Compensation for supervising mid levels?

[Leonardsean]

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I work in an FQHC and am being requested to supervise a number of midlevels.

I was wondering what the typical compensation for that is?

Thanks,

--Sean

 

[smq123]

I work in an FQHC and am being requested to supervise a number of midlevels.

I was wondering what the typical compensation for that is?

Thanks,

--Sean

At an FQHC? I would be amazed if they offered you any kind of compensation. You may be able to negotiate for administrative time, but I would not expect financial compensation.

How many midlevels are you being asked to supervise?

 

[Leonardsean]

so far 2.

--Sean

 

[septoplasty]

That sounds like a ****ty deal, walk if you can.

 

[LeroyJenkinsMD]

Administrator: “Hi, we would like to triple your workload and also have you train your replacements since your education is valuable making you too expensive. What we can do for you to make this worth your while is pay you nothing.”

Typical physician: “Excellent! When do I start?”

 

[BayesianDoc]

At my institution 10k for the year


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[Make Or Break]

At my institution 10k for the year


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What a joke

 

[SLC]

I get $20k per PA per year.

 

[TableMD]

whatever the number is, its too low.

I have no issue with discussing patients with a PA/NP or anyone else, but im not signing anyone’s note.

The person seeing the patient is either qualified or they are not. Unless you have an exhaustive process for determining this, why take the chance?

 

[PlutoBoy]

whatever the number is, its too low.

I have no issue with discussing patients with a PA/NP or anyone else, but im not signing anyone’s note.

The person seeing the patient is either qualified or they are not. Unless you have an exhaustive process for determining this, why take the chance?

This is my approach. I do not supervise midlevels. I’m busy enough as it is and I don’t need the liability.

 

[BigSib]

$500 per month per NP/PA in a small hospital group. We review a handful of their charts per month. They're supposed to come to us with questions and such but typically they'll ask whomever is nearest to them at the time .

 

[LeroyJenkinsMD]

$500 per month per NP/PA in a small hospital group. We review a handful of their charts per month. They're supposed to come to us with questions and such but typically they'll ask whomever is nearest to them at the time .

What happens if you refuse to supervise them? My sense is that is not an option since 500 a month is peanuts. ?

 

[LUCPM]

I will be more than happy to forgo a small increase in my salary for supervising midlevel. This is just a dumb idea.

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[LeroyJenkinsMD]

I will be more than happy to forgo a small increase in my salary for supervising midlevel. This is just a dumb idea.

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Same, physicians need to stand up for themselves. Low pay for training your replacement is insulting.

 

[Keona]

Supervision is included in my salary. I’m in a rural area and there are not enough MDs to manage the population. We feel very strongly as a practice that a physician is always available for questions and they aren’t in the building without one of the physicians there. There’s always an MD designated as on call and the go to person for questions. I don’t sign NPs notes. I’d love to only have MDs in the practice but there’s no way we could serve the community we do without midlevels.

 

[LeroyJenkinsMD]

Supervision is included in my salary. I’m in a rural area and there are not enough MDs to manage the population. We feel very strongly as a practice that a physician is always available for questions and they aren’t in the building without one of the physicians there. There’s always an MD designated as on call and the go to person for questions. I don’t sign NPs notes. I’d love to only have MDs in the practice but there’s no way we could serve the community we do without midlevels.

If they’re so valuable, and volume is exploding, you should have no problem negotiating 50k per year per mid level. Administration would still save money with that deal because 150k is still cheaper than a doctor. But wait, there must be other motives.​

 

[Keona]

I’m in a physician owned practice. . I’m compensated appropriately at this time. If I wasn’t I wouldn’t have joined the practice. The practice would much prefer more MDs as well because if you’re not supervising others you can see more patients.

 

[AFMD]

I work for the federal government, and I was asked if I can just fit in a few extra notes to sign from a mid-level. No extra time and no compensation, but liability seems minimal given coverage from the federal government. I don't think I can get out of it without ruffling a lot of feathers. I am currently the only physician at our site.

 

[Ericslv]

Asked or forced? If it's asked, just say no. If it's forced, quit and find another job. Don't volunteer to give away your power and your profession.

 

[Ironheme]

I work for the federal government, and I was asked if I can just fit in a few extra notes to sign from a mid-level. No extra time and no compensation, but liability seems minimal given coverage from the federal government. I don't think I can get out of it without ruffling a lot of feathers. I am currently the only physician at our site.

You obviously have some reservations if you're asking about it on the forums. I wonder what is it about their request that makes you uncomfortable. It's easy for me to say I would not do it if in your position because no compensation for increased liability doesn't seem like a win to me. If you like the place and are doing a favor for someone you like, then that's a different story, but know what you're getting into. I'd also caution that a "few extra" may turn into 'I have a 50% increase in my workload because I'm finding mistakes on A/P for the midlevel I'm supervising.'

 

[MedicineZ0Z]

Why in the world are you guys agreeing to supervise midlevels?? Can't wrap my head around this.

