Virginia has a rule almost no other state has, and if you're a psychiatric NP it works in your favour.
A Virginia physician may normally serve on a patient care team with six advanced practice registered nurses. Where those APRNs are licensed in the psychiatric-mental health category, the limit rises to ten. That's a specialty-specific carve-out written into the statute — and this page covers what it means for your practice, the route to autonomous practice, and the PA change that landed in April.
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Start the Free Intake Form →The Code of Virginia states it plainly:
"Physicians shall not serve as a patient care team physician on a patient care team or enter into a practice agreement with more than six advanced practice registered nurses at any one time, except that a physician may serve as a patient care team physician on a patient care team with up to 10 advanced practice registered nurses licensed in the category of psychiatric-mental health advanced practice registered nurse."
What this means in practice. Physician capacity is the thing that sets the price of collaboration everywhere. In most states the cap doesn't care what you do — Virginia's does. A Virginia physician who is full at six family NPs has no room for you. A physician building a psychiatric panel has room for ten.
The practical advice: if you're a PMHNP in Virginia, you should be looking specifically for physicians who work with psychiatric APRNs, not for a collaborator generally. It's a different and less crowded pool, and it's the difference between a physician saying "I'm at capacity" and "I have room."
That's precisely the kind of matching a network does and a cold email doesn't.
Virginia lets NPs earn out of the practice agreement entirely.
The threshold is the equivalent of three years of full-time clinical practice, reduced from five years in July 2024. You apply to the Board of Nursing for the autonomous practice designation on your licence, supported by attestation from a patient care team physician that you practised together for the required period.
If the attesting physician is unavailable — death, disability, retirement, relocation — the Board accepts alternative evidence such as employment records or reimbursement records.
A note on the hours figure. The Board states the three-year requirement in hours as well, and the number appears inconsistently across its own materials. Because that inconsistency is on the Board's side rather than yours, confirm your exact hours count with the Board of Nursing before you apply rather than relying on any published figure, including this one. The three-year framing is consistent everywhere; the hours arithmetic is not.
What this means for a collaboration you're arranging now: it has an end date. You're buying three years of compliance rails, not a permanent dependency, and the agreement you sign should be built with the attestation in mind — because the physician who signs it is the one you'll be asking to attest.
Virginia signed HB 746 into law on April 8, 2026. It removes the practice agreement requirement for PAs who have completed the equivalent of three years of full-time clinical experience, with written confirmation from a collaborating physician.
Two things to be careful about.
First, this applies to experienced PAs. If you're under three years, the practice agreement requirement is unchanged and you still need a patient care team physician.
Second, the Board of Medicine is still writing the implementing regulations. They're expected before year end and the process was exempted from the usual administrative timeline, but until they're adopted the operational details aren't settled. Don't dissolve a working arrangement on the strength of a signed bill.
Until then, Virginia PA practice agreements still require what they've always required: a written or electronic agreement with one or more patient care team physicians spelling out roles and functions, an evaluation process, and — unlike the NP agreement — a specified timeframe within which the physician reviews the record of services rendered, proportionate to the acuity of care and the practice setting. Prescriptive authority means the agreement must list the schedules and categories of drugs within scope.
PAs employed by hospitals, state behavioral health facilities, or federally qualified health centres may practise without a separate agreement where the facility's credentialing incorporates equivalent safeguards.
Virginia is more favourable than most states if you're psychiatric, and ordinary if you're not.
The reason is the cap. Six APRNs per physician is mid-range and produces mid-range pricing. Ten for psychiatric-mental health APRNs is genuinely generous, and it means the constraint that drives prices up elsewhere is looser here for exactly the specialty we work in most.
The three-year autonomy threshold also caps your exposure. Unlike states where collaboration is permanent, a Virginia NP is buying a defined stretch — which is worth remembering when a physician quotes you a rate as though it's forever.
At MD-Match, pricing is tailored to your practice rather than flat-rated. The match fee is $50, one time, and rematching is free, always.
Dr. Wasef reviews every Virginia submission personally. If you're a PMHNP, say so — it changes which physicians have capacity for you.
Get My Free Virginia Quote →Psychiatric NPs get told a physician is at capacity when the physician isn't — because neither party knows the higher limit applies to them. This is the most common and most expensive Virginia mistake.
The autonomous practice application depends on it. A collaborator who's disengaged now is a problem at year three, not today.
The bill is signed; the regulations aren't final. PAs who let agreements lapse on the strength of a headline are ahead of the rules.
NP agreements have no review requirement; PA agreements must specify a review timeframe. Practices running both under one template get this wrong in one direction or the other.
Because nothing is filed, nothing prompts you. The obligation is continuous — a scope change means an agreement change.
Every physician in the MD-Match network is background-checked, license-verified for Virginia, and capacity-checked before matching. For psychiatric NPs we match specifically against the 10-APRN limit, because the pool of physicians with genuine room is larger than most people looking for a collaborator realise.