kiser56

Hello again. I am really unsure of the exact number of patients (Ive requested some numbers from this guy). I would be within about a 60 mile diameter from a central location visiting 4-5 centers. Also, I am still unsure of how much I would be responsible for. Feel like giving me some hard numbers to work on from your prospective?

Hello everyone. I am currently working as a hospitalist in eastern KY. I am in the midst of contract renegotiation, but have had an offer from a local nephrologist. He has asked me to join his practice. He wants to open an office in a small town for 4-5 days per week and have me see his patients, but also let me establish a primary care practice within the same clinic. I currently make 100k+ and receive free health insurance and retirement match. This position would offer a lower base salary and I would have additional commitments at multiple community hospitals including dialysis centers. The questions that I have are: 1. What are the legal implications of seeing nephrology patients in the outpatient setting and seeing primary care patients (adults) in the same setting? The nephrologist is also an internist, so would this be ok? I would be taking collections eventually from the patients that I established for primary care concerns. 2. Would it be worth it for me to venture out into this type of practice setting with my current situation? I have a great salary and benefits, my schedule is 7-3 daily so I have no call once I leave. The other practice has insurance for individuals, and I am currently unsure of the retirement, but I would be mostly independent. 3. If at some point, this nephrologist retired, would it be difficult to find a collaborating physician to continue my practice. From my understanding, a nurse practitioner can own a private practice in Kentucky, but still has to have a collaborating physician to continue practicing. 4. Could I still use my established medicare and medicaid billing numbers, or would I have to establish new billing numbers for this practice? I guess it boils down to what I believe my potential may be as a primary care provider. I understand that I have a great situation where I currently am, but as I establish a rapport with patients in the community and establish my practice, I feel that the growth potential is unlimited. At the same time, I feel like that I would be taking a big risk and would risk losing some of benefits when moving to a different role. Does anyone have any thoughts on this matter? Thanks

Hey guys, sorry for the delay there. Heres some answers to some of those questions: Kiser56, What are some good bedside resources to have on you when rounding in the hospital? Hospitalist handbook, Washington Manual, ACC guidelines, Epocrates, etc. Give me a routine how you would see a new patient? I go to the floor and ask the nurse what they know about the patient. I then review old electronic charting or any information on the chart about the patient. Then go and do H & P with patient...not sure what else you want to know on that...just let me know. How did you adjust to call and what helped get you through your first months of call. Were you on call for ICU also? I usually admit a few a day and do a few consults. The only real call is during the day at work. I have no problem with that and no adjustment has been necessary. We have intensivists who cover ICU. Does your hospital have electronic medical records? No. We use physicians portal but do not have the progress notes yet. Other suggestions would be to get started as early as possible, make sure to allocate time prioritizing to the acuity of the patient, and get your rounding done ASAP to get ready for call because it is unpredictable. Next question: Can you let us know if you are a FNP, ACNP or ANP? Im AANP certified as FNP. I did however do the majority of my training in the clinical setting in Internal Medicine and Acute Care. Also, I previously did Neuro Trauma ICU when I was nursing. Sorry one more question I know each state/area is different, but what is the ballpark pay for hospitalist NP's? I think consistently 80-100k. I work lots of overtime, so I am 100k+ but anyone could do that with the hours. Again, sorry for the delay, but dong get on here alot because of work. Hope to hear further input or ideas. Wouldnt mind hearing others experiences if willing. Thanks

Hey, how are you? Finally someone else interested in Hospitalist practice. Where are you located? I work in Eastern KY and we typically have about 60-70 patients on our census. I probably round on 15-20 patients daily and admit 3-5. I work 5 days a week right now and 12 hour days. Call is dispersed to each of us as to the patients we saw. Also, we generally work on a dedicated floor or unit, but unfortunately I sometimes work on all units. We work with split billing meaning that the physicians provide minimal face to face time and documentation along with mine to achieve 100% billing for the patients. I would actually like to work on a block schedule (7on-7off or whatever), but I am the only NP in the group. We have a total of 5 physicians in our practice and myself. Any questions, Id love to try to answer them.