 

[Keona]

Why in the world are you guys agreeing to supervise midlevels?? Can't wrap my head around this.

In the community I’m in there are not enough MDs. Without the mid levels present the number of patients could not be seen. the next closest larger city is 45 minutes away. The big cities are 1.5 hours away. I don’t sign off on charts but I’m present in the building on days I’m “on call” and available for them to ask questions to. Those days I’m supposed to have a lighter schedule. It’s also the day that I’ll do more walk-ins or acute care things.

This physician available in the office is not required in our state but something our office feels strongly about. Some days I get a million questions and on others I forget that I’m on call.

It’s not so much supervision like I did during residency where you had to review all the orders and entire note for the interns.

It’s typically not a ton of work on my part but the benefit to our community is vast.

 

[deleted87716]

In the community I’m in there are not enough MDs...

So, you sold your license for nothing.

Make no mistake...when they screw up, it'll be your ass on the line. I'm sure the community will come to your defense, though...

 

[Keona]

I’d love to have another 5 full time mds to work with. However it’s going to take some time. I’m not signing off on their notes. Their licenses and malpractice insurance covers them. If I am asked a question or need to examine a patient I do

 

[Keona]

I’m going to disengage from this thread and enjoy my days off!

 

[deleted87716]

I’m going to disengage from this thread and enjoy my days off!

Enjoy.

 

[VA Hopeful Dr]

Enjoy.

View attachment 245332

Do you have evidence of a lawsuit/board action against an MD in a state with NP independent practice where the NP screwed up but the MD got in some sort of trouble?

 

[deleted480308]

Do you have evidence of a lawsuit/board action against an MD in a state with NP independent practice where the NP screwed up but the MD got in some sort of trouble?

I guess my question would be, if a doc is specifically scheduled as on call to supervise and be available for patient care if contacted can they accuracately claim the midlevel is independent?

 

[VA Hopeful Dr]

I guess my question would be, if a doc is specifically scheduled as on call to supervise and be available for patient care if contacted can they accuracately claim the midlevel is independent?

Depends on if its written into a contract or just a day where you have a lighter schedule - could officially call it a partial admin day or some such.

That said, I think since legally speaking the midlevel is independent (meaning they never have to curbside the MD) I would think roping the MD into a lawsuit would be tricky. Kinda like how in you never document a curbside consult in the medical record. I do that now-a-days with my internist wife and her OB/GYN father.

 

[Ericslv]

So, you sold your license for nothing.

Make no mistake...when they screw up, it'll be your ass on the line. I'm sure the community will come to your defense, though...

Wow, It's a miracle. I actually agree on something with blue dog. Dude never sell yourself or your skills cheap. Or free in this case.

 

[deleted87716]

Wow, It's a miracle. I actually agree on something with blue dog.

 

[deleted87716]

Do you have evidence of a lawsuit/board action against an MD in a state with NP independent practice where the NP screwed up but the MD got in some sort of trouble?

Medscape: Medscape Access

"If a physician is associated with an NP (through employment, independent contracting, state-mandated collaboration, consultation, or supervision) who is sued, the physician bears some risk of being sued as well."

 

[VA Hopeful Dr]

Medscape: Medscape Access

"If a physician is associated with an NP (through employment, independent contracting, state-mandated collaboration, consultation, or supervision) who is sued, the physician bears some risk of being sued as well."

So no you don't have evidence.

All 6 cases that article mentions either result from the physician directly supervising the NP per some state laws or the physician also saw said patient.

 

[Ericslv]

So no you don't have evidence.

All 6 cases that article mentions either result from the physician directly supervising the NP per some state laws or the physician also saw said patient.

Just say no. I say when the NP's start having to defend themselves they understand the pain physicians go through and how they get extorted. Then they won't want any part of it. It makes me wonder why we want any part of it.

 

[deleted87716]

So no you don't have evidence.

All 6 cases that article mentions either result from the physician directly supervising the NP per some state laws or the physician also saw said patient.

The article also mentions how difficult it is to find information about specific cases. Bottom line, working with mid-levels carries risks. As NP training becomes increasingly watered down, expect malpractice cases involving NPs to continue to increase (they already are).

https://www.google.com/amp/s/medica...dy-shows-nurse-practitioners-facing-lawsuits/

 

[VA Hopeful Dr]

The article also mentions how difficult it is to find information about specific cases. Bottom line, working with mid-levels carries risks. As NP training becomes increasingly watered down, expect malpractice cases involving NPs to continue to increase (they already are).

https://www.google.com/amp/s/medica...dy-shows-nurse-practitioners-facing-lawsuits/

Yep, I saw that as well.

Barring case law (which doesn't really exist as NP independence is relatively new) I'm inclined to think that independent NPs are likely to be treated as equal to physician partners in terms of lawsuits. To me this is actually ideal - if they're independent then they can be legally at risk the same as we are. Let's see how they like it (my guess is they won't).

 

[MedicineZ0Z]

Yep, I saw that as well.

