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Negotiating Contracts, concerned

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Hi All--


I'm not a newbie PA, been practicing for 4 years have had some interesting contracts presented to me in the past and have had to walk previously, so am not afraid to do it.

Have an offer in hand for a part-time position (which is what I want) in a pain management clinic in the Mountain West. The practice is using a group called, CE Medical to do the contract and I guess negotiations, but it's not a recruiting firm, so they have no incentive that I can see to get my salary as high as possible.

Anyways, rambling sorry.

My concern is this, they are offering me 38/hour for the first four months, flat rate, but it's not hourly ,they prefer to pay me on a salaried schedule, which is fine with me. I don't love the number, from what I can tell, most pain management PAs are making 40-50 but I'm willing to live with the 38.

What I'm not thrilled about is after 4 months, it switches to a commissions only base of 35% after collections. So each 2 week pay period you get paid based on the collections of the previous month, divided in half. No base pay at all. No PTO, since I'm part time, and 1500 total for CME, DEA, and licensing per year.


I feel like I am being asked to assume all the risk, all the no-shows, bad accounts etc. I will not be doing procedures, the MDs prefer to do those, so it's only new patients and pain follow ups.

Has anyone ever heard of this at all? It feels like I'm working at a car dealership?

The main negotiator is trying to convince me that this is the new way Pain practices are doing things, to incentivize their midlevels.

I should mention that there are 3 other NPs none of whom are on this contract, I of course am not privy to what their contracts say, but I do know that it's not this commissions only based idea.


Thoughts? Anyone doing something like this?


Will also post in the Pain side, to see if anyone over there has heard of this.





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this might actually be a great deal or a bad deal....


you need more info


likely if they already have 3 NP's following this structure they should (if you demand it) release some data to you

they will not likely release financial data but that is okay as you can usually back into this


what you are looking for is essentially the average RVU's billed and collected per hour of office work.

if they are not willing to provide this ask for copies of the recent 6 months clinic reports showing how many patients were seen by each provider - and what codes are billed.


You say you are not doing procedures but what about injection? joints injections, trigger points? pump refills? these can add up in the reimbursements


other thing to do is talk right directly to the NP's (easy enough to find out their names) might even ask the recruiter to put you in touch with them.... telling fact would be how long the NP's have been there - if they are turning them over fast run away -



some simple numbers for office visit reimbursement can be found with simple we searches so if you get the codes, how often each is billed, and how many patients you see in an hour you should be able to get a rough idea of collections.


As a guideline - most doc's take home 45-55% of their receipts

most PA's hope to be at 45% but likely closer to 40%


rather you are a 1099 (which is likely illegal per the IRS so run away from that) or a full employee is important


health insurance, malpractice, PTO typcially add 30% to the hourly rate for consulting purposes.




When I was in pain management they refused to book any shorter then 30min appointments and a max of 15 patients a day - I saw the writing on the wall that I was not even supporting my own salary (100k/yr) and the director was very unfriendly to PA's so I quit - but if they let you see 20+ patients a day - and you are billing lots of level 3 and 4 visits you might well do very well



you need to sit down and really write out the exact numbers with projections of what your income would be along with comparisons to being a fully salaried employee with full bennies....


ALSO MAKE SURE they do not cap your gross income, the number of patients you see, or the number of days a week you work - there should be very specific working in a contract that clearly states they in no way can limit your productivity. Also you need FULL access to the books to avoid the hiding of reimbursment that sometimes goes on...

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Well there is no turnover at all. All three NPs have been there at least 2 years and the longest for 10, but I was told that none of them are on this exact contract.

Also, it feels more fair for them, as they already have an established patient base to work off of, and I will be starting from scratch, I can see the appeal if you are already working and know the typical numbers etc.

But I feel like I am going in blind and need to have absolute faith. I will write back directly and ask for financials to show the expected numbers to see etc.


Also, I see now as I reread the contract, that I am expected to take phone call during the week. I feel like on a commissions based contract, I would also need to see money for that, as I am not being paid for my time, only patients seen.

Is that being greedy? I just feel like they only want to pay for performance, and taking call doesn't add to my bottom line, it only sucks up more of my time which isn't free.


Yes, I believe they will train me on doing trigger point injections. Not sure how the pump refills work, as they have a drug rep who comes in and does most of the changes needed for the pumps, but maybe that gets billed on my schedule? I'm not sure.


I agree with you, that I need more data. I will email the third party right now and see if I can get some.


Thank you so much for your advice. I just wasn't sure at all if this would be workable.



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DO NOT take call on a productivity pay with out getting compensated for it. This is a becoming an issue as the practicing physicians age and want to take less call - they realize the quality of life issue and newer PA's have not yet learned it - and hence sometimes agree to take call with out being compensated. this is REALLY bad to do as it sets up the rest of the pa's to be compared to the one's that are not getting paid.


Also find out if they will do a guaranted minimum for the first year or two (this is a more common duration for doc's coming into get their panels full and become productive)


Don't forget to add in the unproductive time that you will have that normally would be part of your salary and the fact they are not paying for ANY benefits. honestly this would be a deal breaker for me unless I could make > $70/hour with out the benefits. Think about it - bennies add another 30% on to the cost of having an employee - if they give you none then in fact they are paying you 30% less........


it might well be a great opportunity - and since the other NP's are not on the same contract they are likely trying to make the pay less for the same amount of work (can't blame them) but you have the ability to counter offer.



Overall you have to get as much info as you can and come up with a decent proposal for what you would be happy with - don't shoot for the stars as you might scar them off - but shoot just under them....


4 years out, competent and interested......


I would offer something like this


3 month salary fixed - BE VERY explicite of what hours you need to be in the clinic and how many patients per hour you will see.

3-12 months productivity but no less then $45/hour (you should far exceed this but it gives you a floor and some protection to build a caseload)

They pay all licenses, DEA, Controlled sub, state license (heck you can't work unless you have these so they should be the employeer expense!)

CME funds $1000/yr for part time

PTO - I would ask for some of this in the initial counter offer - medicine is stressful and for them to not offer any PTO is not acceptable. Typical full time is 6 weeks - prorate this down to your hours - ie 20 hours a week would get you 120 hours of PTO

Notice to quit or get laid off - I find 45-60 days about right - shorter or longer seems to be bad for both parties...


Bonus of some type based on productivity - they are tracking it and you should have some type of bonus for different amount of quarterly receipts - do not do annual - is too long....

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  • 6 months later...

I am negotiating my pain contract too.... i have 4 yrs exp... i asked for 95k base sal + bennies+cmes+401k

They came back at 85K but i insisted on staying arround 93k min because of my exp and gave them currents stats !

They came back at 87k and that they would see my work and after my hospital priviledges they would increase to 93k (3/4 month to get priv)

they also agreed for 1500$ cme 5 days off

3% profit sharing year end

401k doc match plan

PTO and 2 weeks days off .........

health insurance i am keeping spouses which is much better !

what say ?? should i accept the offer and have above in writing ??


schedule M-F 8-5 (inpts, clinic n call) fri half day

2 sat half day in a month

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