Nurse Practitioner Contract Negotiation

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Hi everyone,

I have recently passed my AANP exam and I have been offered a job working for a doctor who I have the utmost respect for, and who I have worked alongside for years in the acute care setting. He emailed me a contract that he wants me to consider. I am posting this here to hopefully get advice, guidance, and wisdom from those who have been in similar situations, and understand the value of what I can bring to the table better than I do. I will try to keep the details direct and to the point, but if I leave any pertinent information out, please point it out and I will reply.

Background:

I will be joining a small group consisting of the physician and another NP. am a FNP by trade and the job offer is primarily in the acute care setting, where I will see patients on a general medical floor and a telemetry floor. Eventually, I may see "our" patients in the ICU, but there are usually intensivists there. The other NP primarily does nursing homes, rehabs, and home care, but she will be in the hospital once a week.

The physician is a nephrologist, and we work for a small community hospital in the Northeast. He usually sees the most patients, due to the fact that the family doctors in the community have a deal with him where they admit their patients under his care, instead of the not-so-reliable hospitalist group. Therefore we manage the total care of the patients (H+P's and medicine follow-ups) as well as all of the renal consults.

The Contract: The contract has headings called "Defined Work" and "Non-Defined Work." The Defined Work heading states that I will be rounding on patients, doing notes, and taking calls for the hospitalized patients 4 days a week. I will also have to be on-call for 2 nights a week, every 3rd weekend, and 2 holidays per year. Additionally, the contract states that I must see at least 18 patients per day in the hospital (I'm not sure what that means because I have to see all of the patients we have in the hospital, whether it is 18, less than 18, or more than 18). It further states that I am responsible for doing dialysis rounds on 3 shifts of dialysis patients at the dialysis center (2 miles from the hospital).

The "Non-Defined Work" is the work I do that is not in the hospital. This includes the patients I would see in the nursing home, subacute rehab, assisted living center, and home (yes we do home visits too via the transitional care program). Adding this to my schedule will now mean I am working 2 more days a week in addition to the 4 days I'm in the hospital.

Compensation:

Here are the compensation details of the contract:

Base salary: $80,000/year - and compensation will be bi-weekly

Base salary after 1 year of employment = $85,000/year

Base salary after 2 years of employment =$90,000/year

I must see 18 patients in the hospital. For each patient I see over 18, the incentive is $25/patient

I will receive 60 percent of the collections for the Non-Defined Work I do (nursing homes, rehabs, home visits, etc)

Employer will contribute 50% of cost towards my health insurance plan per year.

3 weeks paid vacation per year.

Employer will pay the cost of my hospital dues, DEA registration, , professional licensure and certification fees, and $500 towards CME's.

Negotiation Questions:

Is this acceptable to anyone? I would like to negotiate for a higher base salary as I feel $80k/year for 4 days a week in the hospital seems low...especially if these pay-scale sites for NP hospitalists are accurate. Also, N.J. usually has higher salaries compared to the rest of the U.S. I was making really close to $80k as an RN working 3 days a week and my per-diem job on the 4th day. I would also like a 401k with match, and 80% towards my health insurance plan (i'm a single male with no kids). And $25 incentive pay for each patient over 18 seems low as well. I know I could make a lot of money if I work 6 days a week doing 4 days in the hospital and the other 2 in the nursing homes, rehabs, home visits, dialysis rounds, etc....but, at the same time, I don't want to burn myself out early. I'd like some work-life balance.

Other Thoughts:

We would be a very small group so I can't say I don't want to do the "Non-Defined Work," because I need to share that responsibility. I always liked the idea of a 60/40 split too, but he told me that it is hard to make that work in the acute care setting and that's why he would rather do a salary.

I appreciate any and all input on this matter as I'd like to go in to the negotiation meeting prepared and with a better understanding of the value of the nurse practitioner than I have now.

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Specializes in Family Nurse Practitioner.

Excellent that you have worked with this physician group and know the routine that will help you figure out how many hours of work this actually translates to and adjust your salary accordingly. First thing I would say is get rid of the identifying information that will bite you in the butt. Second I agree the base salary is way too low. How much are other NPs in your area making? I'm not talking about citing a website with speculated incomes but how much are your peers at local facilities and practices making? How much does the NP in the office make? That information is useful in supporting your request for a higher salary and don't bother bluffing be specific ie. Hospital X is paying Delores Doe $1234. With regard to the incentive pay, long does it take you to see a patient? If on average you are only reviewing labs and laying eyes on a stable patient you might be able to see 4-5 in an hour so $25 per isn't too shabby. If drive time between facilities isn't compensated, you have to regularly deal with team meetings or family then all that should be considered in your price.

Regarding actual negotiations, and this is only my opinion based on experience with business negotiations both inside and outside of nursing, make it clean. Be succinct ask for a significant higher base salary but leave the dickering around over petty $2,000 stuff off the table. What is the actual cost of the extra insurance contribution? Add all that in your base salary request it is all the same in the end and making an employer feel like you are nickel and diming them like a Chinese menu not only comes off as whiney but amateurish.

I love that you are considering what appears to be on par with a physician's schedule. I think too many NPs are looking for that cheesy Mommy friendly schedule and in my experience physician's resent that approach when they are seeking contributing team members.

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Specializes in Nephrology, Cardiology, ER, ICU.

Okay - I'm a neph APRN in central IL (much lower cost of living then the Northeast I would think). That sounds like a crazy schedule with a low salary.

