Who’s Got Your Back?How Do NP’s and PA’s Facilitate Effective Contract
Negotiation, Performance Based Incentive Programs and Foster Career Growth
Nicola Hawkinson, DNP, RNMarch 2011
StatisticsPractitioner
Registered Nurse
Physician Assistant
Nurse Practitioner
US Number
2.4 million
79,706
141,209
According to the National Sample Survey of Registered Nurses March 2008: Preliminary Findings
StatisticsPractitioner
Registered Nurse
Physician Assistant
Nurse Practitioner
Median Income Range
$57,280 ( $51,000-$76,140)
$74,980 ($69,250-$86,347)
$70,000 ($59,000-$91,000)
[Bureau of Labor Statistics, Occupational Outlook Handbook, 2008-2009 edition.
Pay Scale for Nurse Practitioners | eHow.co.uk http://www.ehow.co.uk/about_6539819_pay-scale-nurse-practitioners.html#ixzz11UiBtyQF
Future
Registered Nurse Employment Statistics
2008, RN’s 2.6 million jobs.
2018 employment for RN’s expected to increase to about 3.2 million.
This trend will include a high demand for NP’s as well
Bureau of Labor and Statistics, 2010
Who’s Got Your Back?
Five Steps To a Successful Spine Career
1. Read Contract
2. Negotiate a Contract
3. How To Stand Out in Your Profession
4. Knowing Your Worth
5. Lifestyle Compatibility
How To Read A ContractEven if you can't significantly alter the terms of agreement in your employment contract, it's extremely important to understand what's in it before you sign.
Unfortunately, the "legalese" in most contracts can make this difficult.
While you should attempt to understand your agreement as a whole, focus your efforts on the following key areas:
How To Read A ContractWork Obligations
Termination Clauses
Compensation and Benefits
Malpractice
Restricted Covenants and non-solicitation clauses
How To Read A ContractJob Description
Provides employee / employer with a detailed list of roles / responsibilities and daily duties
http://paworld.net/PhysicianAssistantJobDescription.htm
You Need A Clear Understanding of the Role Before You Can
Negotiate
Before You NegotiateAudit your skills, experience/accomplishments.
Develop a focused salary research strategy.
Do as much homework as possible on the nature and extent of the demand for the skills, training, education and experience within your chosen occupational field.
Know Your Benchmarks
Before You Negotiate
Determine your and the threshold below which you cannot go. This will help you avoid making a lateral move instead of an upward move.
Have an understanding of geographical supply and demand
Understand the lifestyle you want to lead…NOW!
The Principals Of Negotiation
Know what you want, and be able to articulate it.
Describe what you have to offer
include the amount of revenue you can generate.
Learn what the other party wants.
Be able to articulate why what you have to offer fits with what the employer wants.
Put it in writing.
Knowing Your WorthWho believe’s they deserve 50% of collections?
Who knows how much it costs to employ you?
Who Knows how much it costs to Protect you?
Knowing Your Worth20 patients x 5 days/week x 47 weeks per year = 4700 patients per year
If the average charge per patient is $45, $45 x 4700 = $211,500 generated per year.
NP's salary and benefits = $100,000$80,000 plus $20,000 for employer taxes and benefits
overhead expenses = $80,000 (rent on space, electronic medical record, assistants, telephone, supplies, equipment, electricity, malpractice insurance, etc.),
profit is $31,500.
This obviously does not account for surgical assisting
Knowing Your Worth
Other Ways Of Judging Productivity
Time Provider spends in office
Efficiency of the office
Presence / absense of distractions
Fees associated with procedures providedie bracing
Provider productivity may be based on the following:
Total gross charges
Total net medical revenue Growth rate of patient baseHospital admissions
Visits or consults
Office hours
Practice coverage
Volume of procedures
Number of cases
Revenue minus expenses
Patient Panel Size
Relative Value UnitThere are three components to a relative value:
1) practice expense component,
2) work component, and
3) malpractice component.
The work RVU takes into account the time it takes to perform a service, the technical skill and physical effort involved, the mental effort and judgment required, and the stress due to potential risk.
Relative Value UnitEach component is adjusted geographically using three separate Geographic
Practice Cost Indexes (GPCI).
The final formula to arrive at an area specific relative value is:
(Practice Expense RV x Practice Expense GPCI)+
(Work RV x Work GPCI)+
(Malpractice RV x Malpractice GPCI)______________________________________
= Relative value
Relative Value UnitThe relative value is then multiplied by a single nationally uniform "conversion factor" to arrive at a monetary value.
Relative Value UnitFor example, for CPT 99214, in 2005 the work RVU was 1.10, the practice expense RVU was 1.03 and the malpractice RVU was 0.05. The total RVU for 99214 was therefore 2.18. To convert the RVU to a monetary amount, multiply by the conversion factor (37.8975 in 2005). The payment for CPT 99214 in 2005 was $82.61.
How To Stand OutWork Hard!
Be in the right job
Tools for Success
Learn how to become indispensible to a practice
Exceed Benchmarks
Continued learning
Networking with colleagues
Case StudyMike is a Physician Assistant with two (2) years hospital based spine experience applying to a solo spine practice in the suburbs. Mike feels he has extraordinary work ethic and skill set. His salary expectation is 20% above the benchmarked average for the geographic location. In addition, there has been 5 other candidates with similar experience willing to take the offered salary compensation
Case StudyReality
Mike is a phenomenal PA
A solo practice cannot afford him
They are experiencing declining reimbursements
Would rather take someone with a bit less experience and save $20,000.
Case StudyMike Could Have…
accepted the offer
negotiated an incentive program that paid him a percentage of income generated by bringing a PA to the practice
Need To Be Forward Thinking
ConclusionSpine is an ever evolving field
In the next decade we will experience an influx of colleagues into the marketplace
Educating ourselves on how to:
Negotiate
Work toward incentivized compensation plan (if desired)
Foster Career Growth
References
Negotiating Employment: Second edition, (2008) 63-page book, with self-assessment tools. Published by Law Office of Carolyn Buppert
WWW.AAPA.ORG
Bureau of Labor and Statistics, 2010
Pay Scale for Nurse Practitioners | eHow.co.uk
http://www.ehow.co.uk/about_6539819_pay-scale-nurse-practitioners.
http://paworld.net/PhysicianAssistantJobDescription.htm
Thank YouNicola V. Hawkinson, DNP, RN, RNFA
WWW.SPINE-SEARCH.COM
516-333-5050