How to start a medical practice in Texas

To start a medical practice in Texas, confirm professional licensure, choose an ownership structure permitted for the services, arrange any required physician delegation or supervision, and prepare coverage, records, and payment workflows. An NP or PA's prescribing authority is a separate question from business ownership. Resolve those requirements and any employment restrictions before committing to a location or opening date.

This guide summarizes selected Texas requirements checked October 12, 2026. It is general information, not legal advice. Have Texas healthcare counsel review your owners, services, agreements, and locations.

What is the sequence to start a medical practice in Texas?

Build the practice around the clinician and services first. A state license, an entity filing, and an insurance contract serve different purposes. Use the following sequence to identify dependencies, then assign an owner and completion date to each item. The private practice guide covers the federal identifiers and broader business setup.

1. Define the services, clinician credentials, patient populations, and locations.
2. Confirm the applicable Texas license and any prescribing or supervision requirements.
3. Select the entity and ownership structure with counsel.
4. Review the employment contract, including notice, outside work, non-compete, and patient-transition obligations.
5. Arrange malpractice coverage and the records, referral, results, and emergency workflows.
6. Complete relevant payer enrollment and prepare the patient payment process.

Budget for both setup and ongoing operations. The startup cost guide helps separate registration fees from quotes and working cash.

What do Texas NPs and PAs need before prescribing?

Texas permits physician delegation of prescribing through a prescriptive authority agreement under section 157.0512 or the separate facility-based pathway in section 157.054. The general agreement cap is seven APRNs and PAs combined, or their full-time equivalent, with statutory exceptions. An advanced practice registered nurse (APRN) category includes NPs. Occupations Code Chapter 157

For the ordinary agreement path, check:

• The parties' licenses, eligibility, and required disclosures.
• A written, signed, dated agreement naming locations and permitted or excluded drug categories.
• Consultation, referral, emergency, communication, and chart-review plans.
• Documented quality-improvement meetings at least monthly.
• Review, dating, and signatures at least annually.

These are selected requirements; use the complete section for the agreement. Facility-based delegation is not simply an exemption from paperwork, and long-term-care delegation has its own medical-director and number limits. Sections 157.0512 and 157.054

Controlled substances need a separate review. Section 157.0511 limits delegation for Schedules III through V and allows Schedule II delegation only in specified hospital and hospice circumstances. Do not assume a general agreement permits every controlled-substance service. Section 157.0511

Does a Texas PA need the physician onsite?

Continuous supervision does not mean constant physical presence under section 204.204. When apart, the physician and PA must be readily able to communicate. The physician oversees and accepts responsibility for the delegated medical services. Physician approval and notice requirements, and the PA's notice identifying the supervisor, are separate steps. Occupations Code Chapter 204

Before scheduling, verify how consultation works during clinic hours, who covers absences, and how changes in supervision are reported. The collaborating physician guide offers an agreement checklist, while the statute determines which requirements apply to a PA.

Who may own a medical practice in Texas?

Texas professional-entity rules distinguish the services, entity type, and qualified owners. Chapter 301 allows professional associations and professional LLCs for specified professional services and limits ownership to authorized persons. Its professional-corporation definition excludes the practice of medicine by physicians. Do not assume an ordinary corporation or a business partner qualifies merely because a filing is accepted. Business Organizations Code Chapter 301

Structure or owner	Distinction to review
Professional association	Chapter 301 limits owners to qualifying professional individuals.
Professional LLC	Chapter 301 permits qualifying professional individuals or organizations, subject to its authorization rules.
Physician and PA ownership	Section 301.012 permits a specific joint-ownership path with physician control and minority PA ownership.
NP-owned entity	The physician/PA joint-ownership provision does not answer which form an NP may use for nursing services. Review the intended entity and services separately.

Under the physician/PA provision, a PA may not be an officer or employ or contract with a physician to serve as a supervising physician. A physician organizer must ensure physician control and management, and PA interests are subject to individual and combined minority limits. Section 301.012

An MSO agreement is another document to review. Buying business support does not settle clinical-entity ownership or authorize another party to practice medicine.

How do Texas physician non-competes affect a launch?

For covered covenants entered into or renewed on or after September 1, 2025, Texas added physician limits including a maximum one-year term, a five-mile radius from the primary practice location, and a buyout capped at total annual salary and wages at termination. Other statutory conditions still apply. Older covenants are governed by the prior law identified in the act. S.B. 1318

The physician provisions also address patient lists, authorized records access, acute-illness continuity, written clarity, and discharge without good cause. Administrative roles and certain ownership interests have specific treatment. Nursing and PA covenants have a separate section and do not automatically receive every physician provision. Business and Commerce Code sections 15.50 and 15.501

Bring every amendment and renewal to counsel. Record the contract dates, practice locations, departure circumstances, and proposed new work. The state non-compete guide helps organize those facts.

What telehealth rules should a Texas practice check?

Texas Chapter 111 provides pathways for establishing a practitioner-patient relationship by telemedicine and applies the same standard of care as in-person care. The chapter requires consent and sets conditions for technology-based visits and follow-up. A remote appointment is not permission to ignore licensure, delegation, or the information needed for an adequate clinical assessment. Occupations Code Chapter 111

For the technology pathway in section 111.005, the practitioner must provide follow-up guidance and, when the patient consents and has a primary care physician, provide that physician a record or report within 72 hours. Chapter 111 excludes mental health services, so use the applicable rules for those services rather than assuming this chapter is the complete answer. Section 111.005 and section 111.008

At scheduling and at the visit, confirm where the patient is located and that the clinician has the authority required there. The telehealth practice guide covers the broader operating workflow.

Does Texas require physicians to carry malpractice insurance?

The Texas Medical Board states that Texas statutes do not require physicians to carry malpractice insurance, while many hospitals require it for privileges. That answer does not settle a payer, employer, lease, or other contract requirement. Obtain a quote and review the actual obligations and risks for your services. Texas Medical Board

Ask the insurer to confirm clinicians, entities, locations, procedures, and telehealth states. If you are leaving a claims-made policy, review tail or prior acts coverage separately from coverage for new visits.

For licensing costs and application steps, use the Board's full medical license application page and confirm the current fees before filing. Application and initial registration are separate items; an application-stage estimate is not a promised opening date.

What should be complete before you see the first patient?

Make a final readiness file: active licenses, entity documents, executed delegation or supervision agreements, coverage, payment terms, and the people responsible for records and follow-up. Run a sample appointment from booking through a returned result. Resolve missing ownership or prescribing authority before a patient depends on the service.

Vye Health helps providers launch, run, and grow private practices.

Apply to Vye Health.

When you are ready to run the practice on Vye, see Vye Core, and pricing.