googs

I live in the NYC metro area, high cost of living. Can I ask for the 20% AND benefits as well? the 20% would be more than the physicians in the practice are making. So I don't know if this makes sense. I don't have another job lined up except for a possible full-time online telemedicine job, but can't walk away right now. So should I not ask for a raise if I'm not ready to walk away?

Nice, so you bring in well over $300k a year! In my case, should I not ask for 20% of my total billing? Is that not standard? I'd have to ask for 20% if I go over a certain threshold? Also, do you get benefits?

Again, I'm not positive about their exact salary. But they also get unlimited RVUs so at the end of the day they probably earn another 50-60k on top of that or more, I'm not exactly sure. What I planned on doing was adding up the value of the benefits (about $38,000 per year) that I'm offered and adding them to my base salary ($125,000). That comes out to around $162,000. I'm still $80,000 short of earning 20% of my net collections, which I think is the standard. What I'm not sure of is, do people who earn based on collections also get benefits? I'm also not sure whether to negotiate a larger raise or a better RVU bonus structure. The current RVU structure doesn't pay NPs who earn $130k or over.

I see between 14-18 patients per day but I have a high percentage of 99214 and 99204 because of good coding/documentation.

I’m sorry, that was for the fiscal year that started in July. So double that for a whole year: 1.2 million. So am I right going in and asking for 240k? Should I subtract the benefits and ask for that? I’m pretty sure the physicians In my practice get around 220k plus RVUs and their benefits.

Why would 20% of the net be 124k? I bill 2.4 million in a year. About half is collected. Can you explain how you got this number?

Hey all, I work in primary care for a hospital-owned medical group. I have a meeting Friday with the director of our medical group. Our RVU policy is currently garbage. Maximum amount that can be earned is $30,000 per year for NPs (Physician RVU is unlimited) and if one makes over $100k, the RVU is prorated. So if you make $130k, you get no bonus at all. I just ran my numbers in Epic. This fiscal year, which doesn't even include the rest of December, I've billed $1,182,026 and $621,000 of that was collected. At this rate, I earn over $1.2 million a year for the practice. I currently make $125k/ year plus a $5k bonus. I get 216 hours of PTO, $2500 and 5 days for CME and health insurance (I still have to pay premiums, they just cover part of it), as well as STD and LTD, etc. I've read that we should try to get 20% of what we bring in to the practice. Is this correct? Based on that, I should be earning $250k/year. With what I'm bringing in, would I be considered extremely productive? I earn 50-100% over my required RVU targets. Can I go into this meeting and show them what I'm bringing to the table and ask for a raise or at least an improvement in RVU structure to be unlimited. If I subtract the total cost of all my benefits (about $35,000 a year), I'm still WAY under the $250k/ year, if it is reasonable to ask for 20% of what I bring in. What do you think? Is the 20% thing only when one doesn't get offered benefits? Any insight would be appreciated as I have this meeting on Friday.

Yogagal. I totally agree with you! I'm a firm believer that we should receive 85% of physician pay, since that is what we bill for, but if we aren't all in this together, we will never get this. We have a huge, powerful lobbying presence and we need to use it to get what we deserve! Physician wages are elevated because of how selective medical schools are and they artificially limit the amount of graduates and residency spots to skyrocket the salaries. NP schools need to have more stringent entrance requirements so that not just anyone can become an NP. The curriculum needs to be more rigorous with less fluff such as "nursing theory" and more medicine. In terms of the job-they countered and I accepted the offer of $120k/yr plus productivity. The benefit package is very attractive compared to the private office that was only offering $125k with poor benefits. I'll have over 6 weeks of PTO, 2% automatic 403b contribution plus another 2.5% matched if I contribute 5%, good, reasonably priced health insurance, disability, etc. While I agree that the salary is not as high as I would have liked, I plan on looking around continually. I think that if an internal medicine physician earns $225k/year, we should get something like $180k, especially seeing that we often see the same number of patients. Also, I hate the "consultation" argument...that we have to have the doctor there to ask questions. The doctors ask each other questions all the time and are not penalized in their salaries for that. And I wouldn't say we ask more questions than we do.

Thanks for the 100 views and no votes or comments! Almost at the end of the day.

