PNP Contract Negotiation and Renegotiation

The Contract Conversation

Once you have decided to accept a new PNP position, be prepared to negotiate a PNP contract. Advocate for yourself; you have unique training and skills to offer. Enter contract negotiations with an idea of an equitable salary for your level of experience.  Consider strategies that emphasize how you will benefit the practice.  Once you have an offer, take time to think about what you want and what has been offered. Can you comfortably reach a contract compromise in some areas?

 

When you sign your initial contract insist that an annual review and periodic renegotiation is part of the contract. Track your productivity on a monthly basis including billing to demonstrate the impact, outcomes, and revenue you contribute to the practice environment (see Quantifying Your Nurse Practitioner Productivity). Maintain an annual year over year productivity record. You can then use these numbers to negotiate a productivity-driven salary. If you are not directly billing for your services, you may need to provide details other than direct financial productivity to support your contribution. Topics to consider include how your role impacts patient outcomes including hospital length of stay, patient and family satisfaction, and ability of the physician staff to see more patients which leads to overall higher revenue. Who will be doing my performance appraisal?  You may have other ideas based upon your practice area.

There are several areas to consider when you are negotiating a PNP contract, including:

  • base salary
  • on-call requirements and compensation
  • hospital rounds and reimbursement
  • bonus payments
  • non-clinical or administrative work/professional days
  • malpractice insurance
  • health insurance
  • dental insurance
  • disability insurance
  • number of days/hours you are expected to work per week including nights and weekends
  • vacation time
  • sick time
  • CE time
  • CE reimbursement
  • licensing fees
  • professional journal subscriptions
  • professional organization dues
  • reimbursement for attending annual conference(s)
  • protected non-clinical time for professional development (research, publishing, speaking, etc).
  • restrictions to competition (i.e. non-compete clauses)
  • termination clause
  • tuition reimbursement for advanced degrees or specialty certifications
  • NP name and/or picture to appear in all advertising and on the name plate outside the office
  • possibility of partnership
  • amount of time allotted for orientation, expected time before carrying a full patient load, (primarily for new grads, but experienced PNPs should have a clear understanding of the support and infrastructure).

 

These are all important items that should be addressed in your PNP contract and can be negotiated based on how important they are to you. Probably, the most important item along with the base salary is understanding how your bonus, if any, will be figured. You will want to ask very specific questions about this.

  • Does the formula for your bonus benefit you or the employer?
  • You need to expect to pay overhead; how is this calculated? You should also expect to pay a small percentage of your profits to your collaborating physician. This percentage should not be greater than 10% to 15% unless you use an unusually large amount of your collaborating physician’s time.

Don’t feel like you have to make a decision about all of these items during one meeting. Take good notes, ask for a copy to take with you and then reschedule a meeting after you have heard what the employer has to offer. Look at what is proposed.  Is it reasonable?  Do not be afraid to ask someone else for advice. Perhaps ask another PNP and someone outside of the medical field to review the contract. Before signing a PNP contract, you should obtain a legal review by a lawyer who is familiar with PNP practice. It is reasonable to counter the employer’s offer after you have had time to prioritize your thoughts. Once you sign a contract it is difficult to change it until it expires.

Above all, be sure you get what you are worth. Researching salaries in the area is a good place to start.  An employer may try to tell you that you are not worth what you are asking. This is a great opportunity to educate your employer about what a PNP is capable of doing and to ensure you agree on your role. Don’t compromise your education, abilities or independence by taking less than you are worth. Documented productivity cannot be disputed. Do not be afraid to ask for something; if you don’t ask, you certainly will not get it. You are the only person who knows what you are worth to the employer.  Be sure you get what you are worth; consider the lowest salary you feel comfortable with accepting going into the negotiation.

Click here for NP employment contract samples: NP or PNP working in a primary care office setting, NP or PNP working in a specialty care setting (Hospice) that could be altered to fit a variety of other specialty care settings. These sample contracts can be individualized to fit your specific work setting and agreement. The contract should have a specific time period for the agreement. It is important to reconsider your contract details before the agreement expires, so that you will be prepared to renegotiate your contract.

We strongly encourage you to have a lawyer review your contract to ensure all aspects are in your best interest.  Elements of a contract will differ state to state because of variations in statute and scope of practice. Search out examples held by PNPs and/or NPs practicing in your state, and then have them reviewed and updated.  If your employer doesn’t have a contract for NPs, you should consider asking that one is provided prior to accepting a position.