Category : Physician’s Assistants – PA’s

Employment Contracts and Never Having to Say You Are Sorry

Count contracts among the top things you want to get right, or as close to right, as you can before you sign on the dotted line.
TIMING IS EVERYTHING
You should receive a copy of the employment contract either at the same time the offer is extended to you or shortly thereafter.  NEVER, EVER accept an offer until you have had time to fully review the contract.  In my experience, it is not so much that NPs and PAs regret the items they agreed to in their contracts as much as they lament what they neglected to include.

A typical contract is 1-2 pages and commonly uses boilerplate language.  It is sort of a one-size-fits-all form where the employer fills in the proposed pay rate, whether employment is full time or part time and a general description of benefits.  Many may also include a non-compete of some sort.

 
THE BALL IS IN YOUR COURT
Upon receipt and review of the contract you can either 1. accept it, 2. reject it, or 3. negotiate the terms.  Life is easy if you just sign it, which is what the employer is hoping.  And to be honest, quite a few of us feel just a little intimidated and so we close our eyes, hope for the best and comply.  Why? One reason is because we lack the training on employment contracts.  This is especially true for the new graduate NPor PA who has no prior experience in contracting and feels unsure about what is appropriate or how to respond.  It can also be a little intoxicating to receive that first job offer. I often compare it to a marriage proposal in which we are so flattered that we just say “yes” before thinking it fully through.
COUNTER OFFERS
Contracts needn’t be “standardized”. It’s your prerogative to negotiate and you can choose to include anything that is important to you.  In addition a wise NP or PA will clarify any points that they find to be murky or lead to possible confusion down the line.  So, rather than just signing as is use the option to add or delete information and send the edited the contract back.  That’s called negotiation.
*Note – etiquette dictates that you submit a counter offer only once. Employers have little appetite for a prolonged back and forth so you need to carefully think through your response.  In other words, you don’t want to find yourself in a situation where you are countering your counter.  Know your bottom line and leave it at that. 
WHAT TO INCLUDE
Wouldn’t it be nice if you had a handy checklist of items so you could more fully evaluate a proposed employment contract?  I want to share with you a reference that is the most comprehensive list for contract negotiation that I have come across.   It is identified as a “sample NP contract” but would work nicely for a PA as well. Click here 
The only thing I disagree with in this sample contract is the term length.  The sample utilizes a term of 5 years.  That’s an awful long time to commit to a new relationship!  I suggest a shorter term of 1-2 years.  Healthcare is changing rapidly and a shorter term gives you the chance to renegotiate sooner.
If you need more explanation on how healthcare changes can impact your employment please read my article “Contracts:Avoiding the Wrong Regrets”

 

New Grad Class of 2013 – this blog is for YOU

Graduation is exciting but also a little stressful. New grads (or maybe I should call them “soon-to-be-grads”) spend almost as much of their last semester worrying about getting their first job as they do studying.

Well, I personally have never seen any value to worry. It’s far better to spend your time preparing instead of worrying.  And luckily for new grads there is some good advice out there.

Advance for NPs and PAs puts out a great “Guide for NP & PA New Grads” every year and it is chock full of both practical and valuable advice.

This year 2013 the guide has gone digital and you will find 4 extremely helpful articles.

The first (which just happens to be written by me!) is Salary Tips for the New Grad.  I discuss realistic salary expectations as well as the proper time to negotiate.  You might be surprised at what I have to say.  Read more

There is also a nice article on Building a Better Resume. This piece includes some nice tips on social media, keywords and paper resumes.  As your trusted NP Career Coach I can say without reservation that the advice is spot on and will help you be more successful in landing that job interview.

Speaking of interviews, did you know that the new trend is to do your interview via Skype?  Check out the handy tips in Get Psyched to Skype.  You will be glad you did.

And finally, read Networking Know-How and find out how to make the most out of your networking.

Access the entire guide HERE 

 

HAPPY GRADUATION CLASS OF 2013!

 

More reasons to hate on the term “mid-level” – as if there weren’t enough already…

As many of you know I do not particularly care for the term “mid-level” practitioner.  Just in case you aren’t familiar with my opinions on the subject you can read one of my posts from May 2012 in which I give numersous reasons to shun the term.  (if you agree please share!)

Now, as if there weren’t already enough reasons to dislike that label I have found yet another – and it is a doozy.

I came across a link to what is actually a very handy grid from which outlines the DEA authorization to prescribe controlled substances in each state. It is a state by state guide to which schedules we are allowed to prescribe.  This is actually quite a helpful resource if you are considering a move to another state or perhaps thinking of doing a NP or PA travel or locum tenens assignment.

The guide starts out with the official definition of a “mid-level” provider.

