HELP Accepting DERM NP offer!

Specialties NP

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Hello everyone,

So I wanted to get other NP's opinion on this potential job offer. So I just got finished with an interview for a Dermatology NP position. The interview went great, where he pretty much said I'd get the job as long as I accepted.

Some background about myself, I recently graduated with my FNP in December and I'm waiting to sit for my Board Certification Exam hopefully some time by the end of this month.

He briefly went through what my training would be like and what a rough draft on salary would look like. Training with be roughly 4 months, consisting of following another Derm NP and didactic portion of reading books and studying PowerPoints of his.

Salary would be around $60,000 for the first 6 months (4 of which would be the training period), then after 6 months I'd get bumped up to around $75,000. I would stay at this level until I'm able to bill at least $200,000 to the practice, which my salary would then be increased to $90-100,000 (he said most likely $100,000) + Productivity incentive. He would equate the productivity bonus + salary to total approximately 25% of what I bill.

Example: If I bill $400,000, 25% of 400,000 = $100,000. So no productivity bonus

If I bill $600,000, 25% of 600,000 = $150,000. So Base salary of $100,000 + $50,000 of incentive.

I'm not sure what a typical Derm NP would bill on average. He mentioned the NPs at the office will see around 40-50 patients a day once they're established.

Although this isn't an official offer/contract, I just wanted to know if this type of salary structure/layout is worth it. My main concern is I'm not too familiar with billing (being a new grad and all..) and can't gauge how many patients I would need to see to bill "X" amount.

The practice also does small surgical procedures as well as biopsies, if that helps. To give a geographical reference, new grad NP's in my state make anywhere from $75,000-$100,000 depending on specialty.

Thoughts?

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Also if it helps, he mentioned $1000 towards CME, 4 weeks vacation, and malpractice coverage.

Health insurance was mentioned but he did not know the details of it. Unsure about 401k.

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Is this offer with DermOne? Considering the training you get, the low intro offer doesn't sound terrible. 4 weeks vaca and the cme are also reasonable. I'm not sure how long it would take you to get to the 200k billing level. How long is your contract? Can you speak to other providers who already work there and can give you insight? Also, 40+ pt/day does sound like a lot, especially for a new provider!!! I thought about going into derm but it never happened. Right now I'm in Occ Med and I see approx 20 pts/day.

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Normally, I would have knocked this deal because I don't like the money. But it's worth considering since it involves receiving specialty training---which isn't easy to get as a new grad these days. BUT, the training is for 4 months so why does he want to keep you at $60k for 2 additional months before increasing it to the $75k? Derm specialty services aren't cheap, and if you're going to be seeing 50 patients a day you're not going to have any problems with billing much more than $200k a year for this practice.

I would max practice expenses at 50%. I think that he could do better than that 25% that he's offering, but as long as what he's paying you is within the local market range then I suppose it's an acceptable sacrifice to make in exchange for the experience that you're going to get. Make sure that the contract is for one year only and that it doesn't include a non-compete clause. After you've done your year, if better opportunities call you can simply move on.

Congratulations, and good luck!

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I would consider it. derm is great background to have under your belt. One thing I would question is whether the training consist of full time in office training PLUS the reading/studying which means you'll be at the 60k rate for 6 months and working more than full time. If it requires you to do so I would try to negotiate for something a little better starting out. If all of the training is done at the office within your 40-hours a week...I would consider it. I mean, I made 60k as a brand new graduate my first year with little to no overtime. New NPs shouldn't be expected to start at the same rate.

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The training would be me shadowing one of their NPs for 4/5 days. The 5th day would be me meeting with the MD and going over things. The readings would be throughout the week and to be done on my own. The commitment is 4 years unfortunately...I suppose he doesn't want to invest in training me and having me run off after 1-2 years (which is understandable). 4 years is a loooonnngggg time though.

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Yes @NJprisonRN it's DermOne. The reviews I've read about them aren't amazing...

Have you heard anything about them?

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Specializes in Urology.

Here is a big question that popped into my head when reading your offer. If you are going to see 40-50 patients a day, how long do you think it will take to see that many patients? Even if you could somehow manage to see one patient every 10 minutes (which is probably impossible with documentation), that is 7 hours of non-stop running (@40 patients). I would assume it would leave you around 10-12 hour days to see that many patients, combine that with your 4 year commitment. Is that something you want to do everyday? Do you have a family? Pay is another story but I know this varies on area greatly.

Something to think about if you value sanity or have a family that you actually want to spend time with!

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If you are going to see 40-50 patients a day, how long do you think it will take to see that many patients?

In clinical derm, one could get away with high patient volumes without the type of running up and down and stress that it would most likely causes in many other areas. It depends on the setup and the clientele. Most of the patients usually aren't all that complicated. Except for a few types of situations the visits are quick. This obviously wouldn't work well with the aesthetics stuff because you have to spend more time doing procedures and chatting up the clients while you're upselling them on other treatments and products.

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The commitment is 4 years unfortunately...I suppose he doesn't want to invest in training me and having me run off after 1-2 years (which is understandable). 4 years is a loooonnngggg time though.

Yes, it is a very long time. Even Uncle Sam asks only for a 1 or 2 year commitment after they pay down one's student loans. To be real, the more you post about this job the less attractive it sounds. My personal philosophy on people running off after training and a year or so on a gig is that their leaving usually has more to do with the employers' penchant for underpaying and abusing them than anything else. Unless I really, really, really, (dare I add another intensifier?....yes!) really want to go into derm, and there's nothing else, that is perhaps the reason why I would take this job. Otherwise, I would keep looking. If you do the math you're going to find that this deal works out way more to their advantage than yours.

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Thanks for everyone's input. I decided to not go with the position. For the main reason that the 4 year commitment was way too long and the fact that I didn't need to go into Derm 100000%. I am a new grad and pretty flexible with what specialty to go into.

And to clarify, the amount of patients being seen would lurk more around 40. And yes, @Goldenfox is correct, seeing that high volume in derm is fairly normal. At this practice, the medical assistants do most of the documentation for you, especially if they're more established. Then you just sort of go back and add certain assessments, treatments, and review what the medical assistant did.

Thanks again everyone! I suppose I'll be patient and wait for the right opportunity to come!

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Sorry, I missed a lot of this thread d/t a crazy week. But I have heard similar things about this company. Wow, 4 years!!! That would be a deal breaker for me. Too bad, because deem is such a great field. I love the idea of the ma doing the main documentation. That's my main time constraint! Well, good luck to you.

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