New grad, First NP at clinic

[missdeevah, NP]

I'm a new FNP grad, with an offer from a physician-owned group in Texas...family practice....they also do minor procedures. Being that I would be the first NP they hire (will be a new clinic with 4 providers...2 of them, current docs at the group, then me, and one other provider), what are some things I should ask for? They told me to make a list. So far they are offering

- 2 weeks off for the first 5 years, then 3 weeks the following year. The office manager said, "this is what we get." I have a feeling this is not what the providers get. I plan on asking for more, but how much more?

- $1500 CME and 5 days. I suggested the $1500, but wondering if I should ask for more? Maybe similar to what the doc's might get?

- DEA, licensure renewal, malpractice, 401 K (not sure how much they match yet), health, dental, vision.

- 90,000 base + RVU bonus. I'm asking about the structure today.

- Current on call is every 20 weeks.

- 2 months or more to build up to speed. They sound like they don't have a fixed # of pts per day they expect me to see, but rather to focus on quality of care. Will be a patient centered medical home model.

- They have a patient teaching room, and they would like me to take part in this...how does this affect my ability to meet bonus RVUs 8f it's taking away from pt time?

- Should I ask about buy in options (into the practice). They currently have 11 providers.

Any other considerations? Should I ask for student loan repayment? They told me that I have a blank slate to work with...mine to put whatever I want on. I'm expecting the offer letter this week. The office manager just told me the highlights as the letter was not signed yet.

[broughden]

- 2 weeks off for the first 5 years, then 3 weeks the following year. The office manager said, "this is what we get." I have a feeling this is not what the providers get. I plan on asking for more, but how much more?

3 weeks for the first 5 years, increasing to 4 weeks after that. All unused time is bankable up to 60 days.

Any time the office is closed due to national holidays does not count against vacation time.

[Jules A, MSN]

- $1500 CME and 5 days. I suggested the $1500, but wondering if I should ask for more? Maybe similar to what the doc's might get?

This will be delicate and while I appreciate their inclusion of you I suspect they anticipate you will be nurse silly rather than business savvy. Be very careful about putting something out like the above and attempting to sweeten the pie, it looks bad.

Before you say another word I would ask for a blank copy of the standard physicians' contract. Everything except the rate should be equal and you are correct teaching hours will drive down your RVUs unless they adjust for it. It is also in my opinion a waste of money, why can't a RN do it? and minimizes your role, not saying that is their intention but it is the result. I would decline and educate them your time is better used for billable activities.

[missdeevah, NP]

This will be delicate and while I appreciate their inclusion of you I suspect they anticipate you will be nurse silly rather than business savvy. Be very careful about putting something out like the above and attempting to sweeten the pie, it looks bad.

Before you say another word I would ask for a blank copy of the standard physicians' contract. Everything except the rate should be equal and you are correct teaching hours will drive down your RVUs unless they adjust for it. It is also in my opinion a waste of money, why can't a RN do it? and minimizes your role, not saying that is their intention but it is the result. I would decline and educate them your time is better used for billable activities.

- Noted, with regards to RVUs.

- Thanks for the suggestion about a blank physician contract. It hadn't occured to me to do that. This should help a lot, especially considering that they don't have experience with hiring an NP.

Thanks Jules! I highly respect and appreciate your opinion when it comes to contract negotiation. I've learned a lot from you from lurking during my NP program.

[ggoodman]

This will be delicate and while I appreciate their inclusion of you I suspect they anticipate you will be nurse silly rather than business savvy. Be very careful about putting something out like the above and attempting to sweeten the pie, it looks bad.

Before you say another word I would ask for a blank copy of the standard physicians' contract. Everything except the rate should be equal and you are correct teaching hours will drive down your RVUs unless they adjust for it. It is also in my opinion a waste of money, why can't a RN do it? and minimizes your role, not saying that is their intention but it is the result. I would decline and educate them your time is better used for billable activities.

Thank you for posting information like this I am a year out from finishing but I believe that the pay in my area is so wide spread due to negotiating ability. We are not informed about physician pay structures in school hence we do not know how to negotiate appropriately.

[Jules A, MSN]

Thank you for posting information like this I am a year out from finishing but I believe that the pay in my area is so wide spread due to negotiating ability. We are not informed about physician pay structures in school hence we do not know how to negotiate appropriately.

Most important of all is that we discuss our salary with colleagues. Not sharing that information only serves the employers and I don't want someone new coming in driving the rate down. I strongly suspect the people who act as if this offends their sensibilities are working for pennies on the dollar.

[missdeevah, NP]

Update. I asked for a blank copy of new physician contracts. I got this email back:

"There is no contract for you to review. The only contracts we have are with physician shareholders. They are the owners of the company and therefore it would not apply to staff."

What I gathered is that after 2 years, the physicians can buy into the company, so I'm assuming that this is what she's referring to. Does this mean that new physicians who are not yet shareholders don't have contracts?í ¾í´”

[Jules A, MSN]

That is unfortunate. You will have to get in contact with the local heavy hitter NPs in your area. Find out their salaries, benefits and use that data when you present your proposal. What have other places offered you? If this is your only offer you really should be shopping because the offers will stack on each other.

I wouldn't play around and would require a sweet deal. Being the first NP, as I have been, has its pluses and minuses. You will need business acumen or they will take advantage be it willingly or knowingly but either way is not acceptable.

[inthecosmos, BSN, MSN, RN, APRN]

I would love to hear the conclusion to this.

[traumaRUs, MSN, APRN]

I have to add that I do patient education in conjunction with a visit for CKD patients. In my case, it is actually billable under CMS rules. Also, billable is a once per year review of their code status and advanced care planning and signing of the POLST form.

[Jules A, MSN]

I have to add that I do patient education in conjunction with a visit for CKD patients. In my case, it is actually billable under CMS rules. Also, billable is a once per year review of their code status and advanced care planning and signing of the POLST form.

Thanks for adding this, I forget psych isn't the only game in town. :) In psychiatry we have to be careful we aren't billing for things such as therapy that our therapists then can't bill for simultaneously for and in general things that aren't diagnosing and prescribing are billable at very low rates making it a waste of our billable hours.