Andrew R. Silverman

This article is part of a series on Delaware’s new Physician Associate Act. Start with Delaware’s New Physician Associate Act: What Changed and Who It Affects. 

A physician associate who has practiced in Delaware for several years and is considering what comes next now has an option that did not exist a year ago. House Bill 325, signed May 12, 2026, permits a physician associate with sufficient clinical experience to seek authority to practice without a collaborating physician. 

The question that follows is a practical one: who qualifies, how does the application work, and what does the authority actually change? The threshold is specific, the application runs through a body most physician associates have never dealt with, and the authority does somewhat less than the coverage of the new law suggests. 

Collaboration remains the default 

Except in a medical emergency or as otherwise provided, a physician associate may not perform any medical act without a collaborative agreement, and nothing in the chapter authorizes a physician associate with fewer than 6,000 post-graduate clinical hours to practice independent of a collaborating physician. (24 Del. C. § 1772.) 

There are exactly three exceptions. 

1. Independent practice authority, discussed below. We refer to it throughout as “independent practice authority” or “IPA.” 

2. Uncompensated volunteer or charitable care, which may be rendered without a collaborating physician, or with such collaborating physicians as are available. (24 Del. C. § 1774E.) 

3. A medical emergency. 

That is the complete list. Seniority alone does not qualify a physician associate to practice independently, and neither does an employer’s willingness to operate without oversight. 

What independent practice authority requires 

More than 6,000 post-graduate clinical practice hours. Below that threshold, independent practice is expressly unauthorized and there is no discretionary waiver. For a physician associate practicing full time, the threshold generally arrives somewhere around the three-to-four-year mark, although part-time and intermittent practice will extend that considerably. 

An application to the Regulatory Council for Physician Associates. A qualifying physician associate who intends to practice without a collaborative agreement must apply, and the Council verifies the hours. 

One of two application tracks. Which track applies matters more than it initially appears. 

1. Practice in a setting with at least one licensed Delaware physician in the group, practice, or health system. 

2. Practice in a setting without such a physician. This track additionally requires proof that the physician associate has had training which aligns to the physician associate’s practice areas. 

Both forms require the physician associate’s name, license number, practice location, contact information, primary practice area, and proof of the required hours. In addition, a physician associate who later changes practice areas must notify the Council beforehand, again with proof of aligned training. 

The second track is the one that matters for a physician associate planning a solo practice or a practice without a physician in the group, and it carries the additional documentary burden. 

When applications can be filed 

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. 

Those regulations have not been adopted as of the date of this article. Thus, the application forms described in the statute do not yet exist in usable form and no physician associate can presently file. The outside date is May 12, 2027, though the regulations may issue sooner. 

What independent practice authority does not do 

• It does not end the duty to consult and refer. Every physician associate, whether or not he or she holds independent practice authority, must collaborate with, consult with, and refer to the appropriate member of the healthcare team as indicated by the patient’s condition and by the physician associate’s own education, experience, and competencies. Independent practice authority removes the collaborative agreement; it does not remove the underlying obligation of clinical judgment, and it does not alter the standard of care. 

• It does not displace the license. A physician associate’s authority flows entirely from the Chapter 17 license. Treating a Delaware patient constitutes practice “in this State,” and unlicensed practice as a physician associate is a criminal offense carrying a fine of $500 to $2,000, imprisonment of up to one year, or both. (24 Del. C. § 1774B.) This is most easily overlooked by physician associates practicing remotely, who may assume that their physical location governs. It does not. 

• It does not by itself authorize a physician associate to own or operate a practice. Ownership of a practice entity and authority to practice independently are related but distinct questions, and Section 1772 contains a provision concerning the maintenance or management of a practice location that reaches physician associates who have not obtained independent practice authority. A physician associate planning to practice through his or her own limited liability company should review that provision before forming anything, and we address it in detail in the telehealth and entity structure article. 

A note for physician associates re-entering practice 

A physician associate returning after more than three years away from practice, including one who was practicing in another United States jurisdiction, may be subject to Board-imposed re-entry conditions. Those conditions may include requiring the collaborating physician to be physically on site while the physician associate is practicing. (24 Del. C. § 1774D.) 

An on-site requirement will foreclose remote practice for as long as it remains in force. A physician associate planning a telehealth practice after time away from Delaware should therefore resolve this question before building a practice model around remote delivery. 