Barring case law (which doesn't really exist as NP independence is relatively new) I'm inclined to think that independent NPs are likely to be treated as equal to physician partners in terms of lawsuits. To me this is actually ideal - if they're independent then they can be legally at risk the same as we are. Let's see how they like it (my guess is they won't).

They want to shortcut through school with just a year or two of training and...

1. Be called doctor
2. Do everything doctors do
3. Get paid equally for services provided as doctors
4. Have the nearby doctor take the blame for any mistakes they make

It's so ridiculous that we're literally being trolled.

 

[Reboa]

Maybe it's time for a physician slow down of some sort.

 

[VA Hopeful Dr]

Maybe it's time for a physician slow down of some sort.

You have fun with that

 

[Reboa]

You have fun with that

I mean I'm just a resident, I was kinda hoping you guys would have our back with this encroachment stuff, but I was also mostly kidding.

But I do find it interesting that Nursing and PA unions in my region have been striking quite a bit recently but physicians outside of the NHS slow down don't really do it.

 

[VA Hopeful Dr]

I mean I'm just a resident, I was kinda hoping you guys would have our back with this encroachment stuff, but I was also mostly kidding.

But I do find it interesting that Nursing and PA unions in my region have been striking quite a bit recently but physicians outside of the NHS slow down don't really do it.

And we did/do. Its just that we're losing. I'm a member of my state medical associated and have testified at the state house several times. This past year we managed to temper the NPs with merely extending the radius for supervision and giving them short term schedule 2 narcotic rights (they got schedule 2 non-narcotic pretty much the same as we have). In another few sessions, they'll get independent practice because they can point to the 20+ other states that do it without major problems.

Physician strikes seem unwise to me. For those to work, you have to be able to garner sympathy from the general public. No one feels sorry for doctors. The NHS slow down if I recall was mainly their versions of residents. Our residents could probably get away with it. Attendings probably can't. Even if our working conditions are bad for whatever reason, most people are going to look at the 200K/year we make and not give a damn about us.

 

[cabinbuilder]

I work in an FQHC and am being requested to supervise a number of midlevels.

I was wondering what the typical compensation for that is?

Thanks,

--Sean

I get $1000/month

 

[cabinbuilder]

whatever the number is, its too low.

I have no issue with discussing patients with a PA/NP or anyone else, but im not signing anyone’s note.

The person seeing the patient is either qualified or they are not. Unless you have an exhaustive process for determining this, why take the chance?

I don't co-sign my NP's note. I get sent the note when patients are sent to the ER. She tells me in clinic and I just say "agree with plan and ER transfer" on the chart

 

[Ironheme]

Kinda like how in you never document a curbside consult in the medical record. I do that now-a-days with my internist wife and her OB/GYN father.

Resident here. Why not? Wouldn't that help support your case/treatment if you wrote discussed with Dr. X, pulmonology, who reviewed CXR and agrees with plan of care?

 

[Mr.S]

Im in anesthesia and supervising midlevels is absolutely and posititvely the dumbest thing you can possibly do. In anesthesia we have so many problems with CRNAs because of this. DONT DO IT.

 

[LeroyJenkinsMD]

I’m so tired of the argument, “well without mid levels we wouldn’t have enough providers to see all of the patients.”

Without mid levels, maybe the public would feel the burn of increased wait times and vote to expand residency positions. Physicians are justifying their abuse by administration by telling themselves “it’s good for the patients.” If only patients cared about physicians...

The good news is patients don’t have to care about physicians. They will vote based on their needs, and they NEED physicians. We need to quit dressing up nurses as doctors so that patients can recognize their need for us.

 

[VA Hopeful Dr]

Resident here. Why not? Wouldn't that help support your case/treatment if you wrote discussed with Dr. X, pulmonology, who reviewed CXR and agrees with plan of care?

You're giving them liability without compensation.

 

[deleted87716]

You're giving them liability without compensation.

Sorta like supervising midlevels...? 😉

And don't think for a minute that your midlevels won't document that they consulted with you in their notes. They've probably been told to do it, in fact.

Curbside Consults: An Attorney's Take

 

[MedicineZ0Z]

I’m so tired of the argument, “well without mid levels we wouldn’t have enough providers to see all of the patients.”

Without mid levels, maybe the public would feel the burn of increased wait times and vote to expand residency positions. Physicians are justifying their abuse by administration by telling themselves “it’s good for the patients.” If only patients cared about physicians...

The good news is patients don’t have to care about physicians. They will vote based on their needs, and they NEED physicians. We need to quit dressing up nurses as doctors so that patients can recognize their need for us.

If admin workload and paperwork decreased, doctors could also see a greater number of patients. Not to mention staff physicians at any setting with a residency. The attendings could work harder and take on more patients on their own. Many ways to avoid midlevels seeing patients..

 

[VA Hopeful Dr]

Sorta like supervising midlevels...? 😉

And don't think for a minute that your midlevels won't document that they consulted with you in their notes. They've probably been told to do it, in fact.

Curbside Consults: An Attorney's Take

Yep which is why I would never do it for free