In 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
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.