new_horizons555

Thanks BostonFNP and BlueDevil. That's a good point about capitated patients and I will make sure to ask. I recognize that it takes quite some time to be profitable (i.e., pull in greater revenue for the practice than at the starting point where there is a debt due to overhead, training, learning curve, etc). Yet even possibly earning even a small bonus quarterly is exciting at this stage in my life..lol I agree Boston that I should not be focused on the "numbers" in the beginning. It is more of an incentive though than working the same job without this financial structure in place. Thanks!

Are there any particular questions to ask a prospective employer regarding productivity bonus? I'm excited that this is even a possibility as this is the first time it has ever been discussed! Bonus would be offered annually after I can "break even." I know every NP will vary on this, but realistically, for an NP with fairly limited clinician experience (under a year), when should I expect to bring in revenue that would allow for a bonus? After working a full year? I saw from other threads to ask how bonus is calculated. Also, if I see a good deal of acute visits would the productivity bonus still be as high? Have NP's found that traveling to different locations to perform primary care services impacted productivity than from those remaining in one location? Thanks everyone!

"Honestly, I'm a little Meanypants myself for stupid stuff. Do not wake me up at 2am because you haven't pooped in 2 days. Do not. You will poop your pants when I'm done with you, so there is the upside, I guess." BlueDevil - that made me laugh out loud!!!!

Wow, thank you everyone for the detailed information and accompanying references! It appears that there may be some gray area / leeway here for AWV courtesy of CMS. I also didn't realize the regs would be different based on traditional Medicare vs. Medicare advantage. Thanks again!

I'm guessing BlueDevil you likely make a nice salary and may have some higher rank in your practice, and therefore can have those call "rules" in place. If I in the past had come across like that on the phone to patients, my previous employer would have raked me over the coals. Patients would have immediately complained about me to the doc for not fulfilling their requests and it would have been a big scene in work. I agree with you about narcs and call. Have to disagree about it being a walk in the park. I'm a new grad and discussing patient conditions with ED docs / hospital docs in addition to regular patient calls, is not particularly easy while out and about. Maybe it's an experience thing but yes, I sweat call. There have been moments when the phone literally rang all day even to the point that it made bathroom breaks challenging. I was just curious about compensation of some time off particularly if salary excuse my language sucks.

It was mentioned in passing to me by a private practice. The physician feels it is RN capable work. The particulars related to billing I have no idea about. Obviously the practice would want to get paid by Medicare and would need to comply with the regs, so maybe it's something they feels will change in the future in which more of the duties can be put on RNs shoulders and free up time of providers for other tasks. I didn't want to get into questions with them at the time since they are not my employer. It's kind of interesting to talk about on the forum though.

Has any NP's ever heard of the Medicare wellness visit being performed by RN's (non-NP / MD)? This surprised me recently when I heard this.

Request the opinions of any NPs working in primary care who are performing call as part of their duties. Is there any room to negotiate days off or compensation for taking a whole weekend of call plus office hours for the weekend on a rotating basis that are in addition to the full-time 5 day work week, or does this just typically come with the expected duties / long hours of the job? A lot of physicians act like call is a breeze, but in my opinion, it still takes up your time, cuts into your R&R, and can be challenging with acute situations. Just wondering if it's something worth negotiating especially if salary isn't stellar. Thanks.

It doesn't hurt your chances to apply to more than one position. People move for federal jobs all the time. If you are deemed qualified by demonstrating the specialized experience listed in the position description, HR is legally required to refer your name to the selecting official for further consideration. That's a major perk applying to the federal gov't that doesn't always apply to the private sector jobs. All qualified candidates have to be referred although the final decision is at the hiring manager's discretion. Good luck!

As a new grad, my full-time take home pay was $1,079 weekly (all from taxes taken out - no benefits deductions). The gross was $1539. Had there been benefits it would have been lower. Subtract normal bills and student loans and the actual amount I "banked" is even less. I live in a high cost of living area unfortunately. This high salary is not representative of new grads in my area and probably why the position did not work out in the end. Primary care physicians in high demand markets don't want to pay high salaries for newbies. It's ridiculous how hard we have to fight for a fair salary. SMH.....

My advise is to be humble but be smart about your decision on where to work because whether for 65 grand or 80 grand or higher, know that you will work your butt off as an NP for any practice - experience or no experience! Once you earn that degree the same tasks are put on your shoulders as someone without experience because the demand for healthcare delivery is so high. I agree that it would be helpful to know financials of your billing. Get friendly with the billing staff!! Anyone know if NPs qualify for meaningful use?

The latest update on my job situation is that when I almost walked away from the offer last week, the physician with the higher salary offer raised his offer to $10,000 more! It was obvious that he wanted to employ me. It's still on the low end for the area but more fair for someone without experience. I decided to take it! I'm not impressed with the benefits but it's more than what I currently have now which is zilch! I tried to negotiate it higher but was rather unsuccessful. I also have to pay all my license fees/malpractice fees myself and get reimbursed later as well as move into an area with high apartment housing prices. I was not expecting this expense upfront...But I have to start somewhere! It's not just me. I'm hearing other new grads are being offered salaries in the $60s including nearby states. Physicians are taking advantage financially of new grads and hoping you take the low salary and do not question them - that's my opinion. I had one doc argue that the $60,000 NP salary was not at all what RNs make at all...yeah right! We all need to be advocates for ourselves. I'm learning all of this as I go unfortunately!

Currently receiving offers as a new grad FNP in family practices (wealthy areas and poor areas) for $60,000 to 70,000 salary (non hourly rate) with poor benefits/bonuses in Philly and surrounding suburban areas...includes weekly call and contracts that require a year or more of commitment. I'm told reimbursement rates are low in these counties and that's why the salaries are like this for NPs. Is this typical right now due to the economy or am I being taken advantage of as a new grad? Will things get better in January with ACA insurance coverage? Better salaries and benefits? I'm really shocked at the salaries. I can't accept something low. Super discouraged. Any advice out there????

That's great! Congrats!!! It sounds like things are really coming together nicely for your new career. Is your salary / hourly higher now as full-time or equivalent? During the part-time period did you have to pay for your own malpractice and health insurance? Sorry to bombard you with questions!

Thanks Jeanette for your response! I haven't been offered a position yet (still waiting to hear back on that particular one) so I'm remaining cautious but want to be prepared for future interviews with this doc or other practices. I agree it's a tight job market so can't be too choosy...especially for a new grad with limited experience!!! I'm so anxious about the job search and finding/picking the right match. It's a mix of emotions. It's great that your employer has mentored you (they are not all like that) although it seems a bit overkill to be watching over your shoulder constantly after 6 months of working. I read some of your other posts and have a few questions for you. Since you're part-time without a contract does the doc provide any health insurance or pay your malpractice? Is your per diem salary competitive? It sounds like you are gaining invaluable skills in a field you enjoy although ready for full-time understandably. I'm wondering if I will be offered part-time too. It seems that it may be the trend with practices...a sort of trial period.