New grad first job

Trauma Columnist · Nov 27, 2015

2 weeks vacation? Most practices I'm familiar with offer 4 weeks the first year, $1500 CME plus a week for CME, completely free health care for you, all licensure costs (including DEA, NPI, etc).

As to the call, gee whiz every other weekend is a lot of call - that means basically you would be working multiple two week stretches.

What about orientation? Are there other APRNs or PAs already in the practice? IMHO its never a good idea to be the first one the doc hires.

sauce · Nov 27, 2015

salaried is a very dangerous word. Sounds like you might be working like 60 hours a week with that schedule. I would be wary. Also, I would wary that he is adding work. He is basically leaving the door open to keep piling work on with no benefit to you.

Junondfnp · Nov 27, 2015

I am the first Arnp he is hiring, also he did not go into detail about how long orientation would be, he only said I should be more than ready in 4 weeks, he wiould give a stipend toward health insurance but I already have health insurance, so I would not qualify for it.

Goldenfox · Nov 27, 2015

I agree that the CME money should be a bit more. Those conferences are not cheap anymore, and the travel and hotel plus add-on conference fees can easily exceed $1000. Two weeks vacation is not enough. Looks like you're going to be working very hard for this doctor so you should ask for more. And how come no sick days? So if you are ill and unable to work any time off that you take is deducted from the already stingy 2 weeks of vacation time? I'm hoping that that was a typo. Are there any productivity bonuses? profit sharing?

You'll be seeing patients in the office all day, and you'll be covering all his patients in two different hospitals, and you'll be taking call every 2 weeks. Yes, this a lot. Especially when you factor in travel time between the hospitals and the office and depending on how many patients you have to see in each hospital. You may be working late a lot to read all the charts and get your documentation done.

I would also ask for more details about the orientation. This is a specialty practice. Specialists manage disease differently than primary care practitioners do so there will be quite a bit of learning to do.

Birthday_Girl · Nov 27, 2015

This is the second new grad post where they reported there were no or very few sick days. Is this common in healthcare? I currently work in a state department and we earn 12 sick days a year plus a minimum of 14 vacation days and two personal days.

TakeTwoAspirin, MSN, RN, APRN · Nov 27, 2015

How many patients does he expect you to see in each of the locations? Will you primarily be office-based, or rounding in two different locations? Will he pay travel expenses? If you are on call a lot, will he provide you with a phone or pay for your phone?

If you are the first NP he has hired, and you are a new NP who doesn't really know a lot about contracts, etc., either you or he (or both) need to buy Carolyn Buppert's book, Nurse Practitioner's Business Practice and Legal Guide so that you can both start with a basic contract that will address all of the issues that generally come up when hiring NPs. Without a well-defined contract framework both of you are liable to be unhappy with whatever may evolve as you figure out what you are supposed to be doing, and he figures out what your role is going to be.

WIBound · Nov 28, 2015

NP programs just don't bother to educate students about contracts and what is realistic. I try to read postings here and speak to working NPs and preceptors. It is so different from practitioner to practitioner. I do get the consensus of the following:

1. PTO minimum of 4 weeks

2. Fees (licensure/DEA etc..) paid by employer

3. CME anywhere from $2000 on up with paid time off to attend

4. Sick days?? I have not inquired much about that

5. Performance bonuses - these can add up quickly, but I need to research more the different types

6. Non-compete. These are bad and do not want any part of that

7. Employer pays insurance

8. Any call or additional duties needs to be outlined in the contract

9. Travel money

10. Increased base after 6 months when you are properly spun up to the position

There is still much I am discovering and being told. I would rather accept less money and have hours and patient loads that allow for a bettie quality of life than work myself ragged for 10-20k more a year.

Also, I am told the benefit packages are far better when working for a hospital -not sure how true that is across the board.

