DNP- owned private practice Salary?

DrCOVID, DNP · Jan 14, 2021

Hey man, this has been already discussed ad nauseum here in the psychiatric forum; it is not "common" in the sense that most NPs are not making this much. I personally know one that does gross over 330k last year. She had to build up her clients over a period of time so it's not something you just waltz into per say. There is another one on the boards that posts about being a 1099 employee and working for a company as a consultant, and they take a % fee. It is definitely possible in this field. If you do the math and look at the psych coding, it's obvious. Look up E&M coding for routine visits such as 99213/4.

The thing most people turn a blind eye to is tax and overhead, though psych outpatient is probably low, and more so now with COVID (probably don't need an office). Every outpatient facility I know of has transitioned to as much Telehealth as possible.

The DNP probably doesn't matter when doing private practice work. The only thing that matters is license and certification to do the job currently. The only place I have seen the DNP matter is at a Federal facility. The DNPs did start out higher than the MSN providers. Believe you me when the MSNs found this out they went back to school. The DNP is a degree, and you might (far in the future) have to complete it at some point. It is still not mandatory. The degree gets a lot of hate on this forum, but I got an extra equivalent 2 years of training and am "theoretically" a better provider for it and don't ever have to go back to school.

JosephP1983 · Jan 14, 2021

Thanks.... I’m a dental hygienist with a bachelors and looking to applying to the direct masters program which then turns into the DNP at Columbia university. I plan to focus in dermatology and esthetics. I am just being blunt and seeing if it’s common to make over 200k a year owning your own practice because if not it’s not worth the hassle of going and taking out more student loans. Rather just go to dental school or med school then... I do like the autonomy NPs have.

DrCOVID, DNP · Jan 14, 2021

It largely depends on structure. If you are employed, have benefits, etc., are being directly supervised - project 100-150k depending on geographical location.

If you own your own practice or are an independent contractor/1099, I am sure you could do over 200k in derm as an NP. Once you get the hang of things and are proficient, you could likely reach 250k+. There is a reason derm is high on the list for physicians as well. Mostly simple easy quick in and out.

When you become a provider, you will see. Most people don't want to admit it, but It's all about time and reimbursement. I have a close friend that is a dentist. There are close parallels in all these areas; you can choose to do simple easy procedures for patients that net good reimbursement.

JosephP1983 · Jan 14, 2021

I appreciate your response. I am in NYC so salaries tend to be higher. So is cost of living.... It’s nice to hear some numbers regarding practice ownership because all the average salaries for NPs online seem like they are reflective of hospital employment or being employed at another practice and not owning. I know there’s a lot of “variables” with owning but one would have to assume that it’s at least 200k once you nail things down. Personally, I have no interest in working as an RN or as psych or family nurse practitioner. I strictly plan on going right into the dermatology world. Focused and Learning whatever I can... considering the dermatology fellowship program in mass but that’s another two years. I’m sure I could gain more knowledge working with dermatology and plastic surgeons in two years vs the fellowship?

DrCOVID, DNP · Jan 15, 2021

Yes - and again, you will see online job listings as that is mostly for employees, NP salaries (FNP) will be low around 100k~. That is because most NPs don't understand the business end. My mentor was interviewing for a PMHNP position last year, and nearly every NP flaked out when they realized they had to form at least a PLLC.

Salary is a mostly related to structure of business/payment. As an employee, they have to train you, tight supervision, starting out, no experience, etc. These job postings are not for business owners. As a business owner, you control everything, how much you work, how many pts u see, what kind of payment you take, etc... Two different worlds!

The less supervision you have and the more independence, the more $. It's simple math. Don't go into psych if you have no interest in the brain. Derm is a good low risk field with simple procedures (I don't have exp in skin, and don't care to touch other people's skin, that is just my impression). Yes, don't really worry about fellowship. If you go to a DNP program that is solid, apply yourself, learn everything you can in school and do extracurricular work - you will be fine. You will learn most on the job anyway. When you are in school, make sure you network. That is how you get the best offers, learn the most, make connections, etc. I learned all this because of the mentor I had doing clinical my last year is a PhD nurse practitioner that owners her own business! Schools sadly don't go into billing/coding, business structure. About all I got was our first year, in APRN roles, one of the DNP instructors showed us he negotiated an 800$ shift bonus in the ER.

JosephP1983 · Jan 15, 2021

Thank you so much. Yes it’s been frustrating having other NPs say to me that I should be working as an RN for a while first etc. I’m 37 years old LOL. I don’t have that kind of time to waste and I have no interest in working in other fields of medicine besides dental and dermatology/esthetics. I guess you’re always going to get people who advise you to something else first which makes virtually no sense for me. Especially because dermatology is so specialized

DrCOVID, DNP · Jan 15, 2021

Right. That is the thing people don't take into account, your time. You can never get that back. Nursing helps a little, but the provider role is way different and requires different skills and to be safe more advanced application of knowledge.

JosephP1983 · Jan 15, 2021

Thank you. It’s great to hear some positive news. May I ask where you are from? I’m in NYC here.

DrCOVID, DNP · Jan 15, 2021

Yeah, I'm in Texas! I plan on getting endorsed in other IP states to do telehealth with patients.

cubrnjvm, MSN, RN · Jan 19, 2021

back on the days it was about a "mission" or a "vocation", now it is most about the "money", soon will see nurse practitioners at the bedside...

DrCOVID, DNP · Jan 19, 2021

19 minutes ago, cubrnjvm said:

back on the days it was about a "mission" or a "vocation", now it is most about the "money", soon will see nurse practitioners at the bedside...

There already are NPs at the bedside. And it is a thing (as I have observed in practice, and had on my board questions) to see a few patients for free. The biggest thing IMO is no one in their right mind would go to school for 8 years, and in the case of MDs 11+ years to complete training if there was no money in it. There would be no way to pay back the crushing debt of education which most people are on the hook for and not even bankruptcy can save you from.

I am willing to work harder than most people and I surely wouldn't be here if it weren't something I was passionate about, but ... money is a motivator for most people. Again, most people specifically shy away from psychiatry, and I imagine being a neuro/cardiac surgeon (top MD salary) is probably one of the hardest, most grueling jobs to ever have (standing for hours at a time, being extremely precise and having HUGE liability implications)...

Finally, what is wrong with being paid for something when you have a specific, in demand skill set? Besides the usual loan debt , we have liability, overhead, people to employ, insurance, offices to rent, and other business expenses, etc.