Compensation for overseeing NP/PA practice

[Cataclysmic]

I’m putting myself out here, I’m sure this can spark an anti-mid level debate which is not my intention but I need to vent and get people’s advice: I was asked to be the overseeing physician to a NP/PA I know well from a previous job, they are venturing out to form their own practice. I have no desire to form my own practice for the next 5-10 years as I am employed by a larger hospital system and happy where I am. From working together I know they have good medical judgement for the scope of FM they specialize in (addiction medicine). What would be a fair compensation for being their overseeing physician? One colleague stated when he was approached for overseeing a NP practice he was offered $3,000 monthly (for general FM and urgent care). Since I know the pair well and trust their judgement I offered $1,000 monthly. They turned around and offered me less… I’m curious to know of other physician’s experiences.

I realize I’m opening myself up for scrutiny, but I need a sounding board since finding information about “fair compensation” for being an overseeing physician is hard to find. There is no friendships in business, and with their counteroffer on compensation I am strongly considering not overseeing them.

---

Members don't see this ad.

 

[futuredoc331]

You went with 1/3 the rate you were told by another physician and then they countered with even less than that? I'd not do it just out of principle. Principles aside, is <$10,000 even worth the time, energy, and legal risk?

 

[Cataclysmic]

You went with 1/3 the rate you were told by another physician and then they countered with even less than that? I'd not do it just out of principle. Principles aside, is <$10,000 even worth the time, energy, and legal risk?

I agree completely. I was taken by surprise- I thought my offer was very generous… now I feel undervalued and thinking it’s not worth the risk.

 

[anonperson]

I’m putting myself out here, I’m sure this can spark an anti-mid level debate which is not my intention but I need to vent and get people’s advice: I was asked to be the overseeing physician to a NP/PA I know well from a previous job, they are venturing out to form their own practice. I have no desire to form my own practice for the next 5-10 years as I am employed by a larger hospital system and happy where I am. From working together I know they have good medical judgement for the scope of FM they specialize in (addiction medicine). What would be a fair compensation for being their overseeing physician? One colleague stated when he was approached for overseeing a NP practice he was offered $3,000 monthly (for general FM and urgent care). Since I know the pair well and trust their judgement I offered $1,000 monthly. They turned around and offered me less… I’m curious to know of other physician’s experiences.

I realize I’m opening myself up for scrutiny, but I need a sounding board since finding information about “fair compensation” for being an overseeing physician is hard to find. There is no friendships in business, and with their counteroffer on compensation I am strongly considering not overseeing them.

So you are willing to be the liability sponge for their inevitable screw ups for a couple of hundred bucks a month?

The amount of fair compensation for overseeing a mid level depends on a few factors:

The amount of time required on your end
The acuity/risk you are inheriting
The amount of money they are making

It will differ from job to job

Honestly, I'm not even sure why you have given them such a discount to begin with. The fact that they turned around and are low balling you like this should be a huge red flag.

I don't say this to be mean or harsh, but have some self respect for yourself and your profession. If you need an extra $10k a year, there are much easier ways to get it rather than dealing with annoying mid levels.

 

[deleted87716]

Just say no.

 

[Cataclysmic]

So you are willing to be the liability sponge for their inevitable screw ups for a couple of hundred bucks a month?

The amount of fair compensation for overseeing a mid level depends on a few factors:

The amount of time required on your end
The acuity/risk you are inheriting
The amount of money they are making

It will differ from job to job

Honestly, I'm not even sure why you have them such a discount to begin with. The fact that they turned around and are low balling you like this should be a huge red flag.

I don't say this to be mean or harsh, but have some self respect for yourself and your profession. If you need an extra $10k a year, there are much easier ways to get it rather than dealing with annoying mid levels.

Thank you! My thoughts completely, I appreciate your honesty. This wasn’t a low risk venture- it’s addiction medicine with primary care. I thought my original offer would be considered a blessing for them…

 

[Cataclysmic]

Just say no.

👍🏻

Thanks Blue Dog, I appreciate it. I was making sure I wasn’t being unreasonable so everyone is making me feel better.

 

[AMEHigh]

I don’t know the exact answer, but it’s definitely not less than $1,000/month, so I’d definitely say no.

 

[Splenda88]

Why would someone put his/her license at risk when you can work 12 hospital medicine shifts for a year as a FM/IM doc and make 20-24k? I don't get it.

 

[SLC]

I was offered about $1000/month to supervise a PA who they wanted to put in the same office with me. I would have had excellent oversight, and it was only one PA, Employed by my company, not a private practice with multiple providers, where the PA/NP feels they have the right to set protocols etc.

I would NEVER agree to supervise a midlevel looking to open their own practice. To me, that’s just a way to rent out your license for someone else to profit with at your expense.

I don’t even supervise them at my current job, but I would never underwrite a practice for one.

and if I did, I’d demand veto power over all aspects of the practice, hiring, protocols, rules, privileges etc. and I’d demand the bulk of the profits.

