NP Commission Pay

[npjuju]

I am looking for advice as a new grad NP who is searching for work. As it seems that the market is hot for NPs during my job search, I often come across salary-based positions with benefits. I am considering a position that is solely commission based in a primary care practice. I would prospectively earn 45% of everything I bill, and that is without any benefit package. I value that the position would offer me mentoring under the leading physician. I have tried researching a solely commission based position but cannot find much information. I would appreciate any insight anyone may have on this offer. Thank you for your time and input in advanced.

[Oldmahubbard]

This used to be called "split billing" and there was some question back in the day about the legality. Every state is probably different.

Looking at the big picture, the average NP probably brings in 300k and gets paid 100k, sometimes less. This may be with benefits, of course. That is 33% in round figures.

What I am seeing here is that your employer is taking zero chance on you. You will not get a nickel you don't earn. As it should be.

Before you all scream at me for being a horrible capitalist, some providers never earn their keep. They get paid a reasonable salary for doing a reasonable amount of work, and they don't keep up their end of the bargain. I have seen this happen several times.

It is sad. The employer takes the brunt until they can get rid of the person. I have seen employer do back flips trying to help people that will never catch on. More than once.

If they are in a group practice, other people are essentially paying their salary out of the goodness of their heart.

My perspective as a colleague, helping to cover the salaries of non-producers for years.

Life has an ugly side.

[Jules A, MSN]

Probably depends on the geographic area and specialty but this sounds very low. Around here psych NPs are getting 80-90%.

[Oldmahubbard]

Probably depends on the geographic area and specialty but this sounds very low. Around here psych NPs are getting 80-90%.

Serious? of the billing? Wow. I thought I was doing fabulous, way above average, at around 70%.

How can any employer pay you 80-90% of your billing, pay you benefits however minimal, pay the secretary, keep the lights on and make any profit?

or even a physician for that matter?

OK, Jules, I seriously question these numbers.

[Jules A, MSN]

Serious? of the billing? Wow. I thought I was doing fabulous, way above average, at around 70%.

How can any employer pay you 80-90% of your billing, pay you benefits however minimal, pay the secretary, keep the lights on and make any profit?

or even a physician for that matter?

OK, Jules, I seriously question these numbers.

How many therapists do you keep employed? The money isn't being made on the prescribers. No benefits its contractual.

[Oldmahubbard]

Interesting. Nice for you, even without benefits!

[djmatte, ADN, MSN, RN, NP]

The only concern I'd have is being both a new grad and new employee. This works against you from two avenues.... Establishing yourself as a competent and efficient provider as well as building your own practice and patient load. When I started, my patient numbers took time to build. Slow at first to acclimate to a new position, but also once I told my employer I was clear to bust open the doors the patient load was still seeing 9 patients per day. My own practice wasn't built up enough and there were many patients who preferred to stay with specific providers. I'm now pushing the 15 patient mark 6 months deep and some days see up to 20. But this isn't a fault of mine as I reschedule as many patients as I can justify. Fault lies in scheduling or the simple economics of patient acquisition. So I'd say pass on this structure as a new grad. Build your own skills first before risking your income. Maybe consider it once you've worked in a place for a year so you have some form of patient continuity.

[Jules A, MSN]

The only concern I'd have is being both a new grad and new employee. This works against you from two avenues.... Establishing yourself as a competent and efficient provider as well as building your own practice and patient load. When I started, my patient numbers took time to build.

You make good points but I think it depends on the practice and the new grad. Back in the day there was no such thing as ramp up time. NPs were expected to start for a full salary with a full load. The practice I joined as a new grad had a wait list of patients so my docket was full from day one. If OP has concerns about their income they should ask if it will take time for referrals to build up or will they have a full load ready due to a provider leaving or patient wait list.

[djmatte, ADN, MSN, RN, NP]

I don't disagree that it is practice dependent. But we go on and on here about the quality of nursing education and the reality that brew NPs aren't prepared well enough. We also frequently hit home with new grads to try their best to go slow and ensure there's a ramp up because (like your case) NPs were traditionally thrown to the wolves. Do we really want to endorse the idea that a new NP should be able to just hit the ground running with a load that dictates their entire livelihood right out the gate? Especially when we readily acknowledge that education centers are regularly failing their students?

[Jules A, MSN]

I don't disagree that it is practice dependent. But we go on and on here about the quality of nursing education and the reality that brew NPs aren't prepared well enough. We also frequently hit home with new grads to try their best to go slow and ensure there's a ramp up because (like your case) NPs were traditionally thrown to the wolves. Do we really want to endorse the idea that a new NP should be able to just hit the ground running with a load that dictates their entire livelihood right out the gate? Especially when we readily acknowledge that education centers are regularly failing their students?

So I didn't consider it "being thrown to the wolves" and while I agree with much of what you say how awful that instead of insisting we are sufficiently trained to work to our full scope upon board certification you are pointing out the need for new NPs to be put on the idiot program. Again not really disagreeing but more wishing that accepting the dumbing down of our profession wasn't a necessity.

[djmatte, ADN, MSN, RN, NP]

I don't know if I'd call it dumbing down. I think it's dealing with reality. A newly minted physician couldn't work a full load out the gate. Sure they are capable of practicing medicine. But they're expected to finish residency to really hone their skills and practice. NPs don't have the luxury of that setup and shouldn't be held to that standard.

[Jules A, MSN]

I don't know if I'd call it dumbing down. I think it's dealing with reality. A newly minted physician couldn't work a full load out the gate. Sure they are capable of practicing medicine. But they're expected to finish residency to really hone their skills and practice. NPs don't have the luxury of that setup and shouldn't be held to that standard.

I guess it is the reality but accepting an unacceptable reality is lame. All of the physicians I have worked with after residency, while green, are ready to take on a full patient load. Again how sad that being adequately trained to practice before we are in the workplace attempting to practice is considered a "luxury".