“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Top Two Forms of Compensation for the NP

Every nurse practitioner should have some form of part time or PRN job while running 2-3 practices. It is the most optimal model in terms of generating a diverse income, protecting yourself, keeping practice fresh and creating redundancy in your life (redundancy in this context means a system design that duplicates resources to provide alternatives in case one resource fails). Regardless if you are working part-time or full-time though, what is the best form of compensation for a nurse practitioner who is employed?

PRODUCTION BASED!

Working production can put a lot of cash in your pocket compared to a standard hourly rate or salary. You can make some massive bonuses if you negotiate the pay structure correctly and work in a high-volume practice.

What are the benefits of hourly pay or salary?

  • You get paid regardless of how busy it is. If it is slow, you are paid.
  • It is a predictable income.
  • You do not have to “produce” to receive payment.

Cons:

  • If you bust your ass, your pay stays the same. Ever work at an urgent care during influenza season on a basic hourly rate? It sucks.
  • If you are a high functioning nurse practitioner and can generate a lot of revenue for the practice, you do not see the benefits of it.

What are the benefits of working on a production model?

  • You get paid for what you do. If it is busy and you are working your tail off, you will be financially compensated for it.
  • A high functioning nurse practitioner who is very productive can generate MASSIVE bonuses. I am talking to the tune of $20,000 quarterly in addition to a base rate with the right set up.
  • It motivates you to work harder.

Cons:

  • If you do not work, you do not get paid.
  • If you work for a low volume or slow practice, you will not make very much.
  • The taxes on those bonuses are like a punch to your stomach!

There are generally two types of production-based models in medicine:

  1. A percentage of collections
  2. Dollars per Relative Value Unit, or RVU

A percentage of collections is just that. The nurse practitioner is given a percentage of everything they collect within the practice. Most nurse practitioners report this being in the 30%-60% range. So, if you generate $30,000 one month to the practice, you would earn your negotiated percentage of that number. The rest then goes to the overhead of the practice and into the owner’s pocket, which if you were smart would be YOU since you are starting side businesses right?

This model is great because it is so simple to calculate and keep track of. From my experience, smaller practices generally pay by collections because of its simplicity. I do this for my telemedicine practice. It is simple and to the point. But be wary, there are very dishonest people in this world that can “fudge” the numbers and pay you less than what you actually earned. If you are being paid by collections, keep very close track of the numbers yourself and demand to see the books on a monthly basis.

Another downside of a collections earned model is that you are usually not paid any sort of base salary. Consequently, you could go weeks with earning very little. This could cause potentially financial problems if you are strapped for cash.

The most common production model is being paid a base salary with bonus calculated by how many RVUs you produce. This model is widespread among larger practices and corporations. This is because most EMRs can generate reports on how many RVUs the provider produces in a certain time frame. So, it is imperative that you understand how the RVU production model works.

RVUs are units of measure assigned to most codes in medical billing. Everything you do in practice has an RVU amount assigned to it. So, for example, a basic established level 3 visit awards 0.97 RVUs, a knee injection awards 1.94 RVUs, etc… The more you do, the more RVUs you accumulate.

It is a fantastic model and much easier to keep track of than collections. Also, these larger practices and corporations can’t really keep track to see if the insurance actually reimbursed for the RVU you produced. You know what that means? You earn your commission on the RVU regardless if it was paid out or not! This is a huge advantage compared to earning a percentage of collections.

Typically, every quarter the number of RVUs you produced is multiplied by a dollar amount, anything over your base rate is paid out to you resulting in a large bonus if you have been productive.

Now, what type of model should you ask for during a job negotiation? It varies by specialty, experience and region; these numbers are general recommendations based off my experience.

Collections: Think about how much you generate for a practice and then what the overhead is for the practice. If you are working in a top of the line practice that has a $10,000 a month lease, fancy furniture, lots of employees, etc… then the collection amount you will receive will be lower than for a more modest practice. Keep this in mind.

So, before you negotiate this rate, try to guesstimate what their overhead is. Sometimes the practice manager will tell you but more times than not, this will have to be a rough estimate on your part.

If it is a high overhead clinic, I believe 40%-50% is reasonable or ask for RVUs. If it is a smaller practice, then I would try to go as high as 70% of collections. REMEMBER, ALWAYS START HIGH WHEN NEGOTIATING A SALARY! The worse they will say is no.

RVU: You want to negotiate the highest amount per RVU as you can. The more dollars you make per RVU, the more you will be paid. It is that simple. Let’s look at how much an established level 3 visit reimburses.

On average, a level 3 visit will be reimbursed through insurance at around $75-$100. Therefore, if you are offered $18 per RVU, you are only receiving around 20% of collections!

As you can see, it is imperative you understand this concept when negotiating your RVU rate. In my opinion, you should ask for $32 per RVU during job negotiations. That is closer to 40% of collections and is totally reasonable.

