How does your specialty clinic operate?

[NPmimzy75]

Hi all,

I'm planning on working with my office manager to help restructure how our clinic is running. I'd love some examples of models that work well to take to our group meeting.

We are a growing specialty practice with physicians and NPs / 1 PA that work mostly in pairs (the busiest physicians have a NP/PA assigned to them). While it is a hospital based "group" most of these pairs function rather independently and very differently. My personal work load involves admitting, discharging, doing consults and rounding in the hospital on days when my doc is on call. He is a very busy interventionalist so is in the cath lab or reading tests all day. He rounds behind me at the end of the day. Post call is the same. We have 1 clinic day a week where we see patients simultaneously all day. We are now adding some days where I will be there myself seeing mostly routine follow ups, recent hospitalization followups and work-in urgent issues (not needing an ER visit).

I feel that the workload between all the providers is not equal. I'm wondering how I prove (in order to be compensated for it) that I am doing more work than my peers. Right now, our salary is based on a national average with a raise each year which really isn't based on anything other than "cost of living increase" or something like that. I am always there late. My doc accepts new patients and consults (that I need to see) even when he's not on call. And my weekends (1 per month) are always full days with my doc doing procedures where the others mainly get in, round and get out.

We have just obtained our Medicare/caid number to start billing under ourselves which I think should make things easy to track.

So I guess my questions are:

1. how does your specialty clinic (doing both outpatient and hospital work) utilize NPs?

2. how are you compensated for the work you do?

3. is the workload in your group "fair" and how do you even it out?

4. Do you think I'm being abused ha, ha? I actually love how I'm functioning. I'm only 3 years out of school (still feel new!) so I'm happy with the independence level which is: making my own decisions, initiating workup and treatment, but not feeling out on my own to flounder. While I may not see my doc all day, he's always available. We always discuss our patients at the beginning and end of each day. BUT I think I've spoiled him because he expects *someone* to do all his "hospital work" for him when I'm not there. My peers don't like it and also have other stuff to do for/with their docs.

5. related to #4, how independently do you function? Do you have "your own" panel in the clinic. I feel like, being a specialty, the patients should remain under the MD specialist, even if he only sees them himself every few visits.

6. Would you send out a letter to all the clinic patients and give to new patients explaining how the model works... explaining who I am, what my qualifications are, what an NP is and can do? I'm getting tired of hearing "oh I'm not going to see the doctor today?" when I walk in the room (another whole topic!)

thanks for replies or comments on any of the above! I plan to present *something* to my whole group so I need to get prepared!