Paid for NP supervision or not?

[Jules A]

Many do this even in states where NPs have full practice authority. With a supervising physician employers can bill incident to at 100% rather than the NP's reimbursement rate of 85%.

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[Shikima]

The offer is 2050/month for 2 days a week to sign off on NP notes. This will double to 4100/mo if NP becomes full time. Talked to a few of my younger friends who are 1st or 2nd years as attending and it seems they are all doing multiple NP supervisions without any pay! Glad to have a forum with such knowledge. I had no idea this kinda stuff was able to be compensated. Got some thinking to do. Tempting even though below market value as I'd use it to pay off loans..also could be renegotiated at end of year as well or i can opt out.

Question ultimately will be, do you endorse MLPs invading in our territory vs the easy money?

 

[finalpsychyear]

Question ultimately will be, do you endorse MLPs invading in our territory vs the easy money?

I don't endorse it and that was a huge reason i didn't want anything to initially do with the process. However, it seems they are replacing a current np who is leaving for more money so they would have still hired this person it would have just been delayed by a month. In my state an MD can have 5 collaborations and the director is capped but only for the next month.

 

[michaelrack]

Question ultimately will be, do you endorse MLPs invading in our territory vs the easy money?

I'd take the easy money

 

[Psychotic]

I'd take the easy money

But can you understand how some of us youngsters, soon to be or only just out of residency, have so many qualms about this? Maybe in a few years the OP, and people like me, once we know the liability issues better, might accept one of these deals. But right out the chute, I am focusing on MY liabliity, etc.

 

[michaelrack]

But can you understand how some of us youngsters, soon to be or only just out of residency, have so many qualms about this? Maybe in a few years the OP, and people like me, once we know the liability issues better, might accept one of these deals. But right out the chute, I am focusing on MY liabliity, etc.

You youngsters are right to worry about the liability (which varies from state to state). In my states (TN, MS, Arkansas), I would take the money, but you need to check out the situation in your state. When I said I'd take the easy $, I mainly meant that I would be ok to "endorse MLPs invading in our territory"
I have been messed over a several times by fellow physicians and physician organizations, and forced into bankruptcy in early 2015. I have fought the fight previously (I helped in the fight to keep psychologists from reading sleep studies in the American Academy of Sleep Medicine), but now I am done with the fight. You youngsters need to look out for yourselves

 

[FlowRate]

Hey finalpsych, I'm curious about your feeling of needing to be a "team player." Did you go to a residency where people were afraid of being canned for not being "team players?" This whole "team player" thing is doublespeak the business folks (and malignant residencies) use to talk people into doing **** they don't want to do, as if you're somehow hurting everyone else if you don't comply.

Regardless of where that fear comes from, you're an IC. There is no team, it's just you. Yeah, you have a working relationship with these folks, but you don't owe them anything other than what your contract states. They can get rid of you at any time (unless otherwise specified by contract) and you can do the same.

 

[watto]

Hey finalpsych, I'm curious about your feeling of needing to be a "team player." Did you go to a residency where people were afraid of being canned for not being "team players?" This whole "team player" thing is doublespeak the business folks (and malignant residencies) use to talk people into doing **** they don't want to do, as if you're somehow hurting everyone else if you don't comply.

Regardless of where that fear comes from, you're an IC. There is no team, it's just you. Yeah, you have a working relationship with these folks, but you don't owe them anything other than what your contract states. They can get rid of you at any time (unless otherwise specified by contract) and you can do the same.

Think of playing hardball as doing your part to help the organization assimilate the true costs of the service. This is what I always talk about with patients I see working in dysfunctional systems - all you are doing is propping up an organization that needs to solve the problem eventually when employee goodwill runs out. It's not personal, it's just dolla dolla dollas.

 

[Shikima]

You youngsters are right to worry about the liability (which varies from state to state). In my states (TN, MS, Arkansas), I would take the money, but you need to check out the situation in your state. When I said I'd take the easy $, I mainly meant that I would be ok to "endorse MLPs invading in our territory"
I have been messed over a several times by fellow physicians and physician organizations, and forced into bankruptcy in early 2015. I have fought the fight previously (I helped in the fight to keep psychologists from reading sleep studies in the American Academy of Sleep Medicine), but now I am done with the fight. You youngsters need to look out for yourselves

Thanks for fighting the psychologists. I know a few notable persons (Detroit & San Diego) who are still fuming at this ruling.
Youngsters (like me) needs to fight against MOC and MLPs. Prevent other nonsense from occurring like allowing psychologists script rights in other states.

 

[Shikima]

Hey finalpsych, I'm curious about your feeling of needing to be a "team player." Did you go to a residency where people were afraid of being canned for not being "team players?" This whole "team player" thing is doublespeak the business folks (and malignant residencies) use to talk people into doing **** they don't want to do, as if you're somehow hurting everyone else if you don't comply.

