Pay Rate to Supervise an NP on Inpatient?

[psych_0]

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Title pretty much says it all but I was wondering if anyone here in the community supervises NPs on an inpatient basis only, not PHP or IOP. My hospital is expanding and they are asking if we want to fill in some of the gaps with NPs. Obviously not my first choice, but if the pay isn't terrible it may be worth it? This would be my first time supervising NPs so I don't even know where to start in terms of getting paid to supervise them. To anyone supervising NPs now: How much are you getting paid for it? Is it on a per month basis or per patient or what is your set up? Also, is it worth it?

 

[robellis]

They will try to probably barely pay you anything so it will not be worth it, it’s only worth it if you’re being paid at minimum 5k per month for it per NP

 

[Sushirolls]

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[nexus73]

The first offer will probably be do it for free. Because hey we're expanding and you don't want to cover all those beds yourself right? The nps are just here to be extenders to help you out. It's to make you job easier. This is bull$hit.

The second offer is, ok, we can give you $100/hr of supervision time, but we define supervision as some kind of formal teaching time so you probably won't be doing that more than an hour or three a month right. So $300 a month ought to cover it? Of course we can't pay you for work you're not doing, only the time spent supervising, and remember...we can only pay FAIR MARKET VALUE!!! Right? Right? Also bull$hit.

Ok, you drive a hard bargain, we can give you a $500/month stiped to supervise nps. Oh no, not $500 for each np, you'll be sharing the nps with the group so just supervise on the fly for whichever np needs your help and sign off on whatever notes get assigned to you. What a great deal for you! And you're helping improve access to care, here's a gold star (we won't even charge you for the gold star!).

====================================================================================================

Unless you are okay getting paid peanuts for increasing your stress and liability (which maybe you are and that's up to you), my opinion is there needs to be a realistic monthly stipend somewhere in the multiple thousands of dollars range for EACH np assigned to you as a supervisor. You are not just the supervisor for the few hours of formal teaching time each month, or the few hours of chart review and signing. You are the supervisor at all times the np is doing anything with any patients anywhere in the hospital. And there is a value to that. Which should be thousands of dollars.

They are paying the np $140-180K, something like that. So $100K less than an MD. I think they can come up with $50K+ to pay you to supervise and still come out ahead on the deal.

 

[nexus73]

One thing to watch out for.

Surgeons and proceduralists (like cardiology) really like their pa's and np's, and they may not get paid anything to supervise them. The difference is the mid levels on surgery or cardiology are sharing the same patients and taking a ton of work off the MDs plate so they can do more procedures. The midlevels are doing all the pre-rounding, order enter, admits, initial consults, note entry, d/c summaries, etc...which makes life as an procedural specialist very nice.

You can tell why this doesn't work in psychiatry. There is no setup where np's are rounding on all your patients for you, then you just pop in for a minute say hi, then cosign the note. The psych nps are carrying their own independent patient load, just like you. So the procedural specialists are not getting paid directly, but they benefit greatly by having the mid levels do work they would otherwise have to do.

I mention this because my hospital recently tried to use the "I don't understand, neurosurgery and ortho and cardiology all love their np's, why don't you want more np's on psych?" ---At our particular hospital, the problem is a couple older doctors agreed to supervise a few psych np's for peanuts and the hospital expects us to do the same.

 

[psych_0]

The first offer will probably be do it for free. Because hey we're expanding and you don't want to cover all those beds yourself right? The nps are just here to be extenders to help you out. It's to make you job easier. This is bull$hit.

The second offer is, ok, we can give you $100/hr of supervision time, but we define supervision as some kind of formal teaching time so you probably won't be doing that more than an hour or three a month right. So $300 a month ought to cover it? Of course we can't pay you for work you're not doing, only the time spent supervising, and remember...we can only pay FAIR MARKET VALUE!!! Right? Right? Also bull$hit.

Ok, you drive a hard bargain, we can give you a $500/month stiped to supervise nps. Oh no, not $500 for each np, you'll be sharing the nps with the group so just supervise on the fly for whichever np needs your help and sign off on whatever notes get assigned to you. What a great deal for you! And you're helping improve access to care, here's a gold star (we won't even charge you for the gold star!).

====================================================================================================

Unless you are okay getting paid peanuts for increasing your stress and liability (which maybe you are and that's up to you), my opinion is there needs to be a realistic monthly stipend somewhere in the multiple thousands of dollars range for EACH np assigned to you as a supervisor. You are not just the supervisor for the few hours of formal teaching time each month, or the few hours of chart review and signing. You are the supervisor at all times the np is doing anything with any patients anywhere in the hospital. And there is a value to that. Which should be thousands of dollars.

