[NPInfo] An NP/PA article which may come in handy

[dkiley]

an interesting article--  I would add for Mr Lowes that not calling  
professionals "Midlevels" is a good start in creating a positive  
relationship.
DebKiley
On Jan 25, 2007, at 6:39 PM, David Mittman wrote:

> JOIN THE ACC. TOGETHER WE CAN DO SO MUCH MORE!
> www.amcollege.org
>
> NPs and PAs: A seller's market
>
>
> These "midlevel" providers are in demand, so your salary and working
> conditions had better be competitive.
>
> Jan 5, 2007
> By: Robert Lowes
> Medical Economics
> If you're in the market for a midlevel provider, get ready to offer  
> more
> than you might expect. In 2005, nurse practitioners in group practices
> earned a median of $70,503; physician assistants earned $75,573; and
> midwives, $77,814, according to the Medical Group Management  
> Association.
> But these clinicians easily pay for themselves—and then some. NPs,  
> PAs, and
> midwives bring in more revenue in proportion to their compensation  
> than
> internists and family physicians. Even when you factor in their  
> overhead,
> you still get a bigger return on your investment.
> Not surprisingly, these so-called "midlevel providers" are a hot  
> item these
> days, particularly in primary care, where a shortage of physicians is
> prompting practices to plug in these clinicians, says Kurt Mosley,  
> vice
> president of marketing at the recruiting firm Merritt, Hawkins &  
> Associates
> in Irving, TX. "As demand goes up for internists and FPs, so does  
> demand for
> midlevels," he says.
>
> Power Points
> Income trends reflect their popularity. From 2001 to 2005, MGMA  
> data shows
> compensation for NPs and PAs grew 13.2 percent and 15 percent  
> respectively,
> outpacing the growth rate of 9.6 percent for FPs and 11.3 percent for
> pediatricians (internists led everyone with a 17.6 percent gain).  
> Although
> midlevels' income growth slowed in 2005, all the signs still point  
> upward.
> One of those signs is the emergence of in-store clinics in retail
> establishments like Walgreens, Wal-Mart, and Rite Aid that are  
> staffed with
> NPs and PAs. "These new opportunities for midlevels make the market  
> for them
> that much more competitive," says Ken Hertz, an MGMA consultant  
> based in
> Alexandria, LA.
> It takes more than just a generous salary, however, to attract—and  
> keep—a
> good midlevel provider. Here's what you need to know about making a  
> job
> offer they can't refuse. (In an upcoming issue, we'll tell you about
> recruiting—and retaining—an NP or PA for your practice.)
> Spread the perks and sweeteners around
> NPs and PAs are trained to diagnose illnesses and prescribe  
> medication.
> Experts say they can handle roughly 80 percent of the medical  
> problems—the
> relatively uncomplicated cases—that walk through the door of a  
> doctor's
> office.
>
> The pay-to-revenue ratio is lower than MDs
> Their compensation package is similar to a physician's, starting  
> with the
> recruitment process. Almost 60 percent of recruited physicians  
> receive a
> signing bonus that averages $20,480, according to Merritt, Hawkins &
> Associates. Such deal sweeteners are commonplace for midlevels, too,
> although they're not as sweet. "They run between $5,000 and  
> $10,000," says
> Mosley. Don't forget an allowance for relocation if your new NP or  
> PA is
> coming from out of town. That's another $5,000 to $10,000, he adds.
> In addition, your NP or PA will expect the same kind of benefits  
> you have.
> These include health insurance, malpractice insurance, a retirement  
> plan,
> allowances for journals and continuing education, and paid time off  
> to take
> the coursework. As would be expected based on salary differences,  
> the level
> of those benefits will be less generous than yours. In 2005, MGMA  
> numbers
> put the median for retirement benefits between $4,500 and $4,800  
> for NPs,
> PAs, and midwives, compared to $14,225 for internists and $12,529  
> for FPs
> who don't deliver babies.
> Do you believe that the harder you work, the more you should be  
> paid? NPs
> and PAs think that way, too. So consider building financial  
> incentives into
> your midlevel's compensation plan. In 2006, 24 percent of PAs  
> surveyed by
> the American Academy of Physician Assistants said they received a  
> bonus
> based on their individual performance, with revenue generated being  
> the most
> common yardstick. Some PAs also received extra money for overtime,  
> assisting
