Beyond the Paycheck: Contract Essentials

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In a dynamic health care landscape, physician associates (PAs) and nurse practitioners (NPs) must look beyond base salaries to navigate their careers with confidence, clarity, and strategic negotiation. At the Fall Clinical PA/NP 2025 conference, Kasey D’Amato, PA-C, a seasoned clinician and founder of Clinical Practice and Career Consulting, delivered a compelling presentation designed to empower clinicians with negotiation tools and mindset strategies to maximize professional fulfillment.^1-2

D’Amato opened her session by challenging conventional taboos. “We’re going to talk a little bit about sex, drugs, and money. We’re going to talk mostly about money and negotiations—those are the taboo topics,” she said, setting the tone for an honest and data-driven dialogue on contracts and compensation.

The foundation of successful negotiation, D’Amato emphasized, lies not in entitlement but in confidence rooted in value. “Confidence is not the same as arrogance and entitlement. None of us are entitled, nor should we feel that we are owed anything by the practice,” she explained. Instead, clinicians must approach negotiations as an opportunity to build a mutually beneficial relationship with their employer.

D’Amato, who has worked with PAs across 19 states and consulted for pharmaceutical and insurance companies, outlined several key components of employment contracts. These include salary structure, malpractice insurance type (claims-made vs. occurrence), non-compete clauses, dedicated staff, and benefits like PTO. She advised attendees to verify their malpractice policy, explaining, “If you take away 1 thing, take away this: go look up what your malpractice policy is. If it is occurrence, you do not need tail coverage if you were to leave. If it’s claims made, you do need to purchase tail coverage.”

On the topic of non-compete agreements, she offered pragmatic guidance: avoid expensive legal battles unless absolutely necessary. “In most cases, you’re going to win, but there have been some recent lawsuits where the PA has lost...so if you impact the practice negatively, there can be some negative outcomes,” she warned.

Importantly, D’Amato highlighted that salary isn't the only negotiable element. Many clinicians can increase their value—and, by extension, their compensation—through non-revenue contributions such as mentoring, EMR optimization, or leading new clinical initiatives. “When you show that you are passionate about the future...I promise they will find some money to throw your way,” she said, encouraging PAs to recognize and articulate their broader contributions.

She also dismantled the myth that clinicians are locked into multiyear contracts without room for negotiation. “You can renegotiate at any point in time...especially if you are bringing something unique and different to the table,” D’Amato noted. The key, she reiterated, is data. By using objective performance metrics—like patient volume, collections, or leadership roles—clinicians can make a case based on value rather than emotion.

To help clinicians evaluate their current situations, D’Amato introduced her “3 Doors” framework: (1) accept the status quo and refocus on side pursuits, (2) create a win-win negotiation for change, or (3) exit the role if alignment is impossible. She emphasized the importance of introspection and fit: “Every person in this room is going to have a different opinion on the patient volume…It’s a unique individual comfort level. There’s no right or no wrong.”

Ultimately, D’Amato’s presentation underscored the evolving definition of value in health care employment and offered clinicians a practical roadmap to career empowerment. Her insights serve as a timely reminder that thoughtful negotiation is not just about the paycheck—it's about aligning professional goals with workplace realities and cultivating long-term career satisfaction.

As she put it succinctly: “Data means emotions. When you focus on the numbers…you can avoid over-emotional negotiation, where people cry, get flustered, and those do not result in positive outcomes.”

References

1. D'Amato K. Beyond the salary: Navagating contracts, benefits, and what really matters. Presentation at Fall Clinical PA/NP 2025 Conference; May 30-June 2, 2025; Orlando, Florida.

2. D'Amato K. Kasey D’Amato. https://www.kaseydamato.com/. Accessed May 31, 2025.