Clinicians Business Tip: Collaborating Physicians: The Basics, Part 2

Nurse Practitioners and Physician Collaboration: www.npbusiness.orgIn part one of our article on Collaborating Physicians, we discussed why you may need a collaborating physician and what the responsibilities may be for each of you. Several of NPs shared their experiences and the impact it has had on their practice – especially those who own their practices. Today, in part two, we will discuss how to find a collaborating physician, associated cost and the need for a written agreement.

How can I find a collaborating physician?
This can be one of the most challenging issues for the clinician who is required by their state practice act to have a collaborating physician. The question is not only how do you find someone who is willing to be your collaborator, but how do you find the right person?

It can help to create a “position description” that outlines your requirements. What are the duties, requirements, and responsibilities? What qualifications do you need/desire in this individual? What are the working and personality characteristics you desire?

Being clear on who you are looking for will allow you to fine tune your search, eliminating those “dead ends”. Your objective is to find the ideal physician for your practice

Nurse Practitioner collaboration: www.npbusiness.org

So where do you start?  Always start with your inner circle. Who do you know? Who do your colleagues know? Who is their collaborating physician?  Always ask for referrals if you get a no.

From there, begin to cast a wide net. Look to your local physician and NP groups for likely candidates. Have a conversation with your pharmacy rep – they absolutely know what’s going on in the community and can be great allies. What about your local university program, live networking groups, new and retiring/near retirement physicians? Another great resource is social media. Check out Facebook, LinkedIn, and Twitter for both referrals and candidates.

More recently, clinicians are looking for their collaborating physicians on job boards such as Indeed.com. (Update 2020).

What are the costs are associated with having a collaborating physician?

A frequent question is what does it cost? This number varies tremendously depending on the region of the country and local practices. I have spoken with NPs who have not paid anything for collaboration. An employed NP most often has a “built-in” collaborating physician. However, even self-employed NPs have been able to negotiate a “no-fee” collaboration, often as a result of the individuals involved and their mutually respectful relationships.

Other NPs have been able to work out agreements to provide call, work a few hours a week in lieu of payment or other such arrangements. Always be mindful of the ever-present “kickback” rules when it comes to “in-kind” payments.

Numbers I often hear from NPs include a flat monthly fee and a per-patient fee (percentage or flat). The highest flat rate I’ve heard was $5,000/month – which was unsustainable for the NP involved. Most often I hear anywhere from $500.00 to $1000.00 per month. But do your homework. The cost varies with state, local and regional practices and what is involved in collaboration – which is why you want to do your homework upfront (see part 1).

What about malpractice? This too is variable and there is no consensus. Some will say they are liable for your practice and want either a rider or a new policy, others say they are covered by their own policy. You will want to check with colleagues,  your own liability insurance, and local attorneys to get a better and more specific idea for your practice.

Should I have a written contract or agreement?

Having a collaborating physician is a legal requirement and should be sealed with a written agreement. The agreement should contain clauses that are essential to your state rules and regulations as well as information that would protect your practice. Consider including:

·      Dates including start and ending date of the agreement with the ability to renew.

·      Who the agreement is between (the entire practice, individual NPs, etc)

·      Required responsibilities (charts, visits, availability)

·      Any financial agreement (how much, when, how payment will be made)

·      Insurance coverage if needed

·      Immediate and future termination – conditions for immediate termination, notification time for future termination.

·      Anything else that is essential to your practice and your state rules.

Eventually, the rules and regulations around collaboration will be abolished, but until then, for those of us that have requirements for collaboration, finding the ideal physician collaborator and creating a win-win situation will benefit both of you as well as your patients.

