I am always being asked “how much should a physician collaborator cost?” I always answer, “it depends.” There are four factors you need to consider:
It depends on how busy your practice will be.
It depends on your location.
It depends on the liability and risk of your service.
It depends on the relationship you have with the physician.
If you live in a restrictive state and want to start your own practice, you need to have a collaborator. There is no way around it. Implementing the Elite Nurse Practitioner Model in a restrictive state is more difficult, but it is still doable. So do not let this barrier to your practice get you down. You just need to be prepared for it.
Having a physician collaborator is just one more step, of many, when starting a practice in a restrictive practice state. So how much should you budget for when paying this “collaborator?” (Remember, they will be doing very little most of the time other than taking your money.)
It depends on how busy your practice will be: If you are first starting off and this practice will be a part time endeavor as I advocate for, then you should not pay this person very much. They will be doing nothing other than having their name associated with your practice. If you are only seeing 15-20 patients a month, then you need to make this fact apparent to the physician and let them know this is very part time, thus they should be paid on a part time basis. I believe $500 a month is fair for doing nothing. If your practice is more of a full-time gig, you will need to pay at least $1,000 or more a month typically.
It depends on your location: Do you live in a saturated market or more of a rural area? If you live in a saturated market, the demand for a physician collaborator will likely be higher. If you live in a rural area, not so much. You could get away with paying $500 a month in a rural area, but a saturated market will increase the price to $1,000 simply because of supply and demand.
It depends on the liability and risk of your service: Are you giving out medical cannabis cards or managing peoples congestive heart failure? The lower the risk, the lower the price. The higher the risk, the higher the price. If your practice is low liability, I would not pay a physician more than $500 a month. They are taking very little risk and making free money. On the other hand, if you are undergoing a riskier endeavor, then the physician will require anything between $1,000-$2,000 a month.
It depends on the relationship with the physician: This is the most important factor to consider when looking for a physician collaborator. Is this person a friend? Professional colleague? Or a stranger? If the person is a friend or a long-term colleague, I would simply ask if they would be willing to do it for free or for $250-$500 a month. If the person is a stranger from some “collaborator” service or a physician a friend is using, then the cost will be closer to $1,000.
Overall, you need to budget $500-$1,500 a month for a collaborator. I would not pay more than $500 a month with a part time low risk practice. If I had a riskier service line and a higher volume practice, then I would consider $1,000. Personally though, I would not pay more than $1,000 a month for a collaborator in any situation.
Best of luck! I feel for my colleagues in restrictive states…
81 Responses
I charge $3000/month for my EMS medical direction. NP’s have more liability. I would expect at least $5000/month and even higher if more patients are being seen.
And thank god I live in an independent practice state for this exact reason. It is my opinion that $5,000 a month for “supervision” is robbery and a significant expense for the NP entrepreneur.
Exactly!! I do not know any NP willing to pay that kind of money! I do live in a restrictive state and this is why I practice in a FPA state.
Ya its absurd
I agree with you Justin, it is robbery when the physician has little to no patient contact/care/review i.e., very limited if any responsibility when collaborating for a small practice with low liability. Caveat would indeed be medical direction for an EMS service as Michael referenced. EMS requires, complete and continued oversight including but not limited to; continued edu. for staff, DEA licensure, review / collaborative participation with establishing and maintaining practice protocols that are ever evolving as EMS is ever evolving, for those types of services you would charge “more”.
I have a physician colleague, that is willing to be my supervising physician in North Carolina and South Carolina for a telehealth practice as well as aesthetics. He is also a friend and knows that this will be a part time business and it is opening slowly. He said he will not charge me monthly so that I don’t have to pay so much out of pocket while I’m trying to get started and wants 6%. He also states that I can work as much as I want to or as little as I want to and that way I wouldn’t have to be worried about $1000 a month if I am not seeing patients. Do you feel this is a good deal? The aesthetics part is really only going to be Botox to start off with.
Ya, this is a good deal… why wouldn’t it be? It sounds like free collaboration basically but there needs to be a clause for renegotiation if you get busier and stick to a flat fee after that
What about an RN, Michael?