They are paying the np $140-180K, something like that. So $100K less than an MD. I think they can come up with $50K+ to pay you to supervise and still come out ahead on the deal.

Thanks for this. I appreciate it. Going with this strategy.

 

[AD04]

Supervise under the condition of keeping the wRVU they generate.

 

[psych_0]

Supervise under the condition of keeping the wRVU they generate.

Would love this but there's no way they'd go for it. This would double my salary. I did >7200 wRVU by myself last year.

 

[splik]

One thing to watch out for.

Surgeons and proceduralists (like cardiology) really like their pa's and np's, and they may not get paid anything to supervise them. The difference is the mid levels on surgery or cardiology are sharing the same patients and taking a ton of work off the MDs plate so they can do more procedures. The midlevels are doing all the pre-rounding, order enter, admits, initial consults, note entry, d/c summaries, etc...which makes life as an procedural specialist very nice.

You can tell why this doesn't work in psychiatry. There is no setup where np's are rounding on all your patients for you, then you just pop in for a minute say hi, then cosign the note. The psych nps are carrying their own independent patient load, just like you. So the procedural specialists are not getting paid directly, but they benefit greatly by having the mid levels do work they would otherwise have to do.

I mention this because my hospital recently tried to use the "I don't understand, neurosurgery and ortho and cardiology all love their np's, why don't you want more np's on psych?" ---At our particular hospital, the problem is a couple older doctors agreed to supervise a few psych np's for peanuts and the hospital expects us to do the same.

Actually I have seen this model and I think it is a good one. Some places the NP is basically in a resident role and writes your notes for you does the discharge summaries etc. you may have some additional pts but you are actually supervising them and billing under your name. This is actually a good role. Unfortunately now this is becoming rarer and instead they are replacing psychiatrists. Medicare requires pts to be admitting under an attending physician so they can’t admit pts without physician involvement

i recommend being involved in the hiring of any NP you supervise. If you don’t have a say in that I wouldn’t do it, personally.

 

[Stagg737]

One thing to watch out for.

Surgeons and proceduralists (like cardiology) really like their pa's and np's, and they may not get paid anything to supervise them. The difference is the mid levels on surgery or cardiology are sharing the same patients and taking a ton of work off the MDs plate so they can do more procedures. The midlevels are doing all the pre-rounding, order enter, admits, initial consults, note entry, d/c summaries, etc...which makes life as an procedural specialist very nice.

You can tell why this doesn't work in psychiatry. There is no setup where np's are rounding on all your patients for you, then you just pop in for a minute say hi, then cosign the note. The psych nps are carrying their own independent patient load, just like you. So the procedural specialists are not getting paid directly, but they benefit greatly by having the mid levels do work they would otherwise have to do.

I mention this because my hospital recently tried to use the "I don't understand, neurosurgery and ortho and cardiology all love their np's, why don't you want more np's on psych?" ---At our particular hospital, the problem is a couple older doctors agreed to supervise a few psych np's for peanuts and the hospital expects us to do the same.

Great point, thank you for verbalizing this concisely.

Actually I have seen this model and I think it is a good one. Some places the NP is basically in a resident role and writes your notes for you does the discharge summaries etc. you may have some additional pts but you are actually supervising them and billing under your name. This is actually a good role. Unfortunately now this is becoming rarer and instead they are replacing psychiatrists. Medicare requires pts to be admitting under an attending physician so they can’t admit pts without physician involvement

i recommend being involved in the hiring of any NP you supervise. If you don’t have a say in that I wouldn’t do it, personally.

If I were going to supervise an NP, this would be their role for at least several months (probably years) until I felt they were competent enough to be trusted (if they every got to that point).

 

[robellis]

The first offer will probably be do it for free. Because hey we're expanding and you don't want to cover all those beds yourself right? The nps are just here to be extenders to help you out. It's to make you job easier. This is bull$hit.

The second offer is, ok, we can give you $100/hr of supervision time, but we define supervision as some kind of formal teaching time so you probably won't be doing that more than an hour or three a month right. So $300 a month ought to cover it? Of course we can't pay you for work you're not doing, only the time spent supervising, and remember...we can only pay FAIR MARKET VALUE!!! Right? Right? Also bull$hit.

Ok, you drive a hard bargain, we can give you a $500/month stiped to supervise nps. Oh no, not $500 for each np, you'll be sharing the nps with the group so just supervise on the fly for whichever np needs your help and sign off on whatever notes get assigned to you. What a great deal for you! And you're helping improve access to care, here's a gold star (we won't even charge you for the gold star!).

