Fair compensation for collaborating Physician

[NPDude362]

Hello,

I am new around these parts and appreciate all the valuable insights into private practice I have found. I am a current Family Nurse Practitioner with around 15 years experience in healthcare between various positions. I will be completing a Post Masters Psychiatric Mental Health Nurse Practitioner Certificate this December and will be looking to eventually open up a private practice.

While my state has independent practice for nurse practitioners I will be still be acquiring a collaborating physician for oversight and for reimbursement from certain insurance companies. I was wondering what kind of ball park figure I am looking at. I have done some research and the numbers are all over the place. I understand not everyone here has favorable opinions on NPs but please keep that out of here. I have identified a severely underserved area where no psychiatrists are even taking on new patients.

Thanks for any advice and I look forward to participating in discussions here.

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[Sushirolls]

50K per year is a truly appropriate supervision price.

Possible to find less. I was approached once for $500/month for 1 hour to simply sign charts, naturally passed on that. You'll find everything in between. But I wouldn't touch for less than 50K.

 

[NPDude362]

50K per year is a truly appropriate supervision price.

Possible to find less. I was approached once for $500/month for 1 hour to simply sign charts, naturally passed on that. You'll find everything in between. But I wouldn't touch for less than 50K.

$500/month is absurd and not close to being worth the amount of liability. $50k is a little too much for me and my calculations as I am weighing the cost/benefits of private practice vs working for someone. I don't just want an absentee landlord who signs off on a couple charts a month.

Thanks for your input and I appreciate your personal thread regarding your practice, it has some great information

 

[Sushirolls]

You'll also need to be clear on what it is you want. Do you want simply an oversight to possible enhance the billings for the few insurance companies? You'll want to know your potential payer mix, what percentage of the panel might be those insurance? Does it even pencil out from your business perspective to capture this extra percentage? Realistically a Psychiatrist is likely to want that entire percentage, to mitigate the increased risks/liability of supervision. So then it becomes a wash, if only done for financial reasons.

Or is this done for learning and experience? If that's the case, you'll be better off getting an employed job and trying to vet out those that will have a detailed supervision so you can milk it for as much as possible. But this will be difficult to find.

What is your goal, what are you trying to achieve and what's the best or most feasible means to get it?

 

[dl2dp2]

Call around--I suspect if you plan a full-time practice less than 50k you'll have trouble finding someone (of perceived good quality).

Don't forget your total gross billing should be in the 200-300k range with Medicare rates at a minimum.

The 50-100k number is also roughly the profit margin for an employed full-time NP for the practice owner, so I really doubt that working for someone else will be better financially.

 

[calvnandhobbs68]

$500/month is absurd and not close to being worth the amount of liability. $50k is a little too much for me and my calculations as I am weighing the cost/benefits of private practice vs working for someone. I don't just want an absentee landlord who signs off on a couple charts a month.

Thanks for your input and I appreciate your personal thread regarding your practice, it has some great information

I mean if you want real deal supervision (like a couple hours of a practicing psychiatrist's time a week), you have to think what they'd be making if they weren't supervising with you. Residents get subsidized by their program/the government to take up attendings time but you don't have that luxury. So estimate number of hours you want to set aside to discuss cases a week x 4 weeks a month x 200+ dollars an hour (a real outpatient billing minimum)= At least 20K/year, if not more. Then adding the liability component onto it.

In the real world? I've seen the same thing as above, people wanting to pay psychiatrists 1000 bucks a month to be a chart monkey. You could probably find someone to do it to, but they won't be interested in teaching/discussing cases, they'll be wanting to take their 12K/year for an hour of work a month signing charts and hoping nothing goes wrong.

 

[NPDude362]

Call around--I suspect if you plan a full-time practice less than 50k you'll have trouble finding someone (of perceived good quality).

Don't forget your total gross billing should be in the 200-300k range with Medicare rates at a minimum.

The 50-100k number is also roughly the profit margin for an employed full-time NP for the practice owner, so I really doubt that working for someone else will be better financially.

Thanks, I know I can get some Docs to sign off on me who will essentially be a check of the month club with little to no supervision but I don't want that.

I am making around 150k in job as an FNP right now so I am not in any rush to get started in Psych and will wait for the right opportunity to present itself. Doing a thorough cost benefit analysis as my wife and I recently had children and we utilize her health insurance with her job as a Pharmacist. We now have a 1 year old and am planning on one more child which I think means that the best scenario would be for my wife to leave her job and stay home for 4 years or so. Working late nights in the pharmacy until 930pm isn't the best thing for woman while pregnant and with a toddler.

