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Message
Question for Docs/Surgeons/ARNPs
Posted on 3/14/17 at 9:10 pm
Posted on 3/14/17 at 9:10 pm
I'm hoping that there might be some on this board in the medical field that might be able to provide some advice/info. I apologize in advance for the long-winded post!
My wife will be obtaining her ARNP (Nurse Practitioner) degree/license in April/May timeframe. She's spent her entire 16 year career in nursing and all of it has been in the operating room. She's performed multiple roles of increasing responsibility including staff nurse in pretty much every specialty, specialty coordinator of multiple specialties, nurse educator, etc. She's very bright, well liked, and basically is good at what she does. She's started looking for a ARNP position and had her first interview today with a very well known and successful orthopedic practice in a major city in Florida. They haven't made an offer yet, but the interview went very well and she feels very good about it. They discussed salary very briefly when they asked (mildly pressured) her to provide her salary expectations, so she threw a number out that we had previously discussed and that was calculated as a base hourly rate and assumed a 40 hour week. The HR person that asked the question indicated (off the record, lol) that the management team would think that the number was high. The discussion pretty much ended there when my wife explained that there were too many unknown variables to be able to state a number, so she wrote down a salary range that inexplicably included a salary $5k below what we had talked about. I've provided details about the position below, and was curious if any of you had any thoughts about what we might expect is an appropriate compensation package. Any constructive comments are welcome and appreciated, especially regarding negotiations!
Ortho Practice is wildly successful with 35 surgeons. Position supports only one surgeon that does 2.5 days in OR doing total hips and knees primarily, but also some revisions and emergencies. Other 2.5 days she would be in the office doing pre-ops, post-ops, helping with writing orders, charting, doing injections etc. Much of this would be with minimal supervision once everyone (including her) is comfortable. Surgeon estimated average 50 hours per week but that could go up/down. Position includes unpaid call of at least 8 nights that includes at least one four day weekend per month. Call back pay is unpaid. Position pays base salary plus bonus that they could not provide an expectation on as it 'varies' and is based on collections. Surgeon is young and growing/building the practice and we are told he/she likes to take call. Again... Call and call back is unpaid. 25% (25 cents on the dollar) 401K match up to 4% of total salary. Malpractice insurance paid, below average health insurance options, and $4K in annual continuing education credit.
Based on this I have a number that I think is reasonable, but what say the board? We think it would be possible to request and receive straight hourly compensation that would include OT and call pay for the first year, but we aren't sure of that. This is the route that I think makes the most sense given the uncertainty of the bonus and on the number of hours that this job seems to require. I feel like they would work her to death with just a straight salary with no call pay or OT. Any advice?
My wife will be obtaining her ARNP (Nurse Practitioner) degree/license in April/May timeframe. She's spent her entire 16 year career in nursing and all of it has been in the operating room. She's performed multiple roles of increasing responsibility including staff nurse in pretty much every specialty, specialty coordinator of multiple specialties, nurse educator, etc. She's very bright, well liked, and basically is good at what she does. She's started looking for a ARNP position and had her first interview today with a very well known and successful orthopedic practice in a major city in Florida. They haven't made an offer yet, but the interview went very well and she feels very good about it. They discussed salary very briefly when they asked (mildly pressured) her to provide her salary expectations, so she threw a number out that we had previously discussed and that was calculated as a base hourly rate and assumed a 40 hour week. The HR person that asked the question indicated (off the record, lol) that the management team would think that the number was high. The discussion pretty much ended there when my wife explained that there were too many unknown variables to be able to state a number, so she wrote down a salary range that inexplicably included a salary $5k below what we had talked about. I've provided details about the position below, and was curious if any of you had any thoughts about what we might expect is an appropriate compensation package. Any constructive comments are welcome and appreciated, especially regarding negotiations!
