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20 Questions to Ask a Prospective Employer
JNP
20 Questions to Ask a Prospective Employer LEGAL LIMITS Carolyn Buppert, CRNP, JD Sometimes a nurse practitioner will find himself or herself in an employment situation that takes an unanticipated turn for the worse. For example, the nurse practitioner (NP) certified in women’s health care expected to provide women’s health care, but the employer has the NP performing pain management or the practice cannot fill up the NP’s schedule and is putting pressure on the NP to bring in new patients or take a pay cut. In each of these examples, the NP who already is employed can try to negotiate the terms he or she wants or find another job. However, knowing what questions to ask up front, before taking a job, allows the option of declining a job offer if the answers do not make sense. At a minimum, the surprise factor can be reduced. The goal is to identify potential problems before actually accepting the position. New graduates especially need to know what questions to ask during the interview process. Here are 20 questions NPs should consider asking before they take a job. 1. Why are you interested in hiring an NP? 2. Is there any aspect of your practice you would like relief from? 3. What aspect of your practice would you like an NP to develop? 4. What is your special interest? 5. Do you have an overflow of patients? 6. Do you want me to develop my own panel of patients or see your overflow? These first 6 questions allow the NP to get a sense of whether the employer wants to develop
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The Journal for Nurse Practitioners - JNP
a new service line or wants relief because the other provider or providers are overwhelmed. The women’s health NP who found herself providing pain management might have found out that this was the plan if she had asked question #3. The NP who moved several states north to take a job might have found out by asking question #5 that there was no overflow of patients and the employer expected her to bring patients to the practice. (Because she was coming from out of state, she had no patient base to offer. She was let go less than 6 months into the job.) 7. Do you want to pay a salary, an hourly rate, or a percentage of billings? 8. Will you pay for benefits or would you rather pay a higher rate without benefits? 9. If paying benefits, what would you cover? 10. If you want to pay a percentage of billings, what is your practice’s collection rate? 11. If you want to pay a salary, how many patients or relative value units per day do you expect me to handle? Questions 7 to 11 get at the employer’s compensation expectations. Because the trend is to compensate health care providers based on productivity, the prospective employee will want to know what the employer expects early on. Some NPs do very well with productivitybased compensation. New NPs, who are likely to require more time per patient visit than experienced NPs, are unlikely to be very productive for the first 6 to 12 months. Those NPs will probably want a set salary at least for the first year. 12. Do you want me to purchase my own malpractice policy or would you cover me under your policy? 13. If you cover me, is your policy a claimsmade or occurrence policy? 14. If your policy is claims made, how much is the premium for a tail? Volume 10, Issue 1, January 2014
15. Would you pay the premium for the tail? 16. If I purchase my own policy, would you reimburse me for the premium? All of these questions about malpractice insurance are essential. 17. What about taking call? Would you expect me to take call? How often? How often, on average, do patients call on evenings and weekends? 18. How would you compensate me for taking call? Questions 17 and 18 get at a lifestyle decision the prospective employee will need to make. Call can be very disruptive to life. However, it is a necessity of practice. Someone needs to do it, and an NP who will take call is valuable to a practice. Whether or not call is very disruptive to lifestyle or just a little disruptive depends on the call schedule and the likelihood that a provider will get called. 19. Would you expect me to sign a noncompete agreement? If so, how would I be compensated for agreeing to limit my future opportunities? (Some employers will say “You get the job in return for limiting your future opportunities.” That may be the time to thank the employer for his or her time and move away from that employer.) 20. If you want me to develop my own panel of patients, would you do the following: a. Put my name on the office sign? b. Help me become a provider with insurance companies? c. Advertise my joining the practice? d. Bill under my name? e. Provide me with a monthly statement of billings, collections, and accounts receivable? f. Let me participate in negotiating fee schedules? These final 2 questions get at the employer’s view of the NP as competition. Ideally, everyone working for a practice is on the practice’s team, www.npjournal.org
and there should be no competition other than friendly, collegial competition to provide the best care. However, in reality, there is competition in a practice, especially if everyone is being paid on a productivity basis. Some employers are very worried that an NP will build up a patient base and then leave, taking the patients. Question #17 gets the issue of restrictive covenants (or noncompete clauses) out on the table early. It is not in an NP’s best interest to sign a noncompete clause. If an NP agrees to a covenant not to compete, then it is in the NP’s best interest to craft a covenant that places only very narrow restrictions on future practice. For example, the NP will want statement #1 rather than statement #2: Statement #1: “Employee agrees not to practice in the field of endocrinology within 2 miles of the Main St. office, for 6 months after leaving the practice. Should the employer, not employee, terminate this agreement, then the employee is released from his/her obligation under this paragraph.” Statement #2: “Employee agrees not to practice within 20 miles of any location where the company practices for 2 years after leaving the practice.” If the employer says yes to all of the components of question 20, then the implication is that the employer views the NP as a full team member, not just an assistant and not as competition. These questions are by no means the only questions a prospective employee should ask, but, hopefully, they will give NPs a start. Carolyn Buppert, CRNP, JD, practices law in Boulder, CO, and can be reached at [email protected].