My first job out of nurse practitioner school was an RVU/salary hybrid. I was paid a base salary with RVU production. I had to earn a certain amount of RVUs to meet my base salary, then anything after that was paid as a bonus. I earned $22 per RVU, it was a bad set up, but I was new and didn’t know any different. The other problem though was that they also capped the bonus! I was naïve back then, so I didn’t understand the ramifications of having a salary/bonus cap.

NEVER ACCEPT HAVING A SALARY/BONUS CAP!

You will end up working for free after you hit that cap. There is nothing more de-motivating than knowing you are working for free. It sucks so do not ever, under any circumstances, let an employer put a salary/bonus cap into your contract!

Be very proactive when negotiating a bonus structure. If you can get a large percentage of collections such as 60%-70% then go for it. You could really kill it. Otherwise, stick with $28-$32 per RVU produced. You can earn some very lucrative bonuses in addition to a base salary that pays the bills!

109 Responses

  1. Thank you for these articles. I really want to start a business… I have some ideas so we will see. This information is gold. I have 2 months full time urgent care, and a month as inpatient observation for my 2nd job. Dream is to start my own thing, thank you for the motivation and inspiration.

  2. Really appreciate this article. Can you take this a step further and discuss pay as a 1099 versus not having this?

  3. So I am curious if Anyone has heard of a “negative”bonus ? Meaning if the percent of collections does not exceed salary, then the NP owes the company the difference ??

    1. Yes, and that is an awful form of compensation. You need to negotiate in your contract a “salary” that is paid regardless of production. Then once you meet that number, you receive bonus. BUT, when you negotiate a higher production type model then the payoff can be huge. So there are plus and minuses. Go straight production if the clinic is busy. If it is not, I would do a salary/production hybrid.

  4. Thanks Justin! Great information. So, that is the situation I am in, working in internal medicine in a rural clinic, and I could not survive on just RVU bonus, as my numbers are still fluctuating, but I do want to renegotiate my rate. You mentioned on another site to ask no less than $30/RVU. We are paid in work RVUs, does that change this rate any? And if I can find out what I billed all last year, I should be asking for at least 50% in salary? We have 5 providers and I am the only one with 1 CMA, they all have 2, which even though they have higher numbers (3 providers also do addiction tx which are 5 minutes & level 4 visits), I still don’t see how they justify the need/cost.
    The other concern, however, is we are negotiating with a larger health system to buy us out within the next few months. My salary was better than working in a bigger city 2 years ago (new NP), but averages now are 103-108K. They did just give a 2% raise across the board (I think to retain staff since no raise in years) which puts me closer to this number. Is this a bad time to ask for wRVU increase? or better to try now before new system takes over?
    P.S. I know you would prefer I just go open my own clinic, LOL, but that is not an option right now!

  5. Great post as always. Quick question, what do you think about a part-time once a week gig offering only 2 weeks of UNPAID vacation a year?
    Figuratively speaking, since I am only there once a week, it’s actually just 2 days a year, No?
    I mean the whole idea of me getting a part time gig was for more flexibility to enable me plan on how to start up my own business. Is this a reasonable agreement or am I thinking too deep into it?

    1. Your thinking to much into it. Work one day a week and earn a little side income to support you while you start your business. The 2 days of unpaid vacation is peanuts in the grand scheme of everything.

  6. Hi Justin,
    I am a fairly new NP and am being offered a position as a primary care hospitalist. I am being hired as an independent contractor and will be paid based on production at $35/patient. I haven’t signed a contract yet. Is this form of compensation equivalent to the RVU method. Any thoughts on whether this is a fair starting point. Thanks so much for all the information. It’s been very valuable especially when deciding to become an independent contractor.

    1. Hi Nikki,

      $35 per patient is similar to the RVU model, but that seems awfully low to me for hospitalist work. You see 10 patients a shift and only make $350? That is laughable. What is the expected volume per day?

  7. Thanks Justin. I am a Psych NP with 4 years of experience in the field. My last job in NYC just folded mysteriously after 2 years with them . I just got introduced to your page by a friend who has a booming private practice in San Antonio Texas. The more I read your articles the more convinced I am that I am ready to take this leap of faith and dive into private practice .. I would need more of your insights as I venture into this unknown territory

    1. Hi Victor! More than happy to help! Remember, creating your business is MUCH MORE secure than working for someone else. Being in control of your life is the most empowering thing you can do as an NP. I will email you.

  8. I may be joining a very high-production private specialty practice. I have previously only been part-time in private practice or FT in hospitals. They are offering a base salary which I feel is a bit low, and the quarterly productivity bonus is setup like this: I would get 20% of my collections once over $65,000. Does this seem typical? A minimum to reach per quarter?

    1. 20% seems low to me… I would come back at 40% and then hopefully meet them in between. You should be able to generate $65,000 in collections at a high volume clinic without issue. I would ask them to see typical quarterly collections of other providers to see how much they are generating.