Ortho Practice is wildly successful with 35 surgeons. Position supports only one surgeon that does 2.5 days in OR doing total hips and knees primarily, but also some revisions and emergencies. Other 2.5 days she would be in the office doing pre-ops, post-ops, helping with writing orders, charting, doing injections etc. Much of this would be with minimal supervision once everyone (including her) is comfortable. Surgeon estimated average 50 hours per week but that could go up/down. Position includes unpaid call of at least 8 nights that includes at least one four day weekend per month. Call back pay is unpaid. Position pays base salary plus bonus that they could not provide an expectation on as it 'varies' and is based on collections. Surgeon is young and growing/building the practice and we are told he/she likes to take call. Again... Call and call back is unpaid. 25% (25 cents on the dollar) 401K match up to 4% of total salary. Malpractice insurance paid, below average health insurance options, and $4K in annual continuing education credit.
Based on this I have a number that I think is reasonable, but what say the board? We think it would be possible to request and receive straight hourly compensation that would include OT and call pay for the first year, but we aren't sure of that. This is the route that I think makes the most sense given the uncertainty of the bonus and on the number of hours that this job seems to require. I feel like they would work her to death with just a straight salary with no call pay or OT. Any advice?
This post was edited on 3/14/17 at 9:35 pm
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Posted on 3/14/17 at 10:11 pm to 22jctiger22
I'd get extreme clarification on call expaectations and frequency of call. Ortho call is terrible and is what drives NP's and PA's away from that speciality.
Also find out the metrics that the bonus is measured on. Ask them for examples of the last 3 bonus periods and what her bonus would have been if she was working there
Also find out the metrics that the bonus is measured on. Ask them for examples of the last 3 bonus periods and what her bonus would have been if she was working there
Posted on 3/14/17 at 10:27 pm to Finch
8 nights of call a month, below average benefits (other than CME)? I would want a lot of money for that.
Posted on 3/14/17 at 10:33 pm to saderade
Weekends?
Holidays?
If your surgeon takes someone else's call are you too on call?
Are any of the NPs or PAs excluded from call?
Holidays?
If your surgeon takes someone else's call are you too on call?
Are any of the NPs or PAs excluded from call?
Posted on 3/14/17 at 10:33 pm to 22jctiger22
quote:
I feel like they would work her to death with just a straight salary with no call pay or OT
I can tell you that you are spot on with this feeling. The question should be is she/you ok with this? If not, attempt to counter or run from this offer. There are really some other more valuable questions she should ask other than salary questions, but to stick with your original thought process, no do not accept no paid call. Orthopedic surgery is one of the most lucrative medical specialties. The surgeon gets paid for his call time and your wife should too. Period. And another thing, that 50 hours a week will most likely end up being 60 or more. Some days will be better than others but over the long haul it will be 60 if it is a "wildly successful practice."
Posted on 3/15/17 at 4:54 am to 22jctiger22
I would not agree to it simply because they are burying a ton of additional work in a salary. I also wouldn't fall for the hr rep's game with trying to steer her into a lower salary.
These small practices have freedom to manipulate employees because they lack corporate oversight. If I were here I would look into a larger healthcare system where variables are much more defined.
She is more valuable than she realizes because she has a proven history of being able to work well with others.
These small practices have freedom to manipulate employees because they lack corporate oversight. If I were here I would look into a larger healthcare system where variables are much more defined.
She is more valuable than she realizes because she has a proven history of being able to work well with others.
Posted on 3/15/17 at 2:07 pm to 22jctiger22
Base + production bonus is normal. No way I'm paying your wife hourly. I want to get through as many patients as I need to and go home and I'd like my employees to have the same attitude. Profit sharing/production incentives do wonders for efficiency.
Not sure what you guys expect an NP or PA to get for call. You aren't real valuable to your employer in this situation. When I'm on call I go in for things that need surgery, urgent/emergent stuff. Your wife can't operate for me. So her 8 days of call are basically acting as a triage secretary to filter out the bull crap that otherwise would have made it to the surgeon's pager/cell phone. I guess there is value in that, maybe $100 per day? $800 a month before taxes?
