Lindee Abe, APRN
Negotiating nurse practitioner benefits can be a big consideration for most future employees. While salary is an important part of a compensation package, it is only one piece of the compensation package. A lower salary may initially cause applicants to decline a job offer, but it is important to investigate all the benefits are offered as part of the job offer. When taking your first position as a provider there are several benefits that should be factored in that are not typically found outside of provider positions. I found this particularly true when transitioning from a RN to NP role.
Malpractice Insurance
The first benefit to discuss is malpractice insurance. Approximately 72% of nurse practitioners
reported in one study that their malpractice coverage is provided as part of their employment.
Malpractice should be discussed as part of the job offer. If the employer will cover malpractice
insurance, ensure that it covers at least $1 million per occurrence. There should also be a discussion if an employer will provide tail coverage upon termination of employment. Most policies offered by
employers are claims-made policies, meaning they will only cover malpractice claims that are made
when the policy is in effect. If the provider leaves the employer and 3 years later a malpractice claim is
filed, the malpractice policy would not cover the provider. Tail coverage extends the period of coverage
for any claim that may be made after the provider leaves the practice and is no longer covered under the policy. A general rule for how much tail coverage will cost is to expect to be about two times the cost of the yearly premium that was paid. Tail coverage can be for several years or indefinitely, with indefinitely being more expensive.
Tail Coverage Benefit
If the employer does not offer tail coverage as part of the compensation package, it may be worth it to try and negotiate a percentage of the tail coverage paid by the employer for every year employed. An example would be that every year you would be employed, the employer would pay 10% of the cost of tail coverage after termination. Occurrence-based policies will cover any malpractice claim that is made for an incident that occurs in the period the provider was employed but are not the normal type of coverage provided by employers. This benefits both you and your employer.
Another option for malpractice insurance reimbursement is for the employer to pay the entire
cost or part of the cost of the malpractice coverage, with the provider selecting their own individual
policy. This allows for more control and choice for the provider but will also require more research. A
provider should also consider if they want to purchase their own policy outside of the employer
malpractice coverage. The topic of additional malpractice coverage benefit is one that is frequently debated on the internet. It typically will cost between $1,000-3,000 for a nurse practitioner or physician assistant.
The one advantage that an individual policy has over an employer policy is that it will cover any board
actions against the provider. If using an employer-provided malpractice policy, it is important to research the carrier on a site like AM Best Website to determine the dependability of the policy. Federal employment will often be covered by Tort law, but this should also be confirmed prior to accepting a
position.
Continuing Education Reimbursement
Reimbursement for continuing education is a frequent benefit included in compensation packages for providers. The typical reimbursement is between $1,000-4,000. Each company will have an
individual policy as to what can be covered with the benefit. Most will cover the cost of travel to or from
a conference but may limit reimbursement to conferences in the United States. Some employers will
allow for the purchase of items like a stethoscope or tablet to be reimbursed. Employers can cover the
cost of licensing as a separate benefit or as part of the con0nuing educa0on benefit. Considering a DEA
license costs around $800 every 3 years, a RN license around $100-200, an APRN license around $200,
and board certification $250, this can add up quickly if not covered separately and take up most of the
CME budget. You can also ask if the employer sponsors CME events that are at a reduced cost or free to
employees.
In addition to the CME budget, many employers also provide paid time off to attend CME conferences. This is typically around 1 week of paid time off per year if offered.
Sign-on Bonuses – A taxable Benefit
Sign-on bonuses are another means of attracting applicants when negotiating nurse practitioner benefits. These bonuses will come with a contract and the contract should be reviewed carefully. A sign on bonus can be a one-time payment at the start of the contract, or a portion can be paid annually upon completion of that year of employment.
Exclusions
Attention should be paid to the penalties if you leave prior to the end of the contract. I have read of
some contracts that require the provider to repay the entire bonus if they fail to complete the entire
contract. Sign-on bonuses are also taxed at a higher rate, which should be factored into the overall
compensation.
Relocation Allowance Benefit
If you are looking at relocating across the country, there should be a discussion about relocation
reimbursement. This can be through paid moving costs, packing costs, costs to help sell or buy a home,
or even trips to find housing prior to moving. Reimbursement of relocation expenses is found more
frequently in locations that are hard to fill.
Maintenance of Practice Benefits
There are also some lesser-known benefits like professional dues and journal subscription
reimbursement that can be offered. These are nice benefits but are of minimal cost and don’t contribute as much to the overall compensation package. However, while they may not be a significant financial contribution, they can be an indication of the employer’s support of continuing professional
development.
Insurance
There are also typical benefits that should be considered in all employment, like medical and
dental insurance, disability insurance, long-term care insurance, and retirement accounts. These can all
have significant contributions to the overall compensation package. Medical coverage alone can vary by
thousands of dollars.
Paid Time Off
Paid time off is not unique to provider positions but is a significant factor for many providers.
Every individual is different, some providers will prefer more 0me off to more pay. This may also depend on the flexibility and schedule of the job. I have interviewed for positions that require a set number of shifts per month but offered little time off. The theory was that if time off was needed it would be easy to schedule around that time and still work the required number of shifts. This would work unless someone would want to take a longer vacation, then they would only be able to do so if they worked every day the weeks before and after the vacation. The details of the paid time off and if it covers sick time or if that is separate from paid time off should be discussed.
Summary
These are just a few of the benefits that can be discussed as part of the compensation package. When employers may not be able to offer more salary, you can negotiate for better benefits that may
increase the overall compensation package enough that the lower salary would no longer be a factor.
Your goal is to advocate for the benefits that you find the most valuable. A single, otherwise healthy
adult may not value the medical plan as much as the retirement account match percentage. Whereas a
provider with a family of 5 and multiple health conditions would typically value a medical plan more
than CME reimbursement. The key is to ask about all the discussed benefits prior to accepting a position to get a full picture.
References:
Buppert, C. B. (2019, September 3). Malpractice insurance for Nurse Practitioners. Medscape.
https://www.medscape.com/viewarticle/520660?form=fpf.
PracticeMatch. (n.d.). Are your nurse practitioner benefits competitive?
https://www.practicematch.com/advanced-practitioners/articles/competitive-nursepractitioner-benefits.cfm
Tolbert, E. (2022, May 5). How much continuing education allowance should NPS expect?
ThriveAP. https://www.thriveap.com/blog/how-much-continuing-education-allowanceshould-nps-expect