====================================================================================================

Unless you are okay getting paid peanuts for increasing your stress and liability (which maybe you are and that's up to you), my opinion is there needs to be a realistic monthly stipend somewhere in the multiple thousands of dollars range for EACH np assigned to you as a supervisor. You are not just the supervisor for the few hours of formal teaching time each month, or the few hours of chart review and signing. You are the supervisor at all times the np is doing anything with any patients anywhere in the hospital. And there is a value to that. Which should be thousands of dollars.

They are paying the np $140-180K, something like that. So $100K less than an MD. I think they can come up with $50K+ to pay you to supervise and still come out ahead on the deal.

One thing to watch out for.

Surgeons and proceduralists (like cardiology) really like their pa's and np's, and they may not get paid anything to supervise them. The difference is the mid levels on surgery or cardiology are sharing the same patients and taking a ton of work off the MDs plate so they can do more procedures. The midlevels are doing all the pre-rounding, order enter, admits, initial consults, note entry, d/c summaries, etc...which makes life as an procedural specialist very nice.

You can tell why this doesn't work in psychiatry. There is no setup where np's are rounding on all your patients for you, then you just pop in for a minute say hi, then cosign the note. The psych nps are carrying their own independent patient load, just like you. So the procedural specialists are not getting paid directly, but they benefit greatly by having the mid levels do work they would otherwise have to do.

I mention this because my hospital recently tried to use the "I don't understand, neurosurgery and ortho and cardiology all love their np's, why don't you want more np's on psych?" ---At our particular hospital, the problem is a couple older doctors agreed to supervise a few psych np's for peanuts and the hospital expects us to do the same.

This is exactly correct, cardiologists/proceduralists significantly increase their income when they use NPs, when you use them they take the easy cases leaving you with the time consuming difficult patients and pay you nothing for it so you end up actually doing more work for less pay unless you get compensated appropriately

 

[Sushirolls]

Now, back in the real world. Big Box admin just doesn't care:

• They want to keep and maximize the potential profit seen in the differences of wages paid to midlevel vs physician.
• They don't care about liability. The fact they already want to hire a midlevel attests to that. Your problem, not theirs, and not even factored in their equations.
• Supervision to them is nothing more than a signature and anything beyond that is foreign.
• They don't care if they drive you out, because that gives them another opportunity to hire another midlevel.
• Its not about the immediate short term pain financially they endure of filling your shoes with a locums:
  • In the long term the increasing numbers of ARNPs they will eventually get an ARNP
  • Its about implementing this different system now. The systematic change is key for the long term to them.
  • They also don't care because admin are revolving doors and frequently move on to the next hospital to poison that one with their ways. They don't have to witness the damage / fall out in the short term.

Now, let's also pay attention to the cultural changes. Medical students are already being groomed to be "team players" which is indoctrination to keep your mouth shut and say yes to the policies of the Big Box admin which means replacing you with midlevels. Emerging more on interview circuits - even on the job postings themselves - are buzz words reflecting the presence and acceptance of midlevels at that organization. Feeler questions will be put out to assess receptiveness to midlevels during the interview and may even prevent job offer if you aren't able to say "yes" to all things midlevel.

 

[Sushirolls]

This is exactly correct, cardiologists/proceduralists significantly increase their income when they use NPs, when you use them they take the easy cases leaving you with the time consuming difficult patients and pay you nothing for it so you end up actually doing more work for less pay unless you get compensated appropriately

This model is being loosely employed by the PE chains of TMS popping up. Got a bunch in my area with ARNPs doing the consults for the TMS owners.

Even had one have the audacity to comment on the med regiment of one complex patient, to the patient, 'why you on this combo and not a good combo', not knowing its taken months to get to this point. Wasted a whole appointment session to discuss with the patient, the how and the why that got us there and again what options they have if they wanted to change things.

 

[Stagg737]

ven had one have the audacity to comment on the med regiment of one complex patient, to the patient, 'why you on this combo and not a good combo', not knowing its taken months to get to this point

Even worse that their definition of a "good combo" will include at least an antipsychotic, a benzo, and maybe a stimulant if the patients says they feel too tired...

 

[NickNaylor]

We have a couple of NPs that round on our inpatient unit on the weekends, but the day-to-day work during the week is all done by physicians. Our situation is a bit different as we work very closely with these NPs (they work on our ECT service, which is also staffed by our inpatient physicians), thus we are quite familiar with them and they are clinically competent. The physicians on the weekend determine which patients are appropriate for the NPs to see - usually, these are patients that are more straightforward or have a clear plan in place for the next couple of days - and they see those patients independently. There’s no formal supervision that is done (we don’t co-sign their notes) though obviously we are available to answer questions if needed.

