August 2025

Missouri’s Collaborative Practice Under Fire—Physicians Must Stay Engaged

On August 21, Columbia nurse practitioner backed by the Pacific Legal Foundation (PLF) filed a lawsuit challenging Missouri’s collaborative practice agreement (CPA) requirement. The suit targets Attorney General Andrew Bailey and members of the state’s regulatory boards, namely the Missouri Boards of Nursing and Registration for the Healing Arts as defendants. The complaint claims that CPAs are unconstitutional and financially burdensome.

Let’s be clear: this lawsuit isn’t just about one practitioner’s frustration—it’s part of a coordinated national campaign to dismantle physician oversight and redefine scope of practice through the courts. PLF, a libertarian legal group with a history of opposing professional regulation, argues that CPAs are “permission slips” with no public safety value. That claim is not only misleading—it’s dangerous. CPAs exist to protect patients, ensure continuity of care, and uphold clinical standards through physician-led, team-based care. They are not bureaucratic relics—they are safeguards rooted in decades of medical expertise and interdisciplinary teamwork.

The lawsuit cites a $52,800 annual cost for a CPA but fails to acknowledge that collaboration is not a transactional checkbox—it’s a shared responsibility. Physicians provide oversight, mentorship, and accountability that cannot be replaced by independent practice alone. The lawsuit also ignores the flexibility already built into Missouri’s CPA framework, which allows for tailored agreements based on specialty, setting, and patient population.

If successful, this legal challenge could erode the integrity of team-based care, weaken patient protections, and sideline physicians from critical decision-making. Missouri’s medical community must stay informed, engaged, and vocal. This is not just a regulatory issue—it’s a fight for the future of safe, collaborative care.

Read the full complaint here.