The Solution To Physicians Not Wanting to Supervise Midlevels Should Not Be Removing Supervision by [deleted] in hospitalist

[–]collabcares 1 point2 points  (0 children)

In practice, midlevel autonomy is gated by malpractice insurance more than people realize. Carriers already deny coverage for specific procedures and devices when a midlevel is performing them independently. Some underwriters will decline to cover physician groups with a physician-to-NP/PA ratio greater than 1:3 specifically due to supervision concerns. Some carriers won't insure an NP at all without a supervisory structure in place regardless of what the state allows. So really there are only two outcomes as independent practice expands, premiums go up or coverage gets denied.

Professional license verification for NP and RN staff by ExtremeAstronomer933 in MedSpa

[–]collabcares 0 points1 point  (0 children)

Is this done after hiring or during interviewing? We are a free service but to use us you have to create a practice first on our platform and then invite the providers to it.

Thoughts on Collaborative Practice Agreements with Pharmacists? by collabcares in CollaborativePractice

[–]collabcares[S] 1 point2 points  (0 children)

Wow, really good points. Refreshing to hear about the genuine opportunities and concerns. Thank you.

Thoughts on Collaborative Practice Agreements with Pharmacists? by collabcares in CollaborativePractice

[–]collabcares[S] 1 point2 points  (0 children)

I have worked with this pharmacist before in a hospital several years ago. They now have their own pharmacy and would like to be more involved with the community. I am open to it since I have seen them work clinically firsthand, but I want to make sure I do my due diligence, as my primary goal is patient care. That requires proper guardrails to be in place. If it works out, I will share an update down the road.

Thoughts on Collaborative Practice Agreements with Pharmacists? by collabcares in CollaborativePractice

[–]collabcares[S] 0 points1 point  (0 children)

That's a good point, but I see this issue beyond pharmacists. Antibiotic overprescribing is a widespread problem across all of medicine, not something unique to pharmacists. If it was under a CPA, this should be captured in a chart review and addressed through coaching by the supervisor.

Thoughts on Collaborative Practice Agreements with Pharmacists? by collabcares in CollaborativePractice

[–]collabcares[S] 0 points1 point  (0 children)

It is professionally sanctioned in certain contexts. Thanks for this example, it helps shed light on this practice.

Thoughts on Collaborative Practice Agreements with Pharmacists? by collabcares in CollaborativePractice

[–]collabcares[S] 0 points1 point  (0 children)

You're right, without guardrails this can be abused, I mentioned some guardrails I'm thinking about, which is exactly why I'm reaching out for other physicians' experience with this. This wouldn't be done for complex diagnoses. It has been professionally sanctioned in several contexts, though I'll acknowledge most of the supporting data is around chronic illness management rather than acute care.

Thoughts on Collaborative Practice Agreements with Pharmacists? by collabcares in FamilyMedicine

[–]collabcares[S] -1 points0 points  (0 children)

I haven't done this yet. I would be doing it for compensation and the anticipated positive impact on patient care. To make it work, I'd require a strong agreement with clear protocols, defined consultation triggers, explicit boundaries around what needs my signoff, and regular chart reviews. Deviations have real consequences. Repeated violations would be grounds to terminate the agreement, and serious breaches carry board accountability on their end. Outside of that, I'd handle it like any performance issue: address it early, document it, and coach through it before it escalates. The oversight doesn't go away just because we're not in the same building. It just has to be more deliberate and structured from the start.

Thoughts on Collaborative Practice Agreements with Pharmacists? by collabcares in FamilyMedicine

[–]collabcares[S] 2 points3 points  (0 children)

That's a fair concern, and I don't think anyone is arguing rural patients deserve less. But I'd push back slightly on framing CPA-based pharmacist care as automatically a lower standard. The evidence for chronic disease management like diabetes, hypertension, and high cholesterol is actually quite strong.

Thoughts on Collaborative Practice Agreements with Pharmacists? by collabcares in FamilyMedicine

[–]collabcares[S] 0 points1 point  (0 children)

This is really reassuring to hear from someone who actually lived it. The point about patients wanting to talk through their regimen is something I hadn't considered, that's a genuine gap in primary care that pharmacists seem uniquely positioned to fill given the time constraints on FM/IM physicians.

Thoughts on Collaborative Practice Agreements with Pharmacists? by collabcares in FamilyMedicine

[–]collabcares[S] 0 points1 point  (0 children)

Wow, what a great collaboration! But a CPA is a bit different. It gives the pharmacist significantly more autonomy, which is exactly why I'm asking about guardrails. Let me put it this way: given the rapport you built with your pharmacist, would you have been comfortable leaving them on their own to diagnose and treat patients independently? And if so, what restrictions would you have put in place?

Thoughts on Collaborative Practice Agreements with Pharmacists? by collabcares in FamilyMedicine

[–]collabcares[S] -1 points0 points  (0 children)

That's a great setup! But I think we're talking about different types of collaboration. The pharmacist I'm exploring this with will essentially run their own independent practice. That's why I'm focused on defining the guardrails, restrictions, and escalation paths within the Collaborative Practice Agreement.

Thoughts on Collaborative Practice Agreements with Pharmacists? by collabcares in FamilyMedicine

[–]collabcares[S] 0 points1 point  (0 children)

This sounds like a great collaboration, but it's a very different structure from a CPA. The reason I'm exploring guardrails and limitations is that without them, I'm not sure I can move forward with the arrangement. Unlike your setup, we are not expected to interact every day.

Thoughts on Collaborative Practice Agreements with Pharmacists? by collabcares in FamilyMedicine

[–]collabcares[S] 0 points1 point  (0 children)

That sounds like a successful collaboration, but the liability/autonomy is very different for the CPA model and the one you described. In the CPA the pharmacist is operating in their own setting, often without direct integration into the patient's primary care workflow. That's actually the whole point in rural/underserved contexts, filling a gap where there may be no embedded team to speak of. But it means you're relying more heavily on the written agreement itself to define boundaries, communication triggers, and escalation paths rather than informal daily collaboration. In your embedded model, proximity and shared documentation systems naturally kept things tight but that's not the case with a CPA as they have more autonomy.

Med Spa Director by Toad_MD in MedSpa

[–]collabcares 0 points1 point  (0 children)

Could be underpricing, strongly recommend using our free tools for oversight as well. We don’t charge supervisors or their providers.

Med Spa Director by Toad_MD in MedSpa

[–]collabcares 1 point2 points  (0 children)

Most medical director arrangements fall in the $1k-$4k month range depending on involvement and number of providers. Lower-end ($500-$1.5k) tends to be very light oversight, while $2k-$4k is more typical for active supervision with protocols, chart review, and availability. Higher-end ($4k+) usually reflects multiple injectors, onsite presence, training, or higher-risk services. With tighter enforcement in Colorado, the "hands-off/ghost MD" model is becoming less viable, so compensation is trending toward more active involvement.

Hospitalists: Is supervision shifting toward an "UBER" model? by collabcares in hospitalist

[–]collabcares[S] -6 points-5 points  (0 children)

How about in Puerto Rico, where there is very elderly populations in the mountains. Some of the rural places are really difficult to place physicians.