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How to ask for incentive pay for APRNs and PAs

Posted on April 15, 2021   |   by   |   Advanced Practice Structure, Communication Skills, Employers, Job Seekers

How to ask for incentive pay for APRNs and PAs

Author Jill Gilliland

Editor Elizabeth Moran, MSN, RN, CPNP-PC

Advanced Practice Providers (APPs, including APRNs and PAs) have difficult, yet rewarding jobs, and deserve to be paid well for their work.  The more you know about the salary structure, the better your ability to discuss alternatives. The cost of turnover for an employer is 2.5x the cost of compensation, so it is worthwhile for employers to pay APPs well. To ask for incentive pay, APRNs and PAs need to start by gathering information.

  • Discuss with your employer their approach to salary. Understand salary structure – what is the range for your role? What is the max /cap salary for your role at the hospital?
  • Explore expected salary increases. Do they offer them? Why or why not? Does the organization provide annual raises? What is the average percent increase? Does your employer provide inflation or merit based raises, or a combination of both? If it is merit based, what is the criteria for earning your raise?
  • Does your organization regularly assess and provide market adjustments? For example, if the organization provides an annual percent raise, but it is lower than salary increases throughout the rest of the market, then overall salaries will be lower than other places. How will they account for this discrepancy? 
  • Ask your employer if there is consideration for a base plus bonus model based on productivity. See below for an example. 

Sample model for bonus and incentive pay based on productivity (RVU) –(Download this Model)

Sample model for bonus and incentive pay based on productivity (RVU)

Gather and ask for objective data of your performance measures (i.e. number of patients seen, billing, collections, and even patient satisfaction). You can also ask for visibility into other providers in the practice or to benchmark your practice against national data. Visibility can change behavior for the better when providers realize they are behind their colleague’s measures. When individuals are aware that their work is being observed and that their performance is impacting institutional revenue, their productivity and the quality of their work improves. 

Then, ask to use this information to set up a base plus a bonus pay model. Use your current salary as your base and then ask for a percentage of your revenue based on your productivity. Many APPs have found that they are actually the highest producer in the office once they receive visibility.

You can present, as an alternative, a straight inflation based annual increase such as 2%. However, this is actually riskier for the practice becauseit commits them to a fixed salary no matter how much you produce. A base plus a bonus means that you will only be paid when you are producing more than your base. It also helps the employer to know that you are incentivized to code and write accurate notes and work efficiently to see patients. Presenting this alternative and then advocating for a base plus a productivity based bonus is an effective way to negotiate for an incentive salary model.  

All APPs should consider advocating for incentive pay. If you are considering talking with your employer about salary at your next annual review, start by:

  • Downloading the Salary Survey for APRNs and PAs by Melnic to provide the salary data to negotiate.  Fill out the survey to help make the data even stronger and then you will receive the FREE salary survey to help you make what you deserve.  
  • Finding your advocate, APP leader, or other mentor. Learn about who the decision makers are, discuss with them the need for a raise or market adjustment, and then engage them as your advocate.

If you are an employer, working on building an incentive model, please contact Jill Gilliland, President, Melnic, jill@melnic.com for a free consultation and more information. 

Find jobs@melnic.com, if you are looking for a new opportunity. 


  1. Wikipedia contributors. (2020, April 12). Hawthorne effect. In Wikipedia, The Free Encyclopedia. Retrieved 18:10, April 12, 2020, from https://en.wikipedia.org/w/index.php?title=Hawthorne_effect&oldid=950526519

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