Hiring an RN into private practice

Nurses General Nursing

Published

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, well tolerated, and only in extremely rare cases can be associated with a seizure during a treatment. Only 25 or so documented cases of the tens (maybe hundreds) of thousands treatments to date. Some were in people actively drinking heavily and others were from the experimental days of TMS when the treatment intensity was too high. So the likelihood of seizure is very low. I'm looking for advice on how to recruit 1-2 RNs to deliver the treatment. It is a very chill job description, just apply the coil and deliver an 18 minute treatment to the patient (no IVs, draws, nothing). It will be first shift, 0800-1600 and the rest of the time is spent answering the clinic phone, following up phone calls, medical records, etc. I won't be able to offer benefits and the hourly wage I can really offer is $20/hr, for working 50 weeks a year, that is 40k. However, there is a bonus that I am thinking of offering for each billed patient encounter, of $3. I'm projecting about 45 patient encounters billed a week, that's an extra 11k or so and as the practice grows, so does that bonus. Anyone have any input on what population may be interested in this type of opportunity and how I can market this? I have no idea how to find well qualified nurses (good sites to post the listing, or maybe good places to find nurses who are interested in a more chill job description but maybe less competitive pay) and especially someone who can be reliable since the treatments are 5 days a week. There is also the bonus that the nurse can have flexibility in their hours too. Thank you for all the input!

Specializes in Maternal - Child Health.
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.

Specializes in Legal, Ortho, Rehab.

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.

Specializes in Tele, ICU, Staff Development.
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.

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.

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! :(

On 6/1/2018 at 1:21 PM, dirtyrice said:

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! :(

Sorry I am late to the party.

I hear TMS reimbursement rates are $10,000 to $20,000 per patient for 5-6 week treatment.  Is this correct dirtyrice? 

2 hours ago, sagamore said:

Sorry I am late to the party.

I hear TMS reimbursement rates are $10,000 to $20,000 per patient for 5-6 week treatment.  Is this correct dirtyrice? 

It's definitely gone down. In my area it tends to be 10k at the most but a lot of insurances have brought it down to 3-5k for the full 36 sessions.

6 hours ago, sagamore said:

Sorry I am late to the party.

I hear TMS reimbursement rates are $10,000 to $20,000 per patient for 5-6 week treatment.  Is this correct dirtyrice? 

Hey no problem! Yeah usually more like $9000-$12,000 er patient after insurance does the fee schedule adjustment writeoff. Most companies reimbursed on the lower end of that. 

Specializes in oncology.

Yeah! I'm retired. Why would I want to work for you (such an inviting offer with my 45+ plus years experience, Masters etc.) ...besides the low pay; vacation; no pension etc. Look at it this way...when you retire would you work PRN for another MD at a fraction of your previous pay?  I lived and worked in Wisconsin, my son is a surgeon in Madison. The health care dollars available there are commensurate with other areas  of the country except San Francisco, Boston and New York. And the overhead expenses  in psych don't involve  XRay, and lab. 

15 minutes ago, londonflo said:

Yeah! I'm retired. Why would I want to work for you (such an inviting offer with my 45+ plus years experience, Masters etc.) ...besides the low pay; vacation; no pension etc. Look at it this way...when you retire would you work PRN for another MD at a fraction of your previous pay?  I lived and worked in Wisconsin, my son is a surgeon in Madison. The health care dollars available there are commensurate with other areas  of the country except San Francisco, Boston and New York. And the overhead expenses  in psych don't involve  XRay, and lab. 

Appreciate the response. Anyways this is an old thread and I've long established longterm employees. My office now does offer retirement, insurance, dental vision and more thanks to the growth and something called, good management. Oh, and it's more than quadrupled in size.

5 hours ago, curiousMD said:

It's definitely gone down. In my area it tends to be 10k at the most but a lot of insurances have brought it down to 3-5k for the full 36 sessions.

Yeah because it’s fee schedule based, reimbursement varies quite a bit by location. I was working in High cost of living California area, hence higher reimbursement. 

Specializes in School Nursing.
6 minutes ago, curiousMD said:

Appreciate the response. Anyways this is an old thread and I've long established longterm employees. My office now does offer retirement, insurance, dental vision and more thanks to the growth and something called, good management. Oh, and it's more than quadrupled in size.

That's wonderful! Thanks for the update and congratulations. 

+ Add a Comment