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The salaries of your midlevel providers will vary by specialty, practice setting, local pay scales, and the provider’s experience. Expect to pay roughly half of a typical physician’s salary for an experienced physician assistant or nurse practitioner. Whether you pay your midlevel providers a straight salary, an hourly wage, or based on production is up to you.
Bristol Street Pediatrics in Elkhart, IN, pays its nurse practitioners by the hour and gives them an end-of-year production bonus, says Anne Meden-Cutler, administrator. The practice started its production bonus system for nurse practitioners to reward them for their years of service. "They’ve all been here a long time. We felt we needed to offer them something extra," Cutler says. The practice uses a complicated formula based on relative value units (RVUs).
At the beginning of the year, the practice sets a revenue limit over which the nurse practitioners are able to get a bonus. At the end of the year, Cutler adds up the total number of RVUs for all of the nurse practitioners and figures the percentage of the total RVUs each nurse practitioner has produced.
The bonus is based on net collection. The RVUs include office visits and procedures, not ancillary services. "It encourages them to see more patients," Cutler says.
Dean Medical Center in Madison, WI, takes a different approach with its physician assistants. The Dean physician assistants are paid a salary but no production bonuses. Full-time physician assistants are required to have 35 hours of patient contact time open and accessible each week. "Our own feeling is that we are not interested in putting physician assistants in competition with physicians for patients," Falligant explains. At Dean, physician compensation is based on productivity.