PA Ownership: Know the Rules: Insights from running practices in Dallas–Fort Worth and North Carolina

Kris Pyles-Sweet, DMSc, PA-C

National Leader | Advancing the PA Profession Through Advocacy, Governance & Policy | Keynote Speaker • Educator • Author & Editor

I have owned and operated medical practices in two states: Dallas–Fort Worth, Texas, and North Carolina. Each taught me the same lesson differently: owning a practice is not one question but two. For PAs opening a practice today, ownership and clinical authority are separate questions: state entity rules govern ownership, while licensure, scope of practice, prescribing, and applicable physician-relationship requirements govern the care a PA may provide. ¹

Texas: Shared Ownership

Texas Medical Board guidance requires that physicians be free to use their medical judgment without interference from non-physicians.² Texas law does let physicians and PAs co-own a practice entity — a professional association or PLLC.³ For a newly formed physician–PA entity, the conditions are firm: the PA or all PAs combined may hold only a minority interest, no individual PA's interest may equal or exceed any individual physician's, a PA may not serve as an officer, and an organizer must be a physician who ensures physicians control and manage the entity.³ A PA may not employ or contract with a physician to be the PA's supervising physician within the entity.³ Jointly owned physician–PA entities also owe the Texas Medical Board an annual report.⁴

North Carolina: Sole Ownership

North Carolina Medical Board guidance states that a licensed PA may form and fully own a professional corporation or PLLC to render PA services.⁵ The guidance also permits physicians and PAs to jointly own stock with no rule on how shares split.⁶ A practice owned in its entirety by PAs, however, may not hire or contract with physicians to practice medicine on its behalf.⁶ Such a practice may provide PA services and permitted ancillary services, but contracting for physician supervision, where required, is a separate arrangement the Board's guidance permits.⁶ Professional entities must meet NC Medical Board registration requirements, and ownership changes require prior Board approval.⁵

The Takeaway

Texas restricts PA equity but requires physician control; North Carolina lets a PA own outright but limits what the practice can be.³,⁶ Verify your state's rules and consult healthcare counsel before forming or expanding a practice.⁷

References

1.      Barton Associates. In what states can physician assistants (PAs) practice independently? Published September 8, 2026. Accessed October 13, 2026. https://www.bartonassociates.com/blog/physician-assistant-pa-independent-practice/

2.     Texas Medical Board. TMB Bulletin. Accessed October 13, 2026. https://www.tmb.state.tx.us/media/61/download?inline

3.     Tex Bus Org Code Ann § 301.012. Accessed October 13, 2026. https://texas.public.law/statutes/tex._bus._orgs._code_section_301.012

4.     22 Tex Admin Code § 174.5. Accessed October 13, 2026. https://www.law.cornell.edu/regulations/texas/22-Tex-Admin-Code-SS-174-5

5.     North Carolina Medical Board. Professional FAQs: practice ownership. Accessed October 21, 2026. https://www.ncmedboard.org/resources-information/faqs/professional-faqs/practice-ownership

6.     North Carolina Medical Board. PA and NP ownership of professional corporations. Accessed October 13, 2026. https://www.ncmedboard.org/images/uploads/other_pdfs/PA_and_NP_Ownership_of_Professional_Corporations.pdf

7.     Physicians Practice. Liability checklist for buying a medical practice. Accessed October 13, 2026. https://www.physicianspractice.com/view/liability-checklist-buying-medical-practice