What Every NP & PA Should Know to Avoid Costly Contract Mistakes (+3 Bonus Tips for Dermatology NPs/PAs)

Signing an employment contract as a nurse practitioner or physician assistant can feel deceptively simple. An offer is on the table. The role sounds exciting. 

Yet, the fine print in APP contracts often shapes your workload, compensation, autonomy and long-term satisfaction far more than the job description ever will.

Whether you’re early in your career or an experienced APP considering a change, understanding the key elements of your contract and where problems commonly hide can help you avoid costly missteps—protecting your career.

Below are practical, recruiter-backed tips every NP and PA should know before signing—plus three bonus insights for dermatology NPs and PAs to pay attention to.

1. Compensation Is More Than a Base Salary

Many nurse practitioners and physician assistants / associates focus first on base pay, but NP/PA contracts often include additional components that significantly affect total compensation.

Pay close attention to: 

• Productivity bonuses (RVUs, collections or visit-based incentives)
• Raises and review timelines (Are they guaranteed or discretionary?)
• Sign-on or retention bonuses and any repayment clauses

Ask yourself: Is the bonus structure realistic for the patient volume and support provided? A generous incentive plan means little if schedules, staffing or ramp-up expectations make it unattainable.

2. Scope of Practice and Supervision Language Matters

Your contract should clearly define your clinical responsibilities and level of autonomy. Vague language can lead to dissatisfaction with both employee and employer, leading to turnover.

Look for clarity around:

• Patient types and acuity
• Expected procedures and requirements for proctoring / training
• Supervising or collaborating physician requirements
• Expectations for independent decision-making
• Systems surrounding billing and reimbursement

If it’s not clearly written, it can be easily changed in practice—usually not in your favor.

3. Schedule, Call and Coverage Expectations

One of the most common stressors for NPs and PAs comes from schedule and coverage requirements. A contract that doesn’t clearly outline your hours and call responsibilities can lead to unexpected overwork, burnout and dissatisfaction.

Before signing, confirm:

• Weekly hours and clinic days
• Evening, weekend or call responsibilities
• Coverage expectations during PTO or staffing shortages

Having these expectations in writing helps you set boundaries, plan your personal life and negotiate fairly. A clear schedule benefits both you and the practice by reducing miscommunication and fostering a sustainable work flow.

4. Termination Clauses Can Limit Your Freedom

Termination clauses often go overlooked, but they have a big impact on your professional flexibility and security. Knowing how and when either party can end the agreement can prevent surprises if circumstances change.

Key questions to ask:

• How much notice is required from either party?
• Can you leave without cause?
• Are there financial penalties for early termination?

Understanding these details allows you to plan career moves proactively, negotiate favorable terms and avoid getting locked into a situation that no longer fits your goals.

5. Non-Compete and Restrictive Covenants

Non-compete clauses are another area where contracts can quietly limit your future options. These restrictions are especially impactful in competitive healthcare markets and can affect where you can practice or how quickly you can transition to a new role.

Pay attention to:

• Geographic radius
• Length of restriction
• Whether it applies if you’re terminated without cause

Taking the time to carefully evaluate non-compete terms gives you the freedom to plan your next steps, seek opportunities that align with your long-term goals and negotiate limits that protect your career mobility.

Dermatology-Specific Contract Tips for NPs & PAs

Dermatology NP and PA contracts often include additional layers that aren’t common in other specialties. And these are details that can make or break your experience.

1. Understand How Cosmetic Revenue Is Handled

If cosmetic dermatology is part of the role, your contract should clearly outline:

• Whether cosmetic services are included in productivity calculations
• How cosmetic revenue is split (if at all)
• Expectations for upselling or patient conversion

Some dermatology NP/PA contracts include cosmetic responsibilities without fair compensation for the added time, skill or liability.

2. Clarify Training and Ramp-Up Expectations

Dermatology has a steep learning curve for NPs and PAs, with clinical expectations, workflows and patient volume that can differ significantly from other practice settings.

Your contract (or offer letter) should address:

• Length and structure of training
• Reduced patient volume during onboarding
• When full productivity expectations begin

Being held to full-volume expectations too early is a common cause of burnout and underperformance in dermatology roles.

3. Watch for Production Metrics Tied to High-Volume Care

Dermatology practices often operate on volume-driven models. Productivity incentives may be tied to patient counts or RVUs that assume rapid visit turnover.

Make sure you understand:

• Daily patient expectations
• Support staff ratios (MAs, scribes)
• How complex medical dermatology visits are valued

A contract that rewards speed without adequate support can compromise both care quality and job satisfaction.

Why Understanding Your Contract Matters for Your Career and Income

Understanding your NP/PA contract isn’t just about knowing the legal language—it’s about shaping your professional life, your satisfaction and ultimately what you take home. The choices you make at the contract stage directly influence workload, compensation, autonomy and long-term career fulfillment. 

At myDermRecruiter, helping providers navigate contracts is a critical part of our mission because we know how much impact these decisions have on your financial and professional well-being.

Partnering with Millionaires in Medicine, we aim to help clinicians not only negotiate fair contracts but also achieve their broader financial goals. By combining contract guidance with practical financial insight, we empower NPs and PAs to secure roles that align with both their career ambitions and their life goals.

When you take the time to understand the terms, ask the right questions and advocate for yourself, you’re not just signing a contract—you’re building the foundation for a career that is both professionally rewarding and financially sustainable.

Before you sign, make sure your contract works just as hard for you as you’ll work for your patients.=

Guest Contributor Note
This article was written by the myDermRecruiter team as a guest contribution for the Millionaires in Medicine blog. myDermRecruiter specializes in helping nurse practitioners and physician assistants navigate career opportunities, contracts, and long-term professional growth. Their insights are grounded in real-world recruiting experience and are shared here to support medical professionals in making informed, confident career decisions.