Suggestions on possible NP job offer


I am currently still in NP school (2 semesters to go :yes:). I have been talkin with a nephrologist about possibly adding an NP to his practice. In doing so, he has asked me if I would be interested in working for him after graduation. He has a very large practice for the area in which we are located. He and one other nephrologist (they are currently recruiting new partners as well) See 60+ patients between 2 local hospitals daily, 20+ patients/day in clinic and have over 300 outpatient dialysis patients between 7 local dialysis clinics. He is looking to add an NP to cover the 300 or so dialysis clinic patients. While there have been no specifics discussed in terms of a contract, he did tell me that he is considering highering the NP on with productivity reimbursement only (no salary/hourly wage). However, he is not talking about being reimbursed for what I bill, he is referring to a fixed amount per patient seen.

This was his proposal, "I will give you $10/patient you see. If you see all 300 patients in one week, that's $3000/week or $150,000/year. That's more than many physicians make after overhead." Like I said before, there were no other specifics discussed in regards to benefits.

My questions to you are:

1) What are your thoughts on this offer?

2) What questions should I be asking and/or negotiating when the time comes?

3) Is it even possible to see 300 patients/week? I mean, that's 60/day if you work 5 days/week.

4) Can any of you that are currently practicing in outpatient dialysis tell me what all your job entails?

Thanks in advance for your thoughts!

Be blessed!


149 Posts

Has 8 years experience.

This kind of an offer would make me wary. As a new grad, it would be unreasonable to imagine that you are going to be seeing the same number of patients that a physician would see in a normal day right off the bat. Also consider how many facilities you will be visiting in a day, travel mileage and time, etc. Will they be covering for you? What kind of orientation will be provided? 60 patients in an 8 hour day seems unreasonable- Is it likely these doctors are working 10-12 hours days and is that the kind of workload you are looking for?

I would counter with a base salary + productivity, to be evaluated and adjusted at 6 months and 12 months as your pace/ billing/ revenue increases.

I believe that TraumaRUs works in this specialty, and I am sure will chime in here with a better response.



31 Posts

As Cardiac has said, this payment model sounds lucrative at the outset, but it is rife with uncertainty. If he's willing to pay you $150,000 I'd make a portion of that your base and a portion your productivity bonus and see what he says.


44 Posts

Has 5 years experience.

Cardiac: Thanks for the reply. I was actually kind of thinking along the same lines as you in regards to the counter and the fact that I, as a new grad, will not be able to see the same number of patients as him, right out of the gate especially. I will also keep in mind the questions you've asked when negotiating a potential contract.

Specializes in Peri-op/Sub-Acute ANP.

These patients are extremely complex. If you see 10-15 of these a day as a new grad, you will be doing well. The whole thing sounds shady to me.


248 Posts

This is very shady. If he want to pay you per patient, please negotiate for split of percentage eg. 60/40, 70/30 of reimbursement. That's way you're less likely to be taken advantaged of. $10 per patient is ridiculous. I would ask the nephrologist about how much percentage is this in the reimbursement. You should not only think about the salary but also also think about how much harder you have to work to earn that. I would rather earn less and work in manageable & safe pace.

As a rule of thump, the pay per patient rate should be calculated out to be higher than hourly rate due to unsteady income from fluctuating numbers with patient. Benefits cost a lot. Therefore, if there is no benefit, you need to ask for more.

Trauma Columnist

traumaRUs, MSN, APRN

153 Articles; 21,232 Posts

Specializes in Nephrology, Cardiology, ER, ICU. Has 31 years experience.

I round on dialysis pts and at one time had 210 pts located in two clinics 11 miles apart (traffic is not an issue). That involved 60 hrs per week!

300 pts in 7 clinic per week is not doable for new grad.

I work for for a very large nephrology practice an currently see 160 pts per week in 4 clinics and travel 500-600 miles per week and still work 50-60 hrs per week. I have 8+ yrs exp doing this.

allnurses Guide

ghillbert, MSN, NP

3,796 Posts

Specializes in CTICU. Has 27 years experience.

My only thought is "oh hell, no"

Specializes in Nephrology.

I was an RN in dialysis for 10 years, so I really know the ropes. My group is starting me with 130 patients who are all in one unit. This should be very manageable since I know the job and will be treating the same patients I had as a nurse....what you are looking at would be overwhelming, not to mention practically impossible for me to do. I would never try to manage that, especially without having a good knowledge base in nephrology.


44 Posts

Has 5 years experience.

Thanks for all of the replies. I will definitely take this all into consideration when/if I were to negotiate a contract with this particular practice.

allnurses Guide


3 Articles; 5,581 Posts

Specializes in Adult Internal Medicine. Has 12 years experience.

There are several red flags here! The flat fee per patient, the fact there has never been a novice NP at the practice, the fact you would be tied to seeing more patients than you are likely comfortable with at first, etc.

Wait until you graduate and get some other offers. The nephrologist will wait for you.

Sent from my iPhone.


789 Posts

If you plan to work 8 hour days with no lunch or no break, you get exactly 8 minutes each to see all 300 patients. That's not including any travel time either. If there are no benefits attached to this job, the only winner in this would be the doctor.