ilovensg

I'm negotiating my contract. Currently, I make just a salary. However, the new contract would give me a salary plus an RVU bonus if I see a certain number of pt's/generate so many RVUs. I don't understand how the practice is making any money from me when NPs are reimbursed at 85% for RVUs. The expectation is that I'd make need to make 2275 RVU annually before I would be eligible for a bonus. Since I'm an NP, I would be getting reimbursed at 85%, which would mean I need to make 3264 RVU annually (85% of 3264 = 2275). That would equate to making 23.919 RVUs per day (I work 3 - 10 hour shifts, so 46 weeks), which would equate to seeing 24 patient's a day (about 12 (99213) and 12 (99124)). I can't meet that standard b/c most I can handle is 18 patients a day. I see complex patients and have a very non-user-friendly EMR. So I don't want to depend on the expectation of 24 patients a day. Even if I see up to 18 patients a day, that would mean 18.89 RVUs per day which equals $98,801 in revenue annually (I work 46 weeks of the year); based upon that, I would only be able to get my baseline salary due to not meeting the RVU minimum, and they would profit about $20,000 off of me. Where am I messing up in my math on this? I thought I generated more income than just $20,000 a year! I understand the practice needs to make overhead, and this doesn't seem like enough. Thanks in advance for the help. I listed my math below: Rate of return for RVUs: 99213 is 0.97, so 85% is 0.8245, and 99214 is 1.5, so 85% is 1.275. We need to make 2275 RVU annually for MD, but NP would equate to 3264 (85% of 3264). 1 RVU is $37.89 Realistic RVU per day is 18.89 x $37.89 x 138 days = $98,772

Thanks for replying! Both your responses highlight my dilemma. Bronchitis can last up for 3 weeks and yet TraumaRus states not to give for more than 10 days. TraumaRus I'm curious what your reference/reasoning is for that? I look at Epocrates and it doesn't explicitly state there should be a max dose for the duration of the prescription. I understand I can logically think through this simple situation, but feel like it's a free for all when I don't have info giving me more guidance.

New FNP here. Anyone have any good resources/suggestions for how to determine the quantity of a prescription (other than antibiotics), frequency of refills, & good time frames for follow ups. Epocrates doesn't have much info on these topics. UpToDate is too lengthy for a quick reference and may not have this info. Ugh, I hate being new and not just knowing these things... ie: how long should I prescribe Tessalon Pearls for bronchitis. Thanks!!!!

I'm a new FNP APRN and about to start my first job in an outpatient office. I'm putting my pride away and hoping I can ask some scenario-based questions and get some answers as what would you do? I feel like I'm constantly thinking of situations where I can't get clear cut answers right away. I apologize if these are dumb and obvious. I don't have an experienced APRN I can bounce ideas off of. I'll start with this situation... Patient comes in with an abscess and is on coumadin. What antibiotic would you prescribe empirically? Normally I'd choose Bactrim or doxycycline...however these affect the INR? Would you prescribe these medications and just check the INR more frequently or prescribe another medication? If so, how often would you check the INR? Otherwise, would you use clindamycin? Lastly, would you have them follow up in like 2 days? Thanks in advance!

FYI I was offered a position at an internal medicine office. I start this week seeing patients!

I think I may be offered a position at a minute clinic? I just graduated as a FNP, but have yet to take my boards. Would I be an idiot to accept this position? If I'm unsatisfied will I corner myself and be stuck working in retail forever? I feel like it may be a good stepping stone to primary care, but practices may not see it as such? Additionally, I may potentially be offered a job in in GI speciality, but my professor told me I would be limiting myself as a FNP. However, in this speciality practice I would at least be prescribing more independently and ordering labs. Currently I have a job as a nurse so technically I don't have to rush into any new FNP job, but one recruiter told me it would look bad to wait to work as a NP. I honestly, wish I hadn't started applying to jobs, until I passed my boards because everything feels so rushed and uncertain now! My ideal situation would be to pass my boards and get an interview/job in a primary care providers office. Thoughts? Thanks in advance for easing my concerns! : )

Wow! Thanks for all the replies and advice!!! As of today, I have gone to 3 different interviews. As most people stated on this thread, I did not get any clinical based questions. However, my interview today was basically "give me an example of when you had xyz scenario?" I still have yet to be offered a job...but at this point I just want to focus on passing my boards!

I have an interview in 2 weeks with two different MD's. I'm nervous I'm going to be asked clinical questions testing my knowledge. Anyone have any examples of clinical practical application questions they have asked or have most of your interviews been generic questions? Thanks!

As a nurse practitioner, do you come across a lot of dilemmas that challenge your ethical principles and if so, what do you do? I'm curious to hear all experiences, but would really like some input on what providers have dealt with in the outpatient setting, where ethical resources are limited. Then, if addressed with a dilemma, how do you make time from your already limited schedule to resolve it? Sometimes, do you feel you just can't devote yourself to it because more pertinent issues need to addressed? What's the reality I'll be getting myself into? Thanks!

Do you feel as nurse practitioners, you practice in a way that is true to your role? Have you ever been in any situation where you thought otherwise?

Congrats plumsicle4!!!!

luckybella, Congrats on your job offers! What floor did you interview on at Duke?

I'm sorry I can't offer you any advice because I'm in a similar situation. I am also a new grad and was verbally offered a per diem job which will start in about three weeks. HOWEVER, the week before I start, I will hear back whether I'm offered a position at my dream job!! My dream job also is full time with benefits. So to add to the list of unanswered questions here, do I notify my dream job employer I have an offer? I believe she has to interview X amount of candidates before she can even put out an offer. I don't want to do anything to make me ineligible for my dream job... Also, I am anticipating my per diem job will give me the formal offer in writing this upcoming week. What should I do? I'm happy I am in this situation, but don't want to ruin a potential wonderful opportunity. ANY ADVICE is welcomed!!!

Where are these places that won't even look at our resumes without a license? I'm from the northeast of America and it seems like it's way too late to even be considered for a job with or without the RN next to my name.

May I ask what state you are from plumsicle4? Graduating without a job makes it extremely difficult to get one. Who knew? Thanks!