Suggestions on possible NP job offer

[earthsalt]

I am currently still in NP school (2 semesters to go ). 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!

[himilayaneyes]

I have to agree with the poster that said it sounds shady. I'm working for a home health company for which the pay rate is $80 per patient. Plus, I don't see how it's possible to see 300 of them every week. I would keep looking elsewhere....this doesn't sound fair to you nor does it sound safe.

[earthsalt]

Just an update...I've also recently received a tentative job offer in a local ER upon graduation. Base rate is $55+/hour with benefits. So the nephrologist will really have to sweeten his deal if he wants to keep me. ?

[harmonizer]

Congrat Earthsalt! That's more than what got paid as new grad NP a few years ago! ER is a hot specialty. If I were you, I would rather go for this ER job and forget about the nephrologist. Benefits are very expensive. PTO and holiday pay alone can add $10,000 per year or more, not including health insurance premium, CME, peace of mind, and etc, plus stable hourly pay.

[Back2SchoolRN]

Yes, and nothing like feeling you are giving substandard care to patients right out of the gates to make you feel even more accomplished and caring as a provider, hmmm? Not to mention the liability risks and reasonable fears associated with inadequate examining, thinking, and documentation time. Finally, where is the time you will need and want to build your knowledge and grow as a practitioner, if there's not a spare minute to read up, consult someone with more knowledge, dig deeper in the record, or just dwell on a tantalizing question for a little while? That's surely one of the more fulfilling and fun part of being challenged, or the "more mental stimulation" many nurses went to NP school to get. Stress and excitement must be balanced or you'll burn out fast! Outside the money and fairness issue (and yes, it sounds as though you are being looked at as a vending machine, not a provider who will be supported) consider your self-image, your confidence, your long-term growth, especially in those first few years where you are creating a foundation, and before the time when your (possibly upscaled) lifestyle may no longer accommodate the lower salary. Expect and demand a fair compensation package, but look out for your other needs and goals, too: Surely where you work and what you do can seriously enhance or decrease those opportunities. Just my thoughts as an experienced RN (and new NP student) who's taken on some challenges over the years.