      1. I am a new grad NP and I was offered a job at a endocrinology office. He was offering a base pay of 80,000. Once I meet the base pay I would make 30% of collections in quarterly bonuses ? Does this seem reasonable ? Would it be better to have a higher base pay to obtain first than go into making a certain percentage of collections? Or would it be better to have a lower base pay to be able to achieve to be able to move into the percentage of collections faster ?

        1. Seems reasonable. If you are productive, you should be able to pull $150k a year. At the end of the day, it doesn’t matter. It is the same thing with a production model.

  9. I make a base salary and a quarterly bonus. Quarterly expectation is $150,000+ to get the bonus which is set at $5,000. I have met this bonus 2/3 quarters so far this year. What percentage of total revenue is fair to ask for? Is $150,000/quarter a reasonable expectation? This is the only job I’ve had that pays a bonus structure and I’m still trying to figure out how much to ask for and what a normal revenue is for a Nurse Practitioner. I’m in a corporately owned pediatric practice in Texas.

    1. I would just ask for straight RVU production. Ask for $32 per RVU. Percentages of revenue aren’t going to happen with a corporate practice, but RVU production could. I think $150k in revenue per quarter is totally reasonable for a busy practice.

  10. Hi,
    A new job wants to pay me 130K base and $34 per RVU on top of that. I am an endo NP so I bill 99913 and 99914. I want to make 160K a year. Does this seem reasonable or should I ask for a higher base? Thanks

  11. How do you compare 1 position that is straight productivity after a year versus a position that is straight pay with a bonus 2xyear? I am a new grad with 2 offers from the same company, but different offices. I struggling to navigate between the contracts. Also, the contracts are very vague, is that normal? They only list the salary amount and how many hours it is based on.

    1. Yes, contracts typically are vague but you need to ensure the pay is outlined clearly!!!!!

      Ultimately the determine factor here will be volume. If patient volume is high, then the straight productivity model will be more lucrative. Straight pay plus a bonus will guarantee a certain amount, but it won’t be as lucrative, so see what the patient volume is like at these facilities.

  12. Hello JustinAllan,

    1st year NP working in clinic setting (GI), but looking to jump to an Urgent Care position d/t demand/need for UC providers. Have extensive ER nursing experience.

    Talked with recruiter, they are reporting $62/hr base pay (129K a year) with quarterly bonuses. How would you negotiate RVU for quarterly bonuses?
    Avg. # pt’s seen per day around 25, 14 days x12hr shifts per month
    Sign on bonus – 10-15K
    Commute to work is 55min one way
    NO – non-compete
    No restrictions

    1. Would you negotiate base pay – if so by how much? Would you forgo bonus for base pay increase?
    2. How would you negotiate RVU for quarterly bonuses? What RVU number would you top out at monthly – before capturing % or $ (dollar amount)?

    Appreciate the input.

    Zach

    1. Hi Zach,
      1. The base pay of $129k is fine. The base pay doesn’t matter if you are RVU based.
      2. $32 per RVU at a minimum. You earn $32 per RVU, once your base of $129k is met, every $32 RVU earned after that is then paid out as a bonus. So, 129k divded by $32 = 4031 RVUs. Once you hit that, you are paid a straight bonus of $32 per RVU. For perspective during flu season, I would generate 900-1100 RVUs PER MONTH! I killed it. This is the most optimal way to be paid IMO. If you are busy, you will easily earn $180k a year on this model.

      1. Hello!

        I have a similar situation- background of ICU RN for 12 years…offered a job at urgent care as new NP. They provide a solid new grad orientation for 90 days which I was very impressed with. Job posting on Indeed said pay range $60-$80/hr, of course they offered to start me at $60hr, and a $5/hr raise after completing 3 month orientation period. Productivity Bonus is $15 per patient for all patients seen above 39 and an additional $5 for all patients seen above 44 in a single shift.

        I want to negotiate for higher hourly rate….I currently make $71/hr as a perdiem RN. Is it unreasonable to shoot for $80/hr?
        Also is the per patient bonus practical?

        Thank you!

        1. Agreed: simply tell them you make more as an RN… Why would I drop down? I would shoot for $70 at the get go then an increase of $10 after 3 months. The productivity bonus sounds reasonable but if you are making $80 an hour, you will be making about $160k a year fulltime, which is pretty good.

  13. My employer has offered all new contracts. Changing from straight salary to lower base wage and RVUs. I recently cut back to 30 hours per week and was making 91,000 in family practice. They are now offering 78,780 with RVU at $15 per. This seems very low to me. I’m not able to find any examples of standard RVUs and base rate pay. Any advice or information would be greatly appreciated.

    1. $15 per RVU is a slap in the face. I was making $32 per RVU at an urgent care just FYI. The lowest RVU rate I was ever paid was $21 per RVU. You are being ripped off.

      1. Thank you! That was my impression from what I’ve read here, however I’ve never dealt with RVUs in the past. I appreciate your reply!

  14. Where are you coming up with the $32/RVU recommendation? I am trying to gather my facts to have a discussion about a salary adjustment and want to have some good footing to stand on.

