Contract Negotiation for Healthcare Professionals

Knowing your worth

Andrew was a new graduate Family Nurse Practitioner. He was excited to sign on with a placement specialist who would help him find the perfect FNP job that was just the right fit for his skillset. 

The search firm had found his dream job at an inner-city Federally Funded clinic predominately servicing the lower socioeconomic population. 

Andrew’s dream was to help the underserved population of his community. The position also offered a loan repayment incentive on his school loans. After several interviews, the clinic decided to hire him on. He was ecstatic. He was getting everything he wanted in his contract which included vacation time, benefits, CME’s and the pay scale he desired. It was the perfect fit. His dream job was turning into a reality! 

As he went in to sign his contract, his dream quickly turned into a nightmare. The Chief Medical Officer decided to change the contract without Andrew’s consent. He was being offered 25% less on his pay scale than previously negotiated. He was also locked into working every Saturday so he respectfully questioned the CMO’s decision and changes. He also spoke to his recruiters, and to the Human Resource department of the organization. There was nothing they could do since the CMO held the final decision in his hands. The CMO’s answer to Andrew’s questions regarding his contract changes was: “Take it or leave it?” 

Would You Take It Or Leave It?

Contract negotiations in healthcare can be tricky. It’s often seen as unchartered territory for Advanced Practice Healthcare providers like Nurse Practitioners and Physician Assistants, especially if you are a new graduate. Many Advanced practice healthcare providers may sell themselves short by not having done the research needed or not possessing the proper negotiating skills.  Even for the experienced practitioner, the task of negotiating an employment contract can be a daunting one. If properly negotiated, employment contracts offer many protections as well as perks.

Know Your Worth

Before considering a new position or negotiating an employment contract, it’s important to take a personal inventory of yourself as well as skill set and know your worth. 

-What can you bring to the practice or organization?

-How many languages do you speak?

-What are your special skills? Do you have any professional certifications?

-What computer programs and EMR (Electronic Medical Record) systems do you know? What type of training does the organization offer? 

-Have you published any articles that will benefit the organization? What type of research are you involved in? 

-What skills obtained from previous employers can you bring to your new employer and enhance their practice? 

What Are Your Wants And Needs? 

As caretakers, healthcare providers may often put their wants and needs last. We are always taught to put everyone’s needs before our own, especially when it comes to patient care. This psychology can affect the way we negotiate our contracts. Before looking for a new position, it’s best to sit and take a personal inventory of what your personal goals and wants, as well as needs, are:

-What hours are you willing to work? Will 8, 10, or 12-hour shifts benefit your lifestyle or impede with your quality of life?

-Are you willing to take a salaried, hourly or per diem position? 

-Are you willing to travel to different facilities the organization may want you to cover?

-Do you want to advance your learning and get a higher degree? Does this position accommodate your educational goals and offer on the job education opportunities like training, grand rounds, or an educational coordinator to help you with further learning?

-What will your commute time be to and from work? Will your commute time affect your personal and family lifestyle? Does this new position offer any commuter benefits like ride share or telecommuting?

-Will loan repayment programs benefit you?

-What types of patient populations are you wanting to serve?

-Will the organization allow you to moonlight or consult on your own time?

Do Your Research Before You Sit Down To Negotiate!

Research is key in contract negotiations. Learning about the organization before sitting down to talk contract logistics is important and can be your wild card to negotiating a successful contract. 

-Obtain your net worth and speak to the business department of the organization you are applying to.

-Identify your manager’s or the department’s pain points.

-What keeps your boss up at night and how can you help?

-Establish your own value relative to those challenges.

The more you showcase yourself as your supervisor’s problem solver the more power you bring to your contract negotiation strategy. 

Learn And Understand The Art Of Contract Negotiations 

Carolyn Buppert, CRNP, JD, a health care attorney for nurse practitioners and author of the Nurse Practitioner’s Business Practice and Legal Guide, Follow the three “Ps” of negotiation – prepare, probe and propose.

Prepare. Be familiar with how to calculate the revenue they bring into a practice or hospital setting. You can determine the profit they generate by asking the practice management for data, or by tracking their own visits, noting CPT codes and dates and becoming familiar with the fee schedule. 