There has been some very light pushing to having the NPs doing initial admissions, which we have vociferously resisted. The patients coming to our unit are generally fairly complex, and we don’t think that having a NP come up with the initial treatment plan is reasonable. So far, we haven’t received much pushback in response. I’m sure it’s a matter of time, though.

 

[Candidate2017]

Supervise under the condition of keeping the wRVU they generate.

The best use of NP I've seen is where the psychiatrist uses an NP as an actual physician extender. The NP does intern-type work: pre-round work (check labs, collect collateral, interview, pend a note) and post round work (carry out orders, triage afternoon issues). The NP is a hand picked entity known to the psychiatrist, but salaried by the hospital. Psychiatrist collects RVUs, and pays a year end bonus to NP.

Otherwise, "supervising" an NP is just shifting profits to the hospital while shifting risk to yourself.

 

[psych_0]

We have a couple of NPs that round on our inpatient unit on the weekends, but the day-to-day work during the week is all done by physicians. Our situation is a bit different as we work very closely with these NPs (they work on our ECT service, which is also staffed by our inpatient physicians), thus we are quite familiar with them and they are clinically competent. The physicians on the weekend determine which patients are appropriate for the NPs to see - usually, these are patients that are more straightforward or have a clear plan in place for the next couple of days - and they see those patients independently. There’s no formal supervision that is done (we don’t co-sign their notes) though obviously we are available to answer questions if needed.

There has been some very light pushing to having the NPs doing initial admissions, which we have vociferously resisted. The patients coming to our unit are generally fairly complex, and we don’t think that having a NP come up with the initial treatment plan is reasonable. So far, we haven’t received much pushback in response. I’m sure it’s a matter of time, though.

So if you don't see them or co-sign the notes, do they still operate under your license since you are available via phone call? Also, how much do you get paid to provide this service?

 

[SmallBird]

Now, back in the real world. Big Box admin just doesn't care:

• They want to keep and maximize the potential profit seen in the differences of wages paid to midlevel vs physician.
• They don't care about liability. The fact they already want to hire a midlevel attests to that. Your problem, not theirs, and not even factored in their equations.
• Supervision to them is nothing more than a signature and anything beyond that is foreign.
• They don't care if they drive you out, because that gives them another opportunity to hire another midlevel.
• Its not about the immediate short term pain financially they endure of filling your shoes with a locums:
  • In the long term the increasing numbers of ARNPs they will eventually get an ARNP
  • Its about implementing this different system now. The systematic change is key for the long term to them.
  • They also don't care because admin are revolving doors and frequently move on to the next hospital to poison that one with their ways. They don't have to witness the damage / fall out in the short term.

Now, let's also pay attention to the cultural changes. Medical students are already being groomed to be "team players" which is indoctrination to keep your mouth shut and say yes to the policies of the Big Box admin which means replacing you with midlevels. Emerging more on interview circuits - even on the job postings themselves - are buzz words reflecting the presence and acceptance of midlevels at that organization. Feeler questions will be put out to assess receptiveness to midlevels during the interview and may even prevent job offer if you aren't able to say "yes" to all things midlevel.

I work for a pretty gigantic box and this just isn't my experience at all. Maybe every single other system is just the way you described and only mine is different, but here the seem to be obsessed about quality, good outcomes, low readmission rates, and good patient feedback. They absolutely want to avoid liability, and they are extremely motivated to hang on to their physicians because we contribute to all of the outcomes they care about. Maybe I am too naive but I think you are too cynical.

 

[Sushirolls]

I truly hope you are in the promised land of what Big Box shops could actually be. And I hope you are a new post residency graduate where zeal, vigor, and enthusiasm will carry you through for the next 25-40 years. To further robustly contribute to the enhancement of systems based care and population health optimization. I truly hope you have found this oasis in the desert and the things I post about and others are merely mirages in the distance to you.

 

[NickNaylor]

So if you don't see them or co-sign the notes, do they still operate under your license since you are available via phone call? Also, how much do you get paid to provide this service?

I am sure they are under some kind of supervision agreement - I think the medical director of the unit. My understanding is that he is not given a stipend for this.

 

[robellis]

I am sure they are under some kind of supervision agreement - I think the medical director of the unit. My understanding is that he is not given a stipend for this.

Lol of course not he just wants to give away his labor for free because he’s a team player

 

[NickNaylor]

Lol of course not he just wants to give away his labor for free because he’s a team player

This situation is a bit different, though, as the patients the NPs see are given clear plans by the primary physician team that they then carry out. There is no "labor" involved because we would do the exact same thing with a rounding physician team for the weekend. In this case, having the NPs do this is actually extremely helpful to us as it allows the physician/teaching team to focus on more challenging patients and seeing admissions over the weekend.

