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Growing Practice

  • 1.  Growing Practice

    This message was posted by a user wishing to remain anonymous
    Posted 07-23-2018 18:30
    This message was posted by a user wishing to remain anonymous

    hi, I have a dilemma. I have a geriatrics practice with my husband for past 5 1/2 years which is doing well. However, it has become diff to take time off together for more than 2 weeks at a time. We both work 4 days/week and finish our notes on the 5 th day . We also don't have office manager and handle things ourselves. Also, our patient base is growing. At this time, we are doing well financially. Therefore, I was thinking of hiring a NP so that I can go back to visit my family and help my sick mother . I interviewed 1 Nurse Practitioner candidate so far and she told me that she is getting paid $115000 with benefits for 30 hr/week of clinical work at Community health center in my area. I don't know if this is fair salary for NP. I am not sure what to do?
    I would appreciate any suggestions. Thanks

  • 2.  RE: Growing Practice

    Posted 07-24-2018 05:11
    Some malpractice policies cover locums

    "going back" to see family sounds like out of country? thats not a vacation thats more like   leave of absence :)  - 1 week is hard enough!!
      ? split it with  your spouse would be easiest-one stays one goes?
     there  may be some potential  to do this: make sure everyone has meds- tell pharmacies to give 2 weeks worth ,  do e  visits , check  your hopefully electronic faxes daily ,and take some phone calls For people  who must be seen arrange iwth a local doc that you take the calls and call the local doc to ask if they will see someone Have  somelocal nurse who will  go in ifyou call to assess someone  .
    yes  extended time away is hard

    Jean Antonucci

  • 3.  RE: Growing Practice

    Posted 07-25-2018 04:35
    You may want to consider just getting a partner. They could just help pay for your expenses (like a roommate) as a separate business entity or join through a buy in. This has worked well for us in the past.

  • 4.  RE: Growing Practice

    Posted 07-30-2018 08:51
    I think you have to decide percentage on every single patient and your billing team will be responsible to provide you reports.

    IMP Guest

  • 5.  RE: Growing Practice

    Posted 07-24-2018 12:37
    Consider paying a mid-level provider a percentage of revenue the practice receives from their visits. If the practice also receives capitation payments, you can reimburse the mid-level a percentage of the cap payments that coincides with their percentage of charges generated on those patients. This tends to work best in a setting where visit numbers fluctuate and prevents a practice from going in the "red" if volume drops. In a setting with little variation in revenue, an hourly rate may work best.  

  • 6.  RE: Growing Practice

    Posted 07-31-2018 16:23
    Depending where in the country you are, that sounds like a reasonable or even low salary for a mid-level practitioner, assuming 30 hours of patient encounters equals full time, given non-face-to-face time.

    The best way to help your sick mother may be to send money instead of yourself.

    The wonderful thing about working for yourself is, you can take off as much time as  you want...except you don't get paid, AND your overhead continues.
    Bottom line is, you own a job, not a business.  The benefit is, you have control.  The downside is, if you hired someone else to do what you do, there would be nothing left over.

    Peter Liepmann MD FAAFP MBA
    My mission is to fix US health care
    Bakersfield CA

  • 7.  RE: Growing Practice

    Posted 08-01-2018 10:32
    Dear anonymous:

    If your problem is covering patient care for an extended leave, then you are really just trying to cut your losses. 

    But if you and your husband are getting too busy, then hiring part or full time mid level COULD be cost effective and even profitable. If you are FFS with billing and they generate charges that you and your husband don't or can't, you can cover their expense and then some. Plus, you'd have SOME coverage when one or both of you are gone.

    HOWEVER, in my experience, the MOST IMPORTANT factor is the medical judgement of the mid-level and their ability to gain the trust of your clientele. I've been lucky enough to hire great choices; but know many docs who have hired the mid level with the wrong knowledge base or interpersonal skills. Just remember, they are often good and competent in what they've done a lot of...but aren't broadly trained with the level of expertise that you might require. Vet your choice carefully, perhaps with a part time trial period. 

    No offense intended to any nurse practitioners; but all my hires for Family Medicine have been very experienced nurses who went back to school for NP-a 20 yr ICU director and a 6 year ER nurse. Other NPs seem to be fresh RNs that enter NP classes (frequently online) with minimal nursing experience and don't have the work experience or training through minimal clinicals to develop sound clinical judgement. They can gain that experience working for you (at your expense); but may not be ready to fly alone as a suitable stand-in for 2 physicians. 

    One thing is for sure, nobody can care for your patients like you do. And, nobody can care for your mom like you can. Good luck. 

    Just my thoughts. 

    Michael McLeod

    Sent from ProtonMail Mobile

  • 8.  RE: Growing Practice

    Posted 08-05-2018 12:57
    "What Michael said."
    Also re "doing everything yourself..."  as long as it's just you and your husband, all you have to worry about re employees, is paying estimated taxes on time.

    Once you have an employee, it gets vastly more complicated. (SUTA, FUTA, MCR, etc. payments) If you 'hire' (contract with) an independent contractor, they have to manage their taxes.  But the IRS has stringent rules about independent contractors.  They have to have their own business, in essence.  Talk w a local accountant, and let them do your payroll.

    Also re "doing everything yourself..."  if you're spending time to do something you can hire someone to do well for less (e.g., billing, entering the visit in an EMR, asking about what meds someone's taking, and calling the pharmacy to check), you're not doing yourself any favors. How much would you earn if you saw patients on that 5th day instead of doing paperwork?  Ditto all the work in seeing patients that doesn't need a 'provider.' A good MA or LVN can get a lot of history, reconcile medications, scribe the visit, etc..  If you pay them $25/hr and see just 3-4 more patients/day, you make money on the deal, plus you do more of what only you can do. Plus all the joys of managing employees!

    All things to ponder.

    Peter Liepmann MD FAAFP MBA
    My mission is to fix US health care
    Bakersfield CA

  • 9.  RE: Growing Practice

    Posted 08-06-2018 20:16 is a good place to start, since their is so much variability area to area.

    Marie Amina Aryan, NP-C
    Lakewood Family Health Clinic
    Lakewood, Colorado


  • 10.  RE: Growing Practice

    Posted 08-07-2018 07:17
    If you are looking mostly for coverage so you and your husband can go away for 2 weeks a locum would be better. Covering for 2 people is going to be difficult for any covering doctor or NP especially if you already have a full practice. I have had a partner in the past and usually we limited our vacations to 1 week at a time to limit the burden on the other person.
    If you are looking to take a lot of time off to take care of your mother then another provider such as an NP might be an excellent choice to work with your husband while you are away

    Larry Lindeman