Delaware’s new Physician Associate Act changes the ground rules for physician associates and the medical practices that employ, collaborate with, or contract with them.
On May 12, 2026, Governor Meyer signed House Bill 325, which, for the first time in Delaware, created a path for experienced physician associates to practice without a collaborating physician. The questions the new law raises depend on who is asking them.
- A practice group wants to know how many physician associates its physicians may engage and what those physicians remain responsible for.
- A physician associate wants to know whether he or she qualifies to practice independently and how the application will work.
- A physician associate who delivers telehealth through his or her own limited liability company wants to know whether the new law permits that arrangement at all.
This article addresses each of the three in summary. Three companion articles address each in detail.
*NOTE: The new law renamed the profession. “Physician assistant” is now known as “physician associate.” Accordingly, I will use “physician associate” throughout this series.
What House Bill 325 did
In addition to changing the name of the profession, two other facets to the physician associate statute are worth noting.
- It created independent practice authority. A Delaware-licensed physician associate with more than 6,000 post-graduate clinical practice hours may apply to the Regulatory Council for Physician Associates for authority to practice without a collaborative agreement. We refer to this below as “independent practice authority” or “IPA.”
- It left most of the existing framework in place. Collaboration remains the default for every physician associate who does not hold IPA, and the four-physician-associate collaboration cap, which is the provision that most constrains a growing practice, was not amended.
When the new law becomes operational
House Bill 325 was signed on May 12, 2026. Although the Act carries a May 12, 2026 effective date, the new independent-practice framework is not fully operational until the earlier of Board approval of implementing regulations or May 12, 2027.
TIP: The planning window is open even though the filing window is not. Practices reviewing their collaboration coverage and physician associates assembling documentation of their clinical hours should do that work now and be prepared to file once the forms are issued.
For practice groups
Independent practice authority is the headline, but the four-physician-associate cap is the compliance trap for the unwary. Under 24 Del. C. § 1771, a collaborating physician may not, at any given time, collaborate with more than four physician associates. The Board’s regulation makes clear that this is a concurrent, point-in-time limit rather than a limit on relationships, so a physician may hold more than four collaborative agreements provided that no more than four are active at once.
Three categories fall outside the cap.
- Physicians and physician associates practicing in the same physical office or facility building are exempt where there is active physician coverage.
- Nurse practitioners are not subject to any ratio at all.
- Physician associates holding independent practice authority likely do not count toward the four-physician-associate cap, although that reading rests on the statutory text and has not been confirmed by the Board.
[Read more: How Delaware’s Four-Physician-Associate Collaboration Cap Works]
For physician associates
Collaboration remains the default. Under 24 Del. C. §§ 1772 and 1774E, a physician associate may not perform any medical act without a collaborative agreement except in a medical emergency, in uncompensated volunteer or charitable care, or under independent practice authority.
Independent practice authority requires more than 6,000 post-graduate clinical practice hours, and there is no discretionary waiver below that threshold. A qualifying physician associate must apply to the Regulatory Council, which verifies the hours. There are two application tracks, and which one applies depends on whether at least one Delaware-licensed physician practices in the group.
What independent practice authority does not do is equally worth understanding. It does not end the duty to consult and refer and it does not displace the license from which all of a physician associate’s authority flows.
[Read more: Independent Practice Authority for Delaware Physician Associates]
For telehealth providers and physician-associate-owned entities
Telehealth is squarely within a physician associate’s scope and the collaboration rules were drafted to work remotely. Under 24 Del. C. § 1770A, constant physical presence of the collaborating physician is not required so long as the physician is readily accessible by electronic communication.
Two points nonetheless catch telehealth practices by surprise. The four-physician-associate cap applies to remote practice unchanged, but its same-building exception does not reach a distributed arrangement. Thus, telehealth practices have fewer compliance options than brick-and-mortar practices, not more. In addition, Delaware’s general telehealth statute, 24 Del. C. ch. 60, imposes its own requirements on top of everything in the Physician Associate Act.
On the ownership question, a Delaware physician associate can very likely own the entity through which he or she practices and an ordinary limited liability company is generally the appropriate form. Section 1772(a), however, prohibits a physician associate from maintaining or managing a location that lacks collaborating-physician oversight and House Bill 325 carved out only those physician associates who hold independent practice authority. For that reason, entity structure and independent practice authority are not separate questions.
[Read more: Telehealth, Limited Liability Companies, and Independent Practice]
Open questions
Several matters remain unresolved and are worth watching.
- Whether physician associates holding independent practice authority count toward the four-physician-associate cap. The statutory text indicates that they do not, but the Board has not addressed it.
- When the Regulatory Council’s regulations and application forms will issue. They are the trigger for everything else in the new framework.
- Whether Delaware will develop a corporate-practice-of-medicine position, now that a statute expressly contemplates practice settings with no physician in the group.
We will update these articles as the regulations issue. Practices and physician associates evaluating their position under the new law are advised to consult with counsel familiar with both Delaware’s professional licensure requirements and its entity statutes, because the two intersect more than they first appear to.
Andy Silverman is a partner in the Business Department at MacElree Harvey, Ltd. He advises medical practices and providers on business structure and governance, equity and physician compensation arrangements, employment agreements, private equity and M&A transactions, and regulatory and tax matters. Admitted in both Delaware and Pennsylvania, he holds an LL.M. in Taxation from Villanova University School of Law and is a member of the American Health Law Association.
This article reflects Delaware law as of August 4, 2026. Several provisions discussed carry 2026 effective dates, and the Regulatory Council’s implementing regulations had not been adopted as of publication.
This article is for general informational purposes and does not constitute legal advice or create an attorney-client relationship. Attorney advertising.
