Four options, four units of payment
A per diem shift pays for a block of clinical labour, usually eight to twelve hours, at an hourly clinical wage. A telehealth panel pays per visit or per hour logged, with volume you do not fully control. Adjunct teaching pays a fixed sum per course for a semester, no matter how many hours the course consumes. Precepting pays for each hour a student spends learning beside you.
That last unit is the one people misread. You are not paid for a shift, a visit or a course. You are paid for measured student time, at a figure you choose between twelve and twenty dollars an hour, half of it after the midpoint evaluation and the rest after the final. A standard block of 120 hours is the usual size, and 60-hour half-blocks exist for tighter schedules.
The comparison that matters is marginal, not gross
Per diem work pays the highest hourly figure of the four, and it should, because you are seeing patients and carrying the risk. No teaching arrangement competes with a clinical wage per hour, and anyone telling you otherwise is selling something. If your goal is maximum income from a free Saturday, take the shift.
Precepting works differently. The hours you give a student are hours you are already in clinic and already being paid for by your employer. The teaching fee sits on top of that, for the same eight hours. What it costs is throughput rather than time: roughly a patient per hour early on, and very little of that by week four. That is the honest trade.
- Per diem: highest pay per hour, but every hour is a new hour away from home.
- Telehealth panel: moderate pay, flexible blocks, income that moves with patient volume.
- Adjunct teaching: a fixed sum per course, and the course decides how long it takes.
- Precepting: teaching income layered onto clinic days you already committed to.
Who controls the calendar
Per diem gives you the choice of shifts and no choice inside them. Once you pick up Saturday, Saturday is gone, and popular shifts are claimed early. Telehealth panels offer the finest control, sometimes down to two-hour blocks, at the cost of income that rises and falls with demand. Adjunct work looks flexible until the third week, when grading deadlines arrive on the university's calendar rather than yours.
Precepting sits in the middle and behaves predictably. You name the days, you name the weeks you are away, and a rotation lasts one academic term before you decide again. A holiday in the middle is planned around rather than apologised for, and the scheduling page explains how blackout weeks are handled. Declining a student costs you nothing at all.
Setup time, which nobody counts and everybody pays
Credentialing for a per diem post takes weeks: applications, references, payer enrolment, sometimes a hospital privileging committee. A telehealth panel wants licences in each state you cover, platform training and often a background check. An adjunct appointment goes through university human resources plus a faculty appointment process, and can take a full semester to complete before you teach anything.
Precepting is the lightest of the four. You send a CV, a licence, a certification card and a description of your practice, and somebody else negotiates the school agreement with whoever owns your practice. Add a 90-minute orientation before your first student. From application to a signed placement is usually about three weeks, and the paperwork page lists what gets signed.
Whether it stacks with a full-time post
It stacks better than the other three, because it does not compete for the same hours. Your employer keeps its schedule, you keep your salary, and the teaching fee is separate income for work done inside those days. Two things to check before you say yes. Your employment agreement, for any clause covering outside professional work. And your practice's willingness to sign an affiliation agreement with a school, which most practices do readily.
Be realistic about capacity in the first year. One student a term is plenty. Two at once is a mistake most people make only once, because the second student halves the attention each one gets and doubles the documentation you review. If you want teaching income without a clinical schedule at all, education and leadership practica are the version that needs no patients.
In order
- 01
Count the hours you actually have free
Not aspirational hours. The ones that exist after the job, the commute and the family.
- 02
Price each option per hour you must give up
A per diem hour costs a free hour. A precepting hour costs throughput on a day you were working anyway.
- 03
Add the first-year setup
Credentialing, licences, platform training or faculty appointment. Some of it takes a whole term.
- 04
Read your employment agreement
Look for outside-work clauses. Teaching is rarely restricted, but read it once rather than assuming.
- 05
Start with the smallest version
One half-block, sixty hours, one term. Decide about the next one when that one ends.
If the maths works on your own clinic day, open your hours and start with a single half-block.
Apply to preceptQuestions
Is precepting a good part-time job for a nurse practitioner?
It is good part-time income and a poor substitute for a part-time clinical post. The fee is paid for teaching during hours you already work, so it adds money without adding shifts. If you need to replace a salary, per diem or a telehealth panel will do it faster. If you want to earn more from the days you already give, precepting is the efficient choice.
Does precepting pay as much as a per diem shift?
No, and it is not trying to. Per diem pays a clinical wage for clinical work you perform yourself. Precepting pays a teaching rate for hours a student spends with you, which is a different unit and a lower one. The gain is that those hours were already on your schedule, so nothing new is subtracted from your week.
Can I precept while working full-time?
Most preceptors do exactly that. A standard rotation works out to eight or nine hours weekly across a term, which fits inside one regular clinic day. Nothing is added to your working week. Check your employment agreement for outside-work language first, and confirm your practice will sign an agreement with the school.
How much of my week does a rotation take?
One clinical day, plus about fifteen minutes of feedback at the end of each session and a few minutes weekly to confirm the student's hour log. Two evaluation forms fall due across the term, one at the midpoint and one at the end. Each takes twenty minutes and there is nothing else to prepare.
Which part-time option has the lowest setup burden?
Precepting, by a distance. Four documents, an orientation of ninety minutes, and an agreement somebody else negotiates. Per diem credentialing and telehealth licensure both take longer and involve more of your own paperwork. Adjunct teaching is the slowest, because a faculty appointment moves at a university's pace.
