I was shadowing a CRNA the other day an he asked me why did I want to become one when ACNP's can make just as much. I told him anesthesia interests me a lot and all the reasons that come with being CRNA. However, his statement surprised me because I had no idea NP's could make $175k. He said he knew plenty making 200k with enough OT and call. Most worked ED's where they could perform a lot procedures am bill for them he said.
I was wondering how valid his statements were regarding earning potential for NP's. is it common if enough time is invested each week?
I'm in the Memphis area to give you an idea of region
What engages me the most-in theory,obviously- is the super focused area of work. I would prefer knowing a lot about one thing, then a little about everything. Personally I think, with the way I function and think, I would put less people at harm this way. It seems too easy to miss something in the practitioner world. Are there sub specialties in NP that one can go into that would be a lot more focused? Eg. Cards or something of the sort? Something I can really learn A LOT about and be REALLY good at. Be someone to get referred to?
Specializes in ICU, CV-Thoracic Sx, Internal Medicine.
Question is: is this common? How did you land such a gig?
In general, I don't know if it's common or not to the majority of practice types. I know it's very common in my group. There's 2 other NPs and we pretty much all have the same deal, +/- a few $k/year.
Telling you how I landed the gig won't help you or anyone else duplicate my results. But I can tell you how I approached developing my skill set as a NP. My thoughts are that my professional NP background really laid the groundwork for earning as I do. Here was my approach:
1. Learn the hospitalist role.
My first gig out of NP school was with the local university med school Cardio Vascular and Thoracic surgery department. It was a grueling work schedule with a very steep learning curve for a new grad. I had nearly a decade of critical care and trauma background as a bedside nurse, and I believe that carried me early on. I learned a lot about managing, as the surgeons put it, "the little things." Those little things were, dehydration, UTI's, diabetes/hyper/hypoglycemia, delirium, etc., in the hospital setting. The surgeons didn't like being bothered with the non-surgical conditions, that's where I came in. Naturally if pt's were too complicated a MD hospitalist was consulted to take on that role. This role taught me a lot about regarding when pt's were surgical candidates and if they were not, how to approach managing the conditions to give the pt the best chance at being a candidate.
2. Learn the primary role.
Less than 2 years with surgery I moved on to the primary world. My acute care background was perfect for a full risk clinic that worked very hard to keep pt's out of the ER and out of the hospital. I ran the treatment room for ambulatory conditions. Things like managing supertherapeutic INR's for coumadin pt's, COPD exacerbations, hyperglycemic events, dehydration, CHF exacerbation, Pneumonias, a whole slew of things.
It was also a tough gig, becuase most other clinics will send these type of pt's to the ER. Basically the decision of admitting the patient is left up to the ER physician. And there's nothing wrong with this approach. But being a full-risk clinic means all of the pt's medical expenses are paid by the clinic, including ER visits and hospital stays.
When I didn't have pt's on my schedule as acute visits, I helped with the chronic visits. Learning much about the difficulties that PCP's face. It's very much a thinking mans role. I loved it. I was good at it. An independent company tracked the clinic expenses and our quality measures.
One of the metrics measured that was very much an indicator of how well our clinic was doing both financially and in quality was READMISSION rates.
Average medicare readmission rates nationally and locally hovers just below 20%.
Our annual readmission rate when I was there was less than 9%, 8.7% to be exact.
I'm very proud of that. I still have a copy of that report.
The year before I arrived the clinic was at 14%.
Also, some of the conditions that were not safe to be treated as ambulatory type but also didn't quite have the necessity for hospital admission were handled by admitting the patients to the local skilled nursing facility.
3. Learn the politics.
They are especially important in a specialty practice that relies on referrals. I learned this well in my surgery role.
4. When you feel ready, take your skills to the highest bidder. That may also very well be your current employer.
So to summarize my long oration here, I would say to you the following.
Learn to manage your patient in the hospital and out of the hospital.
Learn to navigate your way through all the practice settings, ambulatory, skilled facilities/NH/s, hospitals.
Learn the importance of alliances and the local politics by anticipating the repercussions of your actions and how they may affect your practice. Walk that fine line.
Learn to not be satisfied with competence, strive for excellence.
Learn how your practice benefits from your work, and how much ($$$) they benefit from it.
I'm a psych NP, employed in an outpatient community (=not high-paying) psychiatric setting, one year of experience, and make 6 figures..
More than just a few of the psych NPs I know in private practice make between $200,000-$300,000 a year. At least one significantly out-earns both of her psychiatrist partners. I'm looking into starting a telepsychiatry practice, and factoring current reimbursements, no-show rates, etc., working 35-40 hours a week and earning in the $200s is definitely doable looking at the longer term if all goes well with the practice.