Hello again everyone, Well, I decided to take the position. It is 45 minutes from the house, but the compensation package is the best that I have seen. They pay malpractice and tail insurance, CME is ad lib per the hospital, 12 hours vacation per month, health, dental, and vision (Anthem), plus I will have an orientation period directly with a physician for no less than 90 days. I am very happy with this position thus far. I just wish my AANP test package would get here so I could get the ball rolling. I will be signing my contract Monday, so please wish me luck. I am starting out doing 4 10 hour shifts per week and eventually moving into doing 7 on 7 off for 12 hour shifts. If anyone has done hospitalist work before, the experiences during the first few months would be very insightful. Thanks

Hello everyone, I am actually mulling over taking a job as a hospitalist with an internal medicine group within a 261 bed facility. Are there any other FNP's who have taken a role like this? I know that traditionally, this is set up for one educated to be an ACNP, but I have neuro-trauma experience as a nurse and feel that I could manage many of these patients as they came in. The salary is very competitive and I was just interested to hear input from anyone who had anything to add. If you are a hospitalist, what is your job like? Thanks

ive never done this before, but bump

BabyLady, I respect your point of view. 1. If a patient has the choice between seeing you and paying up front, or another NP that will bill the insurance, which one will they see? Usually one seeing his/her is required to pay some sort of copay (ranging from 1$-50$). Many offices that I have seen require a patient to pay this upfront before they can be seen. Patients receiving a socialized form of healthcare would probably not be interested in receiving a cash only practice as their source of primary care. These people are not required to often pay any significant copays and would not be willing to pay more for service. Unfortunately for our current social state and socioeconomic status of these individuals, this may also eliminate seeing many patients who are drug seeking individuals which may infringe upon the environment of your practice. 2. Moral issues regarding people telling YOU what tests they think they need run, the care that they need, etc...based on their ability to pay. You'll be a writer of "estimates" rather than a provider of care. Can you live with yourself if you knew they needed something done and couldn't afford it and something happened to them...if they had insurance? To answer in one word "Yes". As stated earlier, these individuals may qualify for some form of socialized medicine and be able to receive it. If the need is acute, the individual could most certainly be seen in the ED without having to pay at that time. If they could not reach the ED on their own, an ambulance could be arranged to pick up the patient and take them to the ED. The need to marginalize the cost of healthcare is just as important today as it has ever been. Competition is how we as nurses make ourselves affordable as is always stated as one of the examples of being a nurse practitioner. Oftentimes, we are only affordable to the institution who is hiring us, not to the people we are providing care for. The moral benefits would be to help individuals without health insurance as well as those who have high priced premiums on their health insurance be able to receive primary care in an environment where cost was not a mistifying cascade of charges that insurance companies send you back on a bill everytime you go see your PCP and you are charged for each fee included. I believe that one (the business owner) would have to continually be aware of the costs of certain procedures as well as referrals for individuals without health insurance. Perhaps if the business became successful, one could work out deals with specialists in the area or companies with specialty equipment to see these patients because they are cash paying individuals. Networking throughout the community would be very important. Patients could also use insurance if need be if the situation arose. Especially those with HSA's that included high priced premiums. Continual review of performance would also be important and the community could hopefully answer you by mail based surveys or telephone based interviews. This would be a cash for service type of business in the sense that I believe where one would receive their health care service need at a price. Like David said though, one would have to possess a great rapport with the community and be a highly competent provider.

David, 1. I resoundingly agree that a new grad should not even consider an individual practice until they are sufficiently ready to provide good quality patient care and be able to handle the volume of patients that he/she might see during the course of the day and remain treading above water. 2. You should check out this guy's website who I found on the net surfing about being practice owner: http://www.acchealth.com/ . I guess this could be considered a boutique type of practice, but in the same regard, it is reasonable if a patient were using HSA's as their primary source of payment for healthcare. Using a mixed income model, I believe that profiting from business would not be much of a problem. Also, this is very dependent on the amount of overhead that would come from owning this type of practice including but not limited to property leases or ownership prices, one's own liability insurance, supplies and equipment, ancilliary staff, one's own health insurance, and coverage for days to be off so the practice could continue to run in your absence. I in no way intend to open my own practice right now, but am checking the weather on my community for the need and the demand of this type of practice in the future. If I can become sufficient enough to practice independently, it may one day be an option. Thanks for your insight, I always enjoy reading your posts to consider a different vernacular.

Yeah we will keep you in our thoughts; always a good opportunity. Anyone from Virginia have their own practice whether it be cash or traditional practice?

ANPFNPGNP, Where are you located and what type of legislature do you have for practice?