I just am not sure if after operating costs (rent, malpractice, health insurance, collaborator, lawyer on retainer, electric, etc) that my own practice would be that much better off than working for someone else. I have already been offered some PMHNP jobs in the 180kish range with full benefits that will be waiting for me once I finish school. I'll likely do something like that for a few years but still want to have a solid business plan in place for the future.

 

[DownJonesIndustrial]

I've never paid for one. Just take a job that requires the doctors to fill that role as a condition of employment or move to/operate in a state that doesn't require it. Granted, it's obviously something that's tax deductible. Private practice can be great even more so if you're cash only and utilizing a telemedicine medium so that you have no rent.

For example, get a license in a liberal state and only see people there over Zoom or some other medium or look at contracting with a number of telemedicine services that already exist. I take a few hours of hospital call each week and do the odd rounds on a weekend and typically earn about $70,000 more a year over and above my four day per week outpatient compensation. So what I'm suggesting is keep your FNP gig and do psych as a side hustle. The advantage of psych is that you may work remotely keeping your overhead costs down, plus a home office deduction, even more so than if you were at a clinic. (...if you like working remotely, I do.)

 

[calvnandhobbs68]

I've never paid for one. Just take a job that requires the doctors to fill that role as a condition of employment or move to/operate in a state that doesn't require it. Granted, it's obviously something that's tax deductible. Private practice can be great even more so if you're cash only and utilizing a telemedicine medium so that you have no rent.

For example, get a license in a liberal state and only see people there over Zoom or some other medium or look at contracting with a number of telemedicine services that already exist. I take a few hours of hospital call each week and do the odd rounds on a weekend and typically earn about $70,000 more a year over and above my four day per week outpatient compensation. So what I'm suggesting is keep your FNP gig and do psych as a side hustle. The advantage of psych is that you may work remotely keeping your overhead costs down, plus a home office deduction, even more so than if you were at a clinic. (...if you like working remotely, I do.)

So keep doing FM and see psychiatry patients as a "side hustle". Bet that'll keep the skill set sharp over and above the already insanely rigorous requirements of those PMHNP programs.

We were trying to keep it professional but lol these NPs, what an f'ing racket. Bet there's plenty of FM/IM docs who'd love to do a few hours of psych a week as a "side hustle" if they didn't have to, you know, complete 4 years of another residency program to get board certified in psychiatry. So just get a license in another state that has no supervision requirement, call yourself a "board certified" NP and start seeing desperate psych patients over Zoom on your Saturdays huh?

I just can't.

 

[DownJonesIndustrial]

So keep doing FM and see psychiatry patients as a "side hustle". Bet that'll keep the skill set sharp over and above the already insanely rigorous requirements of those PMHNP programs.

We were trying to keep it professional but lol these NPs, what an f'ing racket. Bet there's plenty of FM/IM docs who'd love to do a few hours of psych a week as a "side hustle" if they didn't have to, you know, complete 4 years of another residency program to get board certified in psychiatry. So just get a license in another state that has no supervision requirement, call yourself a "board certified" NP and start seeing desperate psych patients over Zoom on your Saturdays huh?

I just can't.

I never suggested any sort of expertise or sharpening the saw, to quote Stephen Covey, but rather possible business strategies. My family practitioner is the "medical director" for a therapy practice and evaluates and medicates all their SMI which I find interesting as most PCPs I otherwise connect with don't want to shed the time, duress, or CME hours on psych.

 

[Splenda88]

So keep doing FM and see psychiatry patients as a "side hustle". Bet that'll keep the skill set sharp over and above the already insanely rigorous requirements of those PMHNP programs.

We were trying to keep it professional but lol these NPs, what an f'ing racket. Bet there's plenty of FM/IM docs who'd love to do a few hours of psych a week as a "side hustle" if they didn't have to, you know, complete 4 years of another residency program to get board certified in psychiatry. So just get a license in another state that has no supervision requirement, call yourself a "board certified" NP and start seeing desperate psych patients over Zoom on your Saturdays huh?

I just can't.

As long as outcomes are as good or better than physicians, why shouldn't they practice "at the top of their license"?