Continue to share your experiences below so that your colleagues can learn.

~~~~~

Barbara C Phillips, APRN, FNP-BC, FAANP is a professional speaker, author, clinician, and business owner who provides business education, resources, and support to Nurse Practitioners, Physician Assistants, and other Advance Practice Clinicians – both for the employed and self-employed clinician. Additional information about Ms. Phillips is available at Clinician Business Institute.

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Comments 10

  1. I pay 150 per month in NC and paid 200 in TN but had to haggle. Used inner circle here and phone book/web previously to locate someone. Usually a cup does not have to be in the same town, just in the state. One CP I previously worked with for no fee was three hrs away. Just check your state regs for any on site requirements. Phone consult or email is usually acceptable. Written contract drafted Which included specific state requirements my protection. If anyone would like a copy to use as a template let me know. My local board was pleased with it.

  2. Hi TS,
    I am looking for a CP in Houston, TX but I am having a hard time locating one. Any ideas? Also, I would love to have a copy of your written contract draft as a guide for mine. Please email me at above address. Thanks and good luck to you.

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    Author

    For those of you asking for a copy of a collaborative agreement…keep in mind that:
    1. Your state may already have a template for you to use. Several do.
    2. Contents of the agreement are going to be state specific. You must include what is required in your state. Just google it. Here are a few examples:

    Arkansas: http://1.usa.gov/12mMPan (shortened link to pdf document)

    Louisiana: http://bit.ly/17xFXvv (shortened link to pdf document)

  4. Thanks for the info. As a physician who has been precepting FNPs since 1991, I’ve found your blog and the comments to be very informative.
    I have precepted for clinics with multiple FNPs, which were RHCs, requiring every other week site visits and 20% chart review, as well as, solo practices owned by an FNP that required monthly visits. For all of my FNPs, I have been available 24/7.
    I’ve been involved with mid-level providers a long time and believe in the concept.
    If I can help by answering questions, etc, I will be happy to do so.
    Karen Armour, M.D.

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    Author

    Traci, there are lots of ways to find a CP. Start with your inner circle. When you get a “no”, always say “thank you. Do you know someone else who can help?” (or something similar). Networking is going to be one of the best ways…and you may end up paying less. Good luck!

  6. Okay, I might as well share this here because there are no good ideas anywhere else: What would you have done?

    I am a first-year (though not young) psych NP. I was saddled with a terrible collaborator on my first NP job. (He was not the one I interviewed with–a surprise after I signed the contract and turned down other offers. That’s when I also learned they had been sold to a large corporation and little else about the job would remain the same, either.).

    …He was unavailable by text or e-mail, kept my fairly rare calls under 2 minutes, and even discouraged them by making them entirely unproductive. He had zero interest in mentoring: He would either cut me off with a verbal order or (once he knew my skills), say, “yes, yes! That’s fine!” in an irritated way. He had to be dragged into chart reviews, even by remote. He left on vacation without any orientation to his unit, which I had to cover in his absence.

    Finally, I caught him falsifying a chart review/live on-site consultation, and went to my employer, who had not much appreciated my more minor negative previous feedback about him. The employer corrected him, but also made my life hell over the next few months, seeing me as more expendable. In fear of damage to my license (as the next target, should I remain stubborn), I left after a few more months—even thpugh I did not yet have a new job.

    I think now I should have reported him to the medical board, but was advised that I would become a pariah, locally. I didn’t speak directly to him because I knew he would have me fired. I couldn’t afford a nurse attorney for advice until it was too late. That left the employer.

    In retaliation, he refused to sign documentation of the required number of practice experience (1000 hours) for applying to prescribe controlled substances in my state. That makes me a new grad all over again, as far as my value in psych and the ease of finding a job. I signed a gag order in return for a settlement because having gone through cancer treatment in my last year of school, I couldn’t have survived without it only several months into my first year of practice. An employment attorney didn’t have better ideas.

    I don’t know an APRN or physician who will sign that document for me without having personally observed those 1000 hours, and I don’t blame them. I would guess my early departure and his refusal to sign it makes potential new collaborators suspicious of ME, understandably (which is why he did it, no doubt). I have found another position and have actually started the job, not contingent upon the DEA. They have just lost the planned collaborator who was going to prescribe controlled meds the first 6 months, and the replacement is worried/not interested in frequent mentoring and co-signing.

    That puts this new job in jeopardy, too. I’m exhausted.

    So they want me to get that DEA asap, and are now pressuring me to find someone on my own who will sign my attestation document (legally allowed even if they were not on site, etc., those practice hours). I feel like a fool for not finding a better solution sooner. (I did start looking for a job once I saw what that first collaborator was like, but as a new grad, and working 50-plus stressful hours a week in my first year post-cancer treatment, it wasn’t easy.) ………………………Comments?

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    I’m so sorry you had to go through this.

    One of the things I always recommend is that you have your own liability insurance, one that will provide you with an attorney to consult with. Even when we cannot “afford” an attorney, we may have to figure it out to protect our license.

    In terms of your new job, I would have a frank discussion with your employer. They may be able to work with their MD/APRN team to provide you with the oversight you need until you can get your DEA.

    Thank you for sharing and I hope it gives others food for thought as they move through their early years.

    Best wishes to you!

  8. I am nurse practitioner and I am looking for a physicain to collaborate with, if anyone has any recommendation I would highly appreciate it. Willing to pay $400-500.00/mth.

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