Pursuant to Title 21, Code of Federal Regulations, Section 1300.01(b28), the term mid-level practitioner means an individual practitioner, other than a physician, dentist, veterinarian, or podiatrist, who is licensed, registered, or otherwise permitted by the United States or the jurisdiction in which he/she practices, to dispense a controlled substance in the course of professional practice. Examples of mid-level practitioners include, but are not limited to, health care providers such as nurse practitioners, nurse midwives, nurse anesthetists, clinical nurse specialists and physician assistants who are authorized to dispense controlled substances by the state in which they practice.

OK, I don’t like this definition but I can live with it, at least for now.  But then I kept reading and I see that also included in this mid-level category is “animal shelters” and “euthanasia technicians”.  WTF?

This is still a helpful guide but it really is hard to look past this.  Who can we complain to?

You really must see it for yourself.  Click here.

Not sure? Shadowing might be the solution.

Have you received a job offer but you just aren’t sure if you are ready to accept?

You may have left the interview feeling a little rushed, and that your questions were not fully answered. This is not unusual.

Receiving an NP or PA job offer is a bit like receiving a marriage proposal. It’s very flattering to know that you are wanted. But sometimes you can find yourself so overwhelmed by the notion that someone truly desires you that you don’t consider whether or not the feeling is mutual.

Starting a new job is not unlike a marriage, it is big commitment and shouldn’t be left to one’s emotions, because once done, it’s not easy to undo. It’s one of life’s little ironies (or jokes) that getting out of a bad relationship can be much more complicated than entering into one.  (We will leave the topic of how to gracefully “divorce” a job for another blog!)

So for those of you entertaining an offer but still feeling unsure I recommend you consider a longer engagement. Before you think I have completely gone off the rails let me explain.

Ask for a “shadow” day. This has become more and more common in recent years. Requesting to spend a shift or two with one of their current providers, “shadowing” is a good way for both parties to get to know each other better.

As a clinician, you will get a clearer idea of not only the job duties and patient flow but also the personality of the practice. Remember, an interview lasts usually no more than an hour and everyone is on their best behavior. It’s a little harder to hide dysfunction for an entire day. If there is an undercurrent of tension or disorganization you are going to pick up on it.

So what’s in it for the employer? A good fit, that’s what employers get out of the shadow. Employers are just as eager to find an employee who fits in with their practice culture as you are to find a practice that fits you. A happy employee is a long term employee. As I have said many times before, clinicians rarely leave jobs where they are happy even if they can make better money elsewhere. Great pay and benefits aren’t enough for happiness.

Now that I think about it, that is the case for many marriages as well…

From a blog originally published on Advance for NPs and PAs

Survey says: 2012 was a Good Year!

The “2012 Advanced Practice Clinician Compensation and Pay Practices Survey Report” a survey conducted by Sullivan, Cotter and Associates indicates that 2012 was a good year to be an NP or PA.

Key findings include:

NPs and PA job openings:

  • A 17% increase in the number of Advanced Practice Clinicians positions was reported by 63% of the respondents
  • In addition half the respondents plan to increase the number of NPs and PAs in their organizations by 15% during the coming year

NP and PA salaries:

  • 62% indicated that NP and PA salaries increased by an average of 3.9% over the past year.
  • At least half revealed they are planning salary increases of an average of 3.1% in 2013 for their Nurse Practitioners and Physician Assistants.

Reasons cited for the trends:

  • Team based care driving the demand for more NPs and PAs
  • MD shortage
  • Recent national trends to ensure all medical professions can work at the top of their practice level and training.

While this is only one study it does confirm that the market is moving in a positive direction.  This doesn’t mean we can relax just yet though, my contacts tell me that open positions are still attracting large numbers of applicants.

2012 Salary updates

This time of year always bring a new batch of PA and NP salary survey information.  I like to review the various surveys to compare if they match up with the trends I observe.  Sometimes they do, and sometime they don’t .

As always, a few words of caution about salary surveys.  First, they keep in mind the participants are self-selected which may skew the results.  In my experience those doing well are more eager to fill out salary surveys while those experiencing less favorable compensation tend not to want to talk as much.

In a volatile or rapidly changing employment landscape a salary survey can often lag behind current trends.  This has been especially true for PA and NP jobs over the last previous years, however, this past year has seen some increasing stabilization which make recent surveys more reliable.

Here is a quick summary of the most recent salary survey from Clinical Advisor along with my comments:

For an NP in family practice the yearly pay averages in the mid 80K range  Womens health and pediatric NPs come in about 10K lower.  Specialties, such as geriatrics or heme/onc will bring in a yearly salary in the 90K bracket.

My take: This is not a surprise to any of us in the recruiting biz.  For those certified in womens health and peds wages and jobs have been in decline for years. What this survey doesn’t say is how the respondents for these categories are certified.  An FNP working in these areas will earn more than those certified as peds or WH.

PAs earn about 10K more a year than NPs. The exception is in family practice where they come out only slightly ahead of NPs in pay.