What can be done while the regulations are pending 

Although no application can be filed today, the preparatory work is entirely documentary and can begin immediately. 

1. Assemble documentation of clinical hours. Verification is the Council’s responsibility, but assembly is the applicant’s, and reconstructing several years of clinical hours after the fact is considerably more difficult than exporting the records while system access to a current or former employer remains available. Physician associates who have changed positions more than once should begin here. 

2. Map training records to intended practice areas. For a physician associate who plans to practice in a setting with no Delaware physician in the group, the aligned-training requirement is, on the statutory language, the item most likely to delay an application. Continuing education certificates, specialty training records, and procedure logs are all more easily gathered now than under a filing deadline. 

3. Consider the practice area designation carefully. Because a later change in practice areas requires advance notice to the Council together with fresh proof of aligned training, the designation on the initial application is not a formality. 

TIP: If a change in employment is contemplated in the next year, gather the hour documentation before giving notice. Former employers are generally cooperative, but requests made after a departure move more slowly than requests made before one. 

Conclusion 

The qualifying threshold is hours, the gatekeeper is the Regulatory Council, and the preparation is documentary, which means it can be substantially completed before the application process opens. 

Physician associates considering independent practice, and particularly those contemplating a practice with no physician in the group, are advised to review both their documentation and their intended practice structure with counsel before the regulations issue, because the entity and licensure questions are more closely connected than they first appear. 

Also in this series: [Telehealth, Limited Liability Companies, and Independent Practice] and, for employers, [how the four-physician-associate collaboration cap works]. 

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. 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. 

This article is part of a series on Delaware’s new Physician Associate Act. Start with Delaware’s New Physician Associate Act: What Changed and Who It Affects. 

A growing number of physician associates deliver care remotely through an entity they own, contracting with a collaborating physician rather than working as that physician’s employee. It is an efficient structure, and Delaware’s House Bill 325, signed May 12, 2026, changes what it can look like. 

Three questions drive the analysis. Does the collaboration cap follow a physician associate into telehealth? What does Delaware’s general telehealth statute require on top of the Physician Associate Act? And may a physician associate actually own the entity through which he or she practices? 

The short answers are yes, a good deal, and probably. The details are where the structuring occurs. 

Telehealth is within scope, and collaboration may be electronic 

The Act lists among a physician associate’s authorized medical acts the use of telemedicine and the use of and participation in telehealth, and a physician associate may be designated a primary care provider by an insurer. (24 Del. C. § 1773.) 

The collaboration rules were drafted to work remotely. Constant physical presence of the collaborating physician is not required on site, provided that the collaborating physician is readily accessible by some form of electronic communication. (24 Del. C. § 1770A.) Where the physician is not routinely present, adequate means and methods may include telecommunication, chart review, or other methods of communication and oversight. (24 Del. C. § 1771.) 

One limitation survives all of this. The collaborating physician may not be involved in patient care in name only and must be involved in active patient care on a regular basis. A collaborating physician who signs an agreement, collects a monthly fee, and never opens a chart is therefore not a compliance structure; that arrangement places the physician’s license at risk and, by extension, the continuity of the practice that depends on it. 

The cap applies to remote practice, but its exception does not 

The four-physician-associate concurrent cap applies to remote practice unchanged. A collaborating physician may not collaborate with more than four physician associates at any given time. (24 Del. C. § 1771.) 

The cap’s exception, however, is tied to physicians and physician associates practicing in the same “physical office or facility building,” and a distributed remote arrangement across multiple locations does not satisfy that language. 

The result is somewhat counterintuitive. A telehealth practice has fewer compliance options than a brick-and-mortar practice, not more, because the exception most readily available to a physical clinic is simply unavailable to it. What remains is scheduling discipline, the addition of collaborating physicians, the use of physician associates holding independent practice authority, and an application to the Board for an exemption. 

Telehealth rules apply in addition to the Physician Associate Act 

Because physician associates are licensed by the Board of Medical Licensure and Discipline, they are authorized to deliver telehealth subject to the provisions of Delaware’s general telehealth statute. (24 Del. C. ch. 60.) That chapter imposes requirements entirely independent of the collaboration rules. 

• A provider-patient relationship, which may be established in person or by telehealth, including verification of the patient’s location, disclosure of the provider’s identity and credentials, informed consent, a diagnosis by acceptable medical practices, a discussion of options, follow-up coverage, and a written visit summary. (§ 6003.) 

