How Much Should NPs Expect to Pay a Collaborating Physician?

Physician oversight requirements can be a significant hurdle to overcome if you’re thinking about opening your own nurse practitioner practice. For starters, complying with supervision or collaboration requirements affects your practice’s bottom line. You will need to pay an MD to conduct chart reviews or be available for consultation as mandated by laws in your state. Just how much of your practice’s revenue can you expect to spend on compensating an overseeing physician?

Compensation for collaborating or supervising physicians isn’t black and white. How much you can expect to pay for the role depends on a variety of factors, namely the level of involvement required on part of the MD in your state. For example, some states require that a collaborating physician review a certain percentage of the nurse practitioner’s charts. Other states may simply mandate that a physician be able to consult with the nurse practitioner by phone or email as needed. Yet other states require that a collaborating physician physically visit the site where the nurse practitioner practices for a specified duration of time. Nurse practitioners practicing in states with more involved supervisory requirements should expect to pay more for an MD’s collaboration services. 

Professional relationships also come into play in determining compensation for physician oversight. Nurse practitioners who have worked closely with their overseeing physician in the past and developed a solid rapport will likely pay less than those without established MD relationships. If a physician has a high degree of trust in the nurse practitioner’s clinical abilities, there is less likelihood he/she will be called on for consultation. Perceived malpractice risk is also lower if the physician has worked with the nurse practitioner in the past and is confident in the NPs abilities. 

There are a few different compensation models to consider for physician collaboration as you open your practice. They are as follows:

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  1. Per chart basis
  2. Flat fee
  3. Percentage of profits

According to healthcare attorney Alex Krouse who often works with nurse practitioners in setting up their own practices, NPs can expect to pay a physician anywhere from $5 to $20 per chart reviewed. These values are not hard and fast, and can vary significantly by state and type of practice. As a flat, annual fee, he most commonly sees MDs paid anywhere from five to fifteen thousand dollars per year. Again, this number depends on laws within the state as well as other factors. 

While compensating a physician for a collaboration arrangement based on percentage of the practice’s revenue is a possible way to structure the agreement, Krouse says it isn’t advisable. Under the anti-kickback statute, it is prohibited to pay for referrals in healthcare. As a result, nurse practitioners operating their practices with a collaborating physician compensated based on a percentage of profits run into problems. If the physician refers patients to the NP-owned clinic and meanwhile receives a percentage of profits, this is a violation of the anti-kickback statute. As a result, this compensation structure is not advisable. 

Laws in the state where you plan to open your practice as well as the context of the relationship with your collaborating physician will be the driving factors behind the amount you can expect to pay for MD oversight. Speaking to another nurse practitioner business owner or an attorney who assists in medical practice set up is the best way to get an appropriate financial model in place for your practice. 


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14 thoughts on “How Much Should NPs Expect to Pay a Collaborating Physician?”

  1. States with physician oversight requirements require legislative change. The NP payment of physician oversight is a cost that is passed on to the consumer and simply because of the state statute increases the cost of health care without affecting quality in a positive manner.

    Physician oversight requirements are driven in the state legislature by physicians (mostly GP/FP’s) who are fearful they will loose patients (INCOME) from patients who find a NP is a better provider. These statutes are little more than a method of LIMITING COMPETITION

    1. Bill,

      I would suspect you will have trouble finding objective data to support your position and your position is open to much critical analysis. As a flash bite….it sounds good but when put to the real scrutiny of analysis and numbers it just doesn’t stand up. For example, if an CP is getting a yearly stipend of $5000 then the “cost that is passed on to the consumer” is less than a cup of coffee at Starbucks/patient. Having reviewed thousands of medical cases for quality, adverse outcomes, and legal issues, I don’t think you provide any real evidence of no added quality.

      NPs serve a tremendous role and add significant value in our 21st century healthcare delivery especially in rural and under served areas but also with creative ways of offering new delivery models that are outside the “stick and mortar” primary care offices. In terms of competition, again I just do not see the reality of this claim. As an EM physician, a daily complaint of patients who present to the ED is the fact their FP could not see them today, this week, or until next week. Now this is purely anecdotal but this would imply the FPs are plenty busy. Finally, if an FP doc is worried about competition from the NP….they are looking in the wrong direction for where the risk to their practice really resides.

  2. LOL. The better provider is one who has the better training. There is a reason the best and the brightest go to Medical School and graduate with a Medical Degree.

    …who would you rather have your kids see? A Nurse or a Medical Doctor?

    1. Alice Fields MD

      It’s a dumbing down of health care. Is fine with me though. I’m a psychiatrist and practice owner that is burned out. It’s time to supervise.

      But you are exactly right. This is what they told me the first day of medical school, “For 9/10 cases you see as a doctor, anyone could treat. You are here for that 10th case.”

      1. Thank you! You response is greatly appreciated. What’s sad is that as APRNs and MDs, there is a benefit to the public for both.

        Having my physician colleague available for a question or to see a challenging client is important to me because I want they client to know that their care is being conducted as a team approach, which they are very much a part of.

    2. Hi Silly Billy. I’m a practicing FNP and PMHNP. Interestingly my husband is a Cardio-Thoracic Surgeon and was appalled with your comment. Very Very Sad. Hopefully your ego does not get in the way of your clinical judgement.

    3. I’d rather that they see the better provider which in most cases is NOT the physician.

      Beat and brightest huh? You mean they memorized; some facts and regurgitated them for a test?! Wow!!!!

      Give me a break. National statistics have shown for at least the last ten years that nursing school is the hardest program to both get into and to complete in the US.

  3. I’m an NP practicing internal medicine in a small group practice, and an instructor / lecturer at a top tier medical school. I can assure Silly Billy, that he is indeed..silly. I prefer not to see patients with his brand of ridiculous, so it works out well.

  4. As a board certified Family Nurse Practitioner, I respect patient’s concerns when it comes to their confidence regarding who is better equipped to handle their medical complaint or symptoms.
    I simply inform them that I have 17 years experience as an advanced Nurse Practitioner and 30 years in the military and retired Officer.
    No discredit to NP’s or MD’s, but a doctor once told me; “you see that license and Medical diploma/certificate on the wall?”
    Yes I said. “That’s all it is, I graduated at the bottom of my class in medical school”.
    In the end Practitioners and Medical professionals are here for the same goals. We must accept the ” good with the bad”.
    Of course we as professionals want or expect top dollar for our services, and that includes ALL medical practitioners.
    Bottom line if a patient does not like your ” bed side manners” then you will be judged as an “idiot” that’s the bold truth.
    No NP that I know of has ever asked to be called ” Doctor” unless they have PhD. No NP that I have ever known has asked for the same salary as an MD. We ask for similar respect, yet we receive less than half in many cases than an MD’s compensation with the same legal responsibilities.
    We are here to enhance medical care and access to healthcare, let’s work together and respect each other.
    BTW, I have a certificate on the wall too, I graduated with Honors.

    Craig Brady

  5. You are the PROBLEM with medicine and why physicians are called PROVIDERS and are being replaced by barley trained replacements with online bogus training. Thanks for selling your soul to the company store.

    1. Linda, in fact insurance companies are to blame for the majority of the problems with medicine and access to care. I am so sorry that you feel so strongly about nurse practitioners and their training. I earned every thing I worked for while raising my children and working full time, as I am sure you did. Not looking to be your replacement only respect as someone PROVIDING care to patients who desperately need us.

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