    I’m in my 3rd year, started off as a new NP. Started at $87,500 with no specific RVU structure, but was told with more production I could be paid more. With a couple of annual 2% raises and one market adjustment, I’m at $93k. There is a bonus structure in place for anyone (clinic-wide, multiple specialties) who does more than 387 RVUs per month, paid at $10/RVU above 387. I have yet to earn that bonus because of some circumstances that limit my productivity, I have made 3,800 RVUs in the past year.

    I know a couple of my peers make $140k+. I don’t know exactly how many RVUs they’re producing, but they are getting the bonus each month, which means it takes less than 387 RVUs per month to break even on their salaries. I know I don’t produce enough RVUs to be paid equal to my peers, but I’m thinking I should be making a base salary closer to $120k. But we’re not supposed to discuss compensation with each other, so I want to be able to present my argument without using that. Can you point me in the right direction as to WHY I should be paid $32/RVU? Thank you!

    1. Jason,

      $32 per RVU is the going rate at practices that VALUE their providers, not nickel and dime then. It comes out to around 30% of production. I really have no other basis to provide you for the $32 per RVU other than at $10 per RVU you are totally getting RIPPED off.

      1. Thanks for your response. Just a point of clarification, if you don’t mind: you’re talking about $32/RVU and you said that a level 3 visit will collect $75-$100 on average, but from what I’m seeing online, CMS reimbursement is $33.59 per RVU. So where does the rest of the money come from? How does that turn into $75-$100 reimbursement for the practice?

        1. That is just the RVU reimbursement, the actual level 3 visit is billed utilizing an E&M code and that will result in $75-100 average for the practice. The RVU is just to keep track of productivity is all.

  15. Thank you for the articles. I have a question: I just bought new business with 3 vlinics in 3 different cities. Currently there is 1 NP and 2 staff on each location. I see that they are seeing less than 15 patients in 9 hours/ day. They are getting paid $70/hr, no benefits, working 4 days 9 hour shifts but getting paid for 40 hours (4 hours admin pay). This is costing me a lot. Would it be wise to go for straight production base pay? E.g. 35-40% of what they make, they will get paid. Please advise. Ty

    1. Yes, I would pay them straight production. 40-50% is reasonable from the business owners perspective. I pay all my NPs straight production. I just pay a flat rate per new and follow up visits though.

        1. Totally depends on what types of services you are offering… Generally speaking you want 40% of collections

  16. Hi, I am wondering if the RVU calculations that you are using are based on FY2020 or FY 2021? My organization is using 2020 calculations which of course are much lower.

  17. Hello! I own a Family Nurse Practitioner clinic and am looking to hire another NP. I would like to pay her a base salary with quarterly bonus based off of RVUs. You said most EMRs can figure RVUs…… can you tell me how to find that? I need a way to explain this to the NP prior to offering it. Thank you!

  18. Hi I’m new psych NP, I was offered pay per visit 60% then 40% to provide no benefits option for telehealth im responsible for insurance..is this reasonable? How much should the percentage be? No base salary.

  19. I am a nurse practitioner in OBGYN with a specialty in UroGYN and in the OR as a first assist. I have been in practice for 9.5 years.

    I am paid hourly at $48.41. I work part-time, 22 hours per week. I have never been paid more for being more ‘specialized’ nor did I receive additional compensation for first assistant reimbursement in the OR. I do get an additional ‘professionalism’ bonus of about $5,000/year.

    Our charting system is able to give me information about my productivity but I don’t really understand how to interrupt it.

    My estimated payment rate per work RVU is $66.03 and my work RVU’s per scheduled patient are 2.3. I see on average 2.3 patients per hour.

    In this scenario, what would be a fair compensation?

    1. You need to be making at least $75 an hour… you are being ripped off. A production based model of $30-36 per RVU is fair for all parties.

  20. Hey Justin, I have been a NP for 1 year now. I have been working for a private ENT practice. When I first started I accepted a salary below the going avg. as I was willing to take just about anything as a new grad. The benefits are great—great health insurance, 3% matching 401k and generous profit sharing that is distributed into a 401k. When I started I was told I would have the opportunity for productivity incentives after 1 or 2 years. I have been in talks with the lead physician and office manager/finance officer and we are going to sit down here soon to finalize an agreement on bonus pay. My patient volume is still relatively low at about 15-20 patients a day, probably closer to 15. That number is rising though. However, my problem is that I see a lot of surgery follow ups that fall within a global period, these patients are billed a 99024 no charge. Am I generating much revenue? I know with all these 99024 visits I am not directly making money, however I am freeing up time in the other providers’ schedules for new visits and other billable services. I am also performing a few simple procedures in the clinic.
    – How should my “productivity incentives” be structured?
    – Are RVUs generated on these 99024 no charge visits?

    Thanks!

