Paid for NP supervision or not?

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finalpsychyear

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So i'm working at one location where I get paid hourly as an indepdent contractor and do a mix of onsite and tele-psych. They recently hired a PsychNP who i am suppose to supervise and sign her notes off on but after looking at the agreement i got today, which they need signed today, since the NP starts tomorrow there is nothing about me being compensated since i am strictly a 1099 with no benefits as this is a side job to my PP.

What is reasonable to ask for. I did bring this up and they were ok for me to "add" hours per week to my current invoices for doing the supervision and reviewing notes ex: probably like 2 hrs a week since the NP is only part time and seeing pts 2x a week for now.

Thoughts if I am being reasonable or should I be asking for more/less since I have never been in this position before?
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Edit: Sorry misread that, didn't see that you were reviewing your new agreement. Just tell them that you can't sign it without an attorney review and that you'll keep working under your old agreement until the renegotiation process is complete. They might not like it but you definitely shouldn't let them pressure you just because they didn't plan this well.

Edit edit: Definitely do not add hours without the contract explicitly stating you can do so. No matter what they said was ok in past conversations the contract needs to include it.
 
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TexasPhysician said:
Run! You need an attorney drafted supervision agreement. You need to interview and teach the NP after feeling comfortable with their skills. Legal and time compensation should be $4k+/month. They are dropping this on you to deceive you.
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hi. The NP has 20 years of experience I was told. Im not sure how to Pm you. I am a bit freaked now. They are so far ok with half that amt. I have a 30 days notice worse case scenerio. They have already scheduled his full patient load for tmrw and need me to sign off on it before it can be official. Also just found out another doc is leaving who was the other telepsych place but they are really chill with me the 3 months i have been here so no complaints.


Great advice guys. I definitely will heed all of it and am not signing anything till it is reviewed and the hours are in the contract. If i get the hours added over 48 weeks it amounts to 23-30k which i hope i am not being screwed on this as it is my first time. I do like the place they have accommodated all my requests. Again thank you all for your input!!
 
finalpsychyear said:
hi. The NP has 20 years of experience I was told. Im not sure how to Pm you. I am a bit freaked now. They are so far ok with half that amt. I have a 30 days notice worse case scenerio. They have already scheduled his full patient load for tmrw and need me to sign off on it before it can be official. Also just found out another doc is leaving who was the other telepsych place but they are really chill with me the 3 months i have been here so no complaints.


Great advice guys. I definitely will heed all of it and am not signing anything till it is reviewed and the hours are in the contract. If i get the hours added over 48 weeks it amounts to 23-30k which i hope i am not being screwed on this as it is my first time. I do like the place they have accommodated all my requests. Again thank you all for your input!!
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The bolded is not your issue if it's not currently in your contract. It's poor planning on their part.
 
finalpsychyear said:
hi. The NP has 20 years of experience I was told. Im not sure how to Pm you. I am a bit freaked now. They are so far ok with half that amt. I have a 30 days notice worse case scenerio. They have already scheduled his full patient load for tmrw and need me to sign off on it before it can be official. Also just found out another doc is leaving who was the other telepsych place but they are really chill with me the 3 months i have been here so no complaints.
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Going to leave the comments about contracts to those who know better, but in terms of the NP experience...is that experience actually in psych? I did a rotation where among other things I worked with an NP who had significant medical experience, but had just decided to switch into psych, and her level of psych-specific knowledge was well below mine as an M4. The doc we were working with was keeping a very very close eye while she gained psych experience.
 
Psychotic said:
It is more egregious than poor planning - it is a strong arm tactic.
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Not necessarily. Usually it's just incompetence on the part of the department administration. They don't realize how long it takes legal to get a contract done or they forget about it and are like "oh shoot, this needs to be in the contract" and try to rush it through at the last minute. It could definitely be that they're trying to slip this through without the doc noticing but it's just as likely that it's just a screw up.
 
trophyhusband said:
Not necessarily. Usually it's just incompetence on the part of the department administration. They don't realize how long it takes legal to get a contract done or they forget about it and are like "oh shoot, this needs to be in the contract" and try to rush it through at the last minute. It could definitely be that they're trying to slip this through without the doc noticing but it's just as likely that it's just a screw up.
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Maybe it's both, lol
 
Hi. 100% not signing anything till it gets legal review. Person is working 2 days a week and may or may not be doing telepsych as part of that which i just found out! Apparently, the other MD director of the clinic has 5 Nps but he is employed so they were just thinking it could just be slipped into me without compensation which i find ridiculous. To be honest, I don't want any type of supervision if I am being selfish but feel like I'm trying to be a team player here. The 20-30k a year doesn't justify my medical license.

