finally, a job offer worth asking you all about

[aprnjen05]

So after many years as a CNA, LPN, RN, and now APRN for less than 5 years, I have a job offer to write home about.

I've had 4 jobs in 4 years. 3 of which lasted less than 6 months.

I've been at my current job 6 months next week. I found out a few weeks ago I'm going to be asked to work weekends and holidays.

A week before this bombshell, a doc who trained at my hospital while I was in the ICU as an RN called and asked me to come be his aprn.

This would be the first job where I would have a seat at the table reviewing practice business, financial information, RVUs, and be responsible for making my salary and being profitable.

I'm awaiting my 3rd interview with the office staff and PA who currently works there.

After meeting with the practice business manager last week, I am being offered slightly less than my requested salary (which admittedly was very high for this market), but with the opportunity for incentives.

I have never been offered incentives. I'm not sure how to negotiate. One of the men said "if we have 100 practitioners we do incentives 115 different ways." I would like to use this to make my desired salary. I'm nervous about productivity as this is a new specialty for me. The doc will train me hands on, but I'm looking at not being able to bill independently for about 3 months until credentialling goes through.

What should I ask for? Some websites say RVUs, but not how many or how it would be paid. I'm anticipating seeing 10-25 patients 4 days a week. I can also see new patients. My initial thought was once I am independent and able to bill, to see 2-3 new patients a day and 10-13 follow ups. I want to make sure I'm making the practice money since I asked for a high salary.

Help!!!!!! This is my first opportunity since graduating NP school to actually practice as a provider, bill under my name, and maybe be incentivized. It sounds like a great opportunity. I'm hesitant to leave my job with 6 months (another 6 month job) but this sounds like it could be "the one."

[PG2018]

So after many years as a CNA, LPN, RN, and now APRN for less than 5 years, I have a job offer to write home about.

I've had 4 jobs in 4 years. 3 of which lasted less than 6 months.

I've been at my current job 6 months next week. I found out a few weeks ago I'm going to be asked to work weekends and holidays.

A week before this bombshell, a doc who trained at my hospital while I was in the ICU as an RN called and asked me to come be his aprn.

This would be the first job where I would have a seat at the table reviewing practice business, financial information, RVUs, and be responsible for making my salary and being profitable.

I'm awaiting my 3rd interview with the office staff and PA who currently works there.

After meeting with the practice business manager last week, I am being offered slightly less than my requested salary (which admittedly was very high for this market), but with the opportunity for incentives.

I have never been offered incentives. I'm not sure how to negotiate. One of the men said "if we have 100 practitioners we do incentives 115 different ways." I would like to use this to make my desired salary. I'm nervous about productivity as this is a new specialty for me. The doc will train me hands on, but I'm looking at not being able to bill independently for about 3 months until credentialling goes through.

What should I ask for? Some websites say RVUs, but not how many or how it would be paid. I'm anticipating seeing 10-25 patients 4 days a week. I can also see new patients. My initial thought was once I am independent and able to bill, to see 2-3 new patients a day and 10-13 follow ups. I want to make sure I'm making the practice money since I asked for a high salary.

Help!!!!!! This is my first opportunity since graduating NP school to actually practice as a provider, bill under my name, and maybe be incentivized. It sounds like a great opportunity. I'm hesitant to leave my job with 6 months (another 6 month job) but this sounds like it could be "the one."

I think RVUs are crap. You want a livable base salary. That's a salary that does not change no matter what you do during the day. However, in addition to this, you also want bonuses. You can research RVUs to your heart's content. I really recommend MedicalEconomics.ModernMedicine.com and American Academy of Family Physicians. Both of these "publications" have good but concise detail regarding this area.

Instead of relative value units, I think you should hold out for a stake in the revenue, i.e. negotiate a percentage of revenue in excess of salary. I made 80% of revenue beyond salary, yet my salary is excellent. Bonus is paid a month in arrears. For example, I got my July bonus a few days ago. In a clinic, I'd expect at least 20 patients a day+. You want some control over your schedule, i.e. how many you see and when. Your decision might be one patient every 15 minutes or "no more than 30 a day," no one after 5:30, nothing before 8:30, lunches scheduled, etc. Call schedule will be critical for you as well as rounding.

Regarding your hopes to make a lot of money. That's good, and that's what I want to hear NPs. The clinic wants this too, and if you ask for % of revenue then you get even more pie. However, it's a business. They know you won't have an immediate patient base and may only see walk-ins for a while or patients that don't like the PA or doc. You're an asset now so conduct yourself like one! :)

[Jules A, MSN]

First congratulations!

I have worked for RVUs at a very busy hospital and made good money. They made me an offer based on a certain dollar amount per RVU and I translated that into how many RVUs equaled initial evals and med checks so I had an idea of how much I was making which was roughly $80 an hour based on the time it took me to do those encounters.

Like Psychguy said definitely set your schedule and establish boundaries immediately so you can be the most productive. You are not there to be a glorified RN, tech or secretary. The clinic will be happy that you are focused productivity and should provide you with whatever support systems you need to ensure you can crank out the most patient encounters. 80% as a rate if you are paid by what you bill is a very good deal, imo, although if you are able to get a contract like Psychguy's that sounds even better because the money is the same but you are guaranteed a base salary.

A word of caution is that if the thought of working weekends and holidays is a "bombshell" I would definitely clarify the hospitals expectations because we all do them as well as call at all the hospitals where I have worked. Something that I have noticed and a reason I'm guessing that so many NPs make crappy salaries is the desire to work M-F. All the physicians I know who work in hospitals and make the major bucks work their butts off.