Adult NP asked to cover call for Endocrinology

Specialties NP

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Adult NP with 8 yrs experience. Currently working in suburban Endo clinic w 2 docs. I see outpatient DM & thyroid patients.

1 of the docs is leaving and they have approached me to take call instead of replacing the doc. (No talk of salary adjustment either)

I am experienced in thyroid and DM mnmgmt but other endo diseases such as addison, cushings are usually managed by the Endos. Additionally, I dont feel my training supports managing these complex diseases.

When I questioned whether this was outside of my scope of practice; they looked at me puzzled. Of course my state BON verbage is not very specific.

I am currentl looking for another job but in meantime I would like to see what others are doing for inpatient

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Disclaimer: I don't work in Endocrinology, but I'm an NP in the in-patient side (critical care) and ACNP trained.

I would consider this proposition as a way to branch out and learn something new. In my experience, Endocrinologists in the in-patient settings are never the primary service on any hospitalized patient. Their role is limited to a consult service (i.e., hard to control diabetics, seeking endocrinology input regarding suspicion of adrenal disorder). I would do this job if I have back-up support from an attending physician, someone I can call over the phone to discuss my physical exam findings, my work-up, my thoughts on what is going on, and hopefully get some direction on what recommendations I would give to the primary service. This is something I would make sure is in place while I am learning the ropes. Endocrinology is never a specialty you call during the off hours. Regardless of how high blood sugars can run in the middle of the night, you deal with it as a primary service and call Endocrinology in the morning. There is no urgency to the consult usually. I would also take on this responsibility under the condition that I would get additional pay. I don't think you're running across scope of practice issues as an ANP unless they're making you see kids below age of 13.

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Interesting but the Endo states how he gets called all night on dka patients, bg readings. Wonder if this is something he prefers!

I do see this as an opportunity to grow but would like to see the salary be in alignment with the responsibility

Tha ks for your help

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Interesting...what is so difficult with DKA management that an Endocrinologist needs to be called? I've worked as an in-patient NP since my graduation as an ACNP and DKA, at least in the setting I've worked in, is managed by the primary team. It is very straightforward as far management. In my current institution, true DKA patients are admitted in the ICU and insulin drip, IV fluids, and lab monitoring orders are written by the ICU team.

Maybe he prefers to be consulted to generate revenue.

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If it's something you're interesting in trying, you can't wait for the practice to discuss adjustments to your pay - you're going to have to bring it up. Get your numbers together (what is the going rate for call in your area?) and start the conversation. Find out if someone would be willing to be your back-up for call for a limited period of time (a month?) so you know you can call someone and ask questions when/if necessary.

The nice thing about endocrinology is that there is a limited number of diagnoses you'd need to study up on to be proficient. You are not out of your scope of practice as far as your ANCC certification goes as long as you are seeing only those patients 13+. Of course you should check with your state BON, but it doesn't seem to me you would out of your scope anywhere.

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Specializes in Pediatric/Adolescent, Med-Surg.
Interesting...what is so difficult with DKA management that an Endocrinologist needs to be called? I've worked as an in-patient NP since my graduation as an ACNP and DKA, at least in the setting I've worked in, is managed by the primary team. It is very straightforward as far management. In my current institution, true DKA patients are admitted in the ICU and insulin drip, IV fluids, and lab monitoring orders are written by the ICU team.

Maybe he prefers to be consulted to generate revenue.

Juan, When I worked as an RN on an endo unit the endocrinologists would admit DKA's to the floor so they could be the primary admitting team in charge of the DKA's instead of the critical care team. I think it varies by doctor, by at the one hospital I worked at we had no less than 8-10 pts admitted to endocrinology at any one time, plus an out patient endo clinic population of 1200. Endo would have a fellow in house 24/7 though so that made it easier when DKA's were admitted in the middle of the night and such.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Juan, When I worked as an RN on an endo unit the endocrinologists would admit DKA's to the floor so they could be the primary admitting team in charge of the DKA's instead of the critical care team. I think it varies by doctor, by at the one hospital I worked at we had no less than 8-10 pts admitted to endocrinology at any one time, plus an out patient endo clinic population of 1200. Endo would have a fellow in house 24/7 though so that made it easier when DKA's were admitted in the middle of the night and such.

Thanks for that tidbit of information. It certainly varies by health system and region. The teaching hospitals I've been associated with are big proponents of the intensivist and hospitalist models where we feel that care coordination is best achieved in a setting where providers trained in a wide array of medical problems assume primary ownership of a patient in the hospital.

Though we also have an Endocrinology fellowship here, the feeling is that patients who present with DKA also have other medical issues outside of the realm of endocrine disorders and though these specialists also trained under an IM residency, the focus has shifted to their specific specialty, hence, they are only available as consultants.

But I have digressed, if it was me presented with the OP's predicament, I would welcome it as a means to advance my knowledge granted that I would also have a proportional increase in compensation :).

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Thanks for all the information.

Our community based hospital medical staff is not receptive to hospitalists managing their pts- probably why the Endo gets bombarded with call- but I do believe he may prefer this process of handling these pts. Now that he is older- he wants more relief. Hence, my predicament

I am all about expanding my clinical expertise but am trying to determine what constitutes a fair compensation for call. I realize if I don't bring it to the table- it will not happen- it will be "part of my job"

More research is needed. I have inquiries out with colleagues about this topic but in our area- not a lot of NP take call

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Thanks for all the information.

Our community based hospital medical staff is not receptive to hospitalists managing their pts- probably why the Endo gets bombarded with call- but I do believe he may prefer this process of handling these pts. Now that he is older- he wants more relief. Hence, my predicament

I am all about expanding my clinical expertise but am trying to determine what constitutes a fair compensation for call. I realize if I don't bring it to the table- it will not happen- it will be "part of my job"

More research is needed. I have inquiries out with colleagues about this topic but in our area- not a lot of NP take call

Good luck.

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Specializes in FNP, ONP.

Ask for 20% salary increase and take the opportunity!

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