Regardless of where that fear comes from, you're an IC. There is no team, it's just you. Yeah, you have a working relationship with these folks, but you don't owe them anything other than what your contract states. They can get rid of you at any time (unless otherwise specified by contract) and you can do the same.

Anyone reading this thread. Listen to this. There is no teamwork as a physician. The buck stops with you and you alone. All others are replaceable - as a shrink, you are not because there aren't very many of you. If you're getting bullied by a system then let your feet do the walking. Even better, open your own clinic up and refuse medicaid.

 

[finalpsychyear]

Hey finalpsych, I'm curious about your feeling of needing to be a "team player." Did you go to a residency where people were afraid of being canned for not being "team players?" This whole "team player" thing is doublespeak the business folks (and malignant residencies) use to talk people into doing **** they don't want to do, as if you're somehow hurting everyone else if you don't comply.

Regardless of where that fear comes from, you're an IC. There is no team, it's just you. Yeah, you have a working relationship with these folks, but you don't owe them anything other than what your contract states. They can get rid of you at any time (unless otherwise specified by contract) and you can do the same.

Yes, residency was very heavy on this and I was not good at it .... The illusion is sometimes all you need since your correct 100% its me and me.So I do have a private clinic which itself is doing very well yet i plan to move so i am not wasting time expanding it. I'm leveraging the income I'm getting from some of these side jobs to open in another area as the area where my clinic is in is not where I want to be .My fear is the newer area has about 10x the population of my current area but of course a ton more psychiatrists. I'm so glad I do have the PP as whatever happens in these side gigs I will still be able to survive so i never lose sleep over it.

 

[AD04]

Thank you for this thread.

The gig I signed up with sent a last minute "collaboration" agreement for me to sign. I was very confused as why did I have to sign a form to "collaborate." I dug further and found out they want to me to be a supervising physician.

I knew nothing about the NP. I did not interview the NP. I don't even know what type of NP she was. According to the agreement, the person I supervise could potentially be a FNP. And there was no extra money for signing.

I flushed that agreement down like floating crap in a toilet bowl.

As physicians, we really got to watch out for ourselves.

 

[splik]

According to the agreement, the person I supervise could potentially be a FNP.

the majority of NPs working in mental health are FNPs, not psych NPs. so it is more likely than not than a NP a psychiatrist would be supervising would be an FNP rather than a psych NP...

 

[AD04]

Good to know. All I can say is ... I'm sorry for the patients.

 

[Bad Moose]

The offer is 2050/month for 2 days a week to sign off on NP notes. This will double to 4100/mo if NP becomes full time. Talked to a few of my younger friends who are 1st or 2nd years as attending and it seems they are all doing multiple NP supervisions without any pay! Glad to have a forum with such knowledge. I had no idea this kinda stuff was able to be compensated. Got some thinking to do. Tempting even though below market value as I'd use it to pay off loans..also could be renegotiated at end of year as well or i can opt out.

I found an interesting case about this topic. Long story short, a patient was seen by a NP who has an agreement with a doctor like the one you described. The patient died and the doctor was sued and the doctor lost.

Here is the kicker, the Doctor never saw the patient and did not review the chart (he is only legally obligated to review a percent of the charts).

That is why I do not use the word collaboration. If I am working with a midlevel they must agree to a supervision relationship, not a collaboration.


Link to the article: COA: Doctor had duty to nurse practitioner’s patient who died | The Indiana Lawyer

 

[deleted480308]

I found an interesting case about this topic. Long story short, a patient was seen by a NP who has an agreement with a doctor like the one you described. The patient died and the doctor was sued and the doctor lost.

Here is the kicker, the Doctor never saw the patient and did not review the chart (he is only legally obligated to review a percent of the charts).

That is why I do not use the word collaboration. If I am working with a midlevel they must agree to a supervision relationship, not a collaboration.


Link to the article: COA: Doctor had duty to nurse practitioner’s patient who died | The Indiana Lawyer

“Collaboration” is a lie

 

[michaelrack]

That case is state specific, and this played a big role: " In fact, he admitted that he never reviewed any of Barger’s charts on a weekly basis"

 

[milesed]

I have 3 ARNP's I supervise. It's not a big deal if you have trained them properly from the start and they know to call when have questions or are stuck. You just need to get paid for the time used for it. Set up a specific hour each day with no patients and have them bring whatever they need to you then. I don't have to sign off on notes as our state allows them to practice independently. I do periodically review random notes.

We do have a collaborative agreement which is more of a protection for them. I don't know the details of the lawsuit mentioned above, but it sounds like there has to be much more to that story.