 

[robellis]

I've never paid for one. Just take a job that requires the doctors to fill that role as a condition of employment or move to/operate in a state that doesn't require it. Granted, it's obviously something that's tax deductible. Private practice can be great even more so if you're cash only and utilizing a telemedicine medium so that you have no rent.

For example, get a license in a liberal state and only see people there over Zoom or some other medium or look at contracting with a number of telemedicine services that already exist. I take a few hours of hospital call each week and do the odd rounds on a weekend and typically earn about $70,000 more a year over and above my four day per week outpatient compensation. So what I'm suggesting is keep your FNP gig and do psych as a side hustle. The advantage of psych is that you may work remotely keeping your overhead costs down, plus a home office deduction, even more so than if you were at a clinic. (...if you like working remotely, I do.)

Psych as a side hustle? It all goes back to the “you don’t even know what you don’t know…”and the saddest part is the admins don’t care and the patients don’t know any better..so sad

 

[NPDude362]

I've never paid for one. Just take a job that requires the doctors to fill that role as a condition of employment or move to/operate in a state that doesn't require it. Granted, it's obviously something that's tax deductible. Private practice can be great even more so if you're cash only and utilizing a telemedicine medium so that you have no rent.

For example, get a license in a liberal state and only see people there over Zoom or some other medium or look at contracting with a number of telemedicine services that already exist. I take a few hours of hospital call each week and do the odd rounds on a weekend and typically earn about $70,000 more a year over and above my four day per week outpatient compensation. So what I'm suggesting is keep your FNP gig and do psych as a side hustle. The advantage of psych is that you may work remotely keeping your overhead costs down, plus a home office deduction, even more so than if you were at a clinic. (...if you like working remotely, I do.)

I would keep my FNP gig but I am getting burned out. I work a busy urgent care and see 80-100 patients by myself in a 12 hour day.

I saw around 1200 patients last month.

 

[robellis]

I would keep my FNP gig but I am getting burned out. I work a busy urgent care and see 80-100 patients by myself in a 12 hour day.

I saw around 1200 patients last month.

You see 100 patients a day as an NP? What the hell is actually going on with our healthcare system

 

[NPDude362]

You see 100 patients a day as an NP? What the hell is actually going on with our healthcare system

Most of it is Covid testing but I still lay eyes one very patient. Still see regular urgent care complaints mixed in with the bunch. Prior to Covid a really busy day in Flu season would be 50ish patients but that was manageable.

Thinking of getting an ER gig right now while I finish my Psych NP Cert. In the ER I would only see around 30-40 patients.

 

[comp1]

Ha, there are NOT a lot of family medicine MDs who want to do psych as a "side hustle." There aren't enough psychiatrists who want to do psych as a main hustle...

 

[Candidate2017]

Most of it is Covid testing but I still lay eyes one very patient. Still see regular urgent care complaints mixed in with the bunch.

This is how you define "seeing" 1200 patients a month? Well then, the urgent care receptionist probably sees 6000+ patients a month. Too bad medical receptionists don't have a state board that can put out studies that show medical receptionists "see" more patients, are more efficient, more experienced, and more cost effective at "seeing" patients.

But that's not how we define "seeing" patients on a physician forum.

 

[NPDude362]

This is how you define "seeing" 1200 patients a month? Well then, the urgent care receptionist probably sees 6000+ patients a month. Too bad medical receptionists don't have a state board that can put out studies that show medical receptionists "see" more patients, are more efficient, more experienced, and more cost effective at "seeing" patients.

But that's not how we define "seeing" patients on a physician forum.

I am still seeing all those patients. I am still listening to their lung sounds, asking them brief questions, sending meds to some primarily based on a protocol. Some take longer and others are just exposure/no symptoms.

Sounds like you have some issues with the existence of NPs and our state boards. You can take your arrogance somewhere else.

 

[aim-agm]

Sounds like you have some issues with the existence of NPs and our state boards. You can take your arrogance somewhere else.

Without getting too much into it and without any intent to comment on NPs/NP boards, remember that this is a "Physician and Resident Communities" subforum.

 

[NPDude362]

Without getting too much into it and without any intent to comment on NPs/NP boards, remember that this is a "Physician and Resident Communities" subforum.

Yes, in a thread that I created inquiring regarding how much I can expect to compensate collaborating physicians.

