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.

[djmatte, ADN, MSN, RN, NP]

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 on the work place attempting to practice is considered a "luxury".

True. But I don't consider a NP fresh out of school near comparable. That's why I advocate for mandatory residencies. An np with a 1-2 year active residency could easily operate to the top of (or close to) their game out the gate. It's not like an md fresh out of med school could work effectively (even though they're legally "doctors". Sure they can prescribe and manage care. But nowhere near the level as a residency trained physician.

[Jules A, MSN]

True. But I don't consider a NP fresh out of school near comparable. .

I think we are saying the same thing but disagree on the expectation upon board certification? :)

I believe new grads NPs absolutely SHOULD be comparable to a residency trained physician with regard to being able to function to the full scope of our certification. Not that our education will ever be on a physician's level, which was never the intent, but saying we are ready to work independently but are deficient and thats expected just isn't acceptable, imo. If that means mandatory residencies, I'm all for it.

Thanks for engaging with me, I find this to be an interesting and important conversation.

[djmatte, ADN, MSN, RN, NP]

I think we are saying the same thing but disagree on the expectation upon board certification? :)

I believe new grads NPs absolutely SHOULD be comparable to a residency trained physician with regard to being able to function to the full scope of our certification. Not that our education will ever be on a physician's level, which was never the intent, but saying we are ready to work independently but are deficient and thats expected just isn't acceptable, imo. If that means mandatory residencies, I'm all for it.

Thanks for engaging with me, I find this to be an interesting and important conversation.

Absolutely. Though I would contest that new NPs are entering a role as a provider they never experienced before outside of clinical rotations. A board certified physician had years after med school to practice and hone skills that are largely new to the NP outside of the education environment. And yes those clinical hours in many are not enough, I can't help but feel any number of clinical hours really doesn't prepare you until you are there in the flesh and your license and patient safety is on the line.

[WVFNP, MSN, APRN]

I do think it depends on what your practice will look like. Will you have your own patients, or will you be seeing walk-ins and taking some of the burden off of the other providers when needed. The other posters have mentioned a ramp up time. While i felt capable out of school, the number of patients looking for a new provider just weren't there where I practice. That being said, I do all the above. I see our walk-ins, have my own patients, and help out the MD I work with if she has a busy day, has to go round, etc. I have a base salary with a WRVU goal. Once I reach said goal, I get roughly $35 dollars per WRVU that I accrue. For example, a CPT code of 99213 gives a WRVU rating of 0.97. So, if I have met my monthly WRVU goal, then I would get roughly $33 for that visit.

I hope you're still following me. With this, I also get a regular salary. My WRVU goal is actually achievable, and I get a print out of all of my numbers for each month (I also keep track myself). Some months I am above my goal, other months I'm below. These "bonuses" are paid out quarterly. I really like this structure because I have a base salary, that of course does not change, with the potential to make more based on production. Being a new provider to my area, this is ideal for me. If I don't reach my goal, my salary is still there. If I do reach my goal, he it's just profit from there on. Also, by having all of these numbers available, I have tools to use when my next contract negotiation comes up.

I hope this helps somewhat. I like production, and I have colleagues that work on pure production alone. However, as a new provider, it's going to take time to build up your own patients. So, in my opinion, I would try for a similar structure as I outlined above, with a renegotiation after 1 year. Just my two cents.