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

HOW MANY OF YOU……

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

Where Do You Fit In?

Who Does Not Feel They Are In The Right Spot?

Who’s Interested In Finding Out?

How to Change

All of Us Land Here

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!

Lifestyle Compatibility

Lifestyle Compatibility

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.

Knowing your Worth

How To Stand Out

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