extra salary or paid more when supervising midlevels, PA, NP

[TaxiDriver]

I am recently of out residency (last July) and been working at a non-teaching hospital on the consult-liason psychiatry service. Just recently, they hired a PA to help our patient load. I heard a hospitalist say that we should get paid extra for supervising PA or NPs. I checked my contract and it doesn't say anything ab0ut supervising PAs but does say something about PA students and teaching them.

Should I ask for extra compensation or a change to the contract for supervising PAs? I guess this would be an added responsibility, but then he/she is also helping the patient load on the consult service.

Any thoughts? Still trying to learn the business/negotiating side of medicine!

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[@JackShephard]

Ugh.

I don't think it's a good play to ask for $. Just work hard and do your best in the hours you're there.

Unfortunately it's their business and they get to hire employees they want. The only way to avoid these things are to be self employed.

I've seen business situations like this many times. It's always best to cooperate and be positive. If it's a real problem then bring it up with management. Self employment is the only true safety from stuff like this.

Feeling like you should get something will give you a bad attitude if you don't get it.

 

[primadonna22274]

I'm a PA and in a couple months will be a DO and new FM resident.
I think it's pretty standard for physicians with supervision responsibilities for PAs and NPs to be compensated a little extra. I don't know how much and I don't think it's a significant amount of money typically but you do have to consider the potential liability of supervision/collaboration/whatever your arrangement specifies.
Since your contract does NOT outline supervision duties for PAs/NPs, I think it's reasonable to open a discussion about it.
Good luck and hope you get to work with awesome PAs
(Oops, is my bias showing?)

 

[jokerabc]

if it's not in your contract, then you should mention this. supervising PA or NPs takes on more responsibility and liability. it won't be that much, but hey, every dollar counts in this life.

working hard is correct like JackShephard said, but let's get real -we all work hard and the admins at your hospital will be looking for a cheaper way to work you as well.

 

[vistaril]

I am recently of out residency (last July) and been working at a non-teaching hospital on the consult-liason psychiatry service. Just recently, they hired a PA to help our patient load. I heard a hospitalist say that we should get paid extra for supervising PA or NPs. I checked my contract and it doesn't say anything ab0ut supervising PAs but does say something about PA students and teaching them.

Should I ask for extra compensation or a change to the contract for supervising PAs? I guess this would be an added responsibility, but then he/she is also helping the patient load on the consult service.

Any thoughts? Still trying to learn the business/negotiating side of medicine!

this is nonsensical....the PA is likely reducing your workload. The hospital is putting more money into their provider costs(probably without a corresponding increase in revenue) and you want them to pay you more as well? If the service and collectibles don't expand as the result of additional provider cost, not only will you not get a bump but you need to be worrying about maintaining your current rate of pay......

 

[OldPsychDoc]

It will vary by state laws and organizational (even departmental) policy. In my case, I get compensated a relative pittance (an extra $100/hr I think, I haven't checked lately) for remote supervision of one CNS (who really needs little supervision--like reviewing her tougher cases for an hour or so each month). But it has more to do with the legal backup, I suppose.

 

[heyjack70]

this is nonsensical....the PA is likely reducing your workload. The hospital is putting more money into their provider costs(probably without a corresponding increase in revenue) and you want them to pay you more as well? If the service and collectibles don't expand as the result of additional provider cost, not only will you not get a bump but you need to be worrying about maintaining your current rate of pay......

You have no idea what the op's pay structure is. He/she would be losing money in a productivity model because supervising a midlevel takes time away from seeing his/her own patients.

 

[primadonna22274]

You have no idea what the op's pay structure is. He/she would be losing money in a productivity model because supervising a midlevel takes time away from seeing his/her own patients.

You are most likely wrong on this one. My supervising docs MAKE money on me--a lot--because I'm highly productive and they get paid well for it. Far better than I do. One of the many reasons I went back to med school!

 

[vistaril]

You have no idea what the op's pay structure is. He/she would be losing money in a productivity model because supervising a midlevel takes time away from seeing his/her own patients.

there is very little chance his salary is based mostly on productivity if he is supervising midlevels in such a way that he can't bill for their services. That pay structure wouldn't make any sense for either party.

Yes, he may get some productivity bonus. But it's probably negligible, and within certain ranges(capped) that make it fairly irrelevant. And has no minimum rvus either to get the base salary. That's not really a productivity model....a productivity model is one where they may float a guarantee for the first couple years, but your salary is still tied to collections linearly. Nobody is going to eat what you kill, supervise a PA, and hen not be able to bill for the PA....that doesn't make any sense.

 

[vistaril]

You are most likely wrong on this one. My supervising docs MAKE money on me--a lot--because I'm highly productive and they get paid well for it. Far better than I do. One of the many reasons I went back to med school!

because your collections(through some method of distribution....many possibilities) go directly into their till.