1555-4155/13/$ see front matter © 2014 Elsevier, Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2013.10.011
The Journal for Nurse Practitioners - JNP
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20 Questions to Ask a Prospective Employer LEGAL LIMITS Carolyn Buppert, CRNP, JD Sometimes a nurse practitioner will find himself or herself in an employment situation that takes an unanticipated turn for the worse. For example, the nurse practitioner (NP) certified in women’s health care expected to provide women’s health care, but the employer has the NP performing pain management or the practice cannot fill up the NP’s schedule and is putting pressure on the NP to bring in new patients or take a pay cut. In each of these examples, the NP who already is employed can try to negotiate the terms he or she wants or find another job. However, knowing what questions to ask up front, before taking a job, allows the option of declining a job offer if the answers do not make sense. At a minimum, the surprise factor can be reduced. The goal is to identify potential problems before actually accepting the position. New graduates especially need to know what questions to ask during the interview process. Here are 20 questions NPs should consider asking before they take a job. 1. Why are you interested in hiring an NP? 2. Is there any aspect of your practice you would like relief from? 3. What aspect of your practice would you like an NP to develop? 4. What is your special interest? 5. Do you have an overflow of patients? 6. Do you want me to develop my own panel of patients or see your overflow? These first 6 questions allow the NP to get a sense of whether the employer wants to develop
62
The Journal for Nurse Practitioners - JNP
a new service line or wants relief because the other provider or providers are overwhelmed. The women’s health NP who found herself providing pain management might have found out that this was the plan if she had asked question #3. The NP who moved several states north to take a job might have found out by asking question #5 that there was no overflow of patients and the employer expected her to bring patients to the practice. (Because she was coming from out of state, she had no patient base to offer. She was let go less than 6 months into the job.) 7. Do you want to pay a salary, an hourly rate, or a percentage of billings? 8. Will you pay for benefits or would you rather pay a higher rate without benefits? 9. If paying benefits, what would you cover? 10. If you want to pay a percentage of billings, what is your practice’s collection rate? 11. If you want to pay a salary, how many patients or relative value units per day do you expect me to handle? Questions 7 to 11 get at the employer’s compensation expectations. Because the trend is to compensate health care providers based on productivity, the prospective employee will want to know what the employer expects early on. Some NPs do very well with productivitybased compensation. New NPs, who are likely to require more time per patient visit than experienced NPs, are unlikely to be very productive for the first 6 to 12 months. Those NPs will probably want a set salary at least for the first year. 12. Do you want me to purchase my own malpractice policy or would you cover me under your policy? 13. If you cover me, is your policy a claimsmade or occurrence policy? 14. If your policy is claims made, how much is the premium for a tail? Volume 10, Issue 1, January 2014
15. Would you pay the premium for the tail? 16. If I purchase my own policy, would you reimburse me for the premium? All of these questions about malpractice insurance are essential. 17. What about taking call? Would you expect me to take call? How often? How often, on average, do patients call on evenings and weekends? 18. How would you compensate me for taking call? Questions 17 and 18 get at a lifestyle decision the prospective employee will need to make. Call can be very disruptive to life. However, it is a necessity of practice. Someone needs to do it, and an NP who will take call is valuable to a practice. Whether or not call is very disruptive to lifestyle or just a little disruptive depends on the call schedule and the likelihood that a provider will get called. 19. Would you expect me to sign a noncompete agreement? If so, how would I be compensated for agreeing to limit my future opportunities? (Some employers will say “You get the job in return for limiting your future opportunities.” That may be the time to thank the employer for his or her time and move away from that employer.) 20. If you want me to develop my own panel of patients, would you do the following: a. Put my name on the office sign? b. Help me become a provider with insurance companies? c. Advertise my joining the practice? d. Bill under my name? e. Provide me with a monthly statement of billings, collections, and accounts receivable? f. Let me participate in negotiating fee schedules? These final 2 questions get at the employer’s view of the NP as competition. Ideally, everyone working for a practice is on the practice’s team, www.npjournal.org
and there should be no competition other than friendly, collegial competition to provide the best care. However, in reality, there is competition in a practice, especially if everyone is being paid on a productivity basis. Some employers are very worried that an NP will build up a patient base and then leave, taking the patients. Question #17 gets the issue of restrictive covenants (or noncompete clauses) out on the table early. It is not in an NP’s best interest to sign a noncompete clause. If an NP agrees to a covenant not to compete, then it is in the NP’s best interest to craft a covenant that places only very narrow restrictions on future practice. For example, the NP will want statement #1 rather than statement #2: Statement #1: “Employee agrees not to practice in the field of endocrinology within 2 miles of the Main St. office, for 6 months after leaving the practice. Should the employer, not employee, terminate this agreement, then the employee is released from his/her obligation under this paragraph.” Statement #2: “Employee agrees not to practice within 20 miles of any location where the company practices for 2 years after leaving the practice.” If the employer says yes to all of the components of question 20, then the implication is that the employer views the NP as a full team member, not just an assistant and not as competition. These questions are by no means the only questions a prospective employee should ask, but, hopefully, they will give NPs a start. Carolyn Buppert, CRNP, JD, practices law in Boulder, CO, and can be reached at [email protected].
1555-4155/13/$ see front matter © 2014 Elsevier, Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2013.10.011
The Journal for Nurse Practitioners - JNP
63