So you don’t even know who has “,more liability” and no one in their right mind will pay you that much bud.
LOL
Wow! So you all really expect a physician to risk their license for a few hundred dollars a month!
If you don’t want to supervise a NP then don’t! There are plenty of MDs out there that are willing to “risk” their license for $1,000 a month.
There is literally zero risk to physicians if they follow the rules and don’t do more than required as many do.
For free because they’re your friend? Are you crazy? Wow. I can’t even formulate a comment to the entitlement. Good luck!
yes
How is the physician risking his or her license if the NP has his or her own license with prescriptive authority and is carrying their own malpractice insurance… obviously there is a lot of room for improvement in understanding what “supervising or collaborating physician means”…
You are demonstrating your ignorance of the law and have obviously never been sued! The plaintiff’s attorney will go after the “deep pockets” and the physician is at the head of that list (unless there is also a hospital system involved). BTW, the physician has to pay extra premiums (carry an insurance policy that covers nurse practitioners that he/she supervises).
Dr Tim
Do you know how much a Physican education cost? Who will cheapen their heard earned license for a few hundred dollars per month? Who wants to increase their liability for someone who’s had a fraction of a Physican education?
Yes I am fully aware of the cost. I knew plenty of physicians who supervised for $500-$1,000 a month when I lived on the east coast. I do not have to worry about this anymore as I practice in an independent practice state now. Thank god.
Collaboration and supervision or two different things collaboration just means a physician is available if NP has questions or needs to send the patient to someone who has more expertise in a area if they can’t handle. collaborate physician does not oversee every patient and is not responsible for every patient the NP sees. Stop Making comments on stuff you know nothing about. Again if u don’t want to collaborate that’s fine we don’t want u to!
Thank you Bryan for bringing this to attention as I get so tired of having to explain this.
Absolutely correct.
Tell me again why I Need to know what your student loan debt is? Why do I want to hire someone with issues and an attitude problem? Am I going to have to tolerate you showing up as if you aren’t forced upon me then hear you tell me how inadequate I am? Sounds like you are incredibly miserable..
Your statement is false
“(Remember, they will be doing very little most of the time other than taking your money)”
Right. For YOUR LIABILITY they are assuming for the supervision. Why would you think someone who has given away close to or more than a decade of their adult life to learn how to be a physician, with all the risks of being one of these in today’s litigious society, should not be compensated for allowing someone to practice under his or her umbrella? I legitimately do not understand the disconnect, here.
If you don’t want to pay for the malpractice risk they assume on your behalf, you probably should seek an independent practice state, or go to medical school so you can assume all of the risk for yourself.
Yes, that is why I live in an independent practice state. It is awesome. This article is for those NPs that do not and from experience I had when I lived in a restrictive state. I knew plenty of physicians that supervised for $1,000 a month.
once NPs gain full practice authority nationwide (and its as inevitable as medical marijuana), you physicians will start to become less needed and oversaturated. I suggest you get as much money as you can with these so called “risks” before you lose your opportunity completely.
You realize people deal with more complicated issues than diabetes and HTN, right? Physicians aren’t going anywhere lol don’t worry
No one wants your baggage. No one wants your measly umbrella. No one wants your attitude or your sob story. No one even wants you involved, it was your idea. NPs don’t need your input. You are forced on us in a few states and you seem like too much trouble to deal with. They can call a mentor or a colleague if necessary. You have issues you can work out elsewhere, its really unprofessional to unload your conflicts on us.
It is unprofessional to believe that you are as qualified as a physician and that mid-levels are always confident until someone dies then you remember your online education and subpar clinical time did not cut it.
When it comes to patients dying, the statistics are undeniable. All all the deaths are under a physician. Every single days 1000s of patients die under physician care. This is a crisis. If NPs have a fraction of the number of deaths under a physician then charging more will make sense. Every day a patient dies under a physician CARE. For NPs 1 patient every 6 to 10 years
Who are you? Come back when you legitimately understand this is a job interview and you have lost the job for whoever yo are shilling for. Bye.
this is just crazy. you pay a doctor to sign off on your poor medical decisions! if you want to do doctor stuff, go to doctor school….not nursing school. geeze…
Poor decisions? You have no idea how competent many NPs are.