> on surgeries, administrative duties, and on-call availability and  
> services.
> In all, 68 percent reported some kind of additional pay besides  
> their base
> salary.
> Essential working conditions: space, support, respect
> Besides weighing compensation, NPs and PAs are also sizing up which  
> employer
> offers the best working conditions. Again, they have some of the same
> expectations a physician does.
>
> How compensation1 varies by region
> PAs and NPs frequently have their own daily appointment schedule.  
> While they
> may see a third fewer patients as a physician does, they'll still need
> medical assistants and exam rooms. In 2004, for example, 86 percent  
> of NPs
> employed by physicians had a medical assistant, 88 percent had two  
> or more
> exam rooms, and 60 percent had a private office, according to a  
> survey by
> the American Academy of Nurse Practitioners.
> But job candidates will look beyond these logistical issues. Expect  
> them to
> ask some fundamental questions about a potential workplace. Will  
> they be
> encouraged to operate within the scope of practice defined by their  
> training
> and the laws of their state? Or will doctors treat them like glorified
> medical assistants, never trusting their clinical judgment?
> The issue of professional respect is particularly acute for NPs. While
> physician assistants understand their role as subsidiary to the  
> medical
> profession—their name says it all—NPs view their profession as  
> independent
> and unique. In a 2003 survey by the AANP, the workplace difficulty  
> most
> frequently cited by NPs was "[not being recognized] as a primary care
> provider."
> Some medical practices have learned how to create an atmosphere of
> collegiality, says Kurt Mosley at Merritt, Hawkins & Associates. "I  
> know
> doctors who ask their midlevels for their opinions on complex  
> cases, and
> take them on hospital rounds," he says.
> NPs and PAs also will want to know whether they will be assigned to a
> particular supervising doctor, or a group of them, says David  
> Duncan, a
> consultant at Cekja Search, a healthcare recruiter based in St.  
> Louis. "You
> need a plan for how this person will function," says Duncan.
> Don't forget to scope out the kind of hours a midlevel prefers, he  
> adds.
> "Typically they're looking for a nine-to-five job," he says. "One  
> group that
> decided to extend their hours to 9 p.m. lost some midlevels in the  
> process."
> Bringing someone aboard: MD, NP, or PA?
> Many busy practices ponder whether they'd be better off adding a  
> midlevel or
> a physician, say consultants and recruiters. From a strictly financial
> standpoint, midlevels have the edge, based on compensation and  
> revenue data
> collected by the MGMA. True, FPs and internists bring in anywhere  
> from 40 to
> 100 percent more revenue than NPs and PAs. On the other hand,  
> physician
> compensation is more than double that for the midlevels. Do the  
> math, and
> the compensation to collection ratio turns out to be smaller for  
> NPs and PAs
> than for internists and FPs. And yes, a midlevel will boost other  
> aspects of
> overhead just as a physician will—think exam rooms, staff, and  
> supplies. But
> if you look at the overall cost structure, midlevels still represent a
> bargain, says Mosley.
> However, you need to go beyond simple dollars and cents and decide  
> what
> makes sense for your particular practice. Find out whether local  
> insurers
> will readily—and fully—reimburse you for an NP's or PA's services,  
> says
> consultant Ken Hertz. "Some payers make it easier to bill for their  
> work
> than others," he says.
> It's critical to find out whether your patients will accept  
> midlevels as
> caregivers. "Some practices take a survey and discover that their  
> patients
> don't like the idea," says Mosley. Tip: If you educate people about  
> the
> clinical prowess of NPs and PAs in the process of polling them, you  
> may win
> over wary patients.
> Most important, you have to decide whether you're comfortable  
> working with a
> midlevel, and whether one will fit into your practice. At the very  
> least,
> you may decide that midlevels represent a quick fix for a  
> burgeoning patient
> base that's become unmanageable.
> But remember: Midlevels clearly enjoy a seller's market. So be  
> prepared to
> make a red-carpet job offer. If you don't, somebody else will—maybe
> Walgreens.
>
>
>
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DKiley at Alaska.net
Anchorage