A clinician’s billings in relation to salary and overhead costs will determine whether he or she is profitable. Two rules of thumb are that a clinician’s salary and benefits should come to about one-third of his or her total billings, and the benefits should equate to about 25% of the base salary. 

Health care providers should also be prepared to articulate nonmonetary contributions to the practice, such as improvements in patient satisfaction, increases in repeat customers and declines in no-show appointments. Patient testimonials can be a great way to demonstrate added value. 

Probe. Clinicians should ask about the practice’s financial health during the interview process and determine employer expectation for profits.

Propose. Once prospective employees prove their value in the interview and do their research, they should not be afraid to ask for what they want and deserve.

It’s always best to know the needs of the organization in order to negotiate leverage. 

-What are the threats and opportunities?

-What does the budget look like?

-What are the strategic goals?

In addition to base salary, other benefits clinicians may be able to negotiate include expenses related to:

-CME tuition and travel

-Cell phones or beepers

-Malpractice insurance

-Professional memberships


-Subscriptions and books

-Mileage reimbursement for travel to other clinics

Ability To Re-Negotiate A Contract 

When negotiating a contract in a new practice or organization, it’s best to ask for a renegotiation clause. After 90 days, 6 months, and a year you may be re-evaluated based on your work performance for a promotion or salary increase. This can be a key opportunity to show how you’ve benefited the organization and further evaluate if you have made the organization money. Some vital questions to ask are:

-What is the performance evaluation process?

-Ask to see the Rubric (a scoring tool that explicitly represents the performance expectations for an assignment or piece of work.)

-Who will be doing your performance evaluation? A Fellow Advanced Practice Healthcare Provider? The CMO? How well do they understand your role?

-Will fellow colleagues and or physicians have to evaluate your patient EMR charts and or cases?

-How many and which kinds of patient charts will you have to submit?

-Will this affect your re-credentialing process? 

In business, if you don’t talk about your success you’re not going to get recognized. It’s important to promote yourself. 

Bring Your Poker Face To The Negotiating Round Table

When it’s time to sit down with your organizational leaders and talk business, it’s important to bring your poker face to the table. Step into your power and be confident of what you’re asking for while you are discussing your contract. 

Per Carol Kinsey Gorman Ph.D. Author of “The Silent Language Of Leaders,” In any negotiation, engagement, disengagement, and stress are the most important signals to monitor in the other person’s body language. Engagement behaviors (eye contact, head nods, smiles, forward leans, etc.) indicate interest, receptivity, or agreement. Disengagement behaviors (looking away, leaning back, narrowed eyes, frowns, etc.) signal that a person is bored, angry, or defensive. Stress signals (higher vocal tone, face-touching, tightly crossed ankles, etc.) most often accompany bluffing or discomfort with how the negotiation is proceeding.

Silence Is Golden

Not hearing from a potential employer immediately after you’ve negotiated your contract can increase your stress and anxiety levels. Your mind may ruminate and go over the scenario like a bad movie. Did you say the right things? Did you ask for too much? Even if you think your offer is perfect, it’s best to give it at least a day or 2 to think about the offer. This helps you stay in control of the situation. Don’t be tempted into taking an offer too early. You have to appreciate the value of silence and listen to the responses you get back. 

 Don’t Just Jump Into The Deep End Without Learning To Swim! 

That’s how mistakes can happen and people will take you for granted. Uncertainty and fear can hold Advanced Healthcare Providers back from negotiating their dream job and getting a fair contract. Knowledge is power along with the proper negotiating skills you can avoid jumping into the deep end of a nightmare job. Perhaps Kenny Rogers said it best in his hit song “The Gambler:” 

“If you’re going to play the game, boy
You gotta learn to play it right

You’ve got to know when to hold ’em
Know when to fold ’em
Know when to walk away
And know when to run
You never count your money
When you’re sittin’ at the table
There’ll be time enough for countin’
When the dealin’s done

It’s important for healthcare professionals to stand their ground and get what they want. Know when to hold them and when to fold them. Never take a job where you negotiated one thing and the CMO or powers that be changed it at the last minute. If you are not happy with your contract, apply somewhere else. The world is your oyster and full of opportunities that will be the perfect fit.


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