LOL “doctor school”
friend: hey where did you get your education?
me: at the doctor school
friend: ……
me: with the stethoscopes
Solid comment, thanks for contributing!
LOL …louder
“Doctors School”
Ftr, before doctors go to “doctor school” to become poorly trained, inconsiderate, disease focused western drug dealers, they have to do their residencies and better believe nurses (registered not even NPs yet) are the ones who catch all their mistakes, kill shot orders, and we save many of their patients from the harm of their untrained hands and train them on the healthcare in and outs, dos and dont’s with generally not so much a thank you but rather a turn of their pointed little self righteous noses. Seriously, that degree means nothing in todays world anyone can actually go to “medical” school with any background but who wants to be a CDC/WHO robot??!!! Nurses have usually been in healthcare faarrr longer treating patients and in the trenches and we are trained to be more holistic! In a phrase… we rule!
While I agree that SOME doctors during their training are arrogant jerks, especially to the nursing staff, I have never considered myself to be above anyone when it come to the respective positions we all play in healthcare. I have always been grateful for the experiences and helpful thoughts that nursing staff have provided me during that training. I have, however, gone through extensive training and education, as well as having an additional 26 years of experience in a front-line office situation in a rural town. I am a family practice physician in a rural area and have been here for 26 years. I have worked as employed MD, independent and am currently independent again. I do not subscribe to all the WESTERN, drug-company touted mainstream PHARMA nonsense, and have been trained to provide care in all aspects, classical AND holistic. I had been terminated recently without cause from a large healthcare organization in KY because I stood up for my patients, my staff and for God! I will NOT compromise on my integrity for corporate nonsense by non-clinical personnel who spout CDC/WHO/etc garbage that inflicts harm on my patients. I feel that if anyone has a “chip” on their shoulder about who they are and how they provide care and down-talk other healthcare professionals, it has no place in today’s society. We should all work together to provide quality care, and listen to our patients and provide good evidence-based and common-sense based approaches to their conditions. I have supervised several APRN’s in my years, and most have wanted a guaranteed paycheck with not much effort – sorry if that ruffles your feathers, but it has been my experience, and maybe that is partly my fault for being a trusting doctor who helps others. I do respect APRN’s for what their role in healthcare is, but I do not condone their hatred of physicians because they lump us all into a particular mold, nor do I condone physicians’ similar reactions to them – one bad apple doesn’t spoil the whole bunch, and one good apple can certainly be missed if you don’t take the time to get to know it!!!
May God Bless your every endeavor!
You sound like a real asshole. I bet working with you is a real treat.
Your comment is absurd.
You must remember that the physician is assuming liability for the NP. So the NP should be paying for the physician’s malpractice insurance and should be paid a minimum of 30% of the practice’s production. Whomever wrote this article has a parent who is a physician doing them a favor, leaving them a VERY entitled mentality.
Good Luck getting any PHYSICIAN to risk everything for 500/month.
30%?!?!?! That is completely taking advantage of a NPs hard work, blood, sweat and tears. This is another reason NPs should move to independent practice states and stop lining the pockets of MDs.
How hard was it to be accepted to NP school ? I think it’s laughable that you would blame physicians for not wanting to risk their license for $500 a month. When a patient died they don’t go after you. They go after the physician the one with the higher malpractice payout policy this is med malpractice 101. I don’t know why you seem to hate physicians? We worked hard in undergrad and spent years dedicating our lives to pursue excellence and to training through grueling hours and blood sweat in residency which you have never done! I wish you would just cone out and admit you weren’t willing to work as hard as a doctor works for as long as a doctor trains for as much liability as a doctor takes. You wanted the easy way to make a decent income. You risked little therefore you should only expect to be able to practice within a very small scope and under a physicians direction. Regardless of your state laws and what’s legal. Legal and morally right are rarely the same.
this is why doctors are on their way out like blockbuster. No monopoly survives the test of time, not even physicians. Your time is nearing an end. Instead of being scared partner with us NPs, we are the future and we can help each other. The goal is to help patients not your egos or pockets.