Alright, although this may be more zoned for practicing APRN's, I can give you ideas of the APRN's that I have worked with during my preceptorship to see how they feel. (1) job responsibilities -the np's in my preceptorships have been virtually in the same role as the physician. Living in SWVA, there is a shortage of family practitioners in general. These NP's also have collaborating physicians within his/her health system which they agree on certain terms with the patients that they see. These NP's see patients suffering from chronic conditions (such as heart disease, DM, osteoporosis, and thyroid dysfunction) as well as acute visits which include but are not limited to pharyngitis, sinusitis, allergic rhinitis, and some minor trauma. Job responsibilities include all aspects in the management of care including obtaining history of present illness to objective assessment, to diagnosis, to management of illness. This also includes interpretation of labs and diagnostics and communicating those to the patients and deciding how to act on the results (treat, referral, etc) (2) leadership in professional organizations, I find this to be particularly important although I have only communicated with the leadership within these organizations. I am a part of the American Nurses Association, The Virginia Nurses Association, and The Virginia Council of Nurse Practitioners. I feel like these organization provide one singular and strong voice for nurses in general as a profession. I think it is also important to add that one should try to become a member in the strongest most central organizations first as opposed to smaller more specialized organization. As nurses, one of the hardest struggles we have is to overcome the public's perception of our role. Being a part of these organizations helps us to be able to do that much in the same way that the AMA (American Medical Association) does. (3) continuing education One of the perks of continuing education is that you mostly get to choose what type of seminars that you want to go to. Many of these are in places that are also fun to vacation at (e.g. Miami, FL, Las Vegas, NV). Also, you can guide your practice interests by strengthening your strengths or weaknesses when choosing how to earn your yearly CE credits. Both organizations (AANP & ANCC) both require a certain number of CE's per year and also if you have any further certifications, they will also require you to receive certain number of CE's a year to stay certified. (4) issues that she/he faces in practice. I think many of the issues that we face focus on the NP being not recognized as a valid health care provider perhaps less of a member of a member of the interdisciplinary medical team. This is often because we are somewhere between nursing and medical when we reach this stage and both members of either side do not believe we belong at times. I think that if we continue to define our roles and be examples of excellent alternatives to healthcare both our professional colleagues and the public will change their initial perception of us. I hope that helps you to get the answers that you would like. Like I said, I am not a practicing APRN at this time, but feel like I am starting to ease into that role the further I get to graduation. If this is not sufficient, then just use it as food for thought. Have a nice day.

April, Hello, how are you? I am a graduate student at UVA and will finish in May. I am currently doing clinicals. Would you like my help? Thanks

Hello All: I am a family nurse practitioner student at The University of Virginia. I will graduate in May. This is not an idea that I would be comfortably with initially, but does anyone work in a cash only practice environment or owns his/her own cash only practice. I have read about an expert in this field named Brian Forrest. He is from North Carolina and provides consultations (1500 dollars per day) to teach individuals his practices in producing cash only practice centers across the country. He seems like a very interesting person to me, but I am not sure how this would work in my state (Virginia) and how I could find a valid collaborative agreement (my area is almost bounded fully by physicians in a health system environment who have established covenants to not work outside of the system). This type of system would eliminate much of the overflow of paperwork in a working environment and help the practitioner spread their wings and not feel confined by insurance companies (the elephant in the room). Does anyone have any information to offer about this practice environment? Thank You

Sarah, Hello, how are you? I applaud your choice to become an RN. I started college wanting to go to medical school. I got my B.S. in biology and continued with certification in secondary education thinking about medical school. I toured all the medical schools within four to five hours of me and just never seemed like it was the right fit. They began a B.S.N. program at my college, so I decided on a whim to do it without really knowing why I wanted to become a nurse. While in school, I began learning more about the shortage of family practice physicians in the country and the downward turn in medical schools toward family practice. It made me start to think about becoming an FNP. Here I am now in my second year in the FNP program at the University of Virginia and I could not be happier with my choice. I currently work as a nurse in a level I trauma Neuro/Trauma ICU in TN and I it is far more difficult than I could have ever imagined initially. I think that what you should look into is shadowing both physicians and NP's in family practice or whatever type of practice if you are interested in. If you are interested in specialty practice, depending on your area, maybe becoming a physician is a better route for you. There are also specialty practice options for advanced practice nurses by going through the CNS route. The money is of course different, but the fit is the most important thing. I believe that as a FNP, the role is shaping and growing in ways that the field of family medicine will soon have to accomodate and make our position more valued over time. The good thing is that you have plenty of time to consider your options, so get out there and explore. If you did decide to go to medical school, I would suggest working as a nurse for at least one year before applying so that you will go into school very well prepared for the didactic phase. In the mean time, you can always take tough electives that will prepare you to make medical school always an option (bio, chem, organic chem, and physics). Hope whatever you decide makes you happy!