Np supervision stipend

[Attending1985]

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For those of you that get money for NP supervision, do you have dedicated time in your schedule for meeting with the NP‘s and discussing cases or is it being available for questions?

 

[TexasPhysician]

Supervising a NP should involve dedicated time and a monthly stipend of $4K+

 

[Attending1985]

Supervising a NP should involve dedicated time and a monthly stipend of $4K+

If there’s no dedicated time, but you’re available for questions would a stipend be appropriate? I’ve read 500/month for that type of setup.

 

[Sushirolls]

Liability is always worth something. Don't undervalue it.

 

[TexasPhysician]

If there’s no dedicated time, but you’re available for questions would a stipend be appropriate? I’ve read 500/month for that type of setup.

Very appropriate. $500 is a joke or an insult. I know some people accept that, but it is usually retired MD’s that have set up a deal for the NP to cover all fees for maintaining their license.

As the supervisor, you are taking responsibility for all deficiencies in their education, providing ongoing education, available 24/7 for questions, accepting their liability, meeting with attorneys regarding their legal problems, reviewing ongoing charts to identify deficiencies, etc.

 

[splik]

This will vary depending on whether you are employed by a big system, a small group practice, or collaborating with an NP with their own clinic, as well as the level of training and experience the NP has and whether it is an independent practice state. The typical gig involves no dedicated time and very low compensation with some limited chart review or just being the "collaborating" physician on paper. However, many states actually require much more from the physician. For example, in my state the physician is supposed to be available to see any patients who want to see a physician and when the NP believes the patient needs to see a physician. Disciplinary action usually involves the failure of the physician to be available to do this.

In general, I'd stay clear of NP supervision unless it is your own clinic and you are handpicking the NPs and establishing the terms for the supervision so it is actually meaningful. Most people treat is is a a little bit of passive income and usually take on the maximum number of NPs.

 

[comp1]

Okay so we need a heck of a lot more details. First and foremost, what state are you in? Second, is this some sort of private relationship or part of your salaried employment? What is the setting? Inpatient, outpatient, IOP? Those are just the first couple of questions to get started on a vague idea.

 

[Attending1985]

Okay so we need a heck of a lot more details. First and foremost, what state are you in? Second, is this some sort of private relationship or part of your salaried employment? What is the setting? Inpatient, outpatient, IOP? Those are just the first couple of questions to get started on a vague idea.

Minnesota, part of salaried employment, outpatient, no dedicated time just available for questions

 

[randomdoc1]

Minnesota, part of salaried employment, outpatient, no dedicated time just available for questions

Are there any caps on the potential time commitment and conditions for risk management? Those would be my thoughts. Worst case scenario, it can monopolize one's time or the NP could be super incompetent. I mean, I hope for the best...but as people on this thread know, I'm a control freak. I like details and checks and balances in place.

 

[splik]

Minnesota, part of salaried employment, outpatient, no dedicated time just available for questions

Yikes, so these would be green NPs as minnesota is an FPA state (i.e. no supervision) which means they are either doing their 2000 hours or whatever it is to get their independent practice (and need a lot of supervision) or they are billing under your name for their work afterwards and not compensating you for it.

 

[MedMan80]

I would say depends on the type of work and scope needed, in a independent practice state i worked in a hospital system would give <500/mo for NP supervision, really just for hospital compliacne reasons, wasn't needed by the medical boards.

In a supervised practice state, one offer i got was 1K/mo with the NP needing your license for sched II's. A hospital system was giving 500/mo for supervision. Another practice was giving more than 1K to incentivize you to supervise the NP's with a low base. I would say overall, the market rate (not reasonable rate) in a supervised state is ~1K/mo, in a independent practice state <500/mo. This does add liability, as the supervising doc is usually named in malprac suits as well as board complaints.

 

[Bartelby]

I have never supervised NPs.

That said, I think you need clarification about exactly what responsibility you are taking on. If the NP can ask you questions about a difficult case, you review the case much like you would with a resident, and then your name is also associated with that chart that seems like a pretty reasonable and workable model. To be clear, I am referring to your name being associated only with cases you have directly discussed with the NP. I would also require setting aside time to discuss the case in at least as much detail as you would with a psychiatry intern (PGY-1).

If the arrangement is that you are the "supervising doctor" for hundreds or thousands of charts but you actually only have input if one of the NPs comes to you with a specific question, I would turn that down at pretty much any price point. It seems to me the only purpose of an arrangement like that is to offload liability on to you.

 

[psychoFL]

If there’s no dedicated time, but you’re available for questions would a stipend be appropriate? I’ve read 500/month for that type of setup.