    1. Per the article: be sure you are getting paid per RVU at $32 per RVU at a minimum. If you average 1 RVU per patient (you should be averaging more than that with appropriate billing), then you would make $480 a day at 15 patients which comes out to $115k a year. This assumes only 15 patients a day working 240 days a year. Most visits you should be generating 1.5 RVUs though, therefore now that number goes up to $172k a year. This incentizes you to see patients and maximize billings.

      For the visits that you don’t get paid anything, I would advise being compensated at least 1 RVU for your time as it helps the doc be more productive.

      1. That sounds amazing compared to where I’m at now. My patient load is increasing, I’ve finally gone down to 15 minute appointments. Will eventually be maxing out at 28 patients per day.

        So if you’re saying I’m generating a value to the practice of $32 per RVU, if I hit 2656 RVUs per year (my salary of $85k / $32 per RVU) then every RVU over 2656 should be received in a form of bonus at $32 per RVU?

        Should they be willing to disclose that information to me, how many RVUs I generate? Do they have to disclose this if I ask?

        Thanks for your help!

          1. Now does this take into account any benefits that I receive? Is it reasonable to ask for $32 per RVU even with the benefits I am currently receiving?

  21. If I have a 1099 where I split the compensation, 75/25 for example… do I pay taxes on 100% of it, or only the 75% I receive?

    Is this negotiable with employers?

  22. Owner of busy OBGYN office with one physician and one NP. Collections on NP range between $380,000 to $400,000. One receptionist and 2 medical assistants are assigned for the NP. Profit sharing 401k is provided. Is $140,000 a good salary, not including 401k benefits? Or would a production model be better for the NP?

    1. Just do straight production. It is good for you as a business owner and good for th NP. It motivates the NP to generate revenue and build the practice.

      1. Thank you. What does a straight production model look like? That’s the part we can’t seem to figure out.

        1. The 2 models in the article. Either an RVU production or a straight produciton (percentage of collections or flat rate per visit)

  23. I am a fairly new NP doing overnight coverage in a 16 bed community ICU. I have tele-ICU backup. My contract is for 184 shifts/year (12 hour shifts) which averages out to just over 15 shifts per month. My pay is $150k, no bonus for RVUs. The contract lists an annual wRVU target of 3000 RVUs, there is no defined process for what happens if I exceed or fall below this target. This is an entirely new position for them and there is no NP/PA working opposite my shifts just the tele-icu person, so they have to call the ED doc or in house anesthesia docs for intubations, central lines, etc.

    Although there is no RVU bonus, I am about 6 months into the job and (because I do my own billing) I have run a couple reports to see where I am at. Just under 6 months at 555 RVUs. In hindsight, there are probably about a dozen or so patients that I could have written a note on – like a 99233 or a 99292. Even about another dozen cases where I could have written a transfer notes – but ultimately even with that I’d still be under 700 wRVU. My biggest RVU producing activities are the admission/consult H&Ps of course. Probably after that intubations which are fairly infrequent, and central lines which are pretty frequent. Any thoughts on how to maximize wRVU production, or general thoughts on that wRVU target from your experience/perspective?

    1. Personally, if they aren’t doing anything about your RVU production, then I wouldn’t even worry about it. If there is no penalty or no bonus surrounding it, then this should be the last thing on your mind. Focus on your patients instead 🙂

      1. Thanks! If I hear anything back from them when it comes time for contract re-negotiation I’ll be sure to post about my experience. Hopefully they will just revise the target. There is no way for me to control the census or acuity so I’m hoping I’ll deliver well enough that they keep the position and my compensation.

  24. Hi, Justin
    I have 3 years experience as a Primary Care NP. I am negotiating moving to another clinic, also a private practice and would be going from a flat salary with no bonuses at all to a production model. I wanted to be sure I was understanding the article correctly. Does $32/RVU translate to $32 per patient visit? Would it matter if it is a 99213 vs. 99214? I am meeting with the doc officially tomorrow but he’s briefly mentioned pay is per patient and type of visit?
    It would be 2 days walk in/sick, 2 days internal med and 1 day home visits. 8-5 M-Th and 8-12 Fri.

    1. $32 per patiet visit roughly equals $32 per RVU give or take…. If you billed more level 4 visits though, you are potentially leaving some money on the table.

  25. Glad I found this thread and not sure if anyone can help but I am hoping. I have been at my current practice since July 2019. My offer letter outlines my starting salary and that I am eligible for RVU reimbursement. I asked over and over for a review of what I was owed if anything. Two years ago I met with the owner (it is a small owned company) and we discussed this. She swore at that time she was working on all of 2020 and 2021 up to that time and would reimburse what was owed and stay on top of it from that time. I am now 2 years later and still nothing despite constantly asking. I am working through the process to start my own practice. I have been primarily the sole NP at my current practice nearly the whole 4 years which is a busy behavioral health clinic. I want to start getting a spreadsheet together to present prior to leaving to request I be paid for the last 4 years if I am owed anything. I just cannot seem to find a good RVU calculator to use and hope someone can lead me to one. I do have access to my schedule for at least the last 2 1/2 years which can show what code was billed for each patient. There is a way to print a quick report out of the system but of course I have no access to it and am ignored every time I ask for it. Any help would be appreciated.