Your wife needs to talk to other PAs or NPs in the practice. Ask them about pay, production, work environment, etc. The group should have some projections of how she will increase production/collections as well that she should ask for. She has slightly more value than a PA since she can see patients, chart and bill autonomously. Depending on the cases scheduled, I would have clinic patients for her to see on my OR days instead of using her as a first assist. A PA can't do that without one of the partners having to do extra work cosigning his/her charts.
Unless you are going to post the base + bonus numbers, I can't tell you if she's getting ripped off or not...
Not sure what you guys expect an NP or PA to get for call. You aren't real valuable to your employer in this situation. When I'm on call I go in for things that need surgery, urgent/emergent stuff. Your wife can't operate for me. So her 8 days of call are basically acting as a triage secretary to filter out the bull crap that otherwise would have made it to the surgeon's pager/cell phone. I guess there is value in that, maybe $100 per day? $800 a month before taxes?
Your wife needs to talk to other PAs or NPs in the practice. Ask them about pay, production, work environment, etc. The group should have some projections of how she will increase production/collections as well that she should ask for. She has slightly more value than a PA since she can see patients, chart and bill autonomously. Depending on the cases scheduled, I would have clinic patients for her to see on my OR days instead of using her as a first assist. A PA can't do that without one of the partners having to do extra work cosigning his/her charts.
Unless you are going to post the base + bonus numbers, I can't tell you if she's getting ripped off or not...
Posted on 3/15/17 at 2:36 pm to 22jctiger22
I have no idea of the appropriate salary ranges in Florida, but here in the med center she's looking at a $88K-$110 range, IMO. Closer to the lower end b/c she's has yet to be employed as a mid level, despite alot of experience as an RN. But advancement and higher salaries become readily available (in Texas) for mid levels with experience.
As others have said, the call schedule and compensation sound foreboding. Even if it's only call backs as opposed to actual coverage, that shite wears on a home life after a while even with adequate compensation, and there appears to be no clear understanding of how much call could be in her future. My wife, at least, gets designated call pay when when she is covering (mid level covering GI and hepatology service), and it's still a significant strain.
And ignore the HR persons insinuations. Just get the interview with the director or surgeon and go from there.
FTR, the last mid level I hired was for a clinical GI job 2.5 years ago. 5 days of clinic. Fresh out of PA school. No medical experience beyond her rotations. $85,000.
As others have said, the call schedule and compensation sound foreboding. Even if it's only call backs as opposed to actual coverage, that shite wears on a home life after a while even with adequate compensation, and there appears to be no clear understanding of how much call could be in her future. My wife, at least, gets designated call pay when when she is covering (mid level covering GI and hepatology service), and it's still a significant strain.
And ignore the HR persons insinuations. Just get the interview with the director or surgeon and go from there.
FTR, the last mid level I hired was for a clinical GI job 2.5 years ago. 5 days of clinic. Fresh out of PA school. No medical experience beyond her rotations. $85,000.
This post was edited on 3/15/17 at 2:38 pm
Posted on 3/15/17 at 8:25 pm to 22jctiger22
This is what my wife has done as NP
Ortho: Clinic and surg 8-5 M-F no call, no nights/weekends, small bonuses. She found it boring as shite and just pushing pills. $85k
Nephrology: Hospital and clinic, 12-15 multi hospital call nights per month @ 18 hours per call shift, no extra $ (2pm-8am). Good bonuses. She hates it. Your "days off" during the week start at 8am when you get off call so you sleep all day. Also 18hr call shifts are fricking nuts, especially the weekends (Fri, Sat, Sun) $110k
Family Clinic (about to start): General Clinic, 8-6/9-5 M-F. no call, no nights/weekends, bonuses offered. $110k
Ortho: Clinic and surg 8-5 M-F no call, no nights/weekends, small bonuses. She found it boring as shite and just pushing pills. $85k
Nephrology: Hospital and clinic, 12-15 multi hospital call nights per month @ 18 hours per call shift, no extra $ (2pm-8am). Good bonuses. She hates it. Your "days off" during the week start at 8am when you get off call so you sleep all day. Also 18hr call shifts are fricking nuts, especially the weekends (Fri, Sat, Sun) $110k
Family Clinic (about to start): General Clinic, 8-6/9-5 M-F. no call, no nights/weekends, bonuses offered. $110k
This post was edited on 3/15/17 at 8:28 pm
Posted on 3/16/17 at 8:27 am to YipSkiddlyDooo
quote:that definitely depends on the state laws and the particular group. The PAs and NPs in our group do the exact same thing as well as bill the exact same
The group should have some projections of how she will increase production/collections as well that she should ask for. She has slightly more value than a PA since she can see patients, chart and bill autonomously. Depending on the cases scheduled, I would have clinic patients for her to see on my OR days instead of using her as a first assist. A PA can't do that without one of the partners having to do extra work cosigning his/her charts...
