New Grad NP: 5 year contract with monetary prepayment if canceled early

[cowgrlnurse]

I have been offered my first NP contract. It seems like a really reasonable offer and compensation for my area, and I would not have to relocate (YAY!). The only thing that I am unsure of is there is a 5 year commitment with a monetary repayment if I should leave before the 60 months is up. This repayment is broken down by length.

It sounded like they have taken on new grads before. Invested time and money (which I can understand, it is expensive to take on a new grad, pay them a competitive wage from the get go, and them not be seeing enough patients to pay their overhead to begin with) and they leave after 2-3 years.

I know that for them to justify the expense I need to x number of patients to cover my overhead. So understanding that, it is really unreasonable for them to want a longer commitment?

On thing I am really liking about this company is it is provider owned and the main doc (who I interviewed with) explained a very comprehensive orientation process. So it would take time away from their productivity to give me a solid foundation. He explained that it was 6 months solid with 1:1 with another provider. Then if I wanted, or we all decided I needed more we could extend that up to a year. The first year all my charts would be reviewed as well to ensure that I was providing the best care and billing appropriately.

I have a few friends that work for this company and they really like their job. There is little turnover from a support staff standpoint. I also do not know if them losing providers often, so I was very surprised to get a call, let alone an offer from them. I also know that there was talk of in 2-3 years of expanding their offices to some of our rural surrounding towns, one of which being where I live. So that is also appealing to me as I would love to be able to provide medical care to our little ranching town.

Sorry for the long post, I suppose each individual has to weigh the pros and cons, but I was just looking for some insight and advice on the commitment and repayment, if others had experience with practices wanting this as well.

Thanks in advance!

[orangepink, NP]

I don't blame hospitals / companies for those kinds of contracts. Some new grad NPs are very flighty. I knew this one NP who changed 4-5 jobs in 1-2 year since he graduated.

[Jules A, MSN]

At first I was like no way but your post added some positives to taking this job that might make it worth negotiating especially that you know others who work there and enjoy it. However some of it didn't make sense to me. I mean really who wants to work work 1:1 with another provider for an additional 6 months after graduation? And call me skeptical but I can not believe for one minute an employer would pay you a full salary for a 6 month orientation with a chance to extend so if you are counting on that as with everything make sure it is spelled out in writing. I'd also have a lawyer review it especially if there is a non compete clause. Good luck.

[Conqueror+, BSN, RN]

I am not an NP yet but I have worked as a travel nurse and negotiated a lot of contracts. Five years is a LONG time if things are not as they seem. I am not sure why you would even need 6 months of 1:1 and 100% chart review. My gut reaction when reading about your offer is that it is a trap that somehow benefits your potential employer. The problem is that once you figure it out it is too late. If you truly want the job and they are scarce in your area, try renegotiating the length. Congrats on the offer.

[Goldenfox]

it is really unreasonable for them to want a longer commitment?

That depends on what they are paying you, what kind of benefits you are getting, the volume of the practice, and how many (and the type of) patients you see on average each day.

My take is that, for a brand new NP, it takes at least several months to get into the routine (learning the patients, the EHR, the protocols, etc.). You will start off slow (only a few patients a day) but once you get the routine down and your confidence builds up you will be seeing a lot more of them daily. Most NPs get up to speed somewhere between the first 6 months up to a year. After that, they are making good money off you. Nothing wrong with that ---as long as you are also making good money and benefits for yourself.

There may be something that they're not telling you. That they keep losing their NP staff after a couple of years and that they have to be trying to hook people with a 5-year contract is not unimportant. They probably have a non compete clause in the contract too. I know of a company like this in my home state of Florida and they are always hiring because the pay is low and they don't treat the NPs well, so people leave as soon as they find better jobs.

Research them carefully before making your decision. If it sucks you will be stuck there for 5 years.

[JellyDonut]

I would want to speak to another NP with the practice preferably on who has started new and been there about two years to get the skinny. Also 6 months 1:1 is way too long. three months seems more reasonable and allows credentialing. With the 5 year contract are you getting a sign on bonus? Are the rest of the benefits good (vacation, CME, insurance)? Does it outline annual increases in salary? noncompete clause?

Five years is great if you love the position, but I know many new grads where it took a few jobs to find the best fit.

[Goldenfox]

I don't blame hospitals / companies for those kinds of contracts. Some new grad NPs are very flighty. I knew this one NP who changed 4-5 jobs in 1-2 year since he graduated.

"Those kinds of contracts" are usually not too respectful of us or our profession, and to simply accede to them may be telling that we don't respect ourselves or our profession all that much either. Many of these types of terms that these organizations impose on nurses and nurse practitioners are not usually imposed on new hire physicians. One guess as to why!

Do you know exactly the circumstances under which that NP you are referring to changed jobs? Perhaps they were all so bad that he just couldn't stand working at them. Maybe they lied to him about the position before he accepted those jobs. Maybe they didn't treat him with respect. Whole lot of possibilities there...and many of us have experienced such situations before we landed into the right position. Some of us are still experiencing such situations right now.

[YoutubeTheNP]

what kind of job/specialty are you taking? A lot can happen in 5 years, life, kids, relocation, etc; it's longer than a military contract!! Does your contract increase your salary with each year? Does it offer CME/ health/ 401 and other benefits? What if you hate the job or one of the docs, then how much will you have to PAY them for leaving??

[cowgrlnurse]

To the best of my knowledge from asking around the other providers who have left have been physicians and PAs. They only have one NP who has been there 7+ years. The providers who have left it seems is due to being transplants to the area and realizing there is nothing here. I know one of the docs who just left is going back east where her grandchildren are.

There is no noncompete clause.

I do have a lawyer friend of mine looking at it.

The other benefits are very reasonable and well within the norm (401k, health, HRA, vacation, CME, licensing and credentialing, wRVU bonus, etc) . The base salary is within reason as well. Yes it do get that pay while orienting. The 1:1 he said is there for me. If I am able to see and be comfortable with patients and increased load then by all means I can. He won't have me start until all my credentialing and such is done that way I am able to be fully independent.

Beyond the length everything else seems pretty good from that I gather. There is nothing mentioned about pay increase annually, so I do want to try and negotiate for that.

I agree and do not blame places for wanting contracts. It is quite an investment to take on a new provider and a new grad.

Thank you all for the input! I appreciate the responses!