Salary negotiation strategies for physician assistants and nurse practitioners in dermatology

January 18, 2019

Physician assistants (PAs) and nurse practitioners (NPs) in dermatology practice who don’t negotiate their salaries might be selling themselves short. Here's what you should know going into a salary negotiation. Participate in this forum.

Physician assistants (PAs) and nurse practitioners (NPs) in dermatology practice who don’t negotiate their salaries might be selling themselves short. Salaries in general for both professions are on the rise and job outlooks are much better than the average for other jobs in the U.S.

One way to estimate what an NP or PA should be making before accepting a job is to look at salary surveys. But it’s way more complicated than finding the nationwide average in a profession and going with that number.

RECENT NUMBERS TO CONSIDER

PA salaries increased 2.9% from an average $102,000 in 2016 to $105,000 in 2017, according to the American Academy of PAs (AAPA) 2018 Salary Report. And the PA profession is projected to increase 37% from 2016 to 2026, according to the U.S. Bureau of Labor Statistics.

The average base salary for full-time NPs was $105,546, and the average total income for full-time NPs was $112,923, according to the American Association of Nurse Practitioners (AANP) National Nurse Practitioner Sample Survey. NPs across certification types enjoyed pay increases compared with previous years. The job outlook for nurse practitioners is expected to grow 31% from 2016 to 2026, according to the Bureau of Labor Statistics.

Both professionals are not only in high demand but also add value to dermatology practices, and they should understand the value they bring when negotiating salaries.

“Nurse practitioners generate revenue for the practice by providing patient care and billing insurances. As part of the provider staff they are in an excellent position to negotiate their salaries based on production and revenue generated,” according to AANP Dermatology Specialty Practice Group Co-chair Peggy Vernon, RN, MA, CPNP, DCNP, FAANP.

Still, negotiations aren’t always an option. For example, dermatology nurse practitioners in individual or group practices are among those most likely to be able to negotiate, according to Vernon.

“Large corporations have set salaries based on education and experience,” Vernon writes in an email to Dermatology Times.

DEFINING BENCHMARKS

NPs and PAs should prepare for salary negotiations with national and local statistics from credible sources, like the American Academy of Dermatology, AAPA and AANP. Basing one’s negotiations on average salaries for a profession, regardless of specialty, practice setting, experience and more isn’t helpful. But going into the negotiation process armed with more specific salary information can be a powerful tool.

“…NPs should absolutely negotiate individual salaries based on individual education, experience, expertise, and number of years working in the field,” Vernon writes.

Salary can vary by specialty. For example, PAs in primary care tend to earn less than PAs in emergency medicine. PAs in dermatology make up about 3.5% of the profession. They typically earn annual salaries of about $90,000 just out of grad school to about $117,000 for experienced PAs, according to Tim McCall, Ph.D., AAPA’s research manager and salary report author.

The AANP 2017 compensation report suggests NPs reporting certification in dermatology made a total annual salary of $141,352, including all incentives and bonuses. But the number is based on relatively few respondents, so it should be used with caution, according to AANP.

OTHER VARIABLES

Salary report averages can vary depending the state or region in which NPs and PAs work. In 2017, NPs in private practice in the Southern states made an average base salary of $93,836 and those in Western states and the Pacific Islands made an average base salary of $112,920, according to AANP data.

According to AAPA, in many states where PAs report lower compensation, they actually have more purchasing power than PAs in states with higher compensation levels. That’s where cost-of-living comes into play. AAPA offers nationwide cost-of living adjusted compensation statistics on AAPA.org.

Practice setting can make a difference in how much an NP or PA makes, as can employer type. AAPA data suggests PAs who are self-employed or contractors make an average base salary (excluding bonuses and incentives) of $130,000 annually, versus PAs in physician practices who make an average $100,000 a year.

An analysis of AANP data shows NPs that work in private practice, including private group practice, private NP practice or private physician practice, report a mean base salary of $101,323, according to the most recent AANP sample survey.

Then, there are important considerations beyond the base salary in the negotiations. Among those: Expectations of the job. Vernon suggests NPs ask such questions as what ancillary staff will be provided and whether the practice will provide scribes for the electronic health record (EHR).

Ask about the bonus structure, according to Vernon.

“As a patient provider the NP should be offered a bonus plan based on percentage of production and collection,” she writes.

Take into consideration what will and will not be paid by the employer. For example, how is malpractice insurance paid? Who pays the provider’s participation in group health insurance and does that include dependents? If there are multiple offices, does the employer pay for mileage and tolls?

What about work-life balance? Providers might consider an employer’s emphasis on work-life balance as an important and valuable benefit.

What is the on-call status and is it included in the base salary or is there additional pay?

Once providers have done their research to prepare for salary negotiations at a new job, they should go into the negotiation process with the right mindset. While negotiating can be stressful, providers shouldn’t view the process as adversarial but rather as an opportunity to partner with a practice for success, according to Vernon.