Outpatient PMHNP "agreement"

Psychiatrist · Feb 18, 2021

Many private practice agreements have a similar arrangement to what your noted your proposed business associate is offering. If you do not have a solid legal background in setting up a professional practice, I strongly suggest that you consult with an attorney who has this specialization. Your state nursing society should be able to provide you with some references.

DrCOVID, DNP · Feb 19, 2021

Yes I am consulting an attorney as well as other people in healthcare business. This seems steep considering: 1) I have known her for 2 years, we have a good rapport and we talk almost every day & 2) her expenses, even capped at 3k/month would be mostly fully covered by me (that feels greedy). She also has another NP working with her... if we both pay her 3k that is over 6k so she is making money off us. That seems odd considering we are all nearly the same position, she is just been in practice longer.

Also, this 30% is not covering a lot of the expenses that I have that I think would normally be included, such as marketing, the billing company, the collaborator, etc. She also really wants me to work with her and has verbalized that.

Psychiatrist · Feb 19, 2021

An "agreement" is a contract; you will have more protection if it is in writing. As great as your personal relationship with her is, from what you posted, it appears that she has already separated her personal relationship with you from her obvious business objective. But again, those sorts of agreements are common.

What is the reason she is having a difficult time recruiting people? Other than your personal relationship, what else is do you find as a positive about working with her that you cannot do in an alternative manner?

Since you want to do telepsych, is there any reason you are hesitant to rent cheap office space or sublet office space and work at home? With COVID, you should be able to find some pretty good deals on office space due to the shift to telework (and unfortunately some business failures), which has now tilted the office space market in renters' favor.

DrCOVID, DNP · Feb 19, 2021

Yes, my attorney told me it's the same thing. So IDK why she is saying "not a contract" LOL... What she told me is that people don't want to form their own PLLC and credential themselves. I suspect there may be other reasons. She is not the best in people skills and does view her business as "just numbers." My view (as specially as I age is mostly wanting to provide a good service as everything else just follows after that. We are here bc of the people we help.

There really isn't anything I couldn't do on my own as you say. I already know everything that is required. Most of the 30% of expenses I would not be using, especially in the beginning... I do not plan on working full time, maybe 3-4 days a week. I have to do my own marketing, get my own biller and pay for the delegating on my own. I can manage my own schedule and don't even need an EHR but those are cheap now as well. The office is her biggest expense, and she is trapped in it for the next 4 years. She prefers her 2 office staff there, but she doesn't use the office (neither does the other provider).

I guess I do value her as a valuable mentor and her collaborator is a 70 man that is very wise... I don't wanna burn the bridge!

Psychiatrist · Feb 20, 2021

18 hours ago, DrCOVID said:

Yes, my attorney told me it's the same thing. So IDK why she is saying "not a contract" LOL... What she told me is that people don't want to form their own PLLC and credential themselves. I suspect there may be other reasons. She is not the best in people skills and does view her business as "just numbers." My view (as specially as I age is mostly wanting to provide a good service as everything else just follows after that. We are here bc of the people we help.

There really isn't anything I couldn't do on my own as you say. I already know everything that is required. Most of the 30% of expenses I would not be using, especially in the beginning... I do not plan on working full time, maybe 3-4 days a week. I have to do my own marketing, get my own biller and pay for the delegating on my own. I can manage my own schedule and don't even need an EHR but those are cheap now as well. The office is her biggest expense, and she is trapped in it for the next 4 years. She prefers her 2 office staff there, but she doesn't use the office (neither does the other provider).

I guess I do value her as a valuable mentor and her collaborator is a 70 man that is very wise... I don't wanna burn the bridge!

Interesting. I would argue that most, if not all providers would prefer a business entity for tax purposes and liability protection if not an employee.

There are companies that can do credentialing for you.

There are great BH EMR programs that include billing, which can omit your need for a biller. These programs also have scheduling templates built into them.

If you go on insurance panels, you will fill up pretty quickly. Many providers start off taking insurance. As their panels grow, gradually start tapering off insurance panels (Insurance company contracts are yearly). If you are a good provider, you can get lots of referrals word of mouth for your current patient base (directly and indirectly).

Have you thought about casting a wider net for mentorship?

DrCOVID, DNP · Feb 20, 2021

46 minutes ago, Psychiatrist said:

Interesting. I would argue that most, if not all providers would prefer a business entity for tax purposes and liability protection if not an employee.

There are companies that can do credentialing for you.

There are great BH EMR programs that include billing, which can omit your need for a biller. These programs also have scheduling templates built into them.

If you go on insurance panels, you will fill up pretty quickly. Many providers start off taking insurance. As their panels grow, gradually start tapering off insurance panels (Insurance company contracts are yearly). If you are a good provider, you can get lots of referrals word of mouth for your current patient base (directly and indirectly).

Have you thought about casting a wider net for mentorship?

Until I formed the PLLC, consulted CPA/attorney, I didn't understand the implication. I am certain most providers have no idea what the purpose is either. It is a lot and has taken me several weeks to do all of this myself. I would have no idea where to start if I didn't have my mentor and found a one single post here outlining some of the process. Most people don't have the time and are under pressure to get employed right away. I have the luxury of my bills being covered. Most of my cohort has over 100k+ of debt from school.

You can pay someone to do these, but the quotes I have found range from $100-200 and for each application - a lot considering it is just paperwork - I was able to find all of these online applications with the exception of Humana/Tricare. I did all mine myself. Some of them are worse than others; I did CAQH of course followed by BCBS, Magellan, Medicare, Tricare/Triwest/Humana, United, Aetna, Cigna, & Community first. I had to submit BCBS like 7 times total as I did it wrong, and PECOS is a nightmare. I had to call them several times to figure out what numbers to put where.

I am always looking to network, but of course most in person events have been canceled so you are mostly left online. At the pharma sponsored dinners I would always try to chat with someone new. I think setting up a website and online profiles will help, joining FB/linkdin groups. But yes I have at least 7-10 people that know me and can refer since they are rather full/winding down/retiring. Any suggestions how to do this now?

Psychiatrist · Mar 6, 2021

What exactly are you seeking in a mentor? If you have a good idea, then you can start with online events. Many of them have break-out sessions where you can chat with others. Often, they provide attendees with other attendees contact information (for the attendees that opt in). Once you identify what you want in a mentor, you can target your participation in online activities with those who have a similar interest. If you have many things you are seeking in a mentor, then cast a wider net to those activities where you can receive contacts for someone who can offer you guidance in a specific area. You don't want to run the risk of overwhelming one person providing you with guidance for everything. Considering that COVID restrictions are starting to ease, in-person activities are likely to resume in some format.

DrCOVID, DNP · Mar 6, 2021

Sorry if it was unclear, I regularly talk to several senior psychiatrists and have several 10+ year PMHNP mentors. I made all of these connections in the 4 years of grad school. I have had like 7 interviews in the past 2 weeks...