Nephrology NPs

Trauma Columnist · Jan 15, 2015

Good question. However you must factor in distance too. I have 170 pts I round on in four clinics. I will soon add a fifth. They are all at least 40 miles apart and one is 90 miles away from the others. They range from 6 chairs 28 pts running 4 shifts per week to 14 chairs running six shifts per week with 72pts.

you can't quantify on an hourly basis. Much better to figure how many per week.

May i I ask what part of the country you are located? I'm in central IL so must account for snow too.

just keep swimming · Jan 16, 2015

Im still new so am only rounding in one unit with 125-130 patients. I spend 4 days a week rounding on HD pts and last month made 297 visits. Now, as Trauma said, when I expand to more clinics, I will not make as many visits. It just isn't possible.

Trauma Columnist · Jan 16, 2015

Are you doing three visits per month with md doing one to max out the bundle?

just keep swimming · Jan 17, 2015

Not sure if you are asking me but I mostly do the 3/month bit if neph cant see the pt, I do comprehensive as well. Will be starting inpatient as well soon

Trauma Columnist · Jan 17, 2015

JustKeepSwimming - how many dialysis pts are you going to be rounding on? How many units and how far apart are they? Where is the hospital in relation to the dialysis unit(s)?

Adding in hospital rounds could result in many many hours. When I did hospital rounds on my call weekends, we would have between 10-20 pts at two different hospitals about a mile apart - it was wild! Usually 12 hour days because most of our pts were in the ICU on CRRT. Consults took me about an hour - if it was just a daily visit, maybe 30 minutes. And on these weekends, we did not do dialysis rounds.

Let me know how it goes.

Penguins10, MSN, RN, NP · Jan 19, 2015

Thanks for the replies, it's interesting to hear how others work!

We have folks at three clinics. One is about 35 miles away, one is about 25 miles, and the other is in the same town as our office.

We see about 155 people in 3.75 days (we spend the other 1.25 days seeing acute visits in the office). Fortunately, we don't have to drive between different clinics on the same day. I'm in the relatively snowless mid-Atlantic, so weather isn't too much of an issue. We're lucky in that we do dedicated inpatient and dialysis weeks, it would be tough to try to do both at the same time I think.

Trauma, I enjoyed your article on ESRD patient's in primary care.

Trauma Columnist · Jan 19, 2015

Thanks Penguin.

May I ask how many physicians are in your practice?

We have 19 MDs, 4 APRNs, 2 PAs, 830 chronic hemodialysis in-center pts (16 clinics - both Fresenius and Davita) plus another 200 home (both home hemo and PD) pts in our practice. For in-center rounding we have 3 full time APRNs, one 4-day per week PA and one two day per week NP. We cover a very wide area.

just keep swimming · Jan 20, 2015

Wow Trauma, that's a busy practice! We have 12 MDs, I am the only NP, no PAs. 312 dialysis pts (this covers HHD, PD as well). Most of our clinics are within in one county. I cover calls for all dialysis pts, have .5 day in CKD clinic and .5 day in bone and mineral/stone clinic. And like I said, soon adding inpt.

I am curious to hear about your group too, Penguin. Do you guys think I'm taking on too much for being 2.5 months in?

I am soon meeting with the other NP/PAs in Neph for our area so that will give me a good reference point too....

Trauma Columnist · Jan 20, 2015

JustKeepSwimming - how many visits per month do you do for the 312 hemo pts?

In our area, Fresenius has taken over CKD clinic as it was no longer profitable for us (private practice) to do so.

As to bone/mineral clinic - again we (APRNs and PAs) address this with our pts when we see them on dialysis. If pt is CKD, the doc or Fresenius (when they get to CKD 3/4) educate.

As to inpt, again, more profitable for us (APRNs/PA) to remain in clinics because in the hospital systems that we are credentialed (all five of them), the notes must be co-signed by an MD. So, while we are saving them time, we are not billing for our services.

Penguins10, MSN, RN, NP · Jan 24, 2015

Wow, you guys are in big groups and it is interesting to see the ratio of MDs to NP/PAs. We have three nephrologists and four NP/PAs. One MD does CMR each month and does PD/HHD clinics. We see in-center hemo patients the other weeks and trouble shoot acute issues with home patients. We have talked about starting CKD education group visits, but that seems to have fallen by the wayside.

Interesting to think about mineral/bone/stone clinic, would be cool to have specific time to think about those issues. We are doing inpatient work the rest of the time. Our situation is the same as Trauma in that we are doing split/shared inpatient visits and billing under the MD. This has been ok, we save them time and they are a private group, so if they're happy we're employed. In the near future we will be transitioning to a hospital employed arrangement and I expect will need to find ways to bill more.

In terms of how much you're taking on I, I guess it depends on what you need to do (effectiveness of support staff, just dialysis vs primary care and dialysis, etc), what kind of previous experience you have, how much orientation you had/have. Are you the first NP the group has worked with, that can be tricky to figure out if they aren't sure what to do with you?

Trauma Columnist · Jan 25, 2015

Oh yes the primary care model and in nephrology.

i have 70 pts for whom I'm the PCP! That particular md would like it if I did breast exams, pelvics and digital rectal exams while the dialyzed!!!!

ive really had to scramble to get up to date on primary care....lol

My practice is vehemently against joining the humongous 900 bed, 20 hospital and growing system. Is pay and benefits going to remain the same?