• The same standard of care as in-person treatment. Treatment is held to in-person standards, and prescribing based solely upon an internet questionnaire or consultation is prohibited. (§ 6003.) 

• An approved modality before diagnosis or treatment, meaning an in-person examination, another Delaware-licensed provider present at the originating site, diagnosis by audio or visual communication, or compliance with professional-society telemedicine guidelines, together with complete recordkeeping. (§ 6004.) 

The statutory definitions of “telehealth” and “telemedicine” are broad, reaching real-time two-way audio-visual communication, audio-only communication where broadband is unavailable, and store-and-forward transfer. That last category is worth noting for image-based specialties such as dermatology, where the asynchronous workflow is generally the practice model rather than a fallback. 

The patient’s location governs, not the provider’s 

This point is frequently misunderstood and it is worth stating directly. Delaware keys telehealth authorization to the Delaware license and to the patient’s location and not to where the provider happens to be. 

The statutory definitions confirm it. An “originating site,” meaning the patient’s location, “means a site in Delaware.” A “distant site,” meaning the provider’s location, “means a site at which a health-care provider legally allowed to practice in Delaware is located,” and carries no Delaware-location requirement. (24 Del. C. § 6001.) The operative trigger is verification of the patient’s location. 

Two consequences follow. 

1. Delaware’s interstate telehealth registration is not the pathway for a Delaware-licensed physician associate. That registration exists for providers licensed in a state that has not adopted an interstate compact and who are not otherwise licensed in Delaware. A physician associate who already holds a Delaware license practices under the license authorization instead. 

2. Delaware law does not resolve the requirements of the provider’s home state. Chapter 60 governs the Delaware side only. It does not require a physician associate to be licensed where he or she physically sits, and it does not speak to that state’s law. Whether the state in which the provider is located independently regulates practice originating there is a separate, state-by-state question that Delaware law does not answer, and it should be cleared for every provider in every state from which that provider works. In our experience, this is the most common gap in otherwise well-constructed remote practices. 

May a physician associate own the practice entity? 

For a physician associate forming a limited liability company and contracting with a collaborating physician, this is the threshold question. The answer is a qualified yes, subject to one significant limitation and several open items. 

Entity eligibility is not the obstacle 

The statute defines a physician associate as an individual who “is licensed under this chapter to practice medicine as a physician associate.” (24 Del. C. § 1770A.) That satisfies the predicate in Delaware’s Professional Service Corporation Act, which extends eligibility to persons “duly licensed or otherwise legally authorized to render the same professional service.” (8 Del. C. §§ 603, 605.) Because the Act’s test is licensure or other legal authorization to render the service, rather than possession of a full physician’s certificate, a physician associate qualifies. 

Delaware does not mandate a professional entity and has no professional LLC statute 

The professional corporation regime is an optional overlay rather than the exclusive path, and Delaware has no separate professional limited liability company act. Professional services may accordingly be delivered through an ordinary limited liability company formed under the general Limited Liability Company Act. (6 Del. C. ch. 18.) 

Physician associates coming from states that have a professional limited liability company form are often misled by the terminology. In Delaware, professional restrictions on ownership and transfer are written into the operating agreement by contract rather than supplied by the entity form itself. That is more flexible, but it also means that nothing protects the owners by default. 

If a professional corporation is used, all owners must render the same professional service 

Where a physician associate elects the professional corporation form, the same-profession ownership limitation applies. Every shareholder must be an individual duly licensed or otherwise legally authorized to render the same professional service, and the only multi-profession combination the Act permits is the practice of medicine together with the practice of podiatry. (8 Del. C. §§ 603, 610.) 

The consequence is direct. A physician associate and a collaborating physician cannot co-own a Delaware medical professional corporation. For any arrangement contemplating shared equity between a physician associate and the collaborating physician, that limitation alone generally settles the entity choice in favor of the limited liability company. 

The limitation to watch 

Under 24 Del. C. § 1772(a), a physician associate “may not maintain or manage a location that does not have oversight by the physician associate’s collaborating physician.” 

Read against a physician-associate-owned practice entity, the implication is immediate. A physician associate who owns the limited liability company but does not hold independent practice authority must have collaborating-physician oversight of that location. House Bill 325 did not repeal the provision; it carved out around it, exempting a physician associate granted independent practice authority from the section entirely. (24 Del. C. § 1772(i).) 

