Associate Physician Licensing Requirements in Utah

In a world of health care staffing shortages and too few residency slots, physician practices and medical school graduates alike may be wondering about associate physician licensing requirements in Utah. Utah is one of a handful of states that allows recent medical school graduates who didn’t match with a residency to work under the supervision of a collaborating physician licensed in good standing in Utah.  

The law requires the collaborating physician to oversee the associate physician’s (“associate”) work and remain responsible for all care rendered. Care must be provided according to a written collaborative practice agreement jointly developed by the collaborating and associate physicians and approved by the Utah Department of Professional Licensing (“DOPL”). A licensed physician may not maintain collaborative practice agreements with more than 3 full-time equivalent associates.¹ 

In this article, we answer some frequently asked questions about the associate physician licensing requirements, collaborative practice agreements, and the duties and responsibilities of collaborating physicians. 

Who is eligible to apply for an associate physician license? 

During the application process, individuals must establish the following:² 

• Graduated from an LCME accredited school; 
  
  
• Successfully completed steps 1 and 2 of the USMLE or equivalent steps of another Board-approved medical licensing exam (completion must be within 3 years after graduation day and within 2 years prior to applying for an associate physician license); 
  
  
• Not currently enrolled in and haven’t completed a residency program; 
  
  
• Able to read, write, speak, understand, and be understood in the English language and (if requested) be able to demonstrate this proficiency to the board’s satisfaction; and 
  
  
• If requested, must meet with the Physicians Licensing Board (“Board”) and DOPL representatives who will evaluate an applicant’s qualifications. 

How long is the license valid?³ 

• Licenses are issued on two-year renewal cycles. 
  
  
• An individual cannot hold an associate physician license for more than six years total. 

What are the specifics of the collaborative practice agreement requirement?⁴ 

When a Utah physician agrees to supervise a licensed associate physician, the first step is to prepare a contract known as a “collaborative practice agreement.” A complete, physical copy of the agreement must be kept at all sites where the associate provides care. The agreement must be: 

• a written document that limits the associate to providing primary care services,  
  
  
• jointly developed and signed by the collaborating and associate physicians, 
  
  
• submitted to DOPL by the associate, and  
  
  
• approved by DOPL before the associate provides any care.  

The collaborative practice agreement must: 

• Provide complete names, home and business addresses, and phone numbers for the collaborating and associate physicians; 
  
  
• List the collaborating physician’s specialty and board certifications; 
  
  
• List the associate’s certifications (if any); 
  
  
• List all sites/locations where the associate will provide care; 
  
  
• Specify the duration of agreement; and 
  
  
• List remedies in the event of breach by either physician, including procedures for contract termination and subsequent written notification to DOPL. 

In addition, the agreement must contain supervision and collaboration details, including: 

• A list of jointly agreed-upon protocols or standing orders governing care the associate will provide; 
  
  
• A description of how the collaborating and associate physicians will maintain sufficient contact/proximity to engage in collaborative practice (consistent with their individual skill, training, education, and experience); 
  
  
• Arrangements for oversight of the associate in case the collaborating physician is absent due to incapacity, infirmity, emergency, or other reason; 
  
  
• Protocols in place to ensure the clinical tasks assigned are consistent with the associate’s skill, training, and competency; 
  
  
• A description of educational methods and programs the associate will complete to advance his/her medical knowledge and abilities while practicing under the collaborative practice arrangement; 
  
  
• A list of procedures appliable to clinical situations outside the associate’s scope of practice; and 
  
  
• A list of any other written practice arrangements agreed to by the collaborating and associate physicians. 

Can an associate prescribe? 

If the associate will be prescribing, the collaborative practice agreement must: 

• List all sites/locations where the collaborating physician authorizes the associate to prescribe and
    
• Confirm that a prominently displayed disclosure statement will be posted at every office where the associate is authorized to prescribe – the statement must inform patients that they may be seen by an associate physician and they have the right to see the collaborating physician.⁵ 

If the associate will be prescribing controlled substances, he/she must obtain a Utah Controlled Substance License and comply with Utah laws and rules governing physicians who prescribe controlled substances. This includes fulfilling any CME requirements for controlled substance prescribers. In addition, the collaborative practice agreement must: 

• Outline the associate’s authority to prescribe Schedule III through V drugs; 
  
  
• List the controlled substances the collaborating physician authorizes the associate to prescribe;
   
• Confirm that controlled substance prescribing is consistent with the education, knowledge, skill, and competence of the collaborating and associate physicians; and
   
• Include documentation of the associate’s mid-level practitioner DEA registration.⁶ 

Can an associate use the “Dr.” title? 