 

[Stagg737]

I am still seeing all those patients. I am still listening to their lung sounds, asking them brief questions, sending meds to some primarily based on a protocol. Some take longer and others are just exposure/no symptoms.

Sounds like you have some issues with the existence of NPs and our state boards. You can take your arrogance somewhere else.

How is this any different from what an RN is doing? Heck, RNs even put in orders per protocol for the docs to sign, so I don't understand how this is goes beyond a basic nursing level of care...If you're going to call a 5-7 minute encounter "seeing" a patient in the psych forum, you're going to get responses like the above one. Many of us don't consider "laying eyes on them" to be seeing a patient, especially patients coming in for "urgent" needs.

Most of it is Covid testing but I still lay eyes one very patient. Still see regular urgent care complaints mixed in with the bunch. Prior to Covid a really busy day in Flu season would be 50ish patients but that was manageable.

Thinking of getting an ER gig right now while I finish my Psych NP Cert. In the ER I would only see around 30-40 patients.

This is still unreasonable for patients who are unstable. If you're basically just a triage center in urgent care then 50 in a 12 hour shift is realistic but still pretty bad. Seeing 30-40 patients in any ER that's higher than a level 1 trauma center is still very questionable care unless you're just the triage guy that decides if patients are going back to the ER for care or can go see their PCP tomorrow. It's possible, but that would be a rough shift to grind out.

 

[Stagg737]

Thanks, I know I can get some Docs to sign off on me who will essentially be a check of the month club with little to no supervision but I don't want that.

I just am not sure if after operating costs (rent, malpractice, health insurance, collaborator, lawyer on retainer, electric, etc) that my own practice would be that much better off than working for someone else. I have already been offered some PMHNP jobs in the 180kish range with full benefits that will be waiting for me once I finish school. I'll likely do something like that for a few years but still want to have a solid business plan in place for the future.

The two bolded parts seem to be somewhat contradictory in what you're looking for. If you'll likely take an employed position where you're supervised for a few years, what kind of supervision are you looking for down the road? Direct supervision every day?

Find somewhere with strong supervision to work for 4-5 years where you'll be treated like a resident and really dive into the educational aspect. After that, if you want to be supervised by a physician, you can have them review and sign X charts per month and basically pay them to be on retainer for other questions. You could probably find someone to give decent supervision at that point for $15k-$20k per year.

 

[Candidate2017]

I am still seeing all those patients. I am still listening to their lung sounds, asking them brief questions, sending meds to some primarily based on a protocol. Some take longer and others are just exposure/no symptoms.

Sounds like you have some issues with the existence of NPs and our state boards. You can take your arrogance somewhere else.

Nurse comes into physician forum, physician(s) questions nurse about "seeing" 1200 patients/month, nurse tells physician they are arrogant and to get lost. Nurse also has zero insight into own arrogance (still hasn't earned psych "certificate", but feels qualified to set up a PP seeing patients independently, and only needs a Dr to sign off in exchange for $). This is literally a metaphor for what's happening in real life medicine.

Good thing you didn't put up with medical training because it's nothing but years of daily, non-stop questioning by "arrogant" science PhDs, PharmDs, PhD psychologists, attending physicians of every specialty, and even resident physicians.

 

[RustedFox]

It's clear that the op doesn't know pathology when he sees it.

 

[RustedFox]

I am still seeing all those patients. I am still listening to their lung sounds, asking them brief questions, sending meds to some primarily based on a protocol. Some take longer and others are just exposure/no symptoms.

Sounds like you have some issues with the existence of NPs and our state boards. You can take your arrogance somewhere else.

Putting a stethoscope somewhere near a patient while you think about "getting a ER gig while working on your psych certificate" isn't listening to lung sounds.


Folks... this is what we in the ER forum refer to as a "Jenny McJennyson".

 

[deleted456421]

My medical director excitedly told me yesterday, "We sent offers to four NPs!" This is at a state hospital with an incredibly sick patient load, many of whom end up solely managed by midlevels. My heart sank. Crap like that and the idiots like the one in this thread make me want to quit medicine entirely.

 

[DownJonesIndustrial]

Psych as a side hustle? It all goes back to the “you don’t even know what you don’t know…”and the saddest part is the admins don’t care and the patients don’t know any better..so sad

I don't think anyone here is making that argument. Everyone alive doesn't know what they don't know. It's a stupid saying. I'm tai about exerting your credentials to earn a living. Not looking for a SME panel.

