1. 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, RN
March 2011

2. HOW MANY OF YOU……

3. Statistics
Practitioner
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

4. Statistics
Practitioner
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

5. 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

6. Where Do You Fit In?

7. Who Does Not Feel They Are In The Right Spot?

8. Who’s Interested In Finding Out?
How to Change

9. All of Us Land Here

10. 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

11. How To Read A Contract
Even 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:

12. How To Read A Contract
Work Obligations
Termination Clauses
Compensation and Benefits
Malpractice
Restricted Covenants and non-solicitation clauses

13. How To Read A Contract
Job 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

14. Before You Negotiate
Audit 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

15. 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!

16. Lifestyle Compatibility

17. Lifestyle Compatibility

18. 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.

19. Knowing Your Worth
Who 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?

20. Knowing Your Worth
20 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

21. 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 provided
ie bracing

22. Provider productivity may be based on
the following:
Total gross charges
Total net medical revenue
Growth rate of patient base
Hospital admissions
Visits or consults
Office hours
Practice coverage
Volume of procedures
Number of cases
Revenue minus expenses
Patient Panel Size

23. Relative Value Unit
There 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.

24. Relative Value Unit
Each 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

25. Relative Value Unit
The relative value is then multiplied by a single
nationally uniform "conversion factor" to arrive at a
monetary value.

26. Relative Value Unit
For 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.

27. Knowing your Worth

28. How To Stand Out

29. How To Stand Out
Work Hard!
Be in the right job
Tools for Success
Learn how to become indispensible to a practice
Exceed Benchmarks
Continued learning
Networking with colleagues

30. Case Study
Mike 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

31. Case Study
Reality
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.

32. Case Study
Mike 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

33. Conclusion
Spine 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

34. 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

35. Thank You
Nicola V. Hawkinson, DNP, RN, RNFA
WWW.SPINE-SEARCH.COM
516-333-5050