    1. It literally is clicking some buttons to generate this RVU report in any EMR… They are pulling your tail. Take that for what it is.

  26. Thanks for the helpful article. I was recently offered a full-time job at a primary care clinic. Base pay is 100k and then $22/wRVU. I am only eligible for the RVU bonuses after I hit 4200 RVUs. In the interview, I was told that most of the NPs average 140-150k/year, but when I spoke with HR he said the NPs make around 120k/year after bonuses. I have gleaned that $22/RVU is too low, but I was just curious to hear your thoughts on this position.

    1. Ya, $22 per RVU is way too low. If you are productive and see lots of patients, then I think $140k a year is doable even on that model.

      1. Hi, I’m a new grad psych NP. i have a job offer for outpatient psychiatry, i would get 33% of what I bill, and after 15,000/month I get 40%. they put into a 401k (not sure how much), 14 days of PTO and 12 vacation days. (no sick days).

        1. You can only max out your 401k to $22k…. so essentially they are capping your salary. It honestly is not a bad deal as you have the ability to make $180k a year plus max out your 401k. So you are looking at $200k a year.

  27. Hi Justin,
    I’m glad I found your site as eventual goal is private practice.
    I’m confused on what this could mean to my bottom line money wise.

    New FNP offer: non negotiable $97k guaranteed base for first 2years, inheriting half of a retiring provider’s panel.
    Then switch to production based with wRVU of $27 also non negotiable.
    Target of 4700 RVU/year.
    Option to switch to production model earlier but can’t switch back to guarantee base.
    Another option to stay guaranteed base for first 2 years and will be paid a bonus based on the $27 rate if meeting the RVU target.
    Average RVU @ this practice is 1.6-1.8.
    Productivity meetings q 6weeks to help increase productivity if needed.
    Benefits are good but I’m more concerned on my take home now.
    I tried to explain this the best I could and hope this make sense.

    Thank you

    1. Go with the straight production model. It will be the most lucrative option if you can hustle

      1. Thanks for your response!
        Is this wRVU target of 4700 reasonable for a new graduate in family practice?
        Thanks.

        1. Seems a bit high based on the base… The target should be nothing more than your base salary divided by the amount you are being paid per RVU

          1. I have never worked for any kind of production or RVU structure, but I just got an offer rounding for SNF. 100k base with wRVU, recruiter didn’t offer me a percentage or a dollar amount per unit. Is that what I should specifically ask?

  28. Hi, I am a new Pediatric NP in NY and have a job offer at an outpatient specialty practice for a guaranteed base salary of $135,000 and a productivity profit share bonus of 10% for any collections over $162,000. Does this seem like a fair offer? I am mostly wondering about the profit share bonus part of the offer and if 10% of the net collections is below average as a bonus structure. Thanks!

  29. Hi Justin, I am a new grad FNP with 7+ years of experience in critical care. I currently work as an ICU nurse in San Diego, CA and make $65/hour or $122k/year working 36 hours/week. I am looking to start as an NP at a small private practice owned by 2 MDs. 50% of the patient base is HMO and the other 50% is PPO/Cash pay.

    During negotiation, I originally brought up the possibility of a hybrid pay structure (base+RVU) but they said it’s difficult and unfair to do RVU-based pay since 50% of the patient base is HMO. I would see 15-20 patients/day.

    Their initial offer was 100k/year salary as a W-2 employee. I simply told them that this is far below the current market rate of NPs in San Diego, CA (which is $70/hr or $145k/year for new grads) in consideration to the cost of living. I also told them that I spent so much time and energy to get my advanced practice degree and should not have to take a pay cut and make less than an RN.

    Their updated offer is $125k/year salary as a 1099 employee and I would be responsible for malpractice insurance, benefits, CME. Also no license/DEA reimbursement. At year 2 overhead contributions wil be made starting between 20-25%.

    Do you think that this is a fair offer given that I would take advantage of the tax benefits as a 1099 employee? If I made $145k as W-2 employee, it would be $87k after 40% taxes.

    Would love to hear your thoughts about this. Please let me know. Thanks.

    1. No, this offer is total shit. You are being paid less than an RN… How does that make sense? $125k in southern CA is NOTHING… you can make more in a very low cost of living area. I know NPs in New Mexico making $200-250k… WALK AWAY FROM THIS. These people see no value in you.

      1. Justin, thank you for empowering me. That was what I was feeling. For them to initially offer me 100k and then 125k without benefits indicates they do not see the value that I am adding to their practice. It also doesn’t make any sense to me that they can’t match what the market is paying new graduates which is (145k with full benefits). They continue to remind me that they are a small private practice and unable to pay that much. I really like the people in the practice but unfortunately, I can’t make myself accept low pay. It doesn’t make me excited to make less than an RN, especially in southern CA. The other thing is that I am a very experienced and educated nurse who graduated from the top NP program in the nation (I’m not just going to be a warm body they hire). I really regret walking away from my very first offer from neurosurgery (130k base + $40 per RVU).