Once NPs learn how to manage patients that have more than HTN and diabetes, you might have a point. Unfortunately, y’all are nowhere near the expertise that MD/DOs are at. There’s more to medicine than primary care, and there’s plenty in primary care that is out of y’all’s scope. Not many people will trust a nurse heading their surgery, or even dealing with their high risk pregnancy. Y’all need to chill out.
Do you think physicians also do not put in years of hard work, blood, sweat, and tears for their license? NPs now want to take advantage of MY license and the years of hard work. Go get your own.
Then do not supervise them. Stick with your own private practice and do not worry about it. Why are you even commenting on this site?
It is based on principle. It is unethical to allow nurses with suboptimal training to run around playing dress-up as physicians. I say this as an RN who decided to go to MEDICAL SCHOOL because these online NP degree mills do not provide adequate training for independent practice.
Would you advocate for a nursing aide to be allowed an RN license after 2 months of online training? That would be ludicrous. But it is an exact replication of your training pathway to pretending to be a doctor. We are commenting on this site because you are perpetuating the lie that NPs are equivalent to physicians.
As a provider, you should have to self-respect to want to pursue the most arduous path of study possible to best take care of your patients.
NPs are valuable. Very much so. When they function at the top of their license, as a MID-LEVEL provider, then everyone benefits.
I am not saying NPs are equivalent to physicians. I am saying NPs can make as much as a physician with multiple side businesses including practices, real estate, certain investments, etc…
No dear Avis, we “musn’t” Your license is not being borrowed or used. You are very mistaken with your ideas and the drama is tres unprofessional. You are applying for a job. Try sucking up more. You sound like you are a real drag and have an attitude problem. You will never get hired with that tone.
Why do we have to pay for malpractice insurance if physician’s cover us? I would gladly forgo paying my malpractice.
Commenting from Europe (where the concept of “NPs” doesn’t exist)- aren’t you all just nurses with some extra online education? As far as I can gather from American medicine, you’re just a lot cheaper to hire than a physician. And mainly doing urgent and primary care, correct? Or have you started opening up your own neurosurgical suites? No wonder healthcare outcomes in America rank so low compared to most of Europe. Your country is run by insurance companies and online degree factories. What a shame for such a “progressive” society.
Thank you for that comment “from Europe”!! So true. While I love the NPs I work with, and they definitely have an important role, they should not be confused with the value added that a highly trained physician brings to patient care. We each have our role and we should be happy to do our part to care for patients. I am also reluctant to have my license “on the line”, as I am very aware of the fact that money hungry lawyers will go after that MD/DO, as much or more than they go after that NP, as they have deeper personal and coverage “pockets” to pick, and it is very hard getting a job anywhere if you have negative marks on your record, whether justified or not, paid out malpractice $$ not, they are all black marks on your record that follow you forever. Who in their right mind would not be compensated for this risk? I say all states should just make them independent providers, and let them bear their own malpractice risks and let the customer decide how much training/expertise they want to bear on their medical problems. There are more patients who need some level of care, and if there are not enough doctors, thank God we have NPs and PAs!
Not true in Texas, the Doctor has no liability
My malpractice insurers in Texas have consistently told me that I have vicarious and direct liability risk for the NPs and PAs who I supervise. Also, the supervising physician is named in practically every malpractice case brought against an NP or PA. Even if a case is without merit, the cost in time and stress would be considerable.
I supervise three PAs and one NP. For each APP I supervise, I am paid between $775 and $1150 every two weeks. I decide who I will and will not oversee. Speaking only for myself, this is an acceptable arrangement. I’m certain many would disagree.
I’ll add that I’ve worked with many APPs who provide better healthcare than some of the physicians in the same facilities.
Wow Justin! There are a lot of haters out there that are taking what you write much to personal. I mean if they don’t agree then they don’t have to work with you…. Don’t let your panties get in a bunch guys!
Personally, since I’m ‘just a midlevel’ ? I really value what you wrote. I’m not sure what sorts of doctors are commenting on your blog but I work with many really solid Docs that want to see me succeed. Not to mention they know me, my work ethic, my knowledge base and most importantly when I know I’m in over my head. I was smart enough to go to medical school but wanted children early, so NP made a lot of sense to me. It still does. I don’t regret it for a minute!!! ???