 

[DownJonesIndustrial]

My medical director excitedly told me yesterday, "We sent offers to four NPs!" This is at a state hospital with an incredibly sick patient load, many of whom end up solely managed by midlevels. My heart sank. Crap like that and the idiots like the one in this thread make me want to quit medicine entirely.

Please do. More money for me.

 

[DownJonesIndustrial]

You see 100 patients a day as an NP? What the hell is actually going on with our healthcare system

When I was working ER fast track, the norm was for the lone FNP or PA to see 80+ patients. "Throughput"

 

[DownJonesIndustrial]

Ha, there are NOT a lot of family medicine MDs who want to do psych as a "side hustle." There aren't enough psychiatrists who want to do psych as a main hustle...

I can relate.

 

[deleted456421]

Please do. More money for me.

Aww the true nature of APRNs. Heart full of greed...

 

[DownJonesIndustrial]

Aww the true nature of APRNs. Heart full of greed...

Probably not most.

 

[deleted456421]

Alright. I'll stop feeding the trolls who have flocked to this forum. Just wondering if we can somehow keep "provider" clowns from further diluting this place that I've learned so much from?

 

[calvnandhobbs68]

Probably not most.

But just you.

 

[LutGholein]

I would keep my FNP gig but I am getting burned out. I work a busy urgent care and see 80-100 patients by myself in a 12 hour day.

I saw around 1200 patients last month.

This is satire right? This is why people join PPP. This should not be happening.

it’s really sad.

 

[RustedFox]

Aww the true nature of APRNs. Heart full of greed...

No, no, no.

The saying goes: "heart of a nurse, brain of a turnip" or something like that.

They don't know what they don't know, and they don't want to know that they don't know what they don't know.

They just want to play "healthcare".

 

[MisterKitty]

This is satire right? This is why people join PPP. This should not be happening.

it’s really sad.

Imagine how many xanax prescriptions get written by an NP seeing 80-100 patients a day. Printing money

 

[clausewitz2]

Everyone alive doesn't know what they don't know. It's a stupid saying.

Yeah, I heard some Greek idiot thought he was so f*cking smart because of how clearly aware he was of how little he really knew. What an a**hole. What was his name, again? Socrates or something like that?

 

[DownJonesIndustrial]

Yeah, I heard some Greek idiot thought he was so f*cking smart because of how clearly aware of how little he really knew. What an a**hole. What was his name, again? Socrates or something like that?

Perhaps clausewitz2?

 

[RustedFox]

I don't think anyone here is making that argument. Everyone alive doesn't know what they don't know. It's a stupid saying.

He... He still doesn't get it.

Okay.

Yes. Everyone alive doesn't know what they do not know.

But many alive are aware that they do not know the things that they do not know, and have a healthy respect for that.

The pretend-level-provider crowd is not aware that there are things that they do not know; like, for example... the majority of medicine. Thus, when they encounter something that they do not know, they discard it. The corollary here being: "the eye does not see what the mind does not know".

That has deadly consequences.

What's worse, they don't want to know that they don't know the things that they don't know; they just want to jump headfirst into medicine and... oh, say... "open up their own private practice", and just have their mommy-daddy doctor sign their permission slip to go do so for money.

 

[deleted456421]

He... He still doesn't get it.

Okay.

Yes. Everyone alive doesn't know what they do not know.

But many alive are aware that they do not know the things that they do not know, and have a healthy respect for that.

The pretend-level-provider crowd is not aware that there are things that they do not know; like, for example... the majority of medicine. Thus, when they encounter something that they do not know, they discard it. The corollary here being: "the eye does not see what the mind does not know".

That has deadly consequences.

What's worse, they don't want to know that they don't know the things that they don't know; they just want to jump headfirst into medicine and... oh, say... "open up their own private practice", and just have their mommy-daddy doctor sign their permission slip to go do so for money.

Quotes from the NP on my unit over the last two weeks: "Lithium can be dosed once daily?" "So antipsychotics cause essential tremors?" (Clearly misunderstood my discussion of DIP) "What do you mean diabetes insipidus causes hypernatremia?"

Fortunately this individual knows their limits and, although they may sound silly at times, reflects on what they don't know.

People like the commenter here cover both ears and shout, "We're all the same! We're all the same!"

 

[Natremia]

Please do. More money for me.