Money isn't everything, but, since that's what we're talking about... it's all about how aggressively you market yourself, your business sense, and what kind of market, practice, and practice climate you're in.
Just an FYI for new grads and prospective students reading this thread. People reporting 200-500k salaries as nps are outliers. Most mds do not make that much. I'm not saying its impossible if you're savvy enough and money is a very high priority for you. But it's very far from the norm. I'm in NYC and new grads are being offered 80-90. I know people with 20 years experience making around $120. This is not the career path for someone who just wants to make it rich.
In general, I don't know if it's common or not to the majority of practice types. I know it's very common in my group. There's 2 other NPs and we pretty much all have the same deal, +/- a few $k/year.
Telling you how I landed the gig won't help you or anyone else duplicate my results. But I can tell you how I approached developing my skill set as a NP. My thoughts are that my professional NP background really laid the groundwork for earning as I do. Here was my approach:
1. Learn the hospitalist role.
My first gig out of NP school was with the local university med school Cardio Vascular and Thoracic surgery department. It was a grueling work schedule with a very steep learning curve for a new grad. I had nearly a decade of critical care and trauma background as a bedside nurse, and I believe that carried me early on. I learned a lot about managing, as the surgeons put it, "the little things." Those little things were, dehydration, UTI's, diabetes/hyper/hypoglycemia, delirium, etc., in the hospital setting. The surgeons didn't like being bothered with the non-surgical conditions, that's where I came in. Naturally if pt's were too complicated a MD hospitalist was consulted to take on that role. This role taught me a lot about regarding when pt's were surgical candidates and if they were not, how to approach managing the conditions to give the pt the best chance at being a candidate.
2. Learn the primary role.
Less than 2 years with surgery I moved on to the primary world. My acute care background was perfect for a full risk clinic that worked very hard to keep pt's out of the ER and out of the hospital. I ran the treatment room for ambulatory conditions. Things like managing supertherapeutic INR's for coumadin pt's, COPD exacerbations, hyperglycemic events, dehydration, CHF exacerbation, Pneumonias, a whole slew of things.
It was also a tough gig, becuase most other clinics will send these type of pt's to the ER. Basically the decision of admitting the patient is left up to the ER physician. And there's nothing wrong with this approach. But being a full-risk clinic means all of the pt's medical expenses are paid by the clinic, including ER visits and hospital stays.
When I didn't have pt's on my schedule as acute visits, I helped with the chronic visits. Learning much about the difficulties that PCP's face. It's very much a thinking mans role. I loved it. I was good at it. An independent company tracked the clinic expenses and our quality measures.
One of the metrics measured that was very much an indicator of how well our clinic was doing both financially and in quality was READMISSION rates.
Average medicare readmission rates nationally and locally hovers just below 20%.
Our annual readmission rate when I was there was less than 9%, 8.7% to be exact.
I'm very proud of that. I still have a copy of that report.
The year before I arrived the clinic was at 14%.
Also, some of the conditions that were not safe to be treated as ambulatory type but also didn't quite have the necessity for hospital admission were handled by admitting the patients to the local skilled nursing facility.
3. Learn the politics.
They are especially important in a specialty practice that relies on referrals. I learned this well in my surgery role.
4. When you feel ready, take your skills to the highest bidder. That may also very well be your current employer.
So to summarize my long oration here, I would say to you the following.
Learn to manage your patient in the hospital and out of the hospital.
Learn to navigate your way through all the practice settings, ambulatory, skilled facilities/NH/s, hospitals.
Learn the importance of alliances and the local politics by anticipating the repercussions of your actions and how they may affect your practice. Walk that fine line.
Learn to not be satisfied with competence, strive for excellence.
Learn how your practice benefits from your work, and how much ($$$) they benefit from it.
Learn to negotiate with confidence.
Love what you do and you will do it well.
Very insightful, very in depth. Thanks for sharing this. I truly feel like I have a better idea of the inner workings of the role. More so than what I've gathered from the Internet in other places. Thanks again.
JUSTanLPN
147 Posts
What engages me the most-in theory,obviously- is the super focused area of work. I would prefer knowing a lot about one thing, then a little about everything. Personally I think, with the way I function and think, I would put less people at harm this way. It seems too easy to miss something in the practitioner world. Are there sub specialties in NP that one can go into that would be a lot more focused? Eg. Cards or something of the sort? Something I can really learn A LOT about and be REALLY good at. Be someone to get referred to?