Thanks again to all the wisdom being posted here. Very helpful!!
 
As a contractor, who pays your malpractice? Has there been an amendment to supervise midlevels? Will this increase the cost of tail coverage? If you are sued for the midlevels poor prescribing, will you continue to be paid your hourly rate for legal time? What meds can they prescribe? What stops them from prescribing opiates? How many hours are allotted for supervision and teaching? How about chart reviews? What hours are you guaranteeing availability?

There are sooo many issues here. I’d email the clinic admin that you are refusing supervision. Any patients seen currently are not and will never be signed off on by you. This is a major issue that if not handled properly could result in medical board sanctions.

Without going through each step thoroughly and being paid $4-8k/month, you are being screwed.
 
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finalpsychyear said:
Hi. 100% not signing anything till it gets legal review. Person is working 2 days a week and may or may not be doing telepsych as part of that which i just found out! Apparently, the other MD director of the clinic has 5 Nps but he is employed so they were just thinking it could just be slipped into me without compensation which i find ridiculous. To be honest, I don't want any type of supervision if I am being selfish but feel like I'm trying to be a team player here. The 20-30k a year doesn't justify my medical license.

Thanks again to all the wisdom being posted here. Very helpful!!
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Ok, now it sounds like they just think you're basically a salaried employee and don't realize that being an IC is a different beast entirely (so incompetence in a manner of speaking). This also means that they're not considering any of the things TexasPhysician brought up... because they don't need to consider those things for an employed physician. This is not a great situation because you're not interested in doing it and they're not cognizant of the issues involved.

I think I'd just hire a lawyer to review the contract tell him or her you're not really interested in doing it and give him all the info on issues TexasPhysician listed and he can make the counteroffer too onerous for them to accept and then you can offer to stay on in your current capacity. Or your lawyer can just provide you a letter recommending that you don't supervise an NP for x,y, and z reasons and you can give that to them. Your lawyer isn't going to care about looking like the bad guy and you get to seem reasonable while saying sorry my lawyer says I shouldn't do it.
 
TexasPhysician said:
As a contractor, who pays your malpractice? Has there been an amendment to supervise midlevels? Will this increase the cost of tail coverage? If you are sued for the midlevels poor prescribing, will you continue to be paid your hourly rate for legal time? What meds can they prescribe? What stops them from prescribing opiates? How many hours are allotted for supervision and teaching? How about chart reviews? What hours are you guaranteeing availability?

There are sooo many issues here. I’d email the clinic admin that you are refusing supervision. Any patients seen currently are not and will never be signed off on by you. This is a major issue that if not handled properly could result in medical board sanctions.

Without going through each step thoroughly and being paid $4-8k/month, you are being screwed.
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I have halted the entire process and the NP clinic has been canceled and they have apologized for giving it at the last second. They have offered to pay for the expedited lawyer fee and so far I have proposed a 2500 fee per month for the 20 hrs (8-6). This is a community mental health unit. I am still not sure I will do it but given that the person is not full time is this stipend fair or am i being screwed?
 
finalpsychyear said:
I have halted the entire process and the NP clinic has been canceled and they have apologized for giving it at the last second. They have offered to pay for the expedited lawyer fee and so far I have proposed a 2500 fee per month for the 20 hrs (8-6). This is a community mental health unit. I am still not sure I will do it but given that the person is not full time is this stipend fair or am i being screwed?
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You've given them something to think about, wait for their response.
 
finalpsychyear said:
I have halted the entire process and the NP clinic has been canceled and they have apologized for giving it at the last second. They have offered to pay for the expedited lawyer fee and so far I have proposed a 2500 fee per month for the 20 hrs (8-6). This is a community mental health unit. I am still not sure I will do it but given that the person is not full time is this stipend fair or am i being screwed?
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What is the NP doing the other hours of the month? Are they maintaining their skills elsewhere? Will your contract have escalation clauses for when they increase the hours (I guarantee they will).

Things like higher malpractice insurance fees are fixed. The number of hours you supervise makes no difference. Education should be routine regardless of hours worked. Do you have production bonuses that you will miss due to education/supervision hours? How much dedicated time are you given that is paid?

