The 2026 Florida legislative session brought scope of practice back to the floor, and this time, the bills carry real teeth. HB 693, filed by Miami Republican Mike Redondo, would authorize all advanced practice registered nurses to practice independently of physicians. A separate bill, HB 223, would reestablish licensure for naturopathic physicians for the first time since the Legislature abolished it in 1959. For the state’s 75,000-plus licensed MDs and DOs, these aren’t abstract policy debates. They reshape who can do what, to whom, and under what oversight.
Here’s what’s actually in the bills, what the current law still requires, and where physicians need to pay attention.
What Florida Law Currently Requires
Florida operates under a restricted-practice model for APRNs. Under Chapter 464, an APRN may only perform advanced nursing and medical acts (diagnosis, treatment, prescribing) pursuant to a written supervisory protocol with a Florida-licensed physician. That protocol must specify the scope of practice, the conditions requiring direct consultation, and the prescribing parameters. The supervising physician doesn’t need to be in the room, but they do need to be available and accountable.
Physician assistants sit under an even tighter framework. Chapter 458 (allopathic) and Chapter 459 (osteopathic) require PAs to practice exclusively under the supervision of a licensed physician. There is no autonomous pathway for PAs in Florida. The supervising physician must review a representative sample of charts, countersign certain orders, and maintain an active delegation agreement.
Florida did create an “autonomous APRN” registration pathway several years ago, but with a meaningful gatekeeping mechanism: applicants must document at least 2,000 clinical instructional hours or supervised practice hours under an actively licensed physician within the five years immediately before registration. That requirement keeps a real clinical mentorship link in the pipeline.
HB 693: Full Independence for All APRNs
Redondo’s HB 693 would strip the supervisory protocol requirement entirely for APRNs, allowing all nurse practitioners, regardless of specialty, practice setting, or years of experience, to practice independently. No physician oversight agreement. No collaborative practice arrangement. No chart review obligation.
This is the broadest scope expansion bill Florida has seen. Previous iterations required minimum practice hours or limited autonomous practice to primary care settings. HB 693 has neither restriction.
The practical consequences for physician practices are immediate. If this passes, NPs in procedural specialties (dermatology, aesthetics, pain management) could open competing practices with no physician involvement in quality assurance. Referral patterns would shift. Liability questions would multiply, particularly in cases where an NP-only practice misses a diagnosis that a physician-supervised model would have caught.
The Florida Medical Association has opposed similar bills in prior sessions, arguing that independent practice without physician collaboration puts patients at risk in complex clinical scenarios. The AMA’s own data on states that have adopted full practice authority shows NPs disproportionately cluster in urban, commercially insured settings rather than filling the rural access gaps that proponents cite as justification.
HB 223: Naturopathic Physician Licensure Returns
HB 223 would bring naturopathic medicine back under state licensure after a 67-year absence. The bill establishes a defined scope of practice that includes diagnosis, botanical and fungal extracts, clinical nutrition, counseling, dietary supplements, environmental medicine, homeopathic remedies, imaging, lab testing, lifestyle medicine, physical exams, and physical medicine.
Two explicit exclusions: naturopathic physicians would not be permitted to prescribe or dispense prescription medications beyond natural, non-pharmacologic substances, and they cannot perform surgical procedures. The effective date is December 31, 2026.
For practicing MDs and DOs, the questions are practical. Will naturopathic physicians carry malpractice insurance? Will they have hospital privileges? Will patients understand the difference between an ND and an MD when both use the word “physician”? Title confusion is already a documented patient safety concern in states with naturopathic licensure, and Florida’s large elderly population, many of whom navigate multiple providers, makes that risk more acute.
ACN Physicians: A Quiet Fix for a Real Problem
One bill that deserves physician support passed with less fanfare. SB 1480 / HB 809, filed by Sen. Colleen Burton and Rep. Yvette Benarroch, protects physicians who received certificates to practice in areas of critical need. Under current law, if the state redesignates an area as no longer critically underserved, those physicians lose their authorization to practice, even if their patients still need them. The new bill lets them continue serving their communities regardless of redesignation.
This is pragmatic legislation that addresses a real workforce problem without compromising standards. Florida is projected to be short 22,000 physicians by 2030, and pulling credentialed doctors out of communities that still need them because a bureaucratic designation changed is counterproductive.
What Physicians Should Do Now
- Track the committee schedule. HB 693 is in the Health & Human Services Committee. If it advances to the floor, the window for organized opposition narrows quickly. The FMA’s legislative tracker at flmedical.org is the most current source.
- Review your collaborative practice agreements. If you supervise NPs or PAs, ensure your protocols are current and documented. In a shifting regulatory environment, clear agreements protect both parties.
- Engage your specialty society. The FMA, FOMA, and specialty-specific societies (FSPS, FCAP, etc.) are coordinating testimony. Individual physician voices matter in committee hearings — legislators hear from NP lobbying groups constantly.
4. Talk to your patients. Many patients don’t understand the training difference between a physician and a nurse practitioner. A 60-second conversation about your team’s credentials and oversight structure builds trust and helps patients make informed choices.
5. Watch the naturopathic licensure timeline. If HB 223 passes with the December 2026 effective date, your local market could see ND practices opening by early 2027. Understand what they can and can’t do so you can counsel patients who ask.
Frequently Asked Questions
What are the current APRN supervision requirements in Florida?
Florida APRNs must practice under a written supervisory protocol with a licensed physician that specifies scope, consultation triggers, and prescribing limits. An autonomous registration pathway exists but requires 2,000 documented clinical hours under physician supervision within the preceding five years.
Would HB 693 allow nurse practitioners to practice without any physician oversight in Florida?
Yes. HB 693 would eliminate the supervisory protocol requirement for all APRNs regardless of specialty, experience level, or practice setting. If enacted, NPs could diagnose, treat, and prescribe independently without any physician collaboration agreement.
How does Florida’s scope of practice compare to other states?
As of 2026, 27 states plus D.C. grant full practice authority to nurse practitioners. Florida remains in the restricted-practice category, requiring physician supervision. HB 693 would move Florida into the full-practice-authority column if passed.
What does HB 223 mean for naturopathic physicians in Florida?
HB 223 would reestablish state licensure for naturopathic physicians, allowing them to diagnose and treat using natural modalities, order labs and imaging, and perform physical exams. They would not be able to prescribe conventional medications or perform surgery. The effective date is December 31, 2026.
How can Florida physicians get involved in scope of practice legislation?
Contact your state representative and senator directly, participate in FMA and FOMA legislative action campaigns, attend committee hearings in Tallahassee, and submit written testimony. The Florida Medical Association maintains a real-time bill tracker at flmedical.org with current committee assignments and hearing dates.