 

[yeasports]

so I agree with above but your response should be:

YOU: Hey, I know I offered my oversight for 1k a month but on second thought I did that in error just being friendly from our previous relationship. Upon review of my malpractice license I would not be able to offer oversight.

My response personally if you care to read:
Yeasports: So you are asking to use my license that I earned- to satisfy the legal requirements of the lack of your license; for less money than I should spend on retaining a good medical malpractice lawyer for you using my license?

Or as my young kids would say (they watch a lot of charlie and the chocolate factory):
My kids: You get nothing, you loose, good day sir!

 

[Sushirolls]

50K/year is the supervision value, anything less than that ain't worth your time. And the ability to see any patient, review any note, and demand any clinical correction to mistakes.

 

[Fatalis]

I’m putting myself out here, I’m sure this can spark an anti-mid level debate which is not my intention but I need to vent and get people’s advice: I was asked to be the overseeing physician to a NP/PA I know well from a previous job, they are venturing out to form their own practice. I have no desire to form my own practice for the next 5-10 years as I am employed by a larger hospital system and happy where I am. From working together I know they have good medical judgement for the scope of FM they specialize in (addiction medicine). What would be a fair compensation for being their overseeing physician? One colleague stated when he was approached for overseeing a NP practice he was offered $3,000 monthly (for general FM and urgent care). Since I know the pair well and trust their judgement I offered $1,000 monthly. They turned around and offered me less… I’m curious to know of other physician’s experiences.

I realize I’m opening myself up for scrutiny, but I need a sounding board since finding information about “fair compensation” for being an overseeing physician is hard to find. There is no friendships in business, and with their counteroffer on compensation I am strongly considering not overseeing them.

Key words: addiction medicine, 1/3 compensation, supervising decisions that others make and you won’t be there to see the patient… addiction medicine… addiction medicine.
Wouldn’t touch that with a 50 foot pole

 

[Splenda88]

If someone asks you to be Medical Director, run.... - Cohen Healthcare Law Group | Healthcare Lawyers | FDA & FTC Law

There's an old quote that says: "If you meet the Buddha on the road, kill him!" And what if your friendly neighborhood chiropractor asks you to be Medical Director, especially in California? Remember, we're lawyers who counsel companies and practices involved in holistic healing.

cohenhealthcarelaw.com

 

[cabinbuilder]

I’m putting myself out here, I’m sure this can spark an anti-mid level debate which is not my intention but I need to vent and get people’s advice: I was asked to be the overseeing physician to a NP/PA I know well from a previous job, they are venturing out to form their own practice. I have no desire to form my own practice for the next 5-10 years as I am employed by a larger hospital system and happy where I am. From working together I know they have good medical judgement for the scope of FM they specialize in (addiction medicine). What would be a fair compensation for being their overseeing physician? One colleague stated when he was approached for overseeing a NP practice he was offered $3,000 monthly (for general FM and urgent care). Since I know the pair well and trust their judgement I offered $1,000 monthly. They turned around and offered me less… I’m curious to know of other physician’s experiences.

I realize I’m opening myself up for scrutiny, but I need a sounding board since finding information about “fair compensation” for being an overseeing physician is hard to find. There is no friendships in business, and with their counteroffer on compensation I am strongly considering not overseeing them.

I oversaw my NP who I requested to be with me and I trusted her due to her having worked neurosurgery for 12 and OB foe 20 before that. I got 1000/month but I didn't have to worry out her care. Was just "offered the same" for a guy who was forced upon me and now I'm in a situation that feels like clinical rape every single day. I said no.

 

[Splenda88]

I oversaw my NP who I requested to be with me and I trusted her due to her having worked neurosurgery for 12 and OB foe 20 before that. I got 1000/month but I didn't have to worry out her care. Was just "offered the same" for a guy who was forced upon me and now I'm in a situation that feels like clinical rape every single day. I said no.

That is 12k/yr. I really don't understand why one would take on that responsibility when you can make 12k working 6 shifts/yr.

 

[Natremia]

That is 12k/yr. I really don't understand why one would take on that responsibility when you can make 12k working 6 shifts/yr.

Because physicians are dumb

Only way to conclude selling out yourself, your profession, and your license for such little money

 

[VA Hopeful Dr]

That is 12k/yr. I really don't understand why one would take on that responsibility when you can make 12k working 6 shifts/yr.

Because with a good mid-level you end up doing basically zero work.

 

[Splenda88]

Because with a good mid-level you end up doing basically zero work.

That is a strange way of looking at it. If I make a mistake, I know that I am responsible for MY mistake and it's on me. I wonder how would feel if someone that I am supposed to supervise make a mistake that end up harming someone badly?

 

[Cataclysmic]

I oversaw my NP who I requested to be with me and I trusted her due to her having worked neurosurgery for 12 and OB foe 20 before that. I got 1000/month but I didn't have to worry out her care. Was just "offered the same" for a guy who was forced upon me and now I'm in a situation that feels like clinical rape every single day. I said no.