You are free to ask for whatever amount you wish, but that NP doesn’t produce without a supervising physician. You have significant leverage, and the burden is high.
 
TexasPhysician said:
What is the NP doing the other hours of the month? Are they maintaining their skills elsewhere? Will your contract have escalation clauses for when they increase the hours (I guarantee they will).

Things like higher malpractice insurance fees are fixed. The number of hours you supervise makes no difference. Education should be routine regardless of hours worked. Do you have production bonuses that you will miss due to education/supervision hours? How much dedicated time are you given that is paid?

You are free to ask for whatever amount you wish, but that NP doesn’t produce without a supervising physician. You have significant leverage, and the burden is high.
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The NP ended up only having 1.5 yrs of experience not the 20 i was told. They are also working at some suboxone clinic in another area that i have nothing to do with. They told me today they are looking at two other part time jobs not associated with this organization. Also, the malpractice even mine is given by the company even though I have my own they provided me with another one just for telepsych.

This company has an older psych doc who has 5 NPs he "supervises" but he is employed by the organization. I also brought up today when i found out one of those other NPs that he supervises is leaving that the current one could just go to him if they are unable to pay me additional money since it feels like he does it for free. the admin seemed surprised when i was like uh..i dont see any mention of compensation in this contract for the midlevel... Also, Im free to turn this entire thing down if i wish as well so if i don't get 2500 a month for the 2 days per week plus 1 wknd day a month which now i will make sure to have escalation clauses due to ur input.

I'd actually prefer to just not do this at all but feel some weird unsaid pressure to be a "team player" although it will NOW require being a well paid team player. Will keep you guys updated. plz keep giving me feedback as you see fit. It totally changed the course of today as my dumb self felt guilty prior to posting this and nearly signed on the spot. Your experience in all these matters is guiding me as I have no experience in how this type of arrangement works when one is an indep contractor.
 
finalpsychyear said:
I'd actually prefer to just not do this at all but feel some weird unsaid pressure to be a "team player" although it will NOW require being a well paid team player. Will keep you guys updated. plz keep giving me feedback as you see fit. It totally changed the course of today as my dumb self felt guilty prior to posting this and nearly signed on the spot. Your experience in all these matters is guiding me as I have no experience in how this type of arrangement works when one is an indep contractor.
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It strikes me that they are trying to take advantage of you while simultaneously making you feel guilty for not being taken advantage of, and accentuating the effort with a time pressure. The situation is setting of alarm claxons for me.
 
michaelrack said:
2.5 k a month for np supervision is a good deal
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Is this the going rate? I was thinking that would be minimum for the 20 ish hours the guy is starting at and then if the hours were to go up to say 40 then my stipend would also go up. The pts being seen are all higher risk usually hospital discharge at this community place. The NP may or may not be doing suboxone later on as well and vivitrol. He also may be using telepsych instead of face to face appts as i was told initally. Not sure if that should effect the fee.
 
Also if you don't want to do it don't. It's as simple as that. It is the medical directors job to be supervising NPs not yours. In fact medical director malpractice is typically required to cover you for supervising NPs.
 
finalpsychyear said:
Is this the going rate? I was thinking that would be minimum for the 20 ish hours the guy is starting at and then if the hours were to go up to say 40 then my stipend would also go up. The pts being seen are all higher risk usually hospital discharge at this community place. The NP may or may not be doing suboxone later on as well and vivitrol. He also may be using telepsych instead of face to face appts as i was told initally. Not sure if that should effect the fee.
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do the supervision while doing your other duties at the place (in other words, sign off on charts, talk to the NP on the phone, etc in between the patients you are seeing). So the supervision time will be paid for under your hourly rate with the facility. And in addition, you will get 2.5 k on top off all that per month. That's how it is often done in the real world (although typically you would get less than 2.5 k extra).
disclaimer: this information does not necessarily apply to employed (W2) situations
 
And regardless of the circumstances, reimbursement, malpractice or contract don't even consider it without first interviewing the midlevel you will be saddled with.
 
splik said:
The going rate is your hourly fee multiplied by the number of hours of supervision you provide. You can't just make up random numbers.
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Disagree. That should be the minimal at worst. They are using your license in order to practice. In my situation the entire process of the NP making money for the company is based on me signing off on it and my medical license being used. Im not an employee of the facility so they are using my credentials to make this legit and push come to shove I am the one who is liable. That should all be reflected in the cost. Just because people slide these things into expectations for most doctors doesn't make any sense from a business perspective.
 