Goldenfox · Nov 28, 2015

NP programs just don't bother to educate students about contracts and what is realistic. I try to read postings here and speak to working NPs and preceptors. It is so different from practitioner to practitioner. I do get the consensus of the following:
1. PTO minimum of 4 weeks
2. Fees (licensure/DEA etc..) paid by employer
3. CME anywhere from $2000 on up with paid time off to attend
4. Sick days?? I have not inquired much about that
5. Performance bonuses - these can add up quickly, but I need to research more the different types
6. Non-compete. These are bad and do not want any part of that
7. Employer pays insurance
8. Any call or additional duties needs to be outlined in the contract
9. Travel money
10. Increased base after 6 months when you are properly spun up to the position
There is still much I am discovering and being told. I would rather accept less money and have hours and patient loads that allow for a bettie quality of life than work myself ragged for 10-20k more a year.

Also, I am told the benefit packages are far better when working for a hospital -not sure how true that is across the board.

My NP school went over all of these things and a whole lot more during our last semester of the program. The way I see it, when you're negotiating as a new grad, know your worth and don't just accept whatever you are offered because you're desperate for a job. Also consider that a job that's paying a higher salary isn't necessarily the one that's going to bring the most satisfaction or the one that puts the most money in your pocket in the long term. During your interview you should ask about the demographics and type of patients that you will be seeing as well as the expected patient volume. You should most definitely ask about orientation and for specifics about how it will be structured and how long it will be.

Even if the job is paying a bit on the lower end, consider whether it is a specialty that you want to gain experience in or if there's something else about it that makes it a good fit for you. And don't be afraid to ask about a base increase and productivity incentives after your orientation is over and you are up to speed. Even though you are making money for these people some of them will not offer these things if you don't ask. Also, ask about loan repayment availability if you have student loans and you're applying somewhere that is either inner city or rural/semi rural. And remember than loan repayment

is a federal program that has nothing to do with what the employer is paying you.

Nothing is written in stone. Whatever you negotiate is valid for the duration of your 1 or 2 year contract. After that, you're not a new grad looking for a first job anymore. Your experience gives you a whole lot more power. If you're into social media, get a professional photo taken and set up a linked in profile. You won't have to go looking for jobs because the recruiters will find you.

Regarding your list, I would say that $1500 or more for CME is reasonable. CME is a tax deductible expense so it doesn't cost employers anything. Whatever they are paying to you as CME money they are writing off with the IRS, still some of them will resist giving you more. Doesn't matter because you can take these deductions yourself on your own 1040, as long as you can provide evidence that the CMEs cost more that what your employer covered. I haven't done it yet, but I know docs and NPs who go on CME cruises every year. Its all deductible.

Sick days, I usually ask for 2 weeks. I usually get 1 week. But I'm not a person who gets sick very often. If I was sickly with some chronic issue I'd buy short-term disability just in case.

Performance bonuses, I always ask for these. I usually get them. It makes a good impression when they see that you're willing to prove yourself. Remember, they're making more money off you than they would be making if they hired a physician to do the job. If you're a good NP and you do the job efficiently it makes sense for them to pay you nice bonuses and to increase your pay to keep you there.

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Non compete clauses, I don't do those. Unless you are a single person with no children and it would not be an issue for you to relocate to another city or state, then no. Draw a line through that whole section with your pen.

Yes, you want full medical insurance benefits.

Most physicians don't like taking call. I don't mind taking call. I would take ALL their calls. BUT, they they would have to pay me very nicely for it. And they would have to pay for my cell phone. And if I am taking call for them at night during the week then they will be seeing my patients in clinic during the AM hours because I will be coming in at noon. That would be the agreement. I have done this in the past. They will take the deal because they want to sleep at night and they like playing golf on the weekends, and they're still making more money than I am.

Junondfnp · Dec 9, 2015

Thank you for all the comments but I chose not to take the job due to lack of support

kdkout, BSN, RN · Dec 11, 2015

Good. I'm glad you didnt - I didnt have a good feeling about it. Neither did you - "I'm afraid this is way too much for me as a new grad"......I'm not an NP but in general you cant go wrong when you listen to your gut! :-) Best Wishes in finding something else....