Compensation for midlevel supervision

[DareGreatly]

Hi everyone,

I’m a pgy4 in the process of looking at jobs/getting offers at this point. I’m pursuing FT outpatient employment (will have a small PP on the side) to start out. Some of these positions necessitate or ask for mid level supervision. What is appropriate compensation in this context? Some of these are for-profit entities where I cannot get ownership/partnership (a really dumb move IMO, just encourages turnover but I digress…)

As far as I know, mid levels are reimbursed by third parties at 85%. Is seems like a psychiatrist can easily get a $250-280k job seeing outpatients in an organization. So, that’s profitable for them including benefits. It’s hard to guage midlevel salaries (seems like I see anywhere from 100-170k) but let’s call it $150k. If you take 85% of 250 you get $212.5k revenue per midlevel. So they’re probably profiting something like 50k per mid level. I feel like a reasonable ask might be half of that? What do you think/have you experienced?

---

Members don't see this ad.

 

[deleted1100659]

Hi everyone,

I’m a pgy4 in the process of looking at jobs/getting offers at this point. I’m pursuing FT outpatient employment (will have a small PP on the side) to start out. Some of these positions necessitate or ask for mid level supervision. What is appropriate compensation in this context? Some of these are for-profit entities where I cannot get ownership/partnership (a really dumb move IMO, just encourages turnover but I digress…)

As far as I know, mid levels are reimbursed by third parties at 85%. Is seems like a psychiatrist can easily get a $250-280k job seeing outpatients in an organization. So, that’s profitable for them including benefits. It’s hard to guage midlevel salaries (seems like I see anywhere from 100-170k) but let’s call it $150k. If you take 85% of 250 you get $212.5k revenue per midlevel. So they’re probably profiting something like 50k per mid level. I feel like a reasonable ask might be half of that? What do you think/have you experienced?

1. They profit way more than 50k per midlevel. Midlevels usually get their scheduled stacked with a ton of patients. 150k seems high as far as their salary but could be wrong what it is these days. I promise you they're making more than 50k

2. I supervise 4 midlevels but wont in the future. I promise you it is not worth it. The least i would take is 25k a year PER midlevel to supervise. Absolute bottom number, especially in a state where they cant be independent. The knowledge gap is huge to be honest and quite blunt. Its not fun having to go behind people all the time and fix things and clean stuff up. Also depending on your job, they may give you crap if you disagree with the NP and want to override them. Sometimes higher ups view you as equals, instead of you as their superior. Which is crap. Your license is tied to them. If they suck, that goes back to you to deal with. Know how many nights I havent slept because one of them did something at work and I ruminated all night thinking about it? If you enjoy not sleeping at night, then thats when I would recommend midlevel supervision.

3. Average for outpatient is around 275k probably, these days.

 

[Sushirolls]

Look here:

Pay Rate to Supervise an NP on Inpatient?

Title pretty much says it all but I was wondering if anyone here in the community supervises NPs on an inpatient basis only, not PHP or IOP. My hospital is expanding and they are asking if we want to fill in some of the gaps with NPs. Obviously not my first choice, but if the pay isn't terrible...

forums.studentdoctor.net

 

[calvnandhobbs68]

I find it very rare that any place gives you an offer to “collaborate” with NPs that’s anywhere near fair. The places I looked at were either 1) nothing or 2) 1k/month. I didn’t even bother negotiating as I agree probably minimum of 25K/year and the understanding that “collaboration” means “supervision” (go over their charts and set aside actual supervision time every week for education). That actually brings you into a semi-reasonable pay range for setting aside 2.5 hours a week for supervision.

But this isn’t what most places want you to do. They want you to be the liability sponge and sign off on whatever crazy decisions the NP is making without reviewing anything for 1k/month so they make as much money as possible. Lord help you if you actually tell that NP that what they’re doing is incorrect.

 

[DareGreatly]

1. They profit way more than 50k per midlevel. Midlevels usually get their scheduled stacked with a ton of patients. 150k seems high as far as their salary but could be wrong what it is these days. I promise you they're making more than 50k

2. I supervise 4 midlevels but wont in the future. I promise you it is not worth it. The least i would take is 25k a year PER midlevel to supervise. Absolute bottom number, especially in a state where they cant be independent. The knowledge gap is huge to be honest and quite blunt. Its not fun having to go behind people all the time and fix things and clean stuff up. Also depending on your job, they may give you crap if you disagree with the NP and want to override them. Sometimes higher ups view you as equals, instead of you as their superior. Which is crap. Your license is tied to them. If they suck, that goes back to you to deal with. Know how many nights I havent slept because one of them did something at work and I ruminated all night thinking about it? If you enjoy not sleeping at night, then thats when I would recommend midlevel supervision.

3. Average for outpatient is around 275k probably, these days.

Thanks for the perspective. I agree with what you’re saying. I will definitely aim high in negotiations and pursue non-supervisory roles if they don’t meet a reasonable number. I find it odd that management often won’t put in contingency allowing higher compensation per mid level since it benefits both parties. I guess it goes to show that there’s a lot of mismanagement in healthcare. What are you being paid to oversee the 4 MLPs?

