10 Ways to Earn Extra Income With Medical Activities

Leigh Page

Disclosures

December 17, 2012

In This Article

Activities in Your Realm

1. Supervise Midlevel Providers

Midlevel providers -- nurse practitioners (NPs) and physician assistants (PAs)-- are entering independent practice or working in retail clinics that have no doctors on-site. Midlevel providers are often required to designate a supervising physician and work with him or her. They pay the supervising physician as much as $15,000 a year for basically several hours of work each month.

"This is very viable work for busy physicians, because it can be done in their discretionary time," says Philippa Kennealy, MD, owner of The Entrepreneurial MD, a career-coaching consultancy for physicians, based in Los Angeles, California.

Physician assistants require supervision in all 50 states, and nurse practitioners need it in most states. AARP reports that as of 2009, supervision was required for NPs in 25 states (including California, Texas, New York, and Florida), and 7 more states (including Indiana, Michigan, and New Jersey) required supervision only if the NP prescribes.[1] Most of the states that don't require physician supervision for NPs are in the West (eg, Oregon and Washington).

Physician supervision of independent midlevel providers involves several basic tasks. First, the doctor sits down with the midlevel to create supervision protocols. Then, he or she regularly reviews a sampling of the midlevel's charts, meets with the midlevel provider to discuss the findings, and is available for phone calls and emails from the midlevel on an ongoing basis. The number of calls can range from virtually none to 10-15 per month, according to Fitzgerald Health Education Associates, a provider of test review courses for nurse practitioners, based in North Andover, Massachusetts.

Fitzgerald estimates the work takes up 30-35 hours a year for a payment of $10,000-$15,000 to the doctor. The payment is usually a flat fee, but it can also be based on the number of charts reviewed or a percentage of the midlevel's revenue.

Because supervising physicians are accountable for the midlevel provider's actions, they can be subject to disciplinary action by the state medical board and could be sued for malpractice for the midlevel's actions. Malpractice lawsuits against PAs are still relatively rare, but the number of these suits has been rising, according to a study by Jeffrey Nicholson, PhD, a PA in Milwaukee, Wisconsin.[2]

In some cases, supervision of midlevel providers may raise your malpractice premium, according to Monte Shields, manager of agency marketing at the Keane Insurance Group, a medical malpractice insurance broker in St. Louis, Missouri. To make sure you are covered, Shields advises checking with your carrier. The carrier may require doctors to put the midlevel on their policy as an additional named insured.

How do physicians find midlevels to supervise? NPs looking for physician-supervisors sometimes advertise on Craigslist, or you might be able to connect with them on LinkedIn, Twitter, or Facebook, according to the Nurse Practitioner Business Owner Website. This site also offers discussion groups.

Pros: Payments are generous, and oversight activities can be performed in your downtime.

Cons: Supervising physicians assume some malpractice liability for their midlevels, and their premium costs may rise. However, lawsuits for such situations are relatively rare.

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