Adding Midlevel (NP)


(Dr Rob Lamberts) #1

I am (if the bankers agree) adding a nurse practitioner to my practice in January. She’s done 2 rotations with me and will graduate by then. My plan (and she’s OK with it) is to start her part-time and work into full-time within the first 6 months (to have the least impact on my personal income) – she will continue doing some of the RN work to supplement her income during that time.

So here are my questions:

  • What is the best way to utilize a nurse practitioner? I have done so in my previous practice, but I am much more sensitive to the feelings of my patients in DPC and so want them to see this as a move forward instead of a move to “dilute” me. My thought was to have her do all of my new patients’ initial interview and history, after which I can see them for new patient visits that are 30 minutes (instead of 60) long and grow faster. I also intend her to do more intensive follow-up on my more complex patients, diabetics, weight loss, and well-woman care. This will hopefully bring new patients in at a faster rate, getting me to break-even faster. I also intend to work harder on getting some businesses to sign up their employees and use her to make this work.
  • Where is the best place to go for reasonable estimates of salaries? She’s fresh out of school, so I don’t have to start too high, but finding salaries and keeping their pay competitive without overpaying or setting too high of expectations was a big headache in my old practice.
  • Any resources for or opinions about contracts? I assume it is best to have a contract (and I prefer that) spelling out their responsibilities and what they should expect from me.
  • Any other thoughts or help in this area?

Looking forward to hearing your thoughts.

(Robin Dickinson) #2

Congrats! That’s an exciting step. :smile: And hiring someone you know so well already is brilliant. There shouldn’t be any surprises!

Having never done this myself…I’ve seen NPs used successfully in various ways depending on your population and her strengths and weaknesses. I think your idea of having her do the first new patient is brilliant, it not only saves you time, it makes sure everyone knows her and is comfortable with her. Where I go, I can always see my MD if I want to but I can often see the NP at funny times like Friday afternoon or 8am in the morning. I can also get in with her immediately. My kids actually prefer her to the MD and I really do like her a lot though as an MD myself, I prefer to see the MD for most things.

I could also imagine a midlevel being super helpful with chronic disease management, making sure everyone is up to date on everything. I’ve known some practices where the midlevel sees DM/HTN/etc every 3 months and the doc annually. I personally would use a midlevel to make sure every single person in the practice is up to date on all the random screening (depression screening, hga1c for diabetes screening, etc).

If only there was a good way to compare with other offices in your area. Also, check with her about what’s important. For some people, having health insurance is more important than a competitive salary and I know an RN who is a single mom and was willing to forego a pay raise in return for having a space at the office where her kids could stay after school so she wouldn’t have to pay for a babysitter.

I know that @lisainden and her midlevel are like a right and left hand so I’m curious to see what she says.

(Nancy Latady) #3

Hi Rob, that’s exciting news. A couple thoughts…you can check NP salary levels at sites like,, As an example, you can see info for NPs in your area here:,7_IM57_KO8,33.htm
What’s also great about these sites is that you can look through job postings for ideas on what you want to include in your NP’s job description. This is very important for setting and communicating job responsibilities, and will help down the road as you do performance reviews with her (which is always a good idea too!). Hope this helps…

(Dr. Peter Lehmann) #4

I have a PA whom I “supervise” – she’s been a PA in another family practice for over 15 years and is highly competent – supervision is negligible practically speaking. She really runs my second clinic along with her MA. She practices full spectrum family medicine. I’ve created a pay structure which incentivizes her to reach a panel size around 600 patients. She will be making far more money than in a traditional role if she hits that target. I still increase my income by having her running the second practice. I have had ZERO patients complain that they are seeing a PA instead of “a doctor” nor any complaints about the same monthly fee. It is working out well. I’m happy to share the contract I’ve made with her (all personal identity information scrubbed). Not sure if we can upload files in the community @Robin_Dickinson

(Robin Dickinson) #5

@Nora_Goldfield How can @drpeter share the file he’s so generally offered? Thanks!

(Dr Rob Lamberts) #6

You should be able to upload. I was. There’s a litle upload button. I uploaded a document here to show that it works. Animal Fluency Test.pdf (29.5 KB)

(Dr. Peter Lehmann) #7