Most places pay you $500 per month (if you are employed) and depending on the state, you should be availabe for questions but also review some charts and meet once a month. This same company did pay me $1000 a month for some TX NP's I was supervising but only because the former collaborator was extorting this amount from them. One telemedicine company pays you an hour a month and the NP is free from other duties during that hour to meet with the MD. I think this is bad because the NP can still call at other times. They also wanted the MD to sign a contract saying they were responsible for all the actions of the NP. Don't do it. The level of work not only depends on how independly minded the NP is but also on their skill level. Nothing is worse than a poorly trained and skilled NP who also does not think they need any help. If you are indepndently contracting with an NP, I guess you can charge what they are willing to pay. But I would only start with a trial commitment of 90 days after an interview and asessment of their CV and training. If they are a new graduate, be sure to assess the quality of their preceptorship.

 

[psydocc]

Small group practice, $5k per month per midlevel, 1hr per week of time commitment. Psychiatrists that voluntarily agree to the commonly offered $500 per month are doing a huge disservice to the entire field of psychiatry and if they are just collecting that tiny little check and not actually supervising anything then honestly they deserve to be named in any lawsuits that come from their NPs sloppy prescribing habits.

 

[Cath Up]

Small group practice, $5k per month per midlevel, 1hr per week of time commitment. Psychiatrists that voluntarily agree to the commonly offered $500 per month are doing a huge disservice to the entire field of psychiatry and if they are just collecting that tiny little check and not actually supervising anything then honestly they deserve to be named in any lawsuits that come from their NPs sloppy prescribing habits.

Are you saying this is what you are actually paid? I have yet to hear about someone actually setting up something that seems fair and reasonable, as many in the community seem to accept oversight for the $500 or similar.

 

[FatherPsychiatry]

All the e-mails and text I get for this also seem to be in that $500 - $1000 range with varying amounts of required input, from "just be available for calls" to what sound like weekly sitdowns (I'm assuming via Zoom). I don't know anyone that does this (or anyone that admits to doing it), and when I read any kind of psychiatry forum, whether SDN or Facebook groups such as Physician Community or Psychiatry Network, the overwhelming consensus is it avoid this kind of thing.

Which makes me wonder - clearly there is an ever increasing number of Psych NPs each year, and I'm assuming they need some sort of physician supervision to get credentialed or to work at all. Since I have never heard of anyone taking on this kind of role (and quite the opposite - they're very against it and warn everyone else not to do it), I'm guessing that there is a small number of doctors that take on a huge number of NPs and just roll with it. Sounds like a high risk - potentially high reward, YOLO strategy.

My bet would be a lot of the docs who somehow see 100+ patients a day covering 5 inpatient units are the ones signing on to this.

 

[TexasPhysician]

Are you saying this is what you are actually paid? I have yet to hear about someone actually setting up something that seems fair and reasonable, as many in the community seem to accept oversight for the $500 or similar.

I earn $6,000/month to supervise a NP.

 

[comp1]

Maybe in some states they need physician supervision during training, but the majority of states have full independent practice authority for NPs and thus NP trainees are often supervised by NPs. You're really providing a service here that most states deem not necessary. That's probably why the reimbursement seems so low. I know, liability, liability, liability, etc. I fully understand the perspective of many here that NPs are killing their patients left and right, then somehow escaping scot-free while also handing all blame to MDs with the full support of their nursing boards. I just don't see or read about that sort of liability findings in practice outside of here, particularly in psychiatry.

 

[psydocc]

Are you saying this is what you are actually paid? I have yet to hear about someone actually setting up something that seems fair and reasonable, as many in the community seem to accept oversight for the $500 or similar.

That's what I get paid per month per midlevel, yes. This is one of the perks of working at a smaller, physician-owned group instead of a giant soulless corporation that has 100s of random administrative roles to pay and investors to satisfy.

 

[FlowRate]

5-6k/mo sounds pretty reasonable, overall. Especially if they're on the better end of NP's/PA's.

 

[comp1]

Salaried psychiatrists make about $150 an hour across the country (2000 hours a year, $310k salary). $6k works out to you spending 2 hours each work day with an NP. What the heck are you doing with an NP for literally a quarter of every day? Maybe if you're collaborating with a dozen NPs at once? I'd be extremely concerned for the long term health of a practice that paid $6k per NP collaboration per month. The reimbursement isn't there for that. You're literally costing over half what the NP does just for this while theoretically lowering your own billing.

