After four and a half years home with her two young children, Georgia nurse practitioner (NP) Erin Patel was ready to return to work—setting her sights on becoming a business owner. She wanted to open an esthetics spa in Smyrna, Georgia, which she describes as a “med spa desert.”
“I never thought I would do this, open my own business solo,” Erin says. “But it was just a problem I had to solve.” It also offered a practical advantage: Owning her practice would let her set her hours around school drop-off, pick-up, and family dinner.
Erin got to work preparing all the necessary paperwork to open her practice. In Georgia, state law requires nurse practitioners to sign a “protocol agreement” with a physician before they can provide care. The Georgia Composite Medical Board approves or denies every agreement.
Erin submitted an application for an agreement with an MD she knows personally—they met through a mutual friend’s baby shower. But on May 7, 2026, the Board declared that any physician who receives “compensation of any kind” from a nurse practitioner is deemed an “employee” of the nurse practitioner. Because Georgia law separately bars physicians from being employees of an NP’s practice, the law boxes out an entrepreneur like Erin who seeks to open her own shop.
One day after the Board issued their reinterpretation position, it denied Erin’s application.
The Board’s statement drew backlash across the Georgia NP community. It then issued two more statements claiming it was not creating new policy, terminating existing agreements, or directing anyone to close. It called its position a “longstanding interpretation of Georgia law dating to 2008.” But at the same time, the Board was denying collaborative agreements and citing the compensation issue as the reason.
On September 11, 2026, Erin filed a petition with the Georgia Composite Medical Board, urging it to reconsider whether a physician becomes an NP’s “employee” simply by accepting payment for a collaborative agreement. The Board declined to respond.
With few options left, Erin filed a lawsuit to stop the Board from rewriting the law, represented free of charge by Pacific Legal Foundation.
Georgia courts long have held that an employee is someone whose boss controls the time, manner, and method of the work. A nurse practitioner who pays a physician for a collaborative agreement doesn’t control how that physician practices medicine, and getting paid by a nurse practitioner doesn’t make a physician her employee. Georgia law prohibits courts from deferring to an agency’s reading of a statute, so the Board’s reinterpretation of the word “employee” does not change the meaning of the law itself.
Erin also challenges the Board’s position on procedural grounds: The new law was imposed without the rulemaking procedures required by the Georgia Administrative Procedure Act.
Erin wants to care for her patients under the rules she followed in good faith. A win would confirm that licensing boards must apply the law the Legislature passed, and that Georgia nurse practitioners can practice without fear that a single redefined word will end their careers.
What’s At Stake?
- An agency cannot expand its own authority by rewriting the statute the legislature enacted.