You deserve to be in jail for the quite literally tens of people you hurt daily. There is a dark day coming for you charlatans. The JDs have smelled the chum

 

[deleted456421]

You deserve to be in jail for the quite literally tens of people you hurt daily. There is a dark day coming for you charlatans. The JDs have smelled the chum

Been thinking about getting my JD to go after people like this.

Edit: Too bad I can't get my advanced paralegal license to do it cheaper while knowing as much as a real lawyer.

 

[Splenda88]

Quotes from the NP on my unit over the last two weeks: "Lithium can be dosed once daily?" "So antipsychotics cause essential tremors?" (Clearly misunderstood my discussion of DIP) "What do you mean diabetes insipidus causes hypernatremia?"

Fortunately this individual knows their limits and, although they may sound silly at times, reflects on what they don't know.

People like the commenter here cover both ears and shout, "We're all the same! We're all the same!"

Medicine is too complex and it's scary that some people think they can fake their way thru it.

 

[RustedFox]

You deserve to be in jail for the quite literally tens of people you hurt daily. There is a dark day coming for you charlatans. The JDs have smelled the chum

Unfortunately, the JDs simply go after the "supervising physician" because they sue everyone in sight.
The only way out of a mess like this is to cut the cord and refuse to sign their field trip permission slips.
"No, Jenny; I won't let you go play healthcare and be responsible for you."

I was involved in a suit where the pretend-level-provider missed a necrotizing fasciitis after ignoring the vital signs and (what I can only guess) doing only a perfunctory physical exam. He had never seen a case before, so "didn't recognize it".

The chart wasn't even supposed to come to me to sign; but this particular doofus sent it to the wrong doc for signature.
Never saw the patient. Yet, there I sat in a deposition.

In summary; it settled, and I was excused from the case. The other doc (in the department at the time), not so much.

 

[Splenda88]

Unfortunately, the JDs simply go after the "supervising physician" because they sue everyone in sight.
The only way out of a mess like this is to cut the cord and refuse to sign their field trip permission slips.
"No, Jenny; I won't let you go play healthcare and be responsible for you."

I was involved in a suit where the pretend-level-provider missed a necrotizing fasciitis after ignoring the vital signs and (what I can only guess) doing only a perfunctory physical exam. He had never seen a case before, so "didn't recognize it".

The chart wasn't even supposed to come to me to sign; but this particular doofus sent it to the wrong doc for signature.
Never saw the patient. Yet, there I sat in a deposition.

In summary; it settled, and I was excused from the case. The other doc (in the department at the time), not so much.

Many docs are profiting from these people. They are the ones that let the system get where it is.

 

[DownJonesIndustrial]

You deserve to be in jail for the quite literally tens of people you hurt daily. There is a dark day coming for you charlatans. The JDs have smelled the chum

I think that's a ridiculous statement. Who's hurt? And how? I haven't said anything about cramming multiple patients into every hour.

 

[NPDude362]

Putting a stethoscope somewhere near a patient while you think about "getting a ER gig while working on your psych certificate" isn't listening to lung sounds.


Folks... this is what we in the ER forum refer to as a "Jenny McJennyson".

When you are bombarded with 100+ people in 12 hours along with a constant barrage of phone calls that is about all you are able to do. I never said it was the best medicine and not something I signed up for. When I began it was 30 patients/day which is manageable.

You obviously have issues with other types of providers though. I am still opening my own practice though so if you want to come work for me I'll offer you a 70/30 split. You need to run your cases by me though if you feel like you can't handle something.

 

[Sushirolls]

 

[Clean7795]

When you are bombarded with 100+ people in 12 hours along with a constant barrage of phone calls that is about all you are able to do. I never said it was the best medicine and not something I signed up for. When I began it was 30 patients/day which is manageable.

You obviously have issues with other types of providers though. I am still opening my own practice though so if you want to come work for me I'll offer you a 70/30 split. You need to run your cases by me though if you feel like you can't handle something.

Listen dude, no one has an issue with you on some personal level. We realize you don't control how many patients you see, or the staffing in your department.

The problem is that your professional national organization continually STRIVES to erode patient care standards and are willingly in bed with corporations that do control staffing (otherwise they would be taking a stand to ensure that every NP has adequate supervision). And what further exacerbates the issue is that over and over again there is a false sense of confidence instilled into midlevel providers from their schooling and organizations.