For that reason, entity ownership and independent practice authority are not separate questions. For a physician-associate-owned practice, independent practice authority is not merely a convenience that eliminates a collaborative agreement. It is what removes the maintain-or-manage limitation on the practice location itself, and the two should be sequenced accordingly. 

TIP: Where the 6,000-hour threshold is still some distance away, the practical structure is generally to form the entity now and to build genuine collaborating-physician oversight of the location into the collaboration agreement, rather than to defer formation. The entity can then continue unchanged once independent practice authority issues. 

Ownership is not authority 

Finally, and importantly, owning the entity does not authorize independent practice. The collaboration requirement runs to a physician associate’s clinical acts rather than to the ownership of the practice. A physician associate who forms an entity while still short of the 6,000-hour threshold has organized a business, not expanded a license. 

Open items to consider before committing capital 

Several questions in this area remain genuinely unresolved, and a physician associate building a practice around this structure should understand them at the outset. 

• Corporate practice of medicine. Delaware has no clear position. No statute, reported decision, Board regulation, or Attorney General opinion squarely addresses whether an entity may employ physicians or physician associates to render medical services. The conclusion above therefore rests substantially on the absence of a prohibition rather than on affirmative authority, which is a materially weaker foundation even if it is the correct reading. (At least one commercial source in circulation asserts that Delaware enforces corporate practice restrictions through the Professional Service Corporation Act. That appears to be an over-reading, since the chapter binds only those entities that elect to organize under it.) 

• Payor credentialing. Whether commercial payors will credential a physician-associate-owned entity in Delaware is not documented. The statute now provides that physician associates must be authorized to bill for and receive direct payment for the medically necessary services they deliver, and that no insurance company or third-party payer may impose a practice, education, or collaboration requirement inconsistent with or more restrictive than state law. Whether payor operations have caught up to those provisions is a separate question, and a statute only months old has likely not yet resolved it in practice. 

• Delaware Medicaid. Published Delaware Medicaid materials appear to condition billing for physician associate services on the individual being in an enrolled practitioner’s or enrolled group’s employ, and those materials predate House Bill 325. The current posture should be confirmed with the Division of Medicaid and Medical Assistance directly rather than taken from the published manual. For a physician-associate-owned entity with meaningful Medicaid volume, this is a threshold question of viability rather than a detail. 

• Federal law operates independently. Compensation flowing from a physician-associate-owned entity to a collaborating physician implicates the federal Anti-Kickback Statute and its personal services safe harbor, and where that physician also refers into the entity, the Stark Law is implicated as well. None of this was affected by House Bill 325, and all of it can defeat an arrangement that is entirely lawful as a matter of Delaware entity law. 

Conclusion 

A Delaware physician associate may very likely own the entity through which he or she practices, and a limited liability company formed under the general Limited Liability Company Act is ordinarily the appropriate form rather than a professional corporation. Independent practice authority is what removes the limitation on maintaining or managing the practice location, and it should therefore be sequenced ahead of the entity build rather than treated as a later upgrade. The four-physician-associate cap follows the practice into telehealth without the same-building exception that assists physical clinics. And the unresolved risk in this structure sits in payor credentialing and federal compensation analysis rather than in Delaware entity law. 

For a physician associate building this kind of practice, the order of operations matters at least as much as the entity documents. We generally recommend confirming the hours, identifying the applicable application track, testing payor credentialing early, and structuring the collaborating physician’s compensation against the federal safe harbors before any agreement is signed. 

Also in this series: [the overview], [how the four-physician-associate collaboration cap works](#), and [independent practice authority eligibility and application]. 

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. 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.

Author: Andrew R. Silverman, Business Attorney at MacElree Harvey, Ltd.

Imagine staring into your computer as a grid of unfamiliar faces—lawyers, accountants, and private equity professionals—fires questions at you about every corner of your business: financials, taxes, contracts, leases, customers, suppliers, employees, ownership, intellectual property, equipment, inventory, A/R, A/P, and more. The questions keep coming, rapid and relentless, and for hours you are expected to have clear, consistent answers. Would you? 