Thanks for sharing your experience! I appreciate it.

 

[anonperson]

Because with a good mid-level you end up doing basically zero work.

No such thing as a good mid level.

I've heard about this since medical school and have yet to see the elusive good mid level. This goes for residency, fellowship, and now practice.

They are all just varying degrees of being terrible. Some are just less terrible then others.

 

[Splenda88]

No such thing as a good mid level.

I've heard about this since medical school and have yet to see the elusive good mid level. This goes for residency, fellowship, and now practice.

They are all just varying degrees of being terrible. Some are just less terrible then others.

Not only that, but the idea of harming someone or losing my license because someone I am supposed to supervise makes a mistake does not sit well with me. You only need to be in clinical medicine for 3 months to know midlevel supervision is a sham for the most part.

 

[VA Hopeful Dr]

No such thing as a good mid level.

I've heard about this since medical school and have yet to see the elusive good mid level. This goes for residency, fellowship, and now practice.

They are all just varying degrees of being terrible. Some are just less terrible then others.

Incorrect

 

[VA Hopeful Dr]

That is a strange way of looking at it. If I make a mistake, I know that I am responsible for MY mistake and it's on me. I wonder how would feel if someone that I am supposed to supervise make a mistake that end up harming someone badly?

I can only speak for myself in that scenario, but if the mistake was a patient that didn't get run by me I'd be furious at the mid-level for not seeking me out. If they discussed the case and I also got it wrong, I'd be angry at myself.

 

[Make Or Break]

I can only speak for myself in that scenario, but if the mistake was a patient that didn't get run by me I'd be furious at the mid-level for not seeking me out. If they discussed the case and I also got it wrong, I'd be angry at myself.

So your midlevel runs every patient by you?

 

[VA Hopeful Dr]

So your midlevel runs every patient by you?

Not even close. But the first month or so I worked with her she ran probably 50% of them by me and I reviewed the charts of the other 50%. Once I knew that she knew how to do her job safely and well, I backed off. Now I review the required number (15%) and she runs the complex ones by me or ones where she wants my thoughts on a particular case.

That's the key, you have to have time and be willing to put forth the effort to make sure a midlevel is good before you can give them slack. I was fortunate in that we both started at a brand new office at the same time so the first several months weren't busy for either of us. I had plenty of time to watch her like a hawk and do enough teaching to fill in the gaps in her knowledge. Plus prior to NP school she was an ED nurse in a level 1 trauma center for 12 years. One of the hardest things to teach is being able to look at a patient and know right away "something isn't right".

 

[Ironheme]

How much is your license worth? I definitely wouldn't supervise an NP/PA running an independent practice where I had no oversight, and all they were using was my medical license to increase billing + the medical malpractice risk.

I did a favor for a colleague, covering their PA, who was supposedly a good PA. I was only sent the charts, no cases were discussed with me. I reviewed one and they had prescribed both opioids (chronic pain) and benzos (for primary sleep issues). It cost me a lot of extra time to fix that.

 

[deleted6669]

Speaking as a PA who knows many PAs and NPs who run their own practices, a typical setup is between $1000-3000/month and a malpractice policy purchased by the practice for the physician. The reason folks do this was alluded to above: It is easy money for zero work, so people line up to do it. Retired docs can make $1000/month+ and never leave their living room. There are docs advertising this as a business model:

Providing Eastern NC Physician Extender Supervision (PA, NP) Services

Dr. Marshall Craig Simpson with Greenville Medical Services provides supervision services for PA and NP providers in Eastern North Carolina.

www.greenvillemedicalservices.com

There are online supervisory services now as well. I will post a link if I can find one, but know they are out there.

 

[Cataclysmic]

Speaking as a PA who knows many PAs and NPs who run their own practices, a typical setup is between $1000-3000/month and a malpractice policy purchased by the practice for the physician. The reason folks do this was alluded to above: It is easy money for zero work, so people line up to do it. Retired docs can make $1000/month+ and never leave their living room. There are docs advertising this as a business model:

Providing Eastern NC Physician Extender Supervision (PA, NP) Services

Dr. Marshall Craig Simpson with Greenville Medical Services provides supervision services for PA and NP providers in Eastern North Carolina.

www.greenvillemedicalservices.com

There are online supervisory services now as well. I will post a link if I can find one, but know they are out there.

Thank you for your information! Yes they seemed hesitant about my request for them to cover any legal fees if any litigation arose. So glad I dodged that bullet!

 

[Candidate2017]

One colleague stated when he was approached for overseeing a NP practice he was offered $3,000 monthly (for general FM and urgent care). Since I know the pair well and trust their judgement I offered $1,000 monthly. They turned around and offered me less…

I'll never understand why so many of us willingly let ourselves get slapped around. These NPs slapped you in the face at least thrice. First for implicitly saying they can practice medicine better than you. Second for not appreciating your generosity. Third for saying your supervision isn't worth much.