NASHVILLE – Everyone knows to negotiate during employment talks, but uncertainty often prevails when it comes down to how to do it well.

Carolyn Buppert, CRNP, JD, a health care attorney for nurse practitioners and author of the Nurse Practitioner’s Business Practice and Legal Guide, attempted to demystify the process during a session at the American Association of Nurse Practitioners 2014 meeting.

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Follow the three “Ps” of negotiation – prepare, probe and propose – Buppert advised.

Prepare. Nurse practitioners should be familiar with how to calculate the revenue they bring into a practice. Clinicians 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 clinicians 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, according to Buppert.

Another essential element of successful negotiations is appropriate form.  Maintain neutral body language, keep an unemotional voice and convey an understanding of the employers point of view, Buppert advised.

Negotiate specific and substantial terms. Clinicians should be able to state why they deserve the salary for which they are asking, such as expected revenue and the profit the practice can anticipate in relation the salary.

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

  • CME tuition and travel
  • Cell phones or beepers
  • Malpractice insurance
  • Professional memberships
  • Transportation
  • Subscriptions and books

Consider compensation in terms of a total package, and take into account the health and retirement plans offered, disability insurance and long-term disability pay, and paid vacation days, Buppert said.


  1. Buppert C. #14.3.051. “Negotiating Terms of Employment.” Presented at: AANP 2014. July 17-22, 2014; Nashville, Tenn.