  30. Hi Justin!
    Thank you so much for sharing this valuable information! I am a new grad NP and have a job offer for a post-acute facility (skilled nursing/assisted living/on-site clinic) and the offer is:
    – first 90 days is a base salary, after 90 days it will be strictly RVU-based at $20.75/RVU
    – $1250 CME allowance
    – licensing reimbursements
    – malpractice
    – 15 days PTO
    – insurance offered
    – 401k

    1. Not a terrible offer. The dollar amount per RVU is pretty low… I was being paid $32 per RVU for perspective. I would try to negotiate that aspect some. Ask for $24 as a new grad

      1. Hi Justin,
        I work for a private Rheumatology office. 1 doc and 1 NP which is me. My base is 100,000 with a productivity bonus. I need to bring in 55,000 a quarter to start getting a bonus of which I will get 15% of collections I bring in from 55,000-65,000 and it goes up from there. I see about 450-600+ patients a month. Most are 99214. I also do data entry for registry’s patients fill out and that brings in an additional 10,000-12,000 a month from the research company and counts towards my productivity ( each registry is worth 100-$125) The problem is I still am told I don’t bring in enough in a quarter. It’s always 47,000-51,000. Does this sound accurate? My gut is telling me things just don’t make sense and something is wrong. I even do a lot of joint injections and they can’t run a report that breaks down everything I am bringing in.

        1. They are bullshitting you. Level 4 costs average $100-150 depending on insurance. Lets just say $100. At an average of 500 patients a month, your quarterly production = $150,000. Demand to see the numbers. Threaten to pay for a 3rd party accountant to audit them if they do not comply. They are comitting fraud.

  31. Hi Justin! Thanks for sharing your knowledge and empowering us! I’m an FNP with 8.5 years experience. I have been given a base salary + wRVU offer at an urgent care. I was hoping to get your opinion on the offer:
    -Months 1-36: base salary $95k + $7 per wRVU
    -Annual cap $125k

    After reading your article this seems like a very low offer. Am I understanding correctly that I would have to bring in 13,571 RVU first before receiving any bonuses? I’m new to this pay structure and am a little confused on how it works.

    I appreciate your input!

    1. Ya, $7 per RVU is an absolute slap in the face. At $7 per RVU, you are basically making $24-28 an hour if you can an average of 3-4 RVUs per hour. Lmao…. walk away from this offer. These people don’t value you.

  32. Hello. I’m working in internal med and am being paid $30 per patient. I average 12-14 patients a day M, T, Th and on Wednesday sometimes 4-8 patients since there is another NP in the office. I still have my RN job because I make $60/hr and work every weekend. My boss offered me a job at a SNF where he is the medical director and initially pay me $30 per patient with a total of 50 patients in total per month. He said that I would see some of the patients twice a month some once depending if they are residents or there for acute care. It is also a 24/7 on call. I’ll be taking over for an independent contractor NP. My boss wants me to eventually do that and set up my own business and bill the insurance independently. I feel like I won’t be making any money as I’m already not making enough. I have to get my own malpractice insurance, do all the leg work for billing eventually. Do you think it’s a good starting point to eventually maybe grow a business or am I being delusional again? I really appreciate your input.

  33. Hello! I am being offered a position that involves seeing patients at LTACs, SNFs, and nursing homes. I am expected to see 15-18 patients/day. The positions involves a base pay and quarterly productivity bonuses. I am supposed to get 50% of collections after expenses (salary, taxes, licenses) are deducted. The 50% increases by 5% after 6 months and reaches 100% at 5 years. I will also be getting $500 each month for not needing their health insurance.

  34. Hi there! I am currently a 1099 Palliative Care NP (inpatient) with 1 year experience. As of right now I receive $35 for follow ups and $50 for new consults. Census has been up and down, I go anywhere from 10-20 patients depending on the year, mainly I am at 15 a day x5 days a week. I pay for all my own Malpractice, DEA, Health Insurance, Credentialing Fees, etc. I was wondering if you had any recommendations of how I can approach my current employer on how to set up a new contract with RVUs for bonus if that is something I am able to do? We use a billing app that tracks them for us. Thank you for your time!

  35. Hi Justin,

    I’m currently an overnight hospitalist making 67$/ hr, I work 6 shifts per pay (12 hr shifts and they end up paying for 80 hours total because it’s night and with and added 105/ shift) = around 155,740. In addition, get all my licenses and certificates covered, 403b with a 3% march, 2k per year for CME, PTO (I never maxed out earning because I keep taking due to an accumulation model), 2 CME days, malpractice insurance.

    I have an offer from another hospital system where it’s a base compensation + productivity compensation + quality compensation. Base is 130k for the first year, 132k for the second year and 134k for the 3rd year. Productivity is that the employer will pay me $4/wRVU personally produced by the provider where an average APN annual product is 3800 wRVUs. The quality compensation is basically a bonus if I meet their metrics, I will get 5% of my yearly base). With this I get 19 days PTO with 5 days of CME as well. All licenses and certain, 401k, malpractice insurance as well. 3k on CME allowance. Sign on bonus of 5K.