 

[DareGreatly]

I find it very rare that any place gives you an offer to “collaborate” with NPs that’s anywhere near fair. The places I looked at were either 1) nothing or 2) 1k/month. I didn’t even bother negotiating as I agree probably minimum of 25K/year and the understanding that “collaboration” means “supervision” (go over their charts and set aside actual supervision time every week for education). That actually brings you into a semi-reasonable pay range for setting aside 2.5 hours a week for supervision.

But this isn’t what most places want you to do. They want you to be the liability sponge and sign off on whatever crazy decisions the NP is making without reviewing anything for 1k/month so they make as much money as possible. Lord help you if you actually tell that NP that what they’re doing is incorrect.

Any idea why they don’t pay a reasonable sum? It seems logical that both parties benefit if they pay up. I’m trying to arm myself with information as negotiations begin. I agree that 12k and no additional supervisory time makes no sense. I guess there are some psychiatrists that see it as free money and overlook the risk they are shouldering for a larger entity?

 

[jbomba]

Why not just take the plunge and open up a private practice of your own and make twice as much and supervise zero midlevels?

 

[DareGreatly]

Why not just take the plunge and open up a private practice of your own and make twice as much and supervise zero midlevels?

To be honest, it’s crossed my mind. However, wife is taking time off from work as we recently had our first child. I’d like to de-risk for a couple years by paying down student loans and build a small PP I can pivot to afterward. At that point, my wife will likely be employed with benefits as well, so wouldn’t need to pay the wild prices on the exchange for medical insurance. To make double, can you take insurance? Or is cash-only the route advised? I wouldn’t be opposed to scaling up a clinic, which would be easier with insurance.

 

[jbomba]

To be honest, it’s crossed my mind. However, wife is taking time off from work as we recently had our first child. I’d like to de-risk for a couple years by paying down student loans and build a small PP I can pivot to afterward. At that point, my wife will likely be employed with benefits as well, so wouldn’t need to pay the wild prices on the exchange for medical insurance. To make double, can you take insurance? Or is cash-only the route advised? I wouldn’t be opposed to scaling up a clinic, which would be easier with insurance.

I'm just a PGY3, but the supervisors I've had who run pp and take insurance said you can expect to make $250-350/hr with a couple 99214+90833 an hour which honestly, is a quite reasonable work load. They've also said you can expect to fill within a few months in the major metro I'm located in. Food for thought.

 

[calvnandhobbs68]

Any idea why they don’t pay a reasonable sum? It seems logical that both parties benefit if they pay up. I’m trying to arm myself with information as negotiations begin. I agree that 12k and no additional supervisory time makes no sense. I guess there are some psychiatrists that see it as free money and overlook the risk they are shouldering for a larger entity?

That's exactly correct. There are some people that'll "collaborate" with 4 NPs and make an extra 48K/year for basically doing nothing but clicking through charts at the end of the week for an hour. And yeah, on the whole, are you likely to be sued statistically? Probably not, psychiatry is one of the least likely to be sued areas of medicine. But it's hoping a lot of things go right for an extra 50K a year which I could make on my own working an extra half day a week (outpatient) while knowing all my decisions are exactly the thing I would do. And then I don't have to sit around wondering how to bring up that it's not a good idea to prescribe 30mg short acting Adderall BID, 1mg Ativan TID and Ambien 10mg QHS to an NP.

honestly it barely makes sense to do anything with NPs from a financial perspective anyway. I could make the exact same amount of money (if not more) seeing patients during those hours i would supervise an NP for 25K/year.

Edit: I should say unless you directly employ the NPs and then actually make the profit difference. Also makes it much easier to say you should actually supervise them if you're their employer

 

[deleted1100659]

There are literally jobs out there that will pay you just to sign charts, so any place that does not pay for NP collaboration is a waste of time, because if you so desired it you could take a non NP job, and add on another job for NP collaboration.

my facility doesnt view np collaboration as a big deal and that has put me at odds with them, especially when in my state they need a physician supervisor. There is at least 2-3 incidences a day I get involved in and have to sort out so its really a lot of work.

There is this weird movement towards the idea that NPs are equal to physicians and healthcare administrators are all about this movement because it allows them ways to save money.

Why dont they pay for more NP collaboration? Because some states they can be independent. Other states they can find some random dude from university of phoenix medical school who probably did a bunch of shady stuff and will gladly "collaborate" as part of the job. These people are out there...

My situation is a bit unique, I needed to be in a certain location at the time so for me the job made sense but i cant imagine doing this long term. The stress is too much.

Administrators are milking physicians and they often use midlevel's as a means to do it.

 

[Candidate2017]

There is this weird movement towards the idea that NPs are equal to physicians and healthcare administrators are all about this movement because it allows them ways to save money.

"We are all equal."
But strangely, NPs, admin and clinic owners love to ask us if we'd be interested in having the NP transfer an "interesting case" to our patient panel.