It's super sketchy they would assume you would agree to this.
 
michaelrack said:
do the supervision while doing your other duties at the place (in other words, sign off on charts, talk to the NP on the phone, etc in between the patients you are seeing). So the supervision time will be paid for under your hourly rate with the facility. And in addition, you will get 2.5 k on top off all that per month. That's how it is often done in the real world (although typically you would get less than 2.5 k extra).
disclaimer: this information does not necessarily apply to employed (W2) situations
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Going rate in my area is much more. That liability and time for $2.5k isn’t worth the effort. Who would agree to that?
 
Merely said:
2.5k per month is a joke, you should've asked for 9k per month and then agreed to 6.5k after negotiating
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2.5 is still a joke even though the NP will only be working 2 days/wk? I could see 9k if the NP was working and needing supervision full-time, but 9k/mo for the NP putting in <20 hrs/wk seems really high to me. Or am I just missing something there?
 
Stagg737 said:
2.5 is still a joke even though the NP will only be working 2 days/wk? I could see 9k if the NP was working and needing supervision full-time, but 9k/mo for the NP putting in <20 hrs/wk seems really high to me. Or am I just missing something there?
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Many of the costs and educational time are fixed. NP is likely starting part-time to save the facility money in building a case load which is not the OP’s problem.

Malpractice company charges a premium for supervising regardless of hours. Education must be provided if using your license. Lawyer must be paid to draft employee contract and separate NP agreement that details prescribing abilities. NP agreement will involve time with you and attorney to specify which meds are or are not allowed. Time must be dedicated to review/sign charts. Only 1 patient needs to sue before it is possible to lose billable hours in a deposition or court room.
 
TexasPhysician said:
Many of the costs and educational time are fixed. NP is likely starting part-time to save the facility money in building a case load which is not the OP’s problem.

Malpractice company charges a premium for supervising regardless of hours. Education must be provided if using your license. Lawyer must be paid to draft employee contract and separate NP agreement that details prescribing abilities. NP agreement will involve time with you and attorney to specify which meds are or are not allowed. Time must be dedicated to review/sign charts. Only 1 patient needs to sue before it is possible to lose billable hours in a deposition or court room.
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They are paying my malpractice already for that site and also the NPs as far as I'm aware.

They are calling me the "primary collaborating physician" and the medical director of the clinic (psychiatrist MD) is another collaborating physician who will also be signing the agreement. I'm only required to audit 2 charts in 6 months for review based on the state I am living in they are quoting to me but of course thats at my potential detriment. This is coming from the nursing director. Just so we're clear this terminology doesn't' change the liability issues in states where NPs are required to have an MD sign charts. They keep saying Collaborating instead of supervising physician. This is just the same from a liability standpoint as far as you guys know?


Also, what they are asking me to sign is called a standard care agreement between an APRN and collaborating physician.
 
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finalpsychyear said:
They are paying my malpractice already for that site and also the NPs as far as I'm aware.

They are calling me the "primary collaborating physician" and the medical director of the clinic (psychiatrist MD) is another collaborating physician who will also be signing the agreement. I'm only required to audit 2 charts in 6 months for review based on the state I am living in they are quoting to me but of course thats at my potential detriment. This is coming from the nursing director. Just so we're clear this terminology doesn't' change the liability issues in states where NPs are required to have an MD sign charts. They keep saying Collaborating instead of supervising physician. This is just the same from a liability standpoint as far as you guys know?


Also, what they are asking me to sign is called a standard care agreement between an APRN and collaborating physician.
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As far as I can tell, collaborating vs supervising are exactly the same thing, just spin put out by the nursing lobby to imply np's and doctors are equal. I'm not aware of specific cases, but I cannot imagine you won't be named in the np's lawsuit and held to exactly the same standard as a "supervising" physician. I really wouldn't trust anything the nursing director has to say on the topic...it's unlikely that person has your best interest in mind. She/he will probably be bragging at a meeting in 6 months about the profitability of bringing on an np and how little you are getting paid to supervise them.

