This is why...

Specialties NP

Published

We need to advocate for equity of pay for the percentage of what we bill. Doctors are making money hand over fist for simply "supervising" mid levels. They can literally not bill for what's their salaries justify, yet continue to make money off our own work. 
 

 

IMG_1490.png
Specializes in Psychiatric and Mental Health NP (PMHNP).

If the NP does not have FPA, and must legally be supervised by an MD, then of course the MD must be paid for that.  Why on earth would they do that for free?  Some NPs really do need close supervision.  And this is a liability issue for the supervising MD.

If the NP is working FT, then $750 per month is not bad as a percentage of billing.

If the NP has FPA, then it may be a different matter, depending on the individual case.

3 Votes
Specializes in Psychiatric and Mental Health NP (PMHNP).

Doing some math, $750 per month is a very small amount to pay for supervision.  As a PMHNP, almost all of my appts are now follow-up appts billed using 99214 and 90833.  For simplicity, I am assuming an NP working FT and only 20 min follow up appts.  That works out to approximately $84,000 in billing per month using Medicare reimbursement.  $750 is about 0.9% of billing, less than 1%.  That seems pretty reasonable.

1 Votes
Specializes in ED RN, Firefighter/Paramedic.

There is a lot of legal theory talk about where the buck stops when mistakes are made.  It seems to happen a lot in medicine, where every level is taught a significant amount of "ITS YOUR LICENSE ON THE LINE" paranoia. 

Physicians have been "supervising" NPs and PAs for quite some time now.  Is there any case law out there where a physician has been held liable for a mistake made by an APP who is working under their license?

 

1 Votes
Specializes in Psychiatric and Mental Health NP (PMHNP).
FiremedicMike said:

Physicians have been "supervising" NPs and PAs for quite some time now.  Is there any case law out there where a physician has been held liable for a mistake made by an APP who is working under their license?

 

Yes, there is.  Since you are brining this up, it would be helpful if you did some research on this and shared your findings with us.

Also, to the OP:  I would not take those types of sources too seriously.  People say all kinds of crap online.

FiremedicMike said:

There is a lot of legal theory talk about where the buck stops when mistakes are made.  It seems to happen a lot in medicine, where every level is taught a significant amount of "ITS YOUR LICENSE ON THE LINE" paranoia. 

Physicians have been "supervising" NPs and PAs for quite some time now.  Is there any case law out there where a physician has been held liable for a mistake made by an APP who is working under their license?

 

https://www.medpagetoday.com/meetingcoverage/acep/106708

Specializes in ED RN, Firefighter/Paramedic.
FullGlass said:

Yes, there is.  Since you are brining this up, it would be helpful if you did some research on this and shared your findings with us.

Also, to the OP:  I would not take those types of sources too seriously.  People say all kinds of crap online.

I did before I posted it.  There's a lot of "could pose liability issues" opinion pieces out there and a lot of "the doc was named in the suit too" (duh, everyone gets named in every suit), but I've found almost no data out there for cases where the doc was liable for the actions of their NP.

You seem to know more than I, can you share some cases with me?

1 Votes
Specializes in ED RN, Firefighter/Paramedic.
core0 said:

https://www.medpagetoday.com/meetingcoverage/acep/106708

I read that article before I posted, to recap its content: out of all the patient/provider lawsuits over a 35 year span, physicians were only named in 96 cases and were only found negligent or involved in the settlement in just a touch over half of those cases.  

This article also lacks any substance.  You're telling me that there were only 50 physicians out of this entire study that either settled or were found personally negligent, yet the authors of this study couldn't point out some of the reasons the physicians held any liability?  Was it strictly the mistake of the NP or was the doctor involved.  Heck, that article mentioned that in some of the cases, the physician actually put eyes on the patient.. 

My questions is whether or not physicians have been held liable for the mistakes of their NP, this article does not satisfy that question, and even if it does, the statistics are OVERWHELMINGLY against it. 

 

2 Votes
Specializes in Psychiatric and Mental Health NP (PMHNP).
FiremedicMike said:

I read that article before I posted, to recap its content: out of all the patient/provider lawsuits over a 35 year span, physicians were only named in 96 cases and were only found negligent or involved in the settlement in just a touch over half of those cases.  

This article also lacks any substance.  You're telling me that there were only 50 physicians out of this entire study that either settled or were found personally negligent, yet the authors of this study couldn't point out some of the reasons the physicians held any liability?  Was it strictly the mistake of the NP or was the doctor involved.  Heck, that article mentioned that in some of the cases, the physician actually put eyes on the patient.. 

My questions is whether or not physicians have been held liable for the mistakes of their NP, this article does not satisfy that question, and even if it does, the statistics are OVERWHELMINGLY against it. 

