Extenders can get paid in different ways

Practice Management. By Mike Norbut, AMNews staff. Oct. 24/31, 2005.

There are two prevailing theories about how to structure a compensation plan for your physician extenders.

Some groups employ their nurse practitioners and physician assistants on a straight salary arrangement, in which they earn the same amount regardless of how many patients they see.

Other groups, meanwhile, use a compensation plan that offers a base salary with a bonus incentive based on a productivity benchmark. While it's not a straight productivity-based system in the way that most physicians structure their salaries, it offers a reward for those physician extenders who are more efficient.

There are pros and cons to each approach, of course, so the choice for your group ultimately comes down to your practice environment and your comfort level.

For example, Diane Noton, MD, a family physician in Saratoga, Wyo., employs two physician assistants on a straight salary basis.

Because Dr. Noton's practice is located in such a remote location -- the nearest hospital is 40 miles away -- the clinic serves as the medical support system for a finite set of patients. While the practice is busy enough to allow her to hire another physician, adding two physician assistants for a comparable cost allows her to have more resources for on-call duty, Dr. Noton said.

However, the practice isn't so busy that efficiency is a chief concern. Promoting productivity incentives when the schedule doesn't necessarily require speedy visits could alter the culture of her practice, Dr. Noton said.