Hiring an RN into private practice - page 7

Hello everyone! I am a psychiatrist and in the process of starting my own practice, it will deliver transcranial magnetic stimulation, an FDA approved treatment for major depression. It's very safe,... Read More

  1. by   ixchel
    I just looked at a typical billing rate for TMS and I am absolutely appalled that with your prediction of 45 treatments per week leaves you with a pay expectation of $20/hour. Stop telling us what your overhead is. Stop trying to compare your anticipated income to what psychiatrists typically make. Either pay a nurse the hourly wages that a nurse should make, offer benefits, and give a competitive vacation package. Would you ever go into practice with a physician and offer them half what they should make? If you WANT a nurse, PAY for a nurse. You CAN afford it.

    (I mean, seriously, the last commenter here is running a TMS program. In my observation, programs offering only one type of treatment (and hiring "coordinators", no less) exist because they're profitable.)

    Also, for the love of god, don't hire a new grad nurse. This would be career suicide for a desperate new grad who would accept any offer thrown at them just to start working, especially if they continue to work for you for a long time.

    God, I'm going to have this thread rattling in my brain for awhile now. Just when we've been working so hard toward better respect between different types of healthcare licenses, stuff like this still happens.
  2. by   Mini2544
    First off, congrats on starting your own practice! My opinion is that 20$ is a bit low... I would do my very best if I was you to try to bump that up to at least 25$. Even without benefits, you will find some takers. Maybe someone who is not the primary breadwinner, someone who has worked the hospital life and will gladly take a pay cut to not have to deal with all that, there are lots of options here. I would also leave the option open for extra, bonuses etc as the practice grows. Per diem may also be a good idea. Best of luck and I think that the new technology you are using is so promising!!
  3. by   MissMoTheMrs
    I would suggest restructuring your schedule so that the actual procedures are all on the same day/limited days of the week, so that you can find an RN who would be interested in Part Time/per diem work that they can hold down with another job elsewhere. For example instead of procedures at beginning of shift every day, they take place all day on X day(s) of the week. Pay them better wages for their hours in line with what an RN should make, and have appropriate medical personnel on hand during those hours. Then you can pay a clerical person a more appropriate (read=lower) wage to do the rest of the non-nursing clerical role you describe the rest of the time.
    Last edit by MissMoTheMrs on Apr 27 : Reason: incomplete sentence
  4. by   Aveda
    Where is this job? Would you consider hiring a nurse who has a reprimand on their license? A lot of nurses can't find work because of the reprimand and they would be willing to work for $20/hr.
  5. by   smartnurse1982
    Quote from Orion81RN
    Private duty companies around here in Chicagoland are, and I'm thinking of 3 specific companies, 22/hr, 25/hr and 27/hr starting pay. No exaggerations here. And they are BEGGING for nurses. Especially the 22/hr company I currently work for. They try to get people in through referral bonuses. I'm not about to subject fellow nursing colleagues to 22/hr. I've only done it myself this last year to take a break from bedside and I needed a job ASAP. My last day is in 2 days. Then I'm bringing my broke butt back to bedside at 35/hr. 6 years experience. No exaggeration needed.

    I DID work for a year in an asthma, allergy and immunology office at only $14/hr for 10 hours a week a few years ago when I was desperate and searching for employment. The doctor and his family of doctors and my family go way back. They are notorious for their horrendous pay. And my mom knows his overhead very well. She did the billing and payroll, including 2k a month to his daughter who didn't even work there. (20 years ago) Stingy af to his employees, yet paid his daughter FOR NOTHING.

    I don't know where you are getting exaggerations from. Pay differs greatly on location, specialty, where the money comes from (like OP coming from a start up company where he cannot afford to pay more) etc.

    I meant that there are many fields of nursing that pay $20/hr to Rn's,private duty being one of them.
    I have not had a raise in PDN for 8 years now,and my pay was actually reduced(Im in Nj now)

    But i still stand by my point.....there are many nurses making $20/hr. I knew very few nurses making $35 an hour and over unless per diem,ER,etc.
  6. by   dream'n
    Quote from Branon
    Hey CuriousMD!

    I'm the TMS Coordinator / Office Manager for a TMS provider in central CA.

    We generally hire graduates of local colleges with degrees ranging from biology to psychology and related fields as technicians. The training for TMS Technician certification is thorough but not too rigorous and our techs do a fantastic job. As nurses generally expect higher compensation maybe look into fresh undergrad - grads looking for their first steps into healthcare: they'd probably also be stoked about the pay as opposed to disappointed. I'm a prospective nurse as well and I am hoping to make far more in nursing than I make now at a TMS clinic but I also totally understand the pay you're offering and can confirm that it's pretty standard if not on the higher side.

    TLDR; you don't need nurses just smart detail-oriented employees as technicians and it may be a better fit.

    Hope that helps! Message me if you have any questions!

