Collaborating Physician Fees: The Ultimate Guide for NPs and PAs
Did you know the Association of American Medical Colleges estimates the United States could see an estimated shortage of up to 124,000 physicians by 2034?
As the demand for quality healthcare services surges, advanced practice providers (APPs) such as nurse practitioners (NPs) and physician assistants (PAs) play a pivotal role in bridging the gap in patient care. However, one significant requirement for many NPs and PAs to practice independently is the need for a collaborating physician. While collaboration is an important part of state regulations and compliance, it can come at a monetary cost.
So, how much should a collaborating physician cost? The short answer is, it depends. Collaborating physician fees are influenced by a range of factors including location, market rates, prescribing privileges, and more.
In this guide, we review the main factors that influence the cost of collaborating physicians and offer insights for navigating this essential aspect of advanced practice across the U.S.
We will explore:
Collaborating physician fees
Strategies for navigating collaborating physician fees
The value of compliant collaborations
What Is Collaborative Healthcare?
For nurse practitioners and physician assistants, compliant collaboration involves actively engaging in a partnership with a collaborating physician that respects legal and professional standards. In turn, a collaborating physician must oversee the practice of their collaborating APP, fostering mutual trust and learning.
Collaboration requirements vary widely across the country, and compliance regulatory structures for collaboration typically fall into three main categories: Full Practice, Reduced Practice, and Restricted Practice.
Full Practice Authority
Full Practice Authority represents the highest level of autonomy for nurse practitioners. In this model, APPs have the ability to practice to the full extent of their education and training without the need for physician oversight or collaboration. This approach recognizes the advanced skills and expertise of nurse practitioners, empowering them to serve as primary care providers.
Reduced Practice Authority
In a state with Reduced Practice Authority, APPs have a bit more independence compared to the restricted model but still operate with certain constraints. While they may not require constant supervision, they may face limitations on specific aspects of patient care, such as prescribing certain medications or performing certain procedures independently.
Restricted Practice Authority
Restricted Practice Authority refers to the most limited scope of practice for nurse practitioners. In this model, APPs are typically required to work under the direct supervision of a physician, with specific restrictions on their ability to diagnose and treat patients autonomously. The intention behind Restricted Practice Authority is often rooted in concerns about patient safety and the desire to ensure that nurse practitioners, while highly skilled, work within a more controlled environment.
The Role of Physician Collaboration
Collaboration between physicians, NPs, and PAs is an important part of effective healthcare delivery in many states in the U.S. While NPs and PAs contribute specialized skills and knowledge, physicians can provide valuable assistance in complex medical scenarios.
Together, they form a partnership that ensures comprehensive patient care. Moreover, collaboration facilitates consultation on challenging cases and serves as a support system for NPs and PAs, enhancing overall clinical outcomes.
Factors Influencing Collaborating Physician Costs
If you are an independent NP or PA, you know that finding a collaborating physician for hire can be difficult. Once you find a collaborating doctor, what is a fair fee to pay a supervising or collaborating physician? What exactly are you paying for?
Collaborating physician fees can vary widely depending on the state and the type of collaboration agreement. In some states, physicians are not allowed to charge for collaboration, while in others, they can charge a flat fee or a percentage of earnings. Fees may cover services such as chart review, consultation, and supervision.
When it comes to collaborating physician fees, setting a fair compensation structure on your own can be complex. Several factors contribute to the cost, including:
The physician's level of involvement
Geographic location
Prescribing privileges
The complexity and size of the patient population
The physician's professional experience
Understanding the determinants of collaborating physician fees is essential for NPs and PAs seeking to establish collaborative relationships. Let's explore these five factors.
1. Level of Involvement
The extent to which a collaborating physician is involved can impact the cost structure. From intermittent oversight to hands-on daily engagement, the level of involvement varies based on state regulations and individual practice requirements.
2. Geographic Location
Geographic considerations play a role in determining collaboration fees. Factors such as the cost of living, physician salaries, and market demand influence the pricing dynamics. States with provider shortages or higher living expenses often witness elevated collaboration costs.
3. Prescribing Privileges
Whether or not the APP requests prescribing authority, or prescribing authority for controlled substances, will impact collaborating physician fees. This is due to a few factors:
Increased Liability: Prescribing medications, especially controlled substances, carries inherent risks and liability concerns. Collaborating physicians may perceive greater risk when NPs or PAs have prescribing authority, as they bear ultimate responsibility for patient outcomes.
Complexity of Oversight: With prescribing authority, NPs and PAs have autonomy in managing patients' medication regimens. This autonomy necessitates closer oversight and involvement from collaborating physicians to ensure adherence to prescribing guidelines, mitigate risks, and safeguard patient safety.