An associate can use the title “Dr.” but must clearly identify himself/herself as an associate physician.⁷ 

What are the collaborating physician’s duties? 

To comply with the law, collaborating physicians must: 

• Ensure that they and their associate physicians are appropriately licensed and practicing according to a DOPL-approved collaborative practice agreement; 
  
  
• Remain available to their associate physicians for advice, consultation, and direction consistent with the standards and ethics of the profession and considering the associate’s skill, training, and competence levels;
   
• Assume responsibility for continuous oversight of their associates;
   
• Accept responsibility for their associates’ care; and  
  
  
• Monitor their associates’ performance for compliance with the laws, rules, standards, and ethics of the profession and report violations to DOPL.⁸ 

What are the associate’s duties? 

Associates must: 

• Comply with the laws, rules, standards, and ethics of the profession; 
  
  
• Enter into a DOPL-approved collaborative practice agreement before rendering any care; and 
  
  
• Maintain required licensure and DEA registration.⁹ 

What if a collaborating physician has concerns about an associate’s performance? 

The law requires the collaborating physician to submit to DOPL a written explanation of concerns if the physician: 

• Terminates a collaborative practice agreement for cause; 
  
  
• Does not support continued licensure of an associate in the state of Utah; or 
  
  
• Has other concerns about an associate that the physician believes require input from DOPL or the Board.¹⁰ 

When DOPL receives such a report, DOPL will: 

• Provide the associate an opportunity to respond in writing;
   
• Review the physician’s statement with the Board; and 
  
  
• Work with the Board to take any appropriate licensure action.¹¹ 

Can a collaborative practice agreement be modified? 

The collaborating and associate physicians may agree to modify their arrangement, but changes are not binding unless the associate notifies DOPL of the changes within 10 days and DOPL approves the changes.¹² 

Risk Management Strategies 

When working with associates, collaborating physicians and their practices should look for ways to make statutory compliance foolproof. Consider developing the following: 

• A written, standardized process to evaluate and track the associate’s skills and competency level. Complete and document an initial evaluation and periodic evaluations after that (consider quarterly). Keep copies in the associate’s personnel file.
   
• A policy and “workflow” that provides for frequent collaboration “meetings” and describes how supervision/collaboration and regular review of medical records entries will be documented. The goal is to make sure the physician can show the required collaboration with the associate.  
   
• A process to obtain patients’ consent to care and treatment the first time they are seen by an associate. Document the discussion and consent in the medical record or use a standardized form patients sign after the discussion.
   
• A clinical training “curriculum” consistent with the terms of the Collaborative Practice Agreement. 

 

If you have questions about transitional training permits or would like to schedule a medical professional liability risk consultation, please contact The Risk Team directly at 800-705-0538 or rm_info@mica-insurance.com. Our experienced Risk Consultants are standing by to answer your questions. 

^{[1] Utah Code § 58-67-807(3)(b)}

^{[2] Id. § 58-67-302.8}

^{[3] Id. § 58-67-303(1)(a) & (4)}

^{[4] Id. §§ 58-67-302.8(2)(a)-(b) & 58-67-807; Utah Admin. Code R156-67-807; https://dopl.utah.gov/wp-content/uploads/2023/07/Restricted-Associated-Physician-Collaboritve-Practive-Agreement.pdf}

^{[5] Utah Code § 58-67-807(1)(b)(v), (vi), & (ix).}

^{[6] Id. § 58-67-807(1)(b)(ix)(A)-(B) & (2)(c); https://dopl.utah.gov/wp-content/uploads/2022/08/restricted-associate-physician-and-surgeon-application.pdf}

^{[7] Utah Code § 58-67-807(2)(a)&(b)}

^{[8] Utah Admin. Code R156-67-807(6)(a)-(d)}

^{[9] Id. at R156-67-807(7)(a)-(d)}

^{[10] Id. at R156-67-807(8)(a)(i)-(iii)}

^{[11] Id. at R156-67-807(8)(b)(i)-(iii)}

^{[12] Id. at R156-67-807(3)(c)}