 

[PrideNeverDie]

at the very least he should be asking administration to clarify the legal and financial ramifications of having a PA on board right?

i'd be more worried about legal liability than the compensation...

 

[heyjack70]

wrong quote

 

[heyjack70]

You are most likely wrong on this one. My supervising docs MAKE money on me--a lot--because I'm highly productive and they get paid well for it. Far better than I do. One of the many reasons I went back to med school!

If you read the original post, it is clear that he isn't getting paid extra, and he's asking if he should approach the hospital about compensation.

 

[primadonna22274]

I did read the original post and responded to it. The quote above was to someone who implied that PAs COST money to the SP...not remotely.

 

[vistaril]

I did read the original post and responded to it. The quote above was to someone who implied that PAs COST money to the SP...not remotely.

it depends. If a PA/NP is hired and doesn't generate extra revenue, they will obviously cost money. When they generate more revenue than their salary(often the case) by allowing more patients to be seen, they result in net profit.....

 

[heyjack70]

I did read the original post and responded to it. The quote above was to someone who implied that PAs COST money to the SP...not remotely.

There might be a time cost. While supervising a midlevel, the physician is not generating RVUs. And if the physician is not paid for the supervision time, it is a money loser.

The problem is there are all sorts payment arrangements. We would need to know the OPs setup, salary, RVU, other?

 

[primadonna22274]

I think you think there is a whole lot more "supervision" going on than is typical in real life.
Supervision for me and most experienced PAs mean my doc is available for me to ask "hey, what do you think about this xray?" Or "would you choose this drug over that one for x condition" or, much more rarely, "hey, this patient is SICK and I really need your help". Those times are quite infrequent for a seasoned PA. I think I've taken about 5 min of my doc's time today in the 7 hr we've worked together in the ED. Obviously this will be different depending on experience and practice setting.

 

[heyjack70]

I think you think there is a whole lot more "supervision" going on than is typical in real life.
Supervision for me and most experienced PAs mean my doc is available for me to ask "hey, what do you think about this xray?" Or "would you choose this drug over that one for x condition" or, much more rarely, "hey, this patient is SICK and I really need your help". Those times are quite infrequent for a seasoned PA. I think I've taken about 5 min of my doc's time today in the 7 hr we've worked together in the ED. Obviously this will be different depending on experience and practice setting.

Time is one consideration. But how is this occasional supervision accounted for? If one of your patient's dies because of a negligence, and it's a case that was not supervised, who is on the hook? Both you and the Psychiatrist?
My concerns with uncompensated PA supervision are:
1. is the Psychiatrist expanding their possibility for a malpractice suit?
2. is supervision taking time away from normal clinical activities, or adding uncompensated obligations to the day?

Maybe your job involves Psychiatrists making more money by having a PA on the service. However, the OP certainly sounds like his/her hospital is thrusting uncompensated PA supervision onto him/her.

 

[michaelrack]

I am recently of out residency (last July) and been working at a non-teaching hospital on the consult-liason psychiatry service. Just recently, they hired a PA to help our patient load. I heard a hospitalist say that we should get paid extra for supervising PA or NPs. I checked my contract and it doesn't say anything ab0ut supervising PAs but does say something about PA students and teaching them.

Should I ask for extra compensation or a change to the contract for supervising PAs? I guess this would be an added responsibility, but then he/she is also helping the patient load on the consult service.

Any thoughts? Still trying to learn the business/negotiating side of medicine!

The answer depends on how your salary/reimbursement is set up. If you are paid on an hourly basis, then you already are being compensated for PA supervision. ON the other hand, if you are being paid based on how much you bill (and the PA's billing is not included in this figure), then you should get extra compensation.

Personally, I supervise an NP in a sleep clinic- her billing goes to the clinic and I am compensated for my time in supervising her (I document how much time is spent going over her charts, talking to her about patients, etc)

 

[Therapist4Chnge]

If it is not explicitly written into your contract, then it'd behoove you to start a conversation BEFORE taking on any supervision/liability.

 

[TaxiDriver]

Thanks for the replies. I have a base salary that is not productivity-based. There is a yearly bonus that is based on productivity, which is a small percentage of the base salary.

We had a meeting with the director/admin today and they agreed to give an extra stipend/pay or whatever you call it for supervising a PA on consults. His reply was actually "I was wondering when you guys would bring this up. I think that is fair." He went on to mention that we would be spending more time listening/supervising and helping the PA.

 

[TexasPhysician]

Way to bring it up! Definitely should be paid more for increased liability!

 

[Shikima]

What is considered to be the going rate for this kind of supervision?