Posted on 3/16/17 at 9:42 pm to saderade
quote:
that definitely depends on the state laws and the particular group. The PAs and NPs in our group do the exact same thing as well as bill the exact same
I stand corrected. Sorry to the OP, in FL your wife is no more valuable than a PA. Go ahead and down vote this one too because you don't like the truth about her value to an ortho group. A poster above gave a very realistic starting salary range IMO, any lower than that and she'd make more money as a floor nurse working a little OT. Of course once any PA or NP learns a little bit about the pathology specific to the specialty, they become increasingly more valuable to the group/employer.
Posted on 3/16/17 at 10:37 pm to YipSkiddlyDooo
Thanks to everyone for the replies with the very helpful info! I will be sure to come back if she gets an offer.
Yip: I didn't downvote your post, at least I didn't intentionally. Although, you do sound like a d#ck. Thanks again.
Yip: I didn't downvote your post, at least I didn't intentionally. Although, you do sound like a d#ck. Thanks again.
Posted on 3/16/17 at 11:52 pm to 22jctiger22
I see this type of situation all the time. Unfortunately, an NP/PA isn't all cracked up what they make it seem like. I work along side both all the time and they are basically overpaid nurses and/or underpaid doctors. That is what steers me away from ever going that route. I'm a nurse and make what she does with a little OT each month based on a 36 hour work week (paid for 40). Yes, I do a little more work but I'm paid hourly plus overtime, on call pay, and incentive pay.
To directly answer your question, I would not even fool with them. An hourly NP will never happen. They regularly work 50+ hours a week. The on call and call back unpaid is normal as they are only salary.
Seems like the HR dept. is going to low ball her but you also have zero leverage. Unfortunately, the 16 years of her being a nurse doesn't have any value when she becomes a mid level. Realistically, she'll be offered around the mid-high 80's. With avg. benefits, and really no perks besides some "bonus", I would steer clear. Hope I'm wrong, good luck to her!
To directly answer your question, I would not even fool with them. An hourly NP will never happen. They regularly work 50+ hours a week. The on call and call back unpaid is normal as they are only salary.
Seems like the HR dept. is going to low ball her but you also have zero leverage. Unfortunately, the 16 years of her being a nurse doesn't have any value when she becomes a mid level. Realistically, she'll be offered around the mid-high 80's. With avg. benefits, and really no perks besides some "bonus", I would steer clear. Hope I'm wrong, good luck to her!
Posted on 3/17/17 at 7:36 pm to murse
Callback pay is unpaid? frick that! Unless the salary is really good. Call sucks enough but not getting paid for it is bullshite.
Posted on 3/18/17 at 8:03 am to tke_swamprat
Just to give you something to sort of compare. My wife is a family practice NP. She works 36 hrs/week. Never on call and has never worked weekends. Been in practice 6 or 7 yrs and makes a little over $100k. Basically same benefits that you are saying your wife is being offered. She has always had the option to work after hours clinic if she wanted to make more, but has never done it.
I would expect someone who is going to be on call, work more hrs, and would be required to work some weekends should be compensated a good bit more. Not to mention that she would be in the Orthopaedic field vs family practice. That right there should guarantee your wife to make a good bit more.