My opinion is your supervision rate should be the difference in what they are paying the np and what they would pay a psychiatrist.
 
nexus73 said:
As far as I can tell, collaborating vs supervising are exactly the same thing, just spin put out by the nursing lobby to imply np's and doctors are equal. I'm not aware of specific cases, but I cannot imagine you won't be named in the np's lawsuit and held to exactly the same standard as a "supervising" physician. I really wouldn't trust anything the nursing director has to say on the topic...it's unlikely that person has your best interest in mind. She/he will probably be bragging at a meeting in 6 months about the profitability of bringing on an np and how little you are getting paid to supervise them.

My opinion is your supervision rate should be the difference in what they are paying the np and what they would pay a psychiatrist.
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thank you for your feedback. I feel stronger now about my asking for 4 billable hours of my hourly rate per week for the 20 hrs the NP is starting to work with it also spelled out that it will be 8 hrs or prorated up if it changes to 40 hrs or some in between. I also figured out that the medical director who is employed is capped at 5 other NPs so he cannot add more so i really have a lot more bargaining power on my end but dont want to overask it further than this. Im also fine walking away so let us see what happens. Thank you again for giving me your thoughts.
 
TexasPhysician said:
Many of the costs and educational time are fixed. NP is likely starting part-time to save the facility money in building a case load which is not the OP’s problem.

Malpractice company charges a premium for supervising regardless of hours. Education must be provided if using your license. Lawyer must be paid to draft employee contract and separate NP agreement that details prescribing abilities. NP agreement will involve time with you and attorney to specify which meds are or are not allowed. Time must be dedicated to review/sign charts. Only 1 patient needs to sue before it is possible to lose billable hours in a deposition or court room.
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They countered my 4 hrs per week or 16 hrs a month which came out to 2500 ish and i had spelled out it would be for the part time hours of the np (0-20) and then increased accordingly if NP went full time later on.

They countered by offering 1500 flat per month for PART TIME NP supervision and
that it would increase if NP hours increased.
 
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finalpsychyear said:
They countered my 4 hrs per week or 16 hrs a month which came out to 2500 ish and i had spelled out it would be for the part time hours of the np (0-20) and then increased accordingly if NP went full time later on.

They countered by offering 1500 flat per month and then saying this was little more than half of what I had asked for when it was actually more like 1/4.

I think I'm walking although it is tempting if the alternative is 0.
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What if you just say no? Is the clinic admin going to end your contract?
 
Shikima said:
You've given them something to think about, wait for their response.
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They countered with 1500 flat rate per month but i was just told it was provided the NP stays part time and it would increase if the went Full time.
 
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Update the offer of 1500 was for part time only flat stipend. I'll ask them to meet me in between at 2k but likely would take 1500 since its just for part time push come to shove. Ill keep you all updated.
 
On a weekly basis that is only approximately a net of $250. Unless this NP is a rock star and you are not spending more an 1 hour a week on it I'd pass.
 
Jules A said:
On a weekly basis that is only approximately a net of $250. Unless this NP is a rock star and you are not spending more an 1 hour a week on it I'd pass.
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They are not expecting any required monthly face to face time. They just need a form signed (standard care agreement) and for me to review 2 notes/ 6 months is what i was just told. I am trying to negotiate 2k at the moment.
 
finalpsychyear said:
They are not expecting any required monthly face to face time. They just need a form signed (standard care agreement) and for me to review 2 notes/ 6 months is what i was just told. I am trying to negotiate 2k at the moment.
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I think you're missing the point others are trying to make. Let's say the NP sees 15 pts a day those 2 days a week. That's 120 encounters per month or 720 per 6 month period. You'll be reviewing 2 of those notes but liable for all of them. Even if that's all your particular state requires that doesn't mean you should be comfortable with that.
 
trophyhusband said:
I think you're missing the point others are trying to make. Let's say the NP sees 15 pts a day those 2 days a week. That's 120 encounters per month or 720 per 6 month period. You'll be reviewing 2 of those notes but liable for all of them. Even if that's all your particular state requires that doesn't mean you should be comfortable with that.
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This. Maybe in a few years when you know the NP’s every move, the state minimum would probably be fine.

Until then, I’d check in daily and review multiple charts weekly. Also weekly education and treatment recommendations.

You basically have someone less prepared than an intern that you are liable for. If you aren’t up for the commitment and time required, don’t risk your license.
 
finalpsychyear said:
No they will not. It is up to me.
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In that case, pass. There is too much you don't know about you liability, and you should not agree to anything, or sign any contracts, without knowing.

I would pass and start looking elsewhere for work.
 
Shikima said:
Passsssssss....... too low
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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.
 
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