Regulatory Compliance: Prescribing medications entails adherence to strict regulatory requirements, including state-specific prescribing regulations, controlled substance laws, and prescription monitoring programs.
4. Patient Population
The complexity and acuity of the patient population served by NPs and PAs can influence collaboration fees. Specialized practices or those dealing with high-risk patient cohorts may entail higher physician involvement and subsequently higher costs.
5. Professional Experience
The expertise and experience of the collaborating physician can affect fees. Physicians with specialized knowledge and extensive experience command higher rates, reflecting the value they bring to the collaborative relationship.
Navigating Collaboration Fees: Strategies for NPs and PAs
There is more than one approach to determining a collaboration physician’s fee. But establishing fair and transparent collaboration fees is essential for both NPs/PAs and collaborating physicians.
Below are some strategies to navigate this process effectively.
Market Research
Research market rates for collaboration fees in your area. Ask around within your professional networks, as peers and supervisors can provide valuable insights.
Meet with Your Potential Collaborator
Even if you find a great physician fee, you should still meet with your potential collaborating physician before signing an agreement. An introductory meeting sets the tone for a successful and compliant collaboration.
Inquire about your potential collaborating physician's clinical background, experience, and expectations for the relationship. This will help you understand their expertise, ongoing education and awareness of evolving medical knowledge, and whether or not they are the right fit for you.
Negotiate a Stipend
In most cases, collaborating physicians prefer a stipend arrangement to an hourly or per-patient fee. Per patient fees can also put your practice at risk due to anti-kickback statutes.
A stipend provides a consistent income stream for the physician and allows you to base the stipend on the expected workload and value the physician brings to the collaboration.
Determine Responsibilities
Define the scope of the collaborating physician's responsibilities, aligning them with state regulations and practice needs. For example, is the physician's involvement limited to periodic case reviews, or do they provide direct supervision?
Clear delineation of duties fosters mutual understanding and facilitates fair compensation negotiations.
Establish Performance Metrics
To make sure you are getting great value for your collaboration fees, you can establish performance metrics or quality indicators to keep everyone accountable. For example, keeping track of chart reviews and patient outcomes ensures accountability and enhances the value proposition for both parties.
Thankfully, the Zivian platform tracks the entirety of your collaborative relationship for you! Contact us today to receive a free quote.
The Value of Collaboration
Key motivators for NPs and PAs to seek collaborating physicians are state licensure and insurance payor credentialing requirements. If you have many years of experience, you may feel that the oversight of a physician is unnecessary. You may even live in a full practice authority state where collaboration isn't required.
But let's unpack a few benefits of engaging in a compliant collaboration with a physician.
Licensing and Credentialing
The first reason to have a quality collaboration in place is your license and credentialing. Non-compliance with regulations puts your career and livelihood at stake, so don't cut corners! Failure to meet regulations can lead to suspension or revocation of your license or credentials. This brings your career progress to a grinding halt.
Compliance is a safeguard against potential legal issues such as allegations of negligence, malpractice, or professional misconduct. A compliant collaboration can help protect you from expensive legal battles, criminal charges, or the risk of losing your practice.
Patient Safety and Quality Care
High-quality collaborations protect patient safety and help ensure quality care. Regulations help ensure patients receive care from practitioners who meet specific educational and licensing requirements.
This reduces the risk of substandard care and patient harm.
Professional Growth
By tapping into the expertise of others, you can continuously learn and grow professionally. Through collaboration, clinicians can share knowledge, discuss best practices, and incorporate evidence-based guidelines into their decision-making.
Collaborating physician fees may seem expensive when you’re first establishing your practice. But maintaining a compliant collaboration is definitely worth the cost. Relying on expert support, meeting regulations, and continuing in your professional growth benefits you and your patients.
Find a Successful Collaborative Relationship with Zivian Health
Setting fair collaborating physician fees is a necessary step for NPs and PAs to establish an independent practice. While negotiating a stipend for supervising physician services can be complex, remember the value that collaboration brings.
Building a high-quality collaboration helps ensure state compliance and much more. Your collaborating relationship will support you in delivering excellent patient care and lay the groundwork for your professional growth and business success.
At Zivian, we recognize the complexities involved in finding quality collaborating physicians. Our dedicated team streamlines the collaboration process, offering transparent and affordable fee structures to support the success of NPs, PAs, and their practices. We’ll find you a collaborating physician in a matter of days, and we’re committed to collaborating fees that are easy to understand and affordable so that you can run thriving businesses.
Interested? Contact us today for a free quote for services!
Sources & Data
According to the AAMC (Association of American Medical Colleges), the United States could see an estimated shortage of between 37,800 and 124,000 physicians by 2034, including shortfalls in both primary and specialty care. (https://www.aamc.org/news/press-releases/aamc-report-reinforces-mounting-physician-shortage)