    Blessings -
    A physician will not be in the office at all times. Does that occur at your clinic? Something doesn't sound legal about a Tech, a Medical Assistant, or a non-medical person performing these procedures while alone in the office.
  7. by   Jolie
    Quote from Nurse Beth
    I've seen this done at Cedar Sinai with a doctor present at all times. The clinic is run like an efficient, safe outpatient surgery clinic. Consents are signed, NPO prior is confirmed, allergies checked. IVs are started on patients for sedation and emergency access. Discharge instructions are given. A crash cart is nearby as are ACLS trained staff.

    I'm just surprised at what you are describing.
    Beth, might you be confusing TMS with ECT?

    What you are describing is typical of out-patient ECT, where an efficient, well-run clinic can admit, treat, recover, and discharge an experienced patient about 1-1/2 or 2 hours.

    TMS does not require a patient to be npo, there is no IV or sedation, and no recovery time. Most patients drive themselves to and from treatment, often before or after work, or even possibly on a lunch hour. Max time in the chair is about 40 minutes.

    I have become familiar with this procedure recently, accompanying a family member. The clinic is part of a multi-specialty psychiatric practice, with MDs, NPs, therapists, RNs and psych. techs.

    The initial mapping of each patient is conducted in 2 steps, first by the RN and tech working in tandem. Once they determine the ideal coordinates, the procedure is repeated by the physician, and then results are compared to those generated by the machine itself. The first treatment is conducted by the physician. Mapping is repeated approximately 1/2 way thru the course of treatment.

    Each session is conducted by either the RN or psych tech, with a second professional present in the office. The person conducting the treatment uses the time to converse with the patient, present educational information, etc. This isn't a therapy session, but is useful in assessing the client's mood, activity level, motivation, behavioral plan, side effects, etc. It is not acceptable in this practice to plug in earphones and "chill" during the treatment.

    To Curious MD, As a business owner myself, I understand the challenge of starting up a new business and realize that personnel represent the biggest expense, by far. Though it may be tempting to cut corners to save on this expense, I implore you NOT to do so. Give up your own salary first. (Like many entrepreneurs, we went for a few years without paying ourselves.) It is necessary, and will pay dividends down the line when your business thrives because of the quality and commitment of the front-line people interacting with your patients.

    Best of luck to you.
    Last edit by Jolie on Apr 28 : Reason: addition
  8. by   nyteshade
    Curious MD, why not just try posting online on a popular job search site and specifically state this job would be great for retirees? What's the worst that can happen? Either someone is interested, or they are not.
    Last edit by nyteshade on Apr 28 : Reason: Comma
  9. by   Nurse Beth
    Quote from Jolie
    Beth, might you be confusing TMS with ECT?

    What you are describing is typical of out-patient ECT, where an efficient, well-run clinic can admit, treat, recover, and discharge an experienced patient about 1-1/2 or 2 hours.

    TMS does not require a patient to be npo, there is no IV or sedation, and no recovery time. Most patients drive themselves to and from treatment, often before or after work, or even possibly on a lunch hour. Max time in the chair is about 40 minutes.

    I have become familiar with this procedure recently, accompanying a family member. The clinic is part of a multi-specialty psychiatric practice, with MDs, NPs, therapists, RNs and psych. techs.

    The initial mapping of each patient is conducted in 2 steps, first by the RN and tech working in tandem. Once they determine the ideal coordinates, the procedure is repeated by the physician, and then results are compared to those generated by the machine itself. The first treatment is conducted by the physician. Mapping is repeated approximately 1/2 way thru the course of treatment.

    Each session is conducted by either the RN or psych tech, with a second professional present in the office. The person conducting the treatment uses the time to converse with the patient, present educational information, etc. This isn't a therapy session, but is useful in assessing the client's mood, activity level, motivation, behavioral plan, side effects, etc. It is not acceptable in this practice to plug in earphones and "chill" during the treatment.

    To Curious MD, As a business owner myself, I understand the challenge of starting up a new business and realize that personnel represent the biggest expense, by far. Though it may be tempting to cut corners to save on this expense, I implore you NOT to do so. Give up your own salary first. (Like many entrepreneurs, we went for a few years without paying ourselves.) It is necessary, and will pay dividends down the line when your business thrives because of the quality and commitment of the front-line people interacting with your patients.
    Thanks for explaining the difference, I did not know.
    Last edit by NRSKarenRN on Jun 2 : Reason: fixed quote
  10. by   PrmedcRN
    Not sure what the local state regulations are, but what about hiring paramedics?

    They'll have ACLS and can work under appropriate protocol and (hopefully) be competent in handling any seizures or other medical emergencies. Plus, the $20 an hour will be much more in line with paramedic pay. The part time availability of a paramedic that works 24 hour shifts is excellent. In Missouri, medics are used in the ED, pain management clinics, and some outpatient procedure areas.

    I would have loved a part-time low stress gig like this during my paramedic days. Not to mention you're paying my OT rate as a medic for part-time work.
  11. by   dirtyrice
    Hey Ixchel!

    TMS billing rates are definitely quite high (especially here in CA), but the insurance reimbursement is often less than half. Our psychiatrists and neurologists are reimbursed more for their routine visits most times than for any TMS session.

    Just some perspective! TMS cash rate though... brutal!

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