Acute hospital rounds - what if you have

Dialysis pts take time too - CMS reimburses for 4 visits/month for chronic ESRD pts. The new deal (eff Jan 1, 2017) is that outpt chronic hemodialysis units can now dialyze ACUTE renal failure pts and get reimbursed. And that is a mess! I have two pts with AKI: both are incredible train wrecks: one coded in the dialysis unit Friday and the other has a LifeVest which keeps activating when he is on dialysis because his ejection fraction is 20%.

So, my questions would be:

1. What if there are

2. How many dialysis pts must you see? I personally have 130 I'm responsible for in 4 geographic areas - I travel 400 miles/week

3. How many nursing home and home pts are you seeing per week? Again figure in travel time

4. As to time, I know I wouldn't take on that job for $80k/year in a high cost of living area.

5. Are the NH pts on dialysis in the NH? If so, those visits are billed as "home dialysis" patients and the reimbursement is only one visit/month.

I would propose:

1. See dialysis patients as the reimbursement (thus your value to the practice) is higher as you can bill at 85% of the MD rate.

2. AKI pts reimbursement is higher than ESRD pts so if you have any of those type of pts, its worth your while to see them every week.

3. Increase your starting salary to 90k and go up from there - I would certainly want more than $25 for hospitalized pt visits if I see >18/day. However, if your MD is seeing the pts in the hospital also, then they are billing under the MD so again your worth is not measured in dollars but rather convenience and efficiency as you will have the note written written and all the MD has to do is see pt, co-sign note.

4. As to benefits - whew! Again I would counter with 4 weeks vacation, $1500 CME and 5 days CME time, either a 401K or some other type of profit-sharing and 100% of your healthcare insurance paid for.

I would also ask about orientation as going from an RN to NP is a transition and you will need some time to get your feet wet. I would ask for one month if you have a strong nephrology background and more time if you don't. I started with this large neph practice 10+ years ago with only trauma/ICU background and we provide 4-5 months orientation as once you are on your own, you are on your own.

We are a large neph practice with 19+ MDs, our own surgi-center for access, procedures, 8 APRNs and 1 PA. Our benefits are excellent and our salaries above the average for my area.

Hope this helps

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Specializes in Family Nurse Practitioner.
As to benefits - whew! Again I would counter with 4 weeks vacation, $1500 CME and 5 days CME time, either a 401K or some other type of profit-sharing and 100% of your healthcare insurance paid for.

Sorry to hijack OP but traumaRUs is free health insurance common in your area? All the hospitals and hospitalist groups here that I am aware of provide excellent coverage but at a reduced cost. I think mine for family costs $450 a month at present. There is one community organization I am aware of who offers not so great coverage for free for the employee only but it is expensive to add family and again not great coverage.

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Specializes in Nephrology, Cardiology, ER, ICU.

@Jules - yes in my area, in private practices, free healthcare is the norm for the employee (providers only, not RNs, other clinical staff, etc).

In fact, my husband who is a high school teacher near St Louis also has free healthcare insurance for himself.

Now if we were to add each other, it would be $550/month.

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Specializes in allergy and asthma, urgent care.

I think the base salary is way too low. And correct me if I'm wrong, but will you be working 6 days a week, in addition to call? If so, then they are really not paying you enough. It sounds like this job will take up a great deal of your time for not a whole lot of compensation. I hope they are open to negotiation.

FWIW-All of the providers in my practice-MD, NP, PA work what might be considered a cheesy Mommy friendly schedule. Four 9 hour days and excellent pay make for a very nice life. It doesn't make any of us lesser providers...we just have a really good gig. None of us want our jobs to own us.

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Specializes in Family Nurse Practitioner.

FWIW-All of the providers in my practice-MD, NP, PA work what might be considered a cheesy Mommy friendly schedule. Four 9 hour days and excellent pay make for a very nice life. It doesn't make any of us lesser providers...we just have a really good gig. None of us want our jobs to own us.

Excellent for you and your colleagues but not exactly what I was talking about when you quoted me so to clarify: I was referring to what I have seen in the way of NPs who apply for hospital positions and expect them to be Monday-Friday 9-5 without any evening, weekend, holiday or on-call requirements. If they actually take the job they rarely last. It is often posted here one of the benefits of becoming a NP is that the hours are easier than RN hours. I never said those jobs don't exist just giving the OP a cyber high five for being willing to work like a physician does at least in my circles.

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Specializes in Nephrology, Cardiology, ER, ICU.

....but Jules if you work me like an MD, than I should get paid a solid wage and 80k isn't a solid wage even in my little corner of the world

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18 patients is a lot in itself..

- base pay too low, i would expect 100k for a new grad

- 2500 cme

- 4 weeks vacation

- extra pay for oncall

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Specializes in Family Nurse Practitioner.
18 patients is a lot in itself..

- base pay too low, i would expect 100k for a new grad

- 2500 cme

- 4 weeks vacation

- extra pay for oncall

Excellent point about the oncall and also weekends. I'm all for working them but get paid a premium.

Is 18 a lot of patients? Not being smart just asking. In psych inpatient providers have anywhere between 10-20 depending on the contract.

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Specializes in Nephrology, Cardiology, ER, ICU.

18 hospitalized renal pts that you don't know can be a lot. Depends on how many on CRRT, ECMO, multiple drips, etc..

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80,000 does seem pretty low. I'm a new NP and make 85,000 but in an area with a very low cost of living. From what you said it also seems like you will be working more hours than me. However, I'm also not familiar with the cost of living in your town/city. Is 80k far below normal for a new grad living in your part of New Jersey?

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