NP run clinic - using medical license remotely

[Superfan1983]

Hi all,

     I have an Ontario medical license and work with a pharmaceutical company full time.  Is it possible to use my license and have a NP run a family medicine clinic in one of the underserved areas? Do I need to be physically present at the clinic or can I ‘mentor and advise/support’ the NP remotely? Do I pay the nurse a salary? How do I bill OHIP? I’m a Family doctor.

[bearded frog]

Yo probably not gonna get a great answer from premeds/medstudents/resdients on that one. I would reach out to the OMA or CPSO for guidance.

[ArchEnemy]

6 hours ago, Superfan1983 said:

Hi all,

     I have an Ontario medical license and work with a pharmaceutical company full time.  Is it possible to use my license and have a NP run a family medicine clinic in one of the underserved areas? Do I need to be physically present at the clinic or can I ‘mentor and advise/support’ the NP remotely? Do I pay the nurse a salary? How do I bill OHIP? I’m a Family doctor.

I don't think this is possible.

My understanding is that you would have to physically be there in person to supervise the NP to bill OHIP for the patients seen. 

[Wachaa]

I don't think that's a good way to make money. The amount you have to pay the NP alone would make it not worthwhile. Not to mention the clinic overhead.

Consider telemedicine.

[medigeek]

Yeah why don't you... not be a sell out for the profession. How about that?

[LittleDaisy]

On 12/15/2019 at 5:38 PM, ArchEnemy said:

I don't think this is possible.

My understanding is that you would have to physically be there in person to supervise the NP to bill OHIP for the patients seen. 

Yeap you have to be physically present and see every patient that NP sees; CPSO won't allow the business model you proposed above.  

Even if you don't have to be physically present, I would strongly advise against it. As NPs that I've worked with in FM, they see patients every 30-45 minutes; and have 1-3 hours break for lunch and charting/ phone calls; and work from 9 am- 3 pm; in the end they only see 6 uncomplicated patients per day; and will consult MD for anything they are not sure!  In ED, I've seen  NP/PAs seeing 5-6 patients, and grab ED physicians to review each case and mostly focusing on stable and low acuity patients. The government only fund NPs for FHT/ busy ED, because they know that NPs will be heavily supervised by MD in a team setting. 

FYI, in a few academic hospitals, they have started to let NPs go, as the admin realized that they don't save that much money and end up with a >120 K pay with 1 hour lunch and good working hours. Get an off-service resident who will do 1/4 calls for you; and can manage unstable patients and doing the scut work for the entire ward, and won't complain for not eating/ going to bathroom/ sleeping,  and being paid 60 K per year. 

I won't do it even if CPSO/ OMA allows it; I personally don't think that you can be a "family doctor" after a nursing degree, and "so-called 2 year master of nursing" which is not the same as 4 year of medical school, 2-5 years of residency. But the stupid government thinks that they are saving money. 

[futureGP]

Honestly NPs are terribly overpaid for the work they do. Even in academic centres, such a useless job.

 

I would love to hire an extender in a private outpt clinic to allow me to see and bill more patients. But if the salary ends up being 100k with benefits and vacation etc, they better work hard for that money. Probably hard to justify the salary unless they can run a similar list as mine (~15-20 per day)

[Let'sGo1990]

On 12/18/2019 at 12:11 AM, LittleDaisy said:

Yeap you have to be physically present and see every patient that NP sees; CPSO won't allow the business model you proposed above.  

Even if you don't have to be physically present, I would strongly advise against it. As NPs that I've worked with in FM, they see patients every 30-45 minutes; and have 1-3 hours break for lunch and charting/ phone calls; and work from 9 am- 3 pm; in the end they only see 6 uncomplicated patients per day; and will consult MD for anything they are not sure!  In ED, I've seen  NP/PAs seeing 5-6 patients, and grab ED physicians to review each case and mostly focusing on stable and low acuity patients. The government only fund NPs for FHT/ busy ED, because they know that NPs will be heavily supervised by MD in a team setting. 

FYI, in a few academic hospitals, they have started to let NPs go, as the admin realized that they don't save that much money and end up with a >120 K pay with 1 hour lunch and good working hours. Get an off-service resident who will do 1/4 calls for you; and can manage unstable patients and doing the scut work for the entire ward, and won't complain for not eating/ going to bathroom/ sleeping,  and being paid 60 K per year. 

I won't do it even if CPSO/ OMA allows it; I personally don't think that you can be a "family doctor" after a nursing degree, and "so-called 2 year master of nursing" which is not the same as 4 year of medical school, 2-5 years of residency. But the stupid government thinks that they are saving money. 

Interesting. Which hospitals have you seen this in, and on what services?

[1D7]

8 hours ago, Let'sGo1990 said:

Interesting. Which hospitals have you seen this in, and on what services?

Not completely related but at Western many, many years back there used to be a emerg psych nursing service that would help see patients then review with the staff psychiatrist. The entire service was stopped after some admin realized they could shift all the work to residents instead.

[LostLamb]

On 1/16/2020 at 8:06 AM, 1D7 said:

Not completely related but at Western many, many years back there used to be a emerg psych nursing service that would help see patients then review with the staff psychiatrist. The entire service was stopped after some admin realized they could shift all the work to residents instead.

Fascinating!!

in Calgary every ER has psych emerg nurses who can discharge patients back to ER doc, otherwise If admit is needed they refer to resident/staff psych. 
 

I think the difference for us is that we do not have a single psychER (we have 5 across the city in each hospital) so without the nurses it would be impossible to staff with residents alone—we cannot cover all sites with our current numbers. 

[JohnGrisham]

1 hour ago, LostLamb said:

Fascinating!!

in Calgary every ER has psych emerg nurses who can discharge patients back to ER doc, otherwise If admit is needed they refer to resident/staff psych. 
 

I think the difference for us is that we do not have a single psychER (we have 5 across the city in each hospital) so without the nurses it would be impossible to staff with residents alone—we cannot cover all sites with our current numbers. 

Similiar exposure, psych ER nurses (typically do a different degree than the regular broad scope RNs) are great. If they have something they think for admission, they refer to MD/resident/MSI working on the team for further assessment and decision making.