Pay per encounter or hourly?

[bethymaester]

So I just informally accepted a part-time job doing H&Ps and medical consults for a behavioral health facility. They are offering pay either hourly or per encounter. I've calculated it out and to come out better per encounter, total time including documentation for H&Ps needs to be under 50 min and my consults under 44 min. I've never worked with behavioral health patients as a nurse practitioner before, although the complaints I'll be addressing are strictly medical and for the H&Ps are things like hyptertension, diabetes, etc., and for the consults, sore throats, stuffy noses, injuries, etc. The only work I've done as a nurse practitioner so far has been occupational health physicals and clearance exams, so I'm still very new as far as true medical care goes. What do you think?

[Psychcns]

I like hourly because the salary is predictable. A friend of mine negotiated a per encounter payment with a minimum per day in case the census drops. You may also run into metabolic syndrome and other side effects from meds as well as medical causes of psychiatric symptoms.

[bethymaester]

Well, there aren't set hours, the NP just sees new admissions and consults for that day and then is done, so it will vary either hourly or per encounter. That's an excellent point about the metabolic syndrome and other side effects - I feel like I'll be looking up a lot of psych meds since I'm not very familiar with their side effects!

[PG2018]

Like my CNS friend, I think hourly is better. What hourly rate did you tell them you'd need?

You might so suggest somethingike 50% of the hourly rate plus 75% of the encounter rate.

You'll likely see a lot of HA, N/V/D, and dizziness due to the psych meds. A good hospital will already have orders for the nurses tontreat that stuff withoutba consult. Treatment isn't really necessary, IMO.

Maybe look at drug interactions and STDs.

[sailornurse]

I'm doing a similar position that's at inpatient psych facility doing H&ps on new admits. I'm a family nurse practitioner every other week and I cover for medical doing the admission history and physical's on the admissions and consuls. I am doing this as a 1099 independent contractor which you didn't say which one this position is for. I contracted what they offered was $75 per each H&P and $60 for each consult. No benefits again this is as a 1099 it's actually pretty lucrative as most weekends I have had as many as 15 admissions on the first day and seven on the second day. On the average it's H&P takes about 45 to 60 minutes depending on their age and other comorbid conditions we do admit teen so sometimes those are pretty quick you know 20 minutes tops on the adolescent consuls can be anything from allergies UTIs to adjusting sliding scale on a type one diabetic which could be a little trickier. They do have a Formulary that's pretty limited so that does make it easier to prescribe him because of the limited first I thought it was going to hinder me but it actually simplifies what I can give a patient because it's limited. I have been a primary care and for over 12 years and Urgent Care for about eight which really helps me to do this job on the weekends.

[bethymaester]

That sounds like exactly what I'll be doing, but they've offered $55/hr or $45/H&P and $40/consult . . . sounds like yours is way better! If it takes you 45 to 60 min with your experience, I'm sure it will take me longer which makes hourly look a lot better.

[jer_sd]

I prefer per encounter. As you gain familiarity with the patient population your speed will increase. As a 1099 you have your own business/practice and you should treat it as your practice not as an employee of someone else. Often NPs keep the staff nurse hourly pay mentality.

[sailornurse]

That sounds like exactly what I'll be doing, but they've offered $55/hr or $45/H&P and $40/consult . . . sounds like yours is way better! If it takes you 45 to 60 min with your experience, I'm sure it will take me longer which makes hourly look a lot better.

OK but are you doing it as a 1099 independent contractor where they do not pay your federal taxes or are you an employee since they offered you hourly salary?

[PG2018]

I prefer per encounter. As you gain familiarity with the patient population your speed will increase. As a 1099 you have your own business/practice and you should treat it as your practice not as an employee of someone else. Often NPs keep the staff nurse hourly pay mentality.

I'm not sure about that mentality. I have a moonlighting gig doing psych evals and charge $90/hr. No shows are huge in psych and so I usually end up making more than the company does. I lucked out and got taken on at a name your rate part-time role. Helps me not deal with 1099 although if I did that I'd run it through a LLC.

[bethymaester]

OK but are you doing it as a 1099 independent contractor where they do not pay your federal taxes or are you an employee since they offered you hourly salary?

Yeah, I'll be a 1099 contractor. They also aren't covering my DEA and are taking the malpractice out of my pay . . . is this a bad gig? Granted I'll need a DEA at some point anyway and the malpractice only comes out to about $25/month.

[PG2018]

Yeah, I'll be a 1099 contractor. They also aren't covering my DEA and are taking the malpractice out of my pay . . . is this a bad gig? Granted I'll need a DEA at some point anyway and the malpractice only comes out to about $25/month.

DEA is irrelevant. They should not take malpractice out of your pay. Yes, it's a bad gig.

If you're doing 1099 work get your own policy.

[sailornurse]

Yeah they are lowballing you bad that's almost RN wages since they are not paying any of the taxes federal tax income tax state tax social security Medicare tax they are not paying any of those taxes. You need to ask for the 75 per hour or per encounter. Just curious what state is this? you're better off getting your own malpractice policy especially when you talk about the coverages and if you have to buy a tail policy.