 

[Merovinge]

Salaried psychiatrists make about $150 an hour across the country (2000 hours a year, $310k salary). $6k works out to you spending 2 hours each work day with an NP. What the heck are you doing with an NP for literally a quarter of every day? Maybe if you're collaborating with a dozen NPs at once? I'd be extremely concerned for the long term health of a practice that paid $6k per NP collaboration per month. The reimbursement isn't there for that. You're literally costing over half what the NP does just for this while theoretically lowering your own billing.

How much time do attending's supervise residents during the day? At least 2 hours would be very reasonable in many settings. Our outpatient was 1 attending to 3 residents so almost exactly 2 hours per resident per clinic day (given a few minutes of buffer where they aren't directly supervising anyone). I would argue the NP needs at least as much supervision as a psychiatry resident.

You may be discussing financial viability which I am not in a position to comment on. But as far as getting appropriate healthcare for the human beings we care for, my point above stands.

 

[comp1]

Residents are subsidized by the government as trainees. NPs are not. Further, residents are, by definition, always at the same constant level of functionality that resets each year. NPs out of training also are not this. Two hours per day per NP is not reasonable from a practical or financial perspective, nor is it clinically necessary unless you have an NP that the practice should not have hired. Heck, 2 hours per day per resident is too much. Where I see attendings supervising multiple residents at once they are generally also seeing their own patients in between and staffing (of new patients only) adds up to about 30-45 minutes per day per resident.

 

[FlowRate]

Salaried psychiatrists make about $150 an hour across the country (2000 hours a year, $310k salary). $6k works out to you spending 2 hours each work day with an NP. What the heck are you doing with an NP for literally a quarter of every day? Maybe if you're collaborating with a dozen NPs at once? I'd be extremely concerned for the long term health of a practice that paid $6k per NP collaboration per month. The reimbursement isn't there for that. You're literally costing over half what the NP does just for this while theoretically lowering your own billing.

I imagine they're spending less time than that. It's a payment for supervision and liability and profit generation.

 

[comp1]

Oh I'm quite sure that they're spending much less time than that and that's why I'm saying $6k per month is not a reasonable ask. Liability should already be included under an employee's malpractice coverage. I can tell you it's not costing any employer $6k a month. I don't know what profit generation means, but paying a MD $6k a month to not see patients themselves doesn't seem to fit at least the lay definition of the term.

 

[TexasPhysician]

Oh I'm quite sure that they're spending much less time than that and that's why I'm saying $6k per month is not a reasonable ask. Liability should already be included under an employee's malpractice coverage. I can tell you it's not costing any employer $6k a month. I don't know what profit generation means, but paying a MD $6k a month to not see patients themselves doesn't seem to fit at least the lay definition of the term.

$6K/month - liability, regular meetings for educational purposes, available 365 days of the year for questions (yes I’m called on some weekends). I sign off on every single clinical note, 100%. I built the template, so I know where everything is.

NP’s will never reach the educational knowledge of a psychiatrist. I’ve never met a NP that can manage everything without support. I’d argue it doesn’t exist unless there are some psychiatrists that re-educated as a NP for some reason. It isn’t about whether you need to assist and monitor them but how much you need to monitor. The states that allow independence are just plain stupid.

There are definitely cheaper options than me that exist. Some docs are taking $500-$1000/month for doing almost nothing. I am the opposite. I am hands on ensuring things are done right, like it should be.

 

[comp1]

Okay, yes, anything where you put yourself on 24/7/365 call may be worth $6k a month. This is not a setup I would propose anyone else develop or sign up for, nor would I argue that it is is something that people are likely to find commonly. I can also see your perspective on this as Texas is an extraordinarily restrictive state for NPs. This sort of setup should not be expected in the vast majority of states. The OP is in Minnesota which has regulations that are much more common throughout the country and I seriously doubt anything vaguely resembling the above is present there.

 

[psydocc]

Okay, yes, anything where you put yourself on 24/7/365 call may be worth $6k a month. This is not a setup I would propose anyone else develop or sign up for, nor would I argue that it is is something that people are likely to find commonly. I can also see your perspective on this as Texas is an extraordinarily restrictive state for NPs. This sort of setup should not be expected in the vast majority of states. The OP is in Minnesota which has regulations that are much more common throughout the country and I seriously doubt anything vaguely resembling the above is present there.

It's clear you're unfamiliar with the level of revenue that highly successful psych private practices bring in if $5-6k/month blows your mind.

It also seems you're being intentionally obtuse for some reason. 1. Yes it's "24/7/365" coverage but outpatient clinic NPs are not reaching out to their supervising psychiatrist at 1am on a Saturday, at least not for any work-related reasons. 2. No one here has said $5-6k per month for supervision is "common" so you'd be arguing with yourself. 3. No one has said they are spending 2 hours a day on supervision.