I’m not ‘playing doctor’, I’m a Nurse Practitioner and proud to say it. I plan to practice to the full scope of my license!
I love your blog. Eager for more ?
-Northern California
Thanks for the kind words Tamara! Yes… lots of haters. Mostly medical students and a handful of physicians who feel threatened.
Some of them are clueless about things. while at the bedside as a nurse, I had a medical student order some Protonix for PEG tube patients. Very well known that Protonix pills are enteric-coated and not to be crashed, I told him to switch to something else that is not extended-release. The physician had no clue what enteric-coated supposed to mean. He was like what does that mean? What should I order?. The second one was a student during my NP rotation, while someone said about their family member awaiting to some biopsy results, she said she was sure the results won’t be cancerous because cancer is painless. It turned out it was cancer. Now please, smart docs give NP some respect.
I have seen some very dumb actions by MDs as well… We are all human, everyone makes mistakes and every one has limited knowledge. My best advice for providers is to just live your life, do as well as you possibly can and mind your own business.
I work in a state that allows me to practice independently from a physician. I also recognize that physicians have far superior training than I do as a Nurse Practitioner. Adding to that, I frequently “collaborate” with physicians of specialty because I recognize the limitations of my training, education, and experience. I have never had a physician consider my collaboration and request for a higher level of care anything but a chance to assist with the health care of a patient. I am appreciative of the response that I receive when I reach out to a physician for expert advise. I don’t have to throw all the research and data out there that indicates Nurse Practitioners are providing excellent service in the Primary Care arena as well as specialties they choose to practice in. We all have a common goal, providing excellent patient centered care to those we have the privilege to serve. No need for all the drama.
Well said.
thank you!
In our “restrictive” state, physicians get paid to “collaborate” meaning I will call someone (often not even the collaborator) when there is something out of my scope…usually it’s a specialist. There is no requirement to review charts or supervise my successful practice. So why are they getting paid extra, to do nothing???
Thankfully NPs in our state will soon be free.
Yes, its a money racket. Nothing more.
I am curious as to how a NP can independently practice safely in one state but not another? If there was a danger to the public, then WHY are so many states adopting independent policies? Too many physicians are feeling insecure, not our problem. Physicians routinely collaborate with each other, and there is nothing wrong with that. NO ONE KNOWS EVERYTHING. Guess what? I have helped train several residents in my time as a NP. I follow those very same medical guidelines. Nurse Practitioners are not going to practice outside of their scope, and if they do- they are subject to the legalities of doing so very much like any medical provider. States will no longer be able to uphold this kind of repression because they need healthcare providers. The states that hang on to these antiquated regulations are hurting people. I am lucky to have a collaborator who lets me do anything I want within my scope.
The collaborative agreements are nothing more than a way to keep NP’s from practicing to their fullest extent. WE WILL PREVAIL I GUARANTEE.
*Shout out to JustinAllen*
Agree with you 100% Christine. It is absolutely ridiculous that you can literally walk over an imaginary line and be 100% independent and then walk back and be severely restricted. It is all about money.
Please let us look beyond the collaboration dynamics and focus on our main goal as either MDs or NPs. We are not in competition here. Our goal is to provide the best care to our patients. Everyone’s situation is different. The cost for supervision is not set in stone. If an NP is competent enough to care for their patients, then go for it. If an MD agrees to supervise then great, if not, there is always someone out there for that role. We are all respectable healthcare workers and the world hold us in high esteem, therefore we should uphold that and refrain from making derogatory comments. We have lost so many of our colleagues to the covid 19 pandemic and there is no better time than this to be supportive and encourage one another. I believe everybody worked very hard for their licenses regardless of our title. Let us uphold our code of ethics, give the best care to our patients and be happy:)
I agree. Healthcare will not improve until we come together to as a team. It will take all of us to care for our great nation. Our nation is filled with really sick people who need the support of a healthcare TEAM. There are enough patients for all of us to see without fighting over them.