And yes, you're correct @splik.

 

[nexus73]

There will usually be a stipend for the directorship the duties of which include supervising the NPs. You wouldn’t get anything additional in an employee position since this would be part of the job description.

Employed positions in high demand areas should be able to negotiate something. I think major metro areas you’re probably screwed because if you won’t do it there’s a line of psychiatrists willing to take the job.

 

[nexus73]

Title pretty much says it all but I was wondering if anyone here in the community supervises NPs on an inpatient basis only, not PHP or IOP. My hospital is expanding and they are asking if we want to fill in some of the gaps with NPs. Obviously not my first choice, but if the pay isn't terrible it may be worth it? This would be my first time supervising NPs so I don't even know where to start in terms of getting paid to supervise them. To anyone supervising NPs now: How much are you getting paid for it? Is it on a per month basis or per patient or what is your set up? Also, is it worth it?

Any update on how this has worked out for you?

 

[deleted1100659]

Yeah, to further add to how ridiculous it is currently, I had a recruiter have the never to email me asking for a physician supervisor role for 500 a month per np. What a joke. I told him he would need to be thinking 3-4k a month per np for me to even flirt with the idea. He said "no worries if you take 6 you can make 3k a month".

Im curious what cerebral pays, that would be interesting to see. Maybe ill email them out of sheer curiosity

 

[psych_0]

Any update on how this has worked out for you?

Not great. I get like ~$100/day of supervision. I control how many patients they see though, so I only give them 2-4 patients when they rotate with me. I guess that is my passive rebellion to being voluntold to supervise them (basically for free. $100/day is a joke imo).

 

[ObsequiousAplomb]

Not great. I get like ~$100/day of supervision. I control how many patients they see though, so I only give them 2-4 patients when they rotate with me. I guess that is my passive rebellion to being voluntold to supervise them (basically for free. $100/day is a joke imo).

Doesn't that come out to like $2k per month?

 

[sloh]

Doesn't that come out to like $2k per month?

Tots not worth it.

 

[ObsequiousAplomb]

Tots not worth it.

If it's $24k/year per NP and there's actual time to supervise in-person and supervision means I'm actually allowed to say they need to change something without fear of reprisal from the nursing manager, I'd consider it. I would definitely counter for a higher amount or that same amount plus being able to count their RVUs towards productivity. Sure beats the inevitable "this is part of your job and you get no say in it or extra compensation."

 

[psych_0]

If it's $24k/year per NP and there's actual time to supervise in-person and supervision means I'm actually allowed to say they need to change something without fear of reprisal from the nursing manager, I'd consider it. I would definitely counter for a higher amount or that same amount plus being able to count their RVUs towards productivity. Sure beats the inevitable "this is part of your job and you get no say in it or extra compensation."

Yea, I'd love to count their wRVUs towards productivity, but that would require the hospital to pay me >$700k annually, which they definitely won't do. I already do ~90000 wRVU on my own per year. My wRVU bonus kicks in at around 4300 wRVU.

Yea, it's ~$100/day, but it's not every day. It's one day here and there. So when I have them, I just give them 3-4 of my chronic follow-ups that are waiting for placement and thus would have been a 99231 for me. I would describe the situation as not ideal, but far from terrible. I'm probably going to end up right around $500-525k total compensation this year.

 

[nexus73]

Yea, I'd love to count their wRVUs towards productivity, but that would require the hospital to pay me >$700k annually, which they definitely won't do. I already do ~90000 wRVU on my own per year. My wRVU bonus kicks in at around 4300 wRVU.

Yea, it's ~$100/day, but it's not every day. It's one day here and there. So when I have them, I just give them 3-4 of my chronic follow-ups that are waiting for placement and thus would have been a 99231 for me. I would describe the situation as not ideal, but far from terrible. I'm probably going to end up right around $500-525k total compensation this year.

Was just saying no an option? Like would they fire you if you didn’t take an np?

 

[psych_0]

Was just saying no an option? Like would they fire you if you didn’t take an np?

Was it in an option? Technically, yes. The rest of our group said yes though, which would have left me the outlier. There are no other jobs that qualify for PSLF in my area so until my loans are forgiven, I will do whatever it takes to stay here....and there are also no other inpatient jobs where I could make close to as much money as I do now (in my area). So supervising an NP see a few patients a few days per week wasn't a huge deal for me. Now if it gets to a point where I have to supervise them seeing 12-15 pts a day, every day, then yea that would be a harder pill to swallow.