    First of all, this concept of RVU and wRVU are completely new to me. I don’t even fully know the difference between wRVU vs RVU is, if there actually is a difference. From what I read I think $4/wRVU is very low. However, it is a hospitalist position and I’m not sure of this offer, especially it being a 3 year contract. I like that the new job (if I decide to take it is about 10 minutes from me vs my current job is about 50 min one way. Sorry to make you read this but most of my colleagues don’t work on the RVU model. Thank you

    1. $4 is a total scam and punch to the gut… What a scam. That is all you need to know about this. $130k is great, but you will never make a bonus with $4 RVU compensation.

  36. I am offered a hospitalist night APRN position at a different hospital working 2 medical hospitals. I have 5 year experience as hospitalist APRN at a behavioral health hospital. I am unfamiliar with RVUs. I was offered $120k annual plus $3/RVU. Although I am making $105K annually now, this new offer is terrible to me as I currently average $100-$130/hr working only 20 hours max per week and come to hospital whenever I want which is usually days at 5x/week. This new job requires me to work one week on and one week off 7p-7am and at two different hospitals. I was also thinking about asking to only work one week on and two weeks off as I would be their 2nd nocturnist NP because they already have one hired. What is a reasonable salary and RVU in my situation? What is the minimum pay I should accept at this new job so I can gain more medical experience? I was thinking $155-$175/year. I do not want to be taken advantaged of with too much work and being underpaid.

    1. Ya you are going to be working more and getting paid less… $3 an RVU is an absolute insult. What a scam. To get to $160-170 a year, you need $30 per RVU minimum. It really just depends how many patients you are seeing and how many RVUs are per encounter

  37. Hi Justin, I am in a similar situation. In a private practice, nephrology has been rounding in a dialysis clinic for 3 years. 1099, paid per patient $35.00 without any mileage or bonus. Rounding weekly, have to see a patient twice a month, total patient per month 165-170, I get paid monthly, Is per patient good or decent pay in my situation? i asked for any mileage at least to compensate when rounding 1 patient that I had to drive 25-30mins, but said NO.

  38. I am reading these posts while trying to think of how the information would apply to my own situation.

    I am an FNP working in a private practice clinic with a hip and knee surgeon. I have over 25+ years in surgery and the last 8 specifically with 2 separate orthopedic surgeons. I have been an FNP for over 3 years now and an RNFA before that.

    We are in office 2-3 days a week where I see an average of 30 patients per day – mix of new patients, established, and post op global. The other days (2-3 days per week), we are in surgery with a billed surgical volume of over 500 billable surgeries per year (average ~38 RVU per surgery). This does not include assisting for non-billable cases. The RVU accrual for office visits does not match the work performed (in my opinion), but the surgical billing gives me a basis for productivity bonus. I typically put in around 50 hours a week…sometimes more.

    I am currently trying to negoitate a hybrid salary. My current salary is a base of $107k with $7500 quarterly bonus. I have asked for the same base salary and RVU based productivity bonus based on the surgical billing for myself (in lieu of the $30k straight bonus)

    Using the AS modifier (16%) for surgery with the current rate ($32.74) puts it at $5.24 per billable RVU – 500 cases per year at an average of 38 RVUs would put this bonus just under $100k.

    Is this reasonable or am I asking for too much in central Illinois?

  39. I just want to say thank for all the posts you respond too. Just reading these posts has given me a wealth of knowledge!

  40. Good offer?
    Compensation package for FNP hospitalist in upstate NY.
    153k base, 20k bonus potential.
    14k annual productivity wRVU bonus 2993-3960
    5.9k citizenship bonus
    CME’s 3,500
    PTO 84hrs, rewards value 5,452

    I was pleased with this offer, I just don’t understand the rvu range?

  41. So glad I came across this thread! Interested to see what you think about this salary/productivity model for outpatient peds NP…
    New grad NP working in private prac outpatient peds office for last year in DC area. I had 5 years ICU experience prior (was making about $50 base as RN with shift differentials added hourly). Starting salary for NP was offered at $98k, I negotiated up to $111k base ($54/hr). Because they increased my base pay, they cut my incentive/productivity pay to 0% (had originally offered me 1.5% of collection).
    Looking back on this, not sure if this is collection vs. RVU? Anyway, I typically see majority 99213 (acute sick), some 99214, and some 99391-99395 (well visits). I average about 20-30 patients per day, sometimes up to 40. I’m convinced I’m underpaid for the sheer volume of patients we see, especially since I’m not making any return $ on my productivity. Thoughts on this? I’m about to renegotiate my salary soon or look elsewhere now I have a year of experience.

      1. When you say practices should offer 30-40% collections, is that on top of a base salary? Or is that for NPs who are just collections/productivity based?

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