Look at the statistics of healthcare in the United States among other developed countries. Then look at the healthcare disparities in the United States among not only patients but healthcare providers as well. The US healthcare system is not serving its citizens equally and physicians are primarily to blame. We’ve allowed physicians to have basically a monopoly on the healthcare system and they have made mistake after mistake after mistake and the overall health of Americans is suffering in order for the American physician to make money. Minority populations, poor communities, indigent population have risked their lives for years for you Physicians to prosper and earn what you do. I think it’s time for change and that you physicians “risk” your license to improve healthcare in America and in the meantime we’ll pay you extra cash you weren’t getting previously. Did you become a Dr. for the money or the purpose? Because you all sound like a bunch of bitter, scared, greedy doctors. Just saying
Well said Ty, I agree with many of your points!
I live in Ohio and looking for a collaborative MD so I can start my Functional Health and wellness practice.
Id like to be able to start and see how much revenue I get and then work out a payment for the MD.
At this point I wont even begin marketing until I have a doc so I have NO CLUE what if any number of clients I will get.
any tips on finding a doc that would work with me then get paid,
PS I have not needed to even call my current Doc at my J-O-B in 5 years!
Like I mentioned in the other article, post an ad on Indeed.com looking for a collaborator. That is where many NPs will find one!
I’m just wondering why physicians that are soooo against NP independent practice are even spending time on this site commenting ? Baby this is NOT your jam, keep it moving. You are not obligated to comment or bash. Be KIND.
Because they are fearful of what we can do.
Because nurse practitioners have a different kind of education, as to nurses, which affords us to think outside of a linear direction. I would love the chance to go head to head with a physician in certain areas in both skill and knowledge, because I guarantee you I am winning. You don’t become a superhuman because you went through residency. I don’t see physicians personally – my last doctor told me I had copper toxicity because of a ceruloplasmin level that was actually in a normal range. RN’s NP’s usually have more emotional intelligence and doctors NO LIKEY.
Lmao wow some of y’all are absolutely delusional
I was trying to get into the zoom group but cannot – I am looking for an NP “medical director” for my wellness practice in Hudson, NY. Cutting through all that tape was holy hell – but I am set up 100% legally and have the go ahead from the nursing board. I won’t work with an MD supervisor because I don’t trust that they will do the work and expect to be paid like they are important.
ANY NURSE PRACTITIONER with a state license in New York interested in getting paid “fair market value” for assigning me tasks “standing orders” in the form of IV drips, botox, and filler please please reach out to me! I have an incredible practice with hyperbaric oxygen chambers, IR saunas, and more. Again, I just won’t work with an MD. email me at sara@poppi.bio
Guys, Doctors, NPs, anyone here! We aren’t talking about wanting your collaboration to do brain surgery here. The services we are wanting to provide have very little liability and depending on the liability risk, so is the compensation. Of course, like the Doctor above was stating, he charges a lot for an EMS practice. You are dealing with medical emergencies which many can be life threatening and one wrong decision can cost you your license. Perfectly understandable! However, for low liability services such a Med Spa, IV hydration, Wt loss… Is that such big of a liability really? NPs are perfectly capable of offering those services without supervision. Most of the times, we go to the same training as MDs do for these particular services. Charging $3k/mo for these low liability/low risk services is plain greediness. We can all collaborate, and I understand that you are concerned of the risk and liabilities, but I think it’s because you are not well versed on the types of services and the level of liability of the services we want to provide. Believe it or not, Nurses know more than you think. Most of us have over 10 years of experience as a nurse before we even consider venturing out to opening a practice. Imagine being a 1st yer resident all your life. Overworked, abused and underpaid. That’s what being a nurse all your life feels like. We want other options. There is room for everyone!
I am overwhelmed by the professional animosity being displayed. Let us respect each other, MD as someone cited are a valuable asset. APNs are a necessary asset but the two are not equal. I respect and salute the doctors, however on the other hand the nurses carry their own cross in case of malpractice, and that is clearly stated in the board exams. All states should end this pull and push by removing the collaboration saga as splitting the nurses earnings is also counted as illegal.