[NPInfo] Retail Clinics.......Chapter Two

[Michelle Holcomb]

Christine - perhaps when your contract expires, you could negotiate a new
contract directly with the hospital. Start your own private contracting
company and you can be the sole employee - it is very likely that you would
make more money, and the hospital would save a substantial amount as well. A
win-win for both sides. 

Michelle Holcomb 

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of Christine Smith
Sent: Thursday, February 08, 2007 7:16 PM
To: NP Info
Subject: Re: [NPInfo] Retail Clinics.......Chapter Two

I think compensation for NPs/PAs is ridiculous too. I make $55 per hour and
cannot comprehend making less unless my job is lots less stressful. The
first 4 hours I see uninsured patients as the sole provider in my clinic -
last night I saw 23 patients in 4 hours. Mostly BS complaints, but still
require documentation, my time and faking some sympathy for yet another
snotty nose. The second 7 hours I worked in the ER, seeing more BS and some
acute pts that actually deserved to be in the ER. I bill an average of $480
per hour and this is only for my time. It does not include what I bill for
the hospital, including meds and supplies. It only includes the time I spent
on the patient, the skills I did include lac repair, I&Ds, monitoring,
reading x-rays, etc.  The patient gets two bills, one from me and one from
the hospital. My average pt gets billed at $269 (yep, snot noses cost a lot
if you go to the ER).

Many of the RNs make more than I do and that is distressing to me. I do not
get night shift or weekend differential though I work minimum of two
weekends a month and every single night (6pm  until at least 2am). The docs
get a shift differential on nights starting at 7pm but they voted against
giving NP/PAs a shift differential even though many nights I am there until
5am saving their ass because the ER is inundated with patients. They just
started giving us a holiday "bonus" if you work on Thanksgiving, Xmas or New
Years - $150 per shift. That is not even time and a half like the hospital
staff gets. The docs all make over $150 per hour. They also get huge
compensation pay for being on various committees - several thousand per
month. I get my hourly pay only.

It is unfair and I am not sure how to fight it. I work my ass off, I
generally have the highest productivity in the dept every month, both in
billing and in patients per hour. Sometimes it does not seem worth it. 
Interestingly, I could quit my job as a NP at my facility and come back as
an RN (I know they would hire me in an instant) and be making far more
money.  A PA who I work with is talking about doing this. He is an RN too. 
We wondered if it would send a message to our company that contracts with
our hospital. Would they care, would they reconsider?  Very sad that we are
not valued by so many of our employers - we are seen as cheap labor.

Sorry, but Megs letter got me going. I am so burned out from seeing every
runny nose and fever in the county in the last month.

Christine Smith



----- Original Message -----
From: <mmhelgert46 at comcast.net>
To: <npinfo at nurse.net>
Sent: Wednesday, February 07, 2007 6:33 PM
Subject: [NPInfo] Retail Clinics.......Chapter Two


> Retail Clinics....Chapter Two
>
> Tracy Klein's article on Medscape addresses many of these issues and more 
> through a series of tough questions and answers....I have always 
> maintained these clinics need providers with a solid background in primary

> care, family practice and/or Emergency Dept....then.. skin cancer (etc) 
> won't be missed and appropriately referred to a dermatologist in the area.

> A good business sense and legal savvy would be helpful as well when one 
> considers being employed by a retail clinic corporation. Review of one's 
> contract before signing is equally as important; Carolyn Buppert helped 
> our group work out details and changes in a contract. Her insight is 
> invaluable.
>
> Compensation for these retail clinics is lower then I had expected and 
> with a seasoned provider working alone for 12 hours, $45-$50 per hour is 
> very reasonable (higher compensation needed for weekends and Holidays) 
> (pay scale: $34-$38 is usual)...consider: if one sees 4-6 people per hour 
> at $59 per visit (baseline)....leaving $300 for the corporation's coffers 
> (+) (-). The clinic overhead is about $100,000 (or so) (probably higher) 
> per year (salaries, equipment, supplies, rent, etc). I also believe 
> compensation across the board for nurse practitioners and physician 
> assistants in many settings is, in a word, embarrassing. Seasoned 
> providers working for $32.50 a hour  ( in many clinic settings) when the 
> clinic bills out $600 (+) per hour is intolerable.
>
> I think David Mittman has some very valid and serious concerns providers 
> ought to be troubled about with the proliferation of these retail clinics,

> how we are being portrayed and the value these concerns should be for all 
> of us.
>
> http://www.medscape.com/viewprogram/5982
>
> Meg (Portland, OR)
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