Alternative Employment and Compensation Structures for Advanced Practice Clinicians

This paper reviews the employment, compensation, and production efforts of Advanced Practice Clinicians (APC's) in three different practice systems.  Each practice system is comprised of a sponsoring health system and a partner medical group.  The elements reviewed include the legal employer for the APC, the economic responsibility for the APC wages and benefits, how patient care collections are credited, the relative productivity of the APC in each system, and APC retention and work satisfaction indicators.

The employment and financial responsibility for APCs in a primary care practice associated with a health system can be set up in a number of ways.  The actual structure for each element should also include agreement on the metrics to be measured and reviewed in an ongoing effort to ensure the overall cost, quality, and access targets are achieved.  Finally, all stakeholders should be involved in the design and modification of the employment and compensation arrangements.