Do Nurse Practitioners Need a Supervising Physician in California?

Are you a California-based nurse practitioner (NP) looking for greater autonomy in your practice? Perhaps you're an aspiring NP wondering, "Do nurse practitioners need a supervising physician in California?" 

Whatever your situation, this guide is here to illuminate the path forward.

Assembly Bill 890 (AB 890) has ushered in a transformative era for NPs in California. This landmark legislation significantly impacts supervision requirements, paving the way for independent practice for NPs.

Let’s dive into the details of AB 890, explore the newly established two-tiered licensing system for NPs, and unpack how it translates to your specific career path, particularly in the setting of a medspa.

Do nurse practitioners need a supervising physician in California?

Please note: The information provided in this article is for general informational purposes only and does not constitute legal advice. It is recommended to consult with your respective state boards, a licensed attorney, or your malpractice carrier to ensure that you are practicing within the letter of the law and adhering to all regulatory requirements. The regulations regarding aesthetic treatments and medical spas can vary from state to state and may change over time.

The question of physician supervision for California nurse practitioners (NPs) has evolved. Previously, a yes was the clear answer.

However, the landscape has shifted thanks to Assembly Bill 890 (AB 890).

AB 890 now offers a path towards independent practice for qualified NPs, eliminating the mandatory requirement for constant physician oversight.

This exciting development comes with a two-tiered licensing system, creating a step-by-step approach for NPs to achieve full autonomy.

AB 890: A new era for California nurse practitioners

In 2020, California took a significant step forward with AB 890. This legislation expanded the scope of practice for NPs, granting them the ability to practice independently under specific conditions.

This move aimed to increase access to quality healthcare, especially in underserved areas.

California’s two-tier system for NPs

AB 890 created a unique system for nurse practitioners in California. Unlike some states with a single "independent practice" license, California has a two-tiered approach with the "103 NP" and "104 NP" licenses.

Let's dive deeper into what each signifies and how it impacts your ability to practice independently.

103 NP

The 103 NP license is your launchpad for independent practice. Here's what it offers:

• Independent practice with a safety net: This license allows you to practice independently, but you must operate within a facility that has at least one practicing physician (MD) or surgeon (DO) accessible.
  
  This ensures that consultation and collaboration are readily available if needed.

• Flexibility in collaboration: The collaboration with the on-site physician doesn't require a formal written agreement. This gives you more flexibility in how you structure your practice.

What 103 NP looks like in action

Sarah Jones is a 103 NP working at a medspa. She sees patients for consultations about neuromodulator injections. During the consultation, she assesses the patient's suitability for the treatment, discusses desired outcomes, and explains potential side effects.

Based on this assessment, Sarah can independently create a treatment plan and perform the injections herself. However, if a patient has a history of certain neurological conditions, Sarah can easily consult with the medspa's on-site medical director for further guidance before proceeding.

104 NP

The 104 NP license provides the maximum independence for NPs in California. Here's what it entails:

• Unrestricted practice: With a 104 NP license, you can practice independently in any setting, without geographical limitations. You don't need a collaborating physician on-site.
  
  This grants you the ultimate freedom to establish your own practice or work in any healthcare environment that suits your preferences.

• Full responsibility and recognition: As a 104 NP, you take on full responsibility for the care you provide to your patients. This signifies the trust placed in your expertise and qualifications. You can also enjoy the professional recognition that comes with complete autonomy.

104 NP in action

Michael Lee is a 104 NP who owns and operates his own medspa specializing in laser skin rejuvenation. He conducts consultations, explains different laser treatment options to patients, and personally performs the procedures.

Mr. Lee manages his entire practice independently, ensuring a seamless patient experience from start to finish.

Important note:

Only 103 NP licenses are being issued at this time since you need to be a 103 NP for a period of three years. The 104 NP option won't be available until 2026.

This allows you to gain valuable experience as a 103 NP within a medspa setting. Use this time to hone your skills, build a strong client base, and establish yourself as a trusted expert in aesthetic treatments.