I would expect someone who is going to be on call, work more hrs, and would be required to work some weekends should be compensated a good bit more. Not to mention that she would be in the Orthopaedic field vs family practice. That right there should guarantee your wife to make a good bit more.
This post was edited on 3/18/17 at 8:09 am
Posted on 3/19/17 at 1:25 pm to 22jctiger22
Ortho clinics are super busy. Like 50 patients a day. Would not do it. Clinic might end at five, but she will be catching up on documentation all night post clinic.
Posted on 3/19/17 at 7:48 pm to 22jctiger22
As an ortho doc I would add some points to thought process.
1. Supply vs demand. If they have a ton of NP or PA applicants for the position, the young orthopedist is going to go cheap while he builds his practice.
2. Experience is a big deal in ortho. It literally takes years to train a PA or NP to be a good ortho practitioner. Unless she has reduced a bunch of distal radius fractures, hip dislocations, etc - she is going to start out low. Once she has ortho experience, she can ask for higher salary.
3. Call is variable for ortho. Call at level 3 community hospital is usually not that bad and may not demand call pay. Ortho call at a level 1 regional referral center can be brutal and should get call pay compensation. Ultimately she will get whatever the other PA/NP get for that practice. Just ask what they get and ask for the same.
4. They won't go for hourly rate. She is still thinking like a nurse and not practitioner. She will have many long nights doing notes in which she won't get paid for doing them just like all the other docs and mid levels trying to survive in the current medical environment. Base salary plus production bonus is standard.
1. Supply vs demand. If they have a ton of NP or PA applicants for the position, the young orthopedist is going to go cheap while he builds his practice.
2. Experience is a big deal in ortho. It literally takes years to train a PA or NP to be a good ortho practitioner. Unless she has reduced a bunch of distal radius fractures, hip dislocations, etc - she is going to start out low. Once she has ortho experience, she can ask for higher salary.
3. Call is variable for ortho. Call at level 3 community hospital is usually not that bad and may not demand call pay. Ortho call at a level 1 regional referral center can be brutal and should get call pay compensation. Ultimately she will get whatever the other PA/NP get for that practice. Just ask what they get and ask for the same.
4. They won't go for hourly rate. She is still thinking like a nurse and not practitioner. She will have many long nights doing notes in which she won't get paid for doing them just like all the other docs and mid levels trying to survive in the current medical environment. Base salary plus production bonus is standard.
This post was edited on 3/19/17 at 7:59 pm
Posted on 3/19/17 at 10:59 pm to 22jctiger22
$500 extra just to answer weekend calls and $150 per case large or small. Nothing less.
Posted on 3/20/17 at 8:46 am to Odinson
Serious question, why would a NP work for an ortho then? FP doc makes $200k Ortho doc makes $550k, FP NP makes $100k and Ortho NP makes $120k maybe? For potentially 50% more work? Doesn't make sense to me? As in, if it was my wife no way I'd be happy with her working the Ortho job? Those extra hours add up real quick too, as in it should be worth double the pay not 20% more pay for 50% more work? I realize the Ortho doc put in tons more work, but my point is the Ortho NP put in barely more work but has to work way more hours for a crappy pay increase for the time put in?
OP, I'd tell your wife she has a ton to figure out if your post is truly where she is. Unless you are a stay at home dad or work part time from home or part time period, that extra little money is in no way worth the extra work load imo. $20k extra money/ year on a $100k salary is no way worth 50-60 hour work weeks when you could work 40-45.
OP, I'd tell your wife she has a ton to figure out if your post is truly where she is. Unless you are a stay at home dad or work part time from home or part time period, that extra little money is in no way worth the extra work load imo. $20k extra money/ year on a $100k salary is no way worth 50-60 hour work weeks when you could work 40-45.
This post was edited on 3/20/17 at 8:49 am
Posted on 3/20/17 at 12:06 pm to baldona
that was sort of my wife's reasoning behind the whole idea of working for family practice vs specialist. Don't make quit as much money, but has a hell of a lot better quality of life.
This post was edited on 3/20/17 at 5:57 pm
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