Hiring a Physician Assistant

[dahlilama]

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I have reached a tipping point in my practice where I am busy enough doing interventional pain procedures half the week that when I return to the clinic, I have way to many calls, and admin/paper work as well as clinic patients that I believe that if I added a P.A. who was capable of answering calls, doing basic follow ups when I am out of the office that it would go a long way to lessening my 60 to 65 hour work week. For those of you in pain practices who have such an arrangement, how has it worked out? Have you at least broken even with the PAs productivity vs cost. How many patients do they need to see per day to break even with their cost? What tips would you have in terms of this arrangement? Thanks in advance for your answers.

 

[PMR 4 MSK]

First, its hard to find a PA or NP with any real pain experience. So you will end up with with the equivalent of PGY1-2 (at best) whom you need to train. That could take several months to get them on their own and many more to be up to speed.

Most PAs and NPs can pay for themselves with 2-3 pts per hour. Many make $75-80K/year, which is about $40 per hour. Taking Medicare as the standard. If they see the pt without you there, they make 85% of MD fees, so you standard 99213 @ $60 becomes $50. 3 per hour = $150. Now subtract from that their salary + benefits, any additional office staff you'll need because of them, increased supplies, claims that don't get paid, etc, and you should break or make a small profit.

Also, do the field a favor, and don't train them on-the-job to do the procedures you do. It hurts everyone.

 

[Tenesma]

a medical assistant can answer calls - with a clear algorithm - and as soon as it gets over her head, she will sched pt for f/u (so that you can actually get paid) or sends pt to ER (ie: loss of bladder control).

each state has different rules re: PA vs NP - explore those differences first

i have an NP - i consider her my physician accelerator - she gets the quick easy f/us done with and does the documentation on the tougher f/us while i get to pontificate...

not a money maker - but does improve quality life a TINY bit.

 

[Jcm800]

a medical assistant can answer calls - with a clear algorithm - and as soon as it gets over her head, she will sched pt for f/u (so that you can actually get paid) or sends pt to ER (ie: loss of bladder control).

each state has different rules re: PA vs NP - explore those differences first

i have an NP - i consider her my physician accelerator - she gets the quick easy f/us done with and does the documentation on the tougher f/us while i get to pontificate...

not a money maker - but does improve quality life a TINY bit.

i break even on mine, and i have posted this a million times, she is the BEST! she does nothing that she is not suppose to do, and jumps on all the grenades. When i am behind, she will see a new patient, then i go in get the more pertinent history, do an exam, BS for a bit, and get out. She schedules, writes orders/scripts and writes the note... ( i still have ichange some stuff)

but it def improves my quality of life.

 

[facetguy]

What types of procedures, if any, do you allow your PA to do? Trigger point injections? Large joint (e.g., knee) injections?

 

[Jcm800]

What types of procedures, if any, do you allow your PA to do? Trigger point injections? Large joint (e.g., knee) injections?

None!

 

[facets]

i break even on mine, and i have posted this a million times, she is the BEST! she does nothing that she is not suppose to do, and jumps on all the grenades. When i am behind, she will see a new patient, then i go in get the more pertinent history, do an exam, BS for a bit, and get out. She schedules, writes orders/scripts and writes the note... ( i still have ichange some stuff)

but it def improves my quality of life.

Whats her name, I may want to hijack her
I have had probably 15 different midlevels over the years. Its hard to break even. The going rate here is not much different from primary care physicians, $50-$80 per hour plus you are responsible for everything they do. They typically know nothing about pain management, primaries don't even know much. It is usually easier, unless you get a gem like docshark, to just do it all yourself

 

[Ligament]

Have you guys thought about hiring a primary care physician instead of a midlevel? seems to me the best way to get quality care without contributing to the downfall of our profession by hiring noctors. I'd personally love to have a primary care physician in this role.

 

[Jcm800]

Have you guys thought about hiring a primary care physician instead of a midlevel? seems to me the best way to get quality care without contributing to the downfall of our profession by hiring noctors. I'd personally love to have a primary care physician in this role.

there is no way a PCP is gonna function as my subordinate for 85-90k a year in my area...