The 103 NP license and its requirements

The 103 NP license offers a fantastic opportunity to expand your skill set and gain valuable experience while working autonomously within a supportive framework.

Let's get into the specifics of obtaining and using a 103 NP license.

Eligibility requirements:

• Registered Nurse (RN) license: This is the foundation. You must be a licensed RN in good standing with the California Board of Registered Nursing (BRN).

• Master's degree in Nursing (NP program): Hold a Master of Science in Nursing (MSN) degree with a specialization in a field relevant to your area of practice within the medspa setting. This could be aesthetics, dermatology, or a related field.

• National certification: Maintain a current national certification from a recognized organization in your area of practice. Examples include the American Nurses Credentialing Center (ANCC) or the American Association of Nurse Practitioners (AANP).

• Experience requirement: Here's where California's new law stands out. You'll need a minimum of 4,600 hours of clinical experience working as an NP in California within the past five years. This experience can be obtained through various avenues, such as working in a hospital, clinic, or even another medspa.

Operational considerations for 103 NPs:

While the 103 NP license grants you independence, it also comes with some operational constraints:

• Facility with an on-site physician: You can practice independently, but within a facility that has at least one licensed physician (MD) or surgeon (DO) on-site.
  
  This physician doesn't need to be physically present all the time, but their availability for consultation and collaboration is crucial.

• Informal collaboration: The collaboration with the on-site physician doesn't necessitate a formal written agreement.
  
  This allows for flexibility in how you structure your practice within the medspa. You can establish a working relationship with the physician, ensuring access to their expertise for specific cases or procedures.

• Supervision vs. collaboration: It's important to understand the distinction between supervision and collaboration. Under the 103 NP license, you won't be directly supervised by the physician. 

Instead, you'll be collaborating with them, leveraging their experience for complex situations while managing your patients independently for most routine procedures within the medspa setting.

Advancing to full autonomy: The 104 NP license

The ultimate goal for many NPs is the 104 NP license. This golden ticket grants you full practice authority, allowing you to practice independently in any setting without the need for a collaborating physician on-site.

While it isn't available yet, understanding the requirements and future steps will prepare you to seize this exciting opportunity when it becomes available in 2026.

Eligibility for the 104 NP license:

The key to unlocking the 104 NP lies in experience and proven competence:

• Three years as a 103 NP in good standing: California requires a minimum of three years of experience working as a 103 NP with a clean record. This ensures you've gained the necessary experience and honed your skills in independent practice within a medspa setting.

Additional practice requirements for 104 NPs:

While the specific details may be forthcoming from the California BRN, here are some potential additional requirements you might encounter:

• Continuing education: The BRN may mandate ongoing continuing education specific to independent practice and areas relevant to medspa services. This ensures you stay up to date on the latest advancements in aesthetics and maintain the highest level of competence.

• Quality assurance measures: The BRN might implement quality assurance measures to evaluate the performance of 104 NPs. This could involve patient satisfaction surveys, random audits of practice procedures, or maintaining a certain level of malpractice insurance.

Obtaining a 104 NP license signifies a significant achievement and comes with immense advantages:

• You'll have the freedom to establish your own medspa or take a leadership role in an existing one. There are no geographical limitations on where you can practice. You'll be able to design the treatment environment, curate the service menu, and build your practice according to your vision.

• As a 104 NP, you'll take complete responsibility for all aspects of patient care within your medspa. This includes consultations, treatment plans, execution of procedures, and ensuring the overall quality and safety of services provided.

The buck stops with you, and the success of your practice hinges on your expertise and management skills.

Preparing for the 104 NP future

While the 104 NP isn't available yet, here's what you can do to prepare:

• Excel as a 103 NP: Focus on delivering exceptional patient care, honing your aesthetic skills, and building a strong reputation within your medspa.

• Stay informed: Keep yourself updated on the latest developments regarding the 104 NP license by monitoring the California BRN website.

• Consider further education: While not mandatory, pursuing additional qualifications in areas like medical spa management or business administration could strengthen your profile and prepare you for the leadership responsibilities that come with a 104 NP license.

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