The reality is that the more prepared you are when that moment arrives, the easier and more successful the process will be. Buyers–whether private equity firms or SBA-backed individuals– are looking for businesses they can understand, trust, and step into with confidence. These buyers are willing to pay more for that certainty. The best outcomes do not come from scrambling after a letter of intent is signed. They are the result of years of consistent financial reporting, clean corporate hygiene, documented relationships, and disciplined planning. 

What You Can Do Right Now 

Regardless of timing, owners can immediately improve exit readiness by reducing legal, financial, and operational ambiguity. 

• Document all related party arrangements, including leases and loans to owners 
• Get financials clean, consistent, and explainable 
• Confirm ownership and equity structure is clear and documented 
• Ensure all material contracts are signed and accessible 
• Eliminate “handshake” arrangements—reduce all agreements to writing 
• Centralize key documents (basic data room: organizational documents, tax filings, financials, employment agreements, IP, and contracts) 
• Reduce reliance on any single person, customer, or vendor 

Ask yourself: if you had to explain your business to a buyer tomorrow, what would be unclear—or undocumented? 

Startup Phase: Build for Transferability 

At formation, most owners are focused on getting a product or service into the market. While exit may not be top of mind, the decisions made at this stage will shape both how the business operates—and how easy it is to sell later. 

• Establish a clean legal structure—be deliberate about entity type, tax treatment, and cash flow 
• Ensure all intellectual property is clearly owned by the company, including through written assignments from employees and contractors 
• Avoid commingling and informal practices from the outset 
• Document all key relationships (employees, customers, vendors) 
• Require baseline protections (confidentiality and IP assignment agreements) 
• Establish financial discipline early 
• Build a trusted advisory team (accountant, banker, and legal counsel) 

You are not just building a business—you are building an asset someone else must be able to step into. 

Five Years from Sale: Institutionalize the Business 

At this stage, the business is established and performing. The focus shifts from growth to making the business legible—and credible—to a third party. Buyers are evaluating not just what the business can do, but how reliably it can continue to do it without you. 

• Develop management depth beyond the founder 
• Improve financial credibility—establish reviewed or audited financial statements and document any deviations or non-standard practices 
• Identify, resolve, and document any issues in the financials that require explanation (e.g., unusual accounting treatments, slow A/P, inconsistent margins) 
• Clean up legacy contracts and unresolved issues 
• Address customer concentration risk where possible 
• Evaluate tax and entity structure with a view toward an eventual exit and clarity to the buyer 

Buyers rarely expect perfection—but they quickly lose confidence where things are unclear. 

One Year from Sale: De-Risk the Transaction 

At this stage, the goal is to eliminate surprises. Buyers often lose confidence not because of performance, but because of what they find once diligence begins. If you identify and resolve those issues in advance, you control the narrative—and reduce the risk of late-stage disruption. 

• Conduct a mock diligence review—what will a buyer find when it reviews your business and its documents? Find those issues now—before the buyer does 
• Organize contracts, financials, and corporate records into a clear, accessible structure 
• Clean up working capital and unusual balance sheet items (common sources of price adjustments) 
• Resolve disputes, contingent liabilities, and informal arrangements before they surface in diligence 

At this stage, you are not increasing value—you are protecting it. 

Six Months from Sale: Optimize for Execution 

As a sale process begins, the focus becomes execution: speed, clarity, and credibility. At this point, preparation is visible—and it directly impacts how smoothly the process runs and how confident buyers feel. 

• Prepare a fully organized, diligence-ready data room 
• Ensure financial performance and the business narrative are consistent and explainable 
• Identify and resolve third-party consents and approvals in advance 
• Anticipate and prepare for key negotiation points (price adjustments, indemnification, etc.) 
• Maintain steady performance—buyers closely monitor any changes during the process 

Deals rarely fail late because of price—they fail because of uncertainty or loss of confidence. 

Closing Thought 

The best exits are not engineered at the end—they are revealed over time. The sale process effectively begins long before you decide to sell—often before the business is even formed. The earlier you approach your business with that reality in mind, the more control you will have over the outcome when the time comes. 

Andrew R. Silverman is a business attorney at MacElree Harvey, Ltd., where he represents clients in a wide range of corporate and commercial matters. His practice includes business formation, governance, contracts, mergers and acquisitions, succession planning, and general counsel services for businesses of all sizes. Andrew works closely with business owners and executives to provide practical, strategic legal guidance tailored to their goals.