Psych NP’s and PMHNP

[Goodlife123]

Can anyone who runs a private cash practice comment on hiring NP’s or PMHNP’s?

Do you hire them as independent contractors or salaried employees? How much supervision as well as turnover do you experience with them? How much do you worry about liability?

Any pros and cons in hiring them within your practice?

Thank you!

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[Sushirolls]

I routinely advise my own family to not get care from ARNPs and endeavor to not be a hypocrite, so I won't hire, supervise or train.

So much of what I do these days for patients who've previously been managed by ARNPs, is deep dive their history often peeling back on diagnoses and optimizing med regiments. *No you don't have Bipolar.

I would rather hire a licensed physician who washed out of residency or stopped after their intern year.

 

[Ironspy]

 

[whopper]

More often than not I see worse practice with NPs. It makes sense. A physician has to do (grammar error hundreds of) tens of thousands of hours of training in serious life-threatening situations. NPs only have to do dozens of hours usually in relatively very stable conditions.

Now that all said I've seen great NPs, and bad physicians, but this is not cause the training. It's cause the NP was a life-long learned, had good mentors and wanted to self-learn, while the physician just plain sucked and didn't give a damn, but somehow graduated.

I disagree with Sushirolls in that I'd be happy to (error-treat) work with an NP that was eager and wanted to learn vs a bad physician.

 

[comp1]

I just don't see the OP getting a straight answer here. It's just going to be a barrage of complaints about NPs that have been rehashed for decades. Most PMHNPs are salaried and work for large corporations or public organizations. It's where they function best. Most cash pay practices don't have NPs. Your chance of finding a cash practice that employs NPs is low in general and amazingly low here.

 

[ObsequiousAplomb]

I don't see the value add of an NP for cash practices outside of pill mills. Would you have them bill at the same rate as you? Would people referred to see you be happy seeing a nurse instead?

 

[Sushirolls]

Now if you step back and look at an insurance based practice - and only from a spreadsheet - hiring an ARNP or PA makes sense, and that's exactly what Big Box shops are doing. Never mind the other variables. But to optimize profits from a business imperative - it has merits.

 

[When is graduation again?]

There's actually a cash only private practice in my area that has an NP on staff. Typically, the rates to see the NP are pretty far below the psychiatrist rate, but still much higher than a psychiatrist taking insurance. The practice has been around for a while I think, so I assume it's working for the owner, though I couldn't imagine paying that much to see an NP.

 

[AcronymAllergy]

Can't speak to having hired an NP, but RE: employee vs. contractor, if you aren't absolutely sure, I'd talk with an attorney. It seems plenty of folks bring someone on as a contractor without realizing that they're treating the person as an employee, which can be a painful lesson down the line. If you're exerting much, if any, control over how the person does their job (e.g., their hours, where they work) and/or are providing materials for them to perform their job, they're probably an employee.

 

[whopper]

Here's what I do with my own NPs. If I stabilize a patient into maintenance phase I offer them the chance to see an NP. The NP can kick the patient back up to me if the patient worsens. Good for me, good for my NP. Gives them easy patients. I also will not work with an NP that sucks. I only keep ones that are good and the ones I got are better than most of the psychiatrists I've seen (e.g. treat Schizophrenia with Risperidone 0.25 mg daily only) , but as I mentioned, that bar is low.

 

[Merovinge]

The only doc I knew who used them had them as salaried employees. He had other office staff salaried as well so it was not as large a burden as say a single cash pay doc. He took insurance and saw patients for very brief visits and would try to get most seen by his several midlevels.

Pros: Making near or over 7 figures
Cons: Pretty obvious

 

[Stagg737]

Here's what I do with my own NPs. If I stabilize a patient into maintenance phase I offer them the chance to see an NP. The NP can kick the patient back up to me if the patient worsens. Good for me, good for my NP. Gives them easy patients. I also will not work with an NP that sucks. I only keep ones that are good and the ones I got are better than most of the psychiatrists I've seen (e.g. treat Schizophrenia with Risperidone 0.25 mg daily only) , but as I mentioned, that bar is low.

Imo this is the way to do it. Allows you to control the acuity of cases they are seeing while working with them and supervising to assess how good they actually are. Would likely require either salary or guaranteed pay for a time until they could get a fuller panel, but basically what practices would do with new psychiatrists too.

 

[dl2dp2]

There's actually a cash only private practice in my area that has an NP on staff. Typically, the rates to see the NP are pretty far below the psychiatrist rate, but still much higher than a psychiatrist taking insurance. The practice has been around for a while I think, so I assume it's working for the owner, though I couldn't imagine paying that much to see an NP.

I know of someone who does this also. Very similar arrangement. That seems to be the only way.

OTOH, as a cash-only PP, I'll tell you that it's a lot easier to just do your own thing without NPs. The overhead per hour tends to be higher than your per hour billing rate.