 

You have a habit of making an assertion without backing it up with evidence.  If you have evidence that physicians have never been held liable for the mistake of an NP, then please provide it.  It is not the job of other people here to do your research for you.

If you find the article/study cited flawed, then provide another one that you feel is better.

It doesn't matter if the docs were found liable.  Getting sued is a big pain.  Even if an MD successfully defends themself, it is an enormous waste of time and money.

Yes, MDs have indeed been found liable.  Now you disprove that statement.  Otherwise, it stands.

 

He arguably just asked the question. And as expected and is characteristic someone decided to jump down his throat demanding he do some research. It's reasonable to suggest that doctors have been held liable for their own, or the work of clinicians that they were "supervising". The article also indicates that a significant portion of those doctors weren't really doing any supervision in the first place, despite their obligations to do it. If anything, that article simply supports a rationale for independent practice as doctors have stated over and over again they don't want that liability.

Specializes in ED RN, Firefighter/Paramedic.
FullGlass said:

You have a habit of making an assertion without backing it up with evidence.  If you have evidence that physicians have never been held liable for the mistake of an NP, then please provide it.  It is not the job of other people here to do your research for you.

If you find the article/study cited flawed, then provide another one that you feel is better.

It doesn't matter if the docs were found liable.  Getting sued is a big pain.  Even if an MD successfully defends themself, it is an enormous waste of time and money.

Yes, MDs have indeed been found liable.  Now you disprove that statement.  Otherwise, it stands.

 

I do?  I'm really not sure why you're coming out with guns ablazin at me.. then again, since we're talking about people having "a habit of" doing anything when they post, you generally have a habit of arguing nearly every post that is ever made on these forums.

While physicians claim all kinds of liability for the actions of their midlevels, the data overwhelmingly doesn't support it.  Of course, it's not zero, because speaking in absolutes is something that only truly ignorant people do, but the risk seems minute.

I did some limited research, the data I've found indicates that it is extremely rare for physicians to be liable for the actions of their midlevels.  I'm not going to do a full on research paper and APA cite all of my sources for a freaking forum post, I have enough of that in my BSN/MSN courses. 

I (non aggressively) asked you to post some data supporting the massive liability that physicians claim, since you assert it is out there.  You've come back at me super aggressive for no reason whatsoever.  I'm not asking you to "do my research", I'm not writing a paper.  This is discussion board where people share their thoughts, ideas, experiences, and the things they have learned, I'm just asking you to do the same.. 

 

 

2 Votes
Specializes in Psychiatric and Mental Health NP (PMHNP).
FiremedicMike said:

I do?  I'm really not sure why you're coming out with guns ablazin at me.. then again, since we're talking about people having "a habit of" doing anything when they post, you generally have a habit of arguing nearly every post that is ever made on these forums.

While physicians claim all kinds of liability for the actions of their midlevels, the data overwhelmingly doesn't support it.  Of course, it's not zero, because speaking in absolutes is something that only truly ignorant people do, but the risk seems minute.

I did some limited research, the data I've found indicates that it is extremely rare for physicians to be liable for the actions of their midlevels.  I'm not going to do a full on research paper and APA cite all of my sources for a freaking forum post, I have enough of that in my BSN/MSN courses. 

I (non aggressively) asked you to post some data supporting the massive liability that physicians claim, since you assert it is out there.  You've come back at me super aggressive for no reason whatsoever.  I'm not asking you to "do my research", I'm not writing a paper.  This is discussion board where people share their thoughts, ideas, experiences, and the things they have learned, I'm just asking you to do the same.. 

I find it interesting that both you and djmatte have been quite unpleasant to me on this forum multiple times in the past, yet when I disagree with you and ask you to perform some simple research to defend your position, you cry about it.

Yes, you do tend to make assertions w/o supporting them.

It literally takes me about 90 seconds to do basic research using an internet search engine.  If I can do it, then you can, too.

If I disagree with something posted here, I explain why, and if appropriate, provide evidence to support my postion.  Nothing wrong with that.  I'm not aware that people are not allowed to disagree with posts on this forum.  It would be a very dull, and rather useless, forum indeed, if all we did was agree with anything anyone wrote here.

Whether or not it is common for docs to be held liable, most physicians do not want to do anything that increases their liability risk.  Go talk to some physicians about it - not just this issue, but liability in general.  

My original point is that when an MD supervises a mid-level:

1.  It can be extra work if they actually supervise.  Would you do extra work for free?  I wouldn't.

2.  It absolutely increases their liability if they are in a formal supervisory role.  That is another reason they want to get paid for supervising.  That is also why some docs, even if they are offered payment, do not want to supervise any mid-levels.  Docs don't do some calculation on how much it increases their liability.  They make decision based on PERCEIVED risk, which is what most people do. 

+ Add a Comment