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NP Practice Owners

Consulting Physicians: To Have or Not to Have

Published July 29, 2008 8:50 AM by Aaron Hartle

In Utah, I can open my own clinic without the oversight of an MD. It is kind of a cool feeling to hang my name on the wall and say, "Hey, this is mine!!" I like not being under the control of a boss or another person. [Well, except my wife, but nothing I can do there. :-) ]

Anyway, when I opened my clinic I had to decide whether to have a physician with me or not. I carefully considered my options. It was a hard decision, especially since I opened the clinic 40 miles away from my previous worksite, and I didn't know any of the local doctors.

I decided to hire a consulting physician mainly because in Utah I need one to prescribe schedule II and III medications and to be reimbursed by a couple of the larger insurances. It was also comforting to know that I have someone I can call if I do have a question.

I chose the closest clinic to mine and went and introduced myself to the physician and told him of my desire to have a consulting physician. He was very concerned at first due to legal reasons. I had to explain the difference between a consulting and supervising physician, which has much more legal responsibility.

He was also concerned about my clinic as a competing clinic for patients. I reassured him that my clinic is patterned like a retail clinic and that I will be treating mostly minor acute illnesses and injuries.

I then told him he would benefit from patients I would refer to him with more chronic problems. Finally, I offered him a payment of $250 a month for consulting fees.

I stopped by his office several times over the next month to chat with him or take him out to lunch. (Luckily we both are into bike racing, so we had something in common). Mostly what I was trying to do was show him who I was, so he could feel comfortable having his name associated with mine.

Finally he agreed, and it has been beneficial to me since. Sure sometimes it is hard to write him out a check every month, especially when I rarely call him, but it is worth it. The comfort of having a backup MD just in case is nice. Plus I have been able to increase the clinic's income by being able to see patients from some select insurances that I would not otherwise be able to help. Also, it is important to be able to prescribe schedules II and III for the benefit of my patients.

A consulting MD may be expensive and you may feel some tiny amount of autonomy taken away, but I believe that it is a good idea to have one and my clinic has benefited by having one.

Aaron Hartle 

3 comments

I had a hard time getting a collaborating MD for the adult side of our clinic.  The first couple of MDs we approached wanted a percentage of our practice.  Another MD wanted 1,000 per month.  IT became a battle between the MD lawyers and our lawyers about liability.  To settle the matter we carried malpractice insurance on the MD as well as ourselves.  I paid the Doc 100.00 per month for collaborating and 100.00 per month to be the lab director (before CLIA allowed non-physician directors).  We scheduled monthly meetings in clinic to discuss difficult patients or new treatments, etc.  The doc(s) were not on site except for these meetings.  All in all it worked out well.  I do advise those who are thinking of Independent practice and need a collaborative physician to choose wisely, and pay what it is actually worth.  I can count on my hands the number of times we had to call the collaborating MD.  (we would call the specialists in the area of question).  

Gretchen , Pediatrics - NP, CEO, Eagan Child and Family August 12, 2008 12:30 PM
Eagan MN

Aaron,

I agree with you and with William.  I like the idea of autonomy, but really, who in this business is truly autonomous?  Our MD counterparts consult with one another when an issue not in their bailliwick arises.

It is sound practice and I appreciate your sharing your experiences.

Desiree Wyatt, Oncology - BSN,RN,CCRN, Springfield Medical care Systems/Springfield Hospi August 12, 2008 11:12 AM
Springfield VT

Aaron, You are a wise man for having a consulting physician. Having that resource will sooner or later payoff big! No one is completely autonomous in medicine, I think NP's that look at consulting MD's as taking away from their abilities are missing the boat. We all need to work together. Good luck in your new business.

William Beatty July 30, 2008 6:59 AM

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