How to negotiate a PA or NP contract

The thought of negotiating a contract can be intimidating to many people, especially if you’re looking for your first job. But for a PA or NP, contract negotiation is an important skill to have, because it can help you get the salary and contract terms you deserve.

What to do before even looking at an employment contract

Determine what’s most important to you, like salary, work/life balance, career advancement, and time with patients, says Jon Appino, principal and founder of Contract Diagnostics, a company that focuses exclusively on reviewing healthcare professional employment contracts.

Appino says it’s important to define what you want out of a career from a variety of angles: geographically, competitively, pace of practice, academic versus private practice versus independent contractor jobs.

“I think establishing these things before anything else is incredibly important before even looking at a contract,” he says.

“It’s also helpful to survey the market — even have a couple of practice interviews to see what you’re worth. Talk to your peers, check out social media, and just do your research, because the more you know the better you’ll be at negotiating.”

What is a letter of intent (LOI)?

So you had a great interview at an organization you loved, and the employer seems equally eager to hire you. What often happens at this point is you’ll be handed an LOI, outlining the terms of employment you both agreed upon in the interview process. It essentially lays out the terms of the job offer, such as compensation, practice expectations, relocation assistance, and sign-up bonuses. And they’ll usually ask for your signature to indicate your acceptance of the offer.

First, you should know this document isn’t legally binding; it’s more of a handshake agreement. Even so, it’s important to read the LOI very carefully, and hold off on accepting it if there’s anything that seems inconsistent with what you negotiated. It’s also important to understand that although this document isn’t legally binding, trying to change the terms of the offer once you’ve accepted an LOI is bad form and could lead to a breakdown in negotiations later on. You shouldn’t accept unless you fully intend to move forward in good faith.

What should be detailed in the contract

Once you receive the actual employment contract, you may choose to have an attorney or employment contract expert review it. But at minimum, the following terms and conditions should be included:

• Compensation (including bonus requirements)

• Termination provisions

• Professional liability insurance

• Medical malpractice insurance

According to Contract Diagnostics, other details that may be in the contract are restrictive covenants (such as a non-compete clause), possible malpractice tail insurance requirements, and signing or relocation dollars.

What things are typically negotiable?

Advanced practice providers are sometimes unaware of the number of things they’re able to negotiate for. Aside from salary, other negotiable items are sign-on bonuses, student loan repayment, call hours and on-call pay, and CME and professional development fees, to name just a few. Appino says another negotiable contract item could even be backfunding COBRA insurance.

“If they say compensation is 100% off the table negotiation-wise, there are many other things you can ask for,” he says. “Ask the right questions of the right person, and then make sure you have reasonable expectations on what they can and are willing to change.”

What things are typically non-negotiable?

While nothing is technically off the table as far as being negotiable, a lot of times benefits, CME allowance, or PTO is non-negotiable as it’s set by the organization and can’t be tailored to each employee. Larger organizations are less likely to have wiggle room, because they have policies and compensation structures to create parity across the company. Additionally, the benefits package may change from year to year, so details are not typically included in the employment contract.

Common mistakes to avoid

“I think the biggest mistake is if a physician expects a large employer to dramatically modify a contract,” Appino says. “To that end though, another big mistake is to not have a discussion at all with the employer because you think they can’t change something.”

He says this mindset typically results in two problems. “One is the advanced practice provider will sign the contract anyway, because they think they can’t change it, and the other is expecting the employer can and will modify and change every section.”

Also, never sign a contract without close scrutiny, whether that be by an attorney or contracts expert. Failing to do so can lead to lost compensation, unsatisfactory working conditions, and missed opportunity. You should also beware of evergreen contracts that never expire and fuzzy, unclear contract language.

What you should pay close attention to

Employment contracts can be up to 20 pages long, so it’s important to carefully review every page.

Here are a few important details to look for:

• Frequency of call

• Number of patient contact hours expected

• How patients are assigned

• Termination provisions

• Bonus structure

• Production bonus benchmarks

Best practices for a successful negotiation

Coming into negotiations with a positive attitude and all your ducks in a row is a great way to get off on the right foot. Preparedness is key, as the employer doesn’t look too kindly upon disorganized APPs. Also have a justification for what you’re asking for.

“Everyone has the same expectations and the same goals,” Appino says. “It’s just making sure the expectations are clear as you move forward with an employment agreement. Make it a clear, robust conversation between you and the practice, and make sure the contract lines up with what your expectations are of them and theirs of you.”

Who can help you in the negotiation process

There are many online resources to help, but it’s always smart — and reassuring — to have experts in your corner. Staffing agencies are adept at helping APPs negotiate contracts, since they’ve typically negotiated thousands of contracts and have established relationships with healthcare organizations big and small nationwide.

There are also companies like Contract Diagnostics whose niche is healthcare professional contract negotiation, and of course there are skilled healthcare attorneys who can assist you.

Get you the pay and benefits you deserve

While you may feel negotiation isn’t your strong suit, it’s important to embrace the process. Educate yourself, and ask for help if you need it. Planning, research, and an expert in your corner will ensure you get the salary and employment conditions you’re entitled to.

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