Collaborative Physician Issues

Trauma Columnist · Sep 7, 2018

Hmm...no have not had this issue. What is their rationale?

Jules A, MSN · Sep 8, 2018

When we needed it the physicians who were our collaborators were usually someone we worked with so they had a vested interest in the responsibility of overseeing us. The other scenario I have heard of is when NPs contract and pay a physician to be their collaborator.

Are you looking for a reference or her to continue being your collaborator? Unfortunately she is under no obligation to do either and if she's refusing a simple reference there is her opinion. If she is not interested in being your collaborator due to no longer working together that is totally understandable.

Kooky Korky, BSN, RN · Sep 9, 2018

Does she have a legal obligation to do what you are asking her to do?

Maybe there were issues you weren't aware of? complaints? problems? Does she maybe think she can't speak well of you and your work, therefore she wishes to remain silent?

If you can't get her to do the paperwork, what harm will you suffer?

Can you get a written request to her to do the paperwork? Can you stop by and see her? Can you get the papers all filled out and just ask for her signature so she doesn't have to spend any time on this?

Can someone else fill out the papers? If this doctor were on sick leave or no longer living or otherwise not available, who could you ask to do the paperwork? Other doctor? Office staff or manager?

Maybe a letter from a lawyer will motivate her, although I would try to get her to do it on my own first, before resorting to using an attorney.

Are you sure she has received your requests? Is someone doing you dirty in that practice?

Best of luck.

InquisitiveAPN · Sep 9, 2018

I ran into a physician not doing their sort of quality control aspects of collaboration. It was a very flighty doctor who had trouble doing anything (no exaggeration) in life and wasn't avoiding the work out of any adversarial reason. The physician's job requirement was to collaborate with seven NPs so we didn't pay or do anything but remind...a lot...and still didn't get done. The doctor thought NPs should be independent and do whatever they want. So supported but neglected. I have no idea how you'd leverage or enforce this.

The medical baord has no collaborative guidelines.

Frankly, the nursing board is generally authoritarian and doesn't care at all in my experience often exceeding what a normal person would deem their scope to be. Their view is that the aprn should collaborate or quit to further avoid violating such board regulaiand what nots. They have to draw the line somewhere I suppose. : Shrugs:

So eventually I quit. Not for the aforementioned reasons, but it was certainly an issue I didn't have to deal with.

Hoosier_RN, MSN · Sep 9, 2018

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lhflanurseNP, APRN · Sep 9, 2018

Guess maybe I'm being obtuse...but what do you mean by credentialing? Insurance? Hospital? Nursing Homes?

nbtw · Sep 9, 2018

To reply to everyone's posts let me provide some clarification.

I worked with this collaborative physician for almost a year in 2016. The collaborative agreement (required in my state) requires them to review your work. She in fact physically signed off on some of my encounters, such as preoperative clearances, because some of the hospitals in the area require a co-signature. If she had issues with my work, she certainly could have brought them up at the time and this never occurred even once, verbally or in writing. To answer Inquisitive APN, yes this provider is very flighty. She has a bad rep personality wise at the organization I used to work but she's an experienced and thorough provider.

I'm going through credentialing at a new employer now. To answer IhflanurseNP, "Credentialing - also called medical, provider or physician credentialing - is a detailed process that reviews doctors' qualifications and career history including their education, training, residency and licenses, as well as any specialty certificates. Credentialing must be completed upon the hire or enrollment of a new doctor and regularly afterwards to abide by the standards set forth by regulatory and accreditation organizations such as the National Committee for Quality Assurance (NCQA) and The Joint Commission (TJC)." The collaborative agreement that I had with the physician in question specifically states her responsibilities to in reviewing my work. She won't do the paperwork at all. This is not professional. Credentialing like the process I'm talking about is not uncommon in the Northeast where I live. What is the point of these nursing boards requiring advance practice nurses to have collaborative agreements if the physician's have no obligation to hold up their part of the agreement? To answer kooky korky: I need to complete credentialing to remain employed. The organization I'm employed by is accredited by the joint commission so there is no way around this credentialing process. I just feel like this is some type of sabotage.

I just wanted to know if any other APRNs have faced this and how you handled it.

TuxnadoDO · Sep 12, 2018

OK, so she was your collaborating physician in 2016. The way you said that implies that she is no longer your collaborating physician. Now, you are setting out to be credentialed somewhere else and you are seeking paperwork from her to provide a reference or evaluation?

Is that correct?

If it is, I think that you are applying the term "review your work," a little too broadly. She was required to review your work when she was your collaborating physician in 2016. That does not obligate her to provide references or evaluations of your work until the end of time. It would be the nice thing to do, the professional thing to do. You haven't stated whether or not you've spoken to her, or emailed her, or why she's not filling out the paperwork. Are you sure that she's received it? Do you have her updated contact information? Has there been any communication at all?

nbtw · Oct 3, 2018

Yes, an evaluation is precise. The agreement we both signed specifically states that this was one of her duties. I've spoken to her. She wants the medical director to complete the evaluation. This makes no sense. First, the medical director is not the person listed on the collaborative agreement. Second, the medical director that works at that organization now is not the same person who was in place when I worked there (that medical director has also moved on). I guess my question was really to ask everyone if they have any knowledge about what the physicians legal obligations are when they sign a collaborative agreement. In my state collaborative agreements are required unless a nurse practitioner is practicing independently; this is written into our states nurse practice act. I just don't understand why there is a requirement if the physician doesn't actually have to adhere to the agreement or do they? I've looked at my states practice act and can't find any information about this or if I have any rights at all. That's my question. As nurse practitioners with collaborative agreements what are our legal rights? I'm not asking this person to evaluate my work from today. I was asking for their evaluation during the time I worked with them, a task they did or at least should have been doing the whole time the agreement was in place. I think this is important for us all to know. After all, malpractice cases can come up years later, credentialing (if you want to work in a joint commission hospital) is not going to go away, and state boards of nursing can decide to audit our practice any time.

Jules A, MSN · Oct 4, 2018

The agreement we both signed specifically states that this was one of her duties.

That may have been her duty when you worked for her but it isn't after the relationship ended. I'm not sure why a credentialing department would be insisting on seeing your evaluations. I have privileges at multiple hospitals and they only required peer references. I really do not think this is a Joint Commision requirement.

nbtw · Oct 4, 2018

I'm not sure why a credentialing department would be insisting on seeing your evaluations. I have privileges at multiple hospitals and they only required peer references. I really do not think this is a Joint Commision requirement.

I'm not sure where you work. I work in CT and this credentialing process is for the largest, research, teaching hospital in the state. They're notorious for asking you for everything except the toilet paper you use. I know every hospital has different credentialing requirements. I've never been credentialed with hospital before as I've only been outpatient. My credentialing process in the past never asked for collaborative physician references only peer references as you mention.