My take: The other categories listed are specialty practice areas.  No surprise they earn more. Specialty practices bring in more revenue so it logically follows that they will pay more too. PAs also still dominate in specialty practices.  They tend to be more open to specializing than NPs although that is beginning to change too.

The survey also compares experience.  In both categories experience brings more pay but for PAs the increase continues over their careers while the earnings of NPs level off after 5 years.

If you want to check out the entire survey, which includes further breakdowns by geographic region, it can be found here.

Do you have a passion for Rural healthcare?

I don’t often discuss specific job openings but I am going to make an exception for this position.

How do jobs make my “short-list” you might wonder?

Because I feel I have a certain trust level with my readers I won’t blog about any and every position. I will only promote a PA or NP job if I feel the employer values and respects nurse practitioners and/or physician assistants. This job meets my criteria due to the high level of independance their NP and PA providers enjoy.

Another plus is this NP/PA job is in my home state of Minnesota – actually small town Minnesota to be exact.

Here are the details:

This position is a true family practice position in a rural satellite clinic providing care for all ages across the lifespan.

Hours are Monday – Friday, 9a-5p.

There is occasional Saturday morning (8-noon) coverage in a neighboring clinic required which is rotated among 6 (yes I said 6!) other advanced practice clinicians.

Other responsiblities include “PRN back-up” for call in nearby Critical Access ER.

Back-up call and Saturday clinic coverage does pay additional compensation on top of the base salary.

Speaking of salary…

Salary range is $75-$95K depending on experience.

Position includes Medical Benefits, 401K, plus CEU/licensure reimbursement. Relocation assistance is negotiable.

They will also consider NEW GRADS! How cool is that?

Now excuse me for a minute while I brag about my home state. I’d like to remind everyone that Minnesota has alot to offer and this clinic location has something for everyone. I’m talking about easy access to the best fishing and camping in the state for you nature enthusiasts as well as theatres and large shopping centers for you city folk. (FYI – Minnesota DID invent the shopping mall) And when you want/need to come to the big city Minneapolis-St Paul is less than 2 hours away.

This is a rare opportunity to provide true family practice services with maximum independence in a rural setting that values nurse practitioners and physician assistants.

If you would like to hear more call Katy at 800-856-6385. ext. 2113.

Be sure to tell her the NP Career Coach sent you!

 

Lots of Locums

Now that my first column on Locum Tenens assignments has gone “live” I have been recieving a ton of emails and calls. First, let me say I am pleased so many NP’s and PA’s are reading what I write! It’s nice to know you are out there. It’s also nice to see so many clinicians warming up to doing temporary jobs. So far I have heard from folks at both ends of the career spectrum, some are NP’s who are just beginning their career while others are looking towards retirement and just looking for something different (but lucrative). All have concerns and questions.

Temp NP or PA jobs definitely take you out of your comfort zone, some see this as exciting and challenging while others might view it as nothing but pure stress. No matter which way you lean I advise you to be sure to get some critical information before you agree to that temporary job assignment.

Be sure you find out the reason that the employer is seeking a locum tenens clinician. Is this a new venture and they prefer to see if things are going to work out before taking on a permanent employee? In our current ecomony this is very reasonable and actually protects you as much as it protects them. If things don’t work out for any reason no one will question a short employment entry on your NP resume if the position was a temp assignment. And if it does work out you could have your foot in the door to be hired permanently.

If the reason they are seeking a locum tenens clinicians is due to a a vacancy it is a good idea for you to you find out why the previous provider left. It could be something as simple as a medical leave or something much more serious such as a toxic work environment. Good to know before you commit.

Next week I will talk about ways to ensure that you have adequate physician back-up while you are out on assignment. Stay tuned…

2011 Market “Forecast”

January is the traditional time each year when we look back at the past year and then try to predict what will be the trends for the coming year. Well, this year is no different!
Last month I was interviewed by Jen Ford at ADVANCE for NP/PA’s regarding my thoughts on what’s in store for NP’s and PA’s in 2011. She wrote a great article which covers several topics that are of interest to all Nurse Practitioners and Physician Assistants regardless of whether or not they are job hunting. We discussed the job market, temporary positions, salaries as well as upcoming trends mixed in with a few thoughts for this years new grads.
I highly recommend that you check out the article “A Changing Landscape – The Job Outlook for NP’s and PA’s. You won’t be sorry 🙂

Finding a job fast

Economic conditions have clinicians considering alternative NP and PA job opportunities.

This week I recieved a question from a reader. Her spouse is out of work and she needs to get to work fast. She was wondering if a short term or Locum Tenens NP job could be the answer to her situation.

Temporary or locum tenens assignments are growing in popularity and as usual I have some advice to help you decide if this is an option for you.

To read my answer check out my latest post over at “Advance for NP/PA’s”