education.
The case relates to a group nurse practitioner practice that pays $16,500 annually for five nurse practitioners, working out to $275 per month per NP. This means that their collaborative agreement fees are well below the median of $500 per month. In this 2019 study from the Journal of Nursing Regulation which sampled 8,701 nurse practitioners, only 3% (263 NP’s of 8,701) personally paid for their supervision fees. Of those 263 NP’s, only 40 (0.4%) paid over $1,000 per month. There was only one outlier in the survey who reported annual fees of $50,000, so one has to wonder if this was an error or covering multiple people, such as in the case above.
Legal challenges like this one seek to erode patient protections under the guise of increasing healthcare access, setting a risky precedent that compromises the standard of care. By attempting to bypass the North Carolina General Assembly, where medical practice standards should be properly debated, proponents of full practice authority are using the court system to weaken oversight.
Dismantling these collaborative frameworks removes an important layer of clinical supervision, ultimately placing vulnerable patients at risk. This incident also highlights a deeper structural problem: collaborative agreements are not standardized. In the absence of clear, enforceable requirements, that inconsistency creates openings for people to exploit the system. When oversight is vague or inconsistently applied, patients have no reliable way to know whether the care they’re receiving is being appropriately supervised.
We endorse meaningful supervision of NPP’s as physician-led care. We do not support “collaboration” as a substitute.
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