You Don’t Need 100% Ownership to Build 100% Freedom: Why Partnering with a Physician Can Strengthen Your DPC Vision
Many PAs believe the only way to achieve true autonomy is by owning 100% of their medical practice.
It’s an understandable assumption. We associate ownership with control, and control with freedom.
But in reality, you don’t need full ownership to build a Direct Primary Care (DPC) practice that gives you time, flexibility, and purpose.
Across the country, PAs are discovering that the key to freedom isn’t independence from physicians. The key is collaboration with the right ones.
The Ownership Myth in PA Practice
When people talk about “PA-unfriendly” states, they’re usually referring to corporate practice of medicine (CPOM) laws. These are regulations that restrict who can own a medical practice.
These laws don’t target PAs specifically; they’re designed to prevent unlicensed individuals or corporations from profiting from clinical decision-making.
Here’s the truth:
No state outright bans PAs from owning a portion of a medical practice.
Some states simply require that a physician holds majority ownership or that the PA’s clinical work is tied to a supervising or collaborating physician.
That’s a limitation, yes. But it is not a barrier.
It just means you need to structure your business intelligently.
Autonomous Practice ≠ Independent Ownership
It’s easy to confuse autonomy in practice with ownership of a business.
State laws that define “collaboration” or “supervision” are talking about clinical authority, not business equity.
Functionally, PAs across the country already operate with a high degree of autonomy. We’re diagnosing, prescribing, and managing panels of patients every day. Even in “PA-unfriendly” states.
So the question isn’t “Can you function autonomously?”
It’s “Can you legally structure your business in a way that supports your autonomy?”
And the answer to that is absolutely!
The Collaborative Advantage
If your state requires a physician to be part of your ownership structure, that doesn’t mean you’ve lost your freedom.
In fact, it might be one of the smartest moves you can make.
Partnering with a physician gives you:
Shared vision and values. You both entered medicine to care for people, not chase billing codes.
Legal and operational protection. Physician ownership satisfies CPOM requirements and reduces regulatory risk.
Shared investment. You don’t have to carry the financial burden alone.
Built-in mentorship. A physician partner with business or clinical experience can strengthen your foundation.
Remember, the goal of DPC isn’t to “escape physicians” it’s to escape bureaucracy.
What “PA-Friendly” Really Means
Let’s redefine that phrase.
A PA-friendly state isn’t one that lets you own 100% of the practice.
It’s one that gives you maximum operational flexibility to deliver high-quality, relationship-based care.
In general, states fall into three broad categories:
Full-Ownership States:
These are the most flexible environments, where PAs can form and own their own medical entities outright. States like Utah, North Dakota, and North Carolina fall into this category. Here, you can operate a DPC practice under your own business name without a physician partner if you choose, provided you comply with the state’s supervision or collaboration requirements.Joint-Ownership States:
Many states such as Texas, California, and Maryland allow PAs to co-own a medical practice with a physician. In these cases, the physician must typically hold majority ownership (often 51%), while the PA can hold up to 49%. This structure satisfies corporate practice of medicine laws and still gives the PA significant operational control. In most of these partnerships, the PA manages day-to-day operations and patient care, while the physician’s ownership fulfills legal requirements and provides collaborative oversight.Operationally Restrictive States:
A few states add specific conditions for PAs working in separate or satellite locations. For instance, Pennsylvania and Iowa require that a supervising physician visit the satellite site periodically (for example, weekly or biweekly) to review patient records and ensure continuity of care. These rules are more about supervision logistics than ownership. They don’t prevent you from running a DPC practice, they just require additional documentation or periodic site visits.
The key takeaway is this: no state outright prohibits PAs from owning any portion of a medical practice. The differences lie in the structure and supervision requirements, not in whether ownership is possible.
Autonomy Lives in How You Practice, Not Who Owns the Paperwork
Let’s be honest, autonomy is less about legal structure and more about how you design your day-to-day practice.
Most PAs already work without a physician in the room.
They manage chronic conditions, order imaging, interpret labs, and build long-term relationships with patients.
If you can do all that under an insurance-based model that buries you in prior authorizations and coding complexity, imagine what you can do under DPC.
Ownership doesn’t create autonomy.
Systems do.
And DPC is that system.
How to Structure a DPC Practice Legally and Strategically
Depending on your state, there are several compliant ways to set up a DPC practice:
1. Joint PLLC or PC
Both the PA and physician hold ownership shares (often 49/51).
The PA runs operations and patient care; the physician fulfills CPOM requirements and offers collaboration.
2. MSO + Physician-Owned PC
The PA owns the Management Services Organization (MSO). The MSO is the business that handles operations, marketing, and administration.
The physician owns the Professional Corporation (PC) that employs clinicians and delivers care.
The MSO bills the PC for management fees, giving the PA control of revenue and brand direction.
3. Collaborative Agreement Model
Simplest form, the PA contracts with a physician collaborator rather than a co-owner.
This satisfies legal requirements while allowing independent business operation under a compliant framework.
All three structures allow you to maintain clinical autonomy, financial control, and professional integrity.
Returning to the Roots of the PA Profession
The Physician Assistant profession was born from collaboration.
PAs and physicians have always worked side by side, not in hierarchy but in harmony. Together we serve our communities where access to care is collapsing.
That same spirit applies today.
You don’t need to “get away from a physician” to gain autonomy.
You just need to work with one who shares your values, your mission, and your commitment to rebuilding primary care through the DPC model.
Autonomy doesn’t mean isolation.
It means alignment.
Freedom Isn’t About Percentage Ownership. It’s About Purpose
Whether you own 49% or 100%, freedom comes from building a practice that reflects your values: time with patients, trust, transparency, and direct access.
If your state requires a physician partner, embrace it.
Use that partnership to create something bigger than either of you could build alone.
At the end of the day, you don’t have to own 100% of the practice to own your future.
