Physician Employment Agreement Sample: Fill & Download for Free

I will answer this question from a Rural American medical perspective. The trend in the big square states full of small towns and agriculture is one of midlevel practitioners replacing the small town Family Practitioner. This is due to a shortage of FP’s and an abundance of RNs wishing to improve their income and prestige. Costal states still generally require APRNs to have a supervising MD (collaborative agreement).Advanced Practice Registered Nursing (APRN) is a 3 or 4 year degree with a BSN that avoids higher level STEM courses like calculus, organic chem, biochem and molecular biology. Science courses are generally not taught at the same level as the science majors. Curriculum is aimed at passing the NCLEX nursing boards. After that, a 2 year degree culminating in a MSN is obtained either on-line or at a brick and mortar school. Key to the process is 2000 hours (50 weeks of 40 hr/wk) of practice supervised by a MD in the area of interest. There is a certification exam. Total time to productive employment—6–7 years.When you are done with your APRN in this state you may “…evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribing medications and controlled substances.”Family Practice FP is a medical specialty like any other. 4 year degree with a core curriculum that includes plenty of STEM courses and higher math. 4 years at a medical school culminating in a DO or MD degree. Licensure exams, then 3 years in an accredited residency and FP board exam. Total time to productive employment 11–12 years.When you are done you can do pretty much the same things a nurse practitioner can do. APRN median salary—$103,880. FP median salary—$198,740.Simple math. Cheaper and quicker path to a very similar job as an APRN. You can do a lot of it on-line at home in your bed.JUST MY OPINIONHere is the reality as I see it. The question shouldn’t be ‘how can I make the most money with the least education?’ The real question is very simple— How can I avoid killing people or allowing them to die? Ninety five percent of human illness is common and easily diagnosed and treated. The other 5% is subtle and uncommon. APRNs who practice on their own are reasonably good at the 95% and often catastrophically bad at diagnosing and treating/referring the 5%.I work at a referral hospital and I can tell you that we look closely at who is referring a patient to us. More and more patients are coming from independently practicing APRNs. We are happy for the referrals but often these people are either wildly overdiagnosed or wildly underdiagnosed. Either way it may lead to patient harm financially or biologically or in several cases it has lead to death. Maybe an MD would not have caught it either, but in general they do a better job working up and referring patients. I say this as someone who samples the work of both on a daily basis in pre-surgical workups. Despite individual variation, the two specialties are not equivalent.Medical professionals are only useful when they are present. If there’s not one in your town and you are acutely ill, your health will suffer. APRNs are filling a need but the system of their education is not adequate. They should either commit to a supervisory practice (Telemedicine?) or find a way to gain better clinical experience. Nursing and Medicine are not competing models of human illness. Spending years studying nursing theory and one year of OJT and presenting yourself as a primary care physician equivalent is disingenuous. It doesn’t prepare you for diagnosing and treating deranged physiology, it is an entirely different thought process that takes several years to build.In a perfect world I would love to see a way that a person could take a hybrid course of study, rigorous enough to ensure selection for intellectual ability, but long enough and clinical enough to have all practitioners be able to pass a family practice level of competency exam. I really believe that will happen eventually as physicians leave primary care and nurses fill it in with scrutiny of their quality. Stocking our clinics by legislation is a really lousy way to ensure quality health care in rural areas.Just my $1.05

I am a psychiatric NP in New York, working with children and adolescents (up to age 21) in the foster care system.In my state, NPs prescribe medication within our scope of practice. I have my own DEA number, and do not need anyone else to sign off on my prescriptions. What I do at my job from day-to-day is identical to that of the psychiatrists. I carry my own caseload. I assess patients, I formulate diagnoses and treatment plans and prescribe medication and ongoing assessment/treatment. I order and interpret labs. I provide psychotherapy as needed (though patients in my setting are assigned to a social worker and sometimes also a psychologist as well, so psychotherapy does not usually fall to psychiatry).The differences are that I am required to have a collborative practice agreement, which means that I have a legal agreement that I have a psychiatrist to consult with on an as needed basis, who will review a sampling of my charts on a quarterly basis, and who will cover my patients in my absence; this agreement also states that I will cover for the psychiatrist who is my collaborator when she is not available, as well. My collaborator and I did our training around the same time and this was my collaborator's first job out of fellowship, and we've had a really nice collaborative relationship- she calls me with questions about as often as I call her (I had been a master's level licensed therapist for several years before becoming an NP, so I have more experience with assessment/diagnosis/psychosocial treatment than other NPs of my experience/training level). The other difference is that some of the agencies that we make referrals to for ongoing treatment require that my evaluations be reviewed by a psychiatrist, though neither the state nor my employer require this.I've read in some places on the internet that people feel that NPs should carry the more "normal" cases, or easier ones, leaving the more complex ones for physicians. In psychiatry, we don't really see "normal," so that's out the door, at least as far as ongoing treatment goes. Cases at my agency are assigned based on where the patient programs (lives), so it's not as if we separate by diagnosis or complexity.I don't think anyone in the psychiatry department at my agency considers me or any of the other NPs to be "junior" anything.Editing a few years later: my state eliminated most of the collaborative practice requirements for experienced nurse practitioners a few years ago, so I am no longer required to have a practice protocol or chart reviews; simply just someone I have legally designated that I can consult as needed. Some, though not all, of the regulations from state agencies have relaxed in that the no longer require a psychiatrist to sign off. And I’m still quite happy with my role as an NP, though I’ve worked in a number of different settings (locums work) since I first answered this question.

It is not clear what you are asking but I will make an effort to provide some information. If I understand even a part of the question, I think you're confused about prescriptions, and possibly taken in by the propaganda that medications for mental disorders are only a means to an end; control and greed. When used properly and with vigilance, the different classes of drugs are of enormous value to millions of people who suffer from acute and chronic disorders. People with a temporary problem such as prolonged grieving, or a lifelong, debilitating disorder such as bipolarity, usually benefit from pharmaceutical treatment accompanied by psychotherapy. Other changes in lifestyle are also helpful.Regarding salary; Psychiatrists, generally, are in private practice after completing a residency in hospital and other clinical settings. Many will have hospital privileges so that they can continue to manage their patients'care, coordinating it with other medical professionals in a hospital. Even if someone is hospitalized for a bad gall bladder, it is critically important that his mental health is monitored and his medications are provided correctly. This is also a time of added stress and different dosages and/or drugs may be needed. The actual costs, which are always exorbitant, of any meds ordered while in hospital would not be influenced by the doctor. The salary of a psychiatrist isn't determined by the healthcare setting except as a resident or as an employee. As an employee, RVU's (relative value units) could be a part of an evaluation for productivity but, generally, they would not reflect the number of prescriptions written. (RVU's are part of a resource -based scale for describing, quantifying and reimbursing physician services.)Psychiatrists are regularly visited by representatives of pharmaceutical companies, and so are most other medical professional who writes prescriptions. They are often given samples, usually of newer drugs, which may actually benefit a patient. This gives someone the opportunity to take a medication with no cost for a short while to determine its efficacy. Incomes of the psychiatrists have little or no connection to the number of prescriptions written unless the company is paying him “under the table”. The one area of concern involves research studies that are funded by a company. Strict guidelines exist for such studies. Any results that are published or released in any way must be accompanied by a statement clarifying the connection to these private funds.Laws exist that prevent the use of drugs unless it is determined that a person is a threat to himself or someone else. As soon as a patient is considered stabilized, he may refuse medications. There is no law that forces a psychiatrist to prescribe any drug. It is possible that there could be some agreement prior to employment in a large practice, let's say, but this would be unusual.