I need to get back to an employer today about a job offer. I currently have been working in internal medicine and urgent care as well as ED for 3 years as an NP with 5 years of ED RN experience prior to that. I started at 109,000 as an NP and haven't received a raise in 3 years due to budget issues at the hospital (a large Catholic health organization). I recently found a job closer to home in internal medicine and have been made an offer. Benefits are similar since it is another large Catholic health organization. The offer was $115,000 and the hiring manager knows I'm making $110,000 now. I received an offer of $125,000 at a private office with worse benefits. Salary.com says my fair market value is $115,000 up to $120,000 at the high end. Glassdoor's new "Know your Worth tool" says I'm worth $122,000 base salary and that salaries of FNPs in the city range from $122,000 to $155,000. I don't want to counteroffer today that makes them rescind the offer because I like the location and the office, but if I ask for $125,000 and mention that I was offered that in another office and the fact that I speak 3 languages is it likely that I will have that offer accepted? I don't want to lose this opportunity but I want to make at least $120,000 since I've been stuck around $110,000 for 3 years. Any advice? I have to let her know by the end of the day.

Does your position and cousin's position include benefits on top of that hourly rate? And you're saying you get $1000-1500 per SHIFT on top of $80/hr if a crisis shift? That's crazy. I'm in CT and I've never seen anyhting like it. An ED I work at run by GARBAGE Emcare pays $70/hr and offers NO BENEFITS except for crappy health insurance. No retirement match. NOTHING.

This is the best post I've ever read!!

This is the best post I've ever read!!!

Hi! Sorry for dragging out an old post. What do they charge per credit? I'm looking to do an MSN/FNP to DNP bridge. Thank you!

I chose fnp and I haven't regretted it!

Thanks for sharing your experience Goldenfox! Can you share what direction you went in? Are you making a lot more now than what you used to make? How did you make yourself richer? Thanks for your advice. These exchanges are what will help advance our profession.

That's awesome. I'm in CT, where are you?

Wow! What state? You're in urology then, since you're doing vasectomies?

Also, a large hospital gave you student loan repayment? Where are you located? No one offers that here. Was that something that they weren't offering but then gave you for a certain amount of service?

So you're a brand new grad and negotiated 108k and what is the RVU structure like? It is family medicine? How did you do the portfolio and how would I do the portfolio with my current practice? The problem is we aren't busy here. I COULD see a lot of patients and I do a lot of procedures too, as I'm in urgent care as well, but we don't have the volume here. If the volume was here, I could easily handle it

OK. and I have over 2 years of experience as an NP as well. I also have 5 years of RN experience before that in the ED. Hopefully that helps. So I can go in asking for 175k?? I know in my practice, the IM docs start at 208k, and we are a part of a huge Catholic nationwide healthcare organization, which owns our hospital that has a Multi specialty group with several practices.

Ok, but my question is: do I negotiate the higher salary after accepting the position and showing my worth, or do I do so initially after they make me an offer, TELLING them about my worth and what I can bill and bring into the practice? Everyone thinks they high to accept what the average for their area is. Here in southern Connecticut, where the cost of living is high, its not much more than 100k. I started at 108k and that was one of the highest in my graduating class. I really would like to make over $200k like you, or more accurately, make that and work 3/4 time and make 175k. One last question: does the bargaining chip of 85% only work with private doctor practices? I would imagine so, as most place like hospital urgent care centers that I have worked for, offer a salary to all NPs and it doesn't vary and then you get paid a little bit on productivity. The UC I work for offers 85 an hour per diem, which isn't bad. But I'd like to make that or more with BENEFITS. All the hospitals say "this is what we offer to NPs with your amount of experience". So-=-only private internal med/specialty offices can be swayed to offer 200k?

That's good to know, thanks TheOldGuy. Will this translate to FNPs though? I know there are less psych NPs and you can probably command a much higher salary, or do you know any FNPs earning in that range? Should I go back and get my Psych certification as well?

Horrifically crappy pay. PLEASE don't take this job. It is high risk and makes the practice a lot of money and they are giving you GARBAGE. I made more my first year as a new grad ED RN. Please stop driving our salaries down by accepting such low pay. It's doing the whole profession a disservice. We deserve 85% of physician pay, since that is what we code for.

Do you work for a hospital or private practice? What specialty? Don't they have set amounts they pay their PAs/NPs? I've always had the same opinion as you with the 85% of MD pay and productivity, but i'm afraid to mention that, even though I'm aggressive with negotiating. Do you bring up the pay after you've worked in the practice for a while or right at the outset? I just feel that they'd hire another NP at 100k or 95k since there are more in the market now. What is your productivity like in terms of coding/patients per day?