I've been an NP for a while, and I am happy and proud to be one. I am well aware of both our shortcomings and our successes. I think we fill a need in the world of healthcare, and "going to see my NP" has become a normal phrase in American households.
For all of our successes, we seem to have a problem with consistently selling ourselves short when it comes to compensation. I have been reaching out to colleagues and previous students, and I have also been serving as a mentor for some new NP graduates looking for advice. As they navigate positions, one common theme is they do not know how much they are worth, and do not understand that as a provider they are revenue producers! We should be paid as such!
Case in point: last week I had a new graduate FNP telling me about a job in a specialty office she intended to accept. She told me she was satisfied with the salary and benefits and shared them with me. It turned out to be a salaried position at $96K annually working 8 AM to 5 PM five days a week. Vacation was 2 weeks paid going up to 3 weeks after FIVE years. It included all the usual benefits but there was no 401K match and no CME.
Sometimes I feel like nurse practitioners are not being taught about healthcare economics at all. Maybe instead of 4-5 classes on research and "NP roles" we should be teaching a dedicated course on billing and reimbursement? I see NP after NP working for peanuts while the practice that employs them is making hundreds of dollars per hour off of their work. The long-term effect, of course, is that all NP salaries will start to flatten out. Those that do the research and demand a salary that reflects what they bring to the practice will be laughed out the door while those who do not know their worth will end up taking their place.
Does anyone else notice this in the NP world? What can we do to bring awareness to it? Let's Discuss! ?
90 Percent of NP schools do not prepare students. If you have been in at a clinic with other PA's or MD/DO students you would know that most NP's don't know much. It is embarrassing and will lead to the role of the NP meaning nothing in due time. If the AANP, ANCC and state boards do not enforce certain entrance exams for schools and make the board exams more stringent this will lead to NP's becoming a joke. Especially when you have around 30000 students graduating each year compared to 7000 PA's.
This is very sad. I would have loved to have had the opportunity to learn in a clinic.
90 Percent of NP schools do not prepare students. If you have been in at a clinic with other PA's or MD/DO students you would know that most NP's don't know much. It is embarrassing and will lead to the role of the NP meaning nothing in due time. If the AANP, ANCC and state boards do not enforce certain entrance exams for schools and make the board exams more stringent this will lead to NP's becoming a joke. Especially when you have around 30000 students graduating each year compared to 7000 PA's.
Has more to do with school accreditation agencies than the certification boards imo.
Specializes in Psychiatric and Mental Health NP (PMHNP).
15 hours ago, C.Love said:
It is nearly impossible to find an NP job in Southern California for a new grad starting out.
Yes, it is. I moved. I suggest new grad NPs be prepared to move for their first job. There is a shortage of providers in the Central Valley and North State. A lot of providers will work in one of these areas and then just go home on the weekends. It's not the end of the world to do this for a couple of years.
Yes, it is. I moved. I suggest new grad NPs be prepared to move for their first job. There is a shortage of providers in the Central Valley and North State. A lot of providers will work in one of these areas and then just go home on the weekends. It's not the end of the world to do this for a couple of years.
This helps to hear, as I was starting to get a complex of low self esteem and feeling defeated. It sounds like it's a common problem. Coming home on the weekends is a good idea. Did you have any kind of orientation period to get accustomed to the new role?
No, it is actually 48/hr, which is twice what a new grad RN makes in my area.
Having NP experience with a lower salary to start is better than becoming a stale new grad and not getting hired at all.
It is about $46/hr based on 52 weeks/yr at 40 hrs per week. It is still relevant to where you work for sure. I agree with you though, having some experience and getting your foot in the door is better than nothing. Not everyone can pick up and move to an area with a market that isn’t saturated.
The quoted position was 45 hours, as it was 8AM to 5PM 5 days per week. So again, 41$.
And this attitude is exactly why so many nurse practitioners accept low paying jobs. They come to sites like this for support and instead of saying "wow, that's a horrible salary they are taking advantage of you!" and advocating for our fellow providers, you have people who instead go into the "Eat the young" mode and say that a new grad is in "no position" to ask for an ethical wage and should just eat whatever scraps they are offered. I completely disagree. We are providers, and a "new grad" is not going to bill any less per appt than an experienced graduate will. If the concern is seeing fewer patients per hour, then the new graduate NP can ask for a base salary +bonus based on RVUs or # of patients seen per quarter. This will allow the NP to increase salary as they become proficient. These days of paying an NP $40 an hour to see 5-6 patients and billing out $300-400 worth of services per hour on behalf of the practice need to end.
I’m sorry, but it is for 40 hours. They do have an hour built in for lunch I’m sure.
It’s basic economics, supply and demand. Too many NP’s in the hiring pool, most NP’s are scared to negotiate, and honestly most HCO’s do not negotiate due to how easily replaceable an NP is.
I have hired new grad pharmacists for 30k-50k a year more than an experienced NP. That makes my stomach hurt!
I see the comments on here saying that 96k is decent depending on location...how many MD providers who do the same job would state that? Look, if you are OK with being a nurse practitioner, diagnosing and treating patient and subsequently following their care for that amount, good on you. I am not an NP, but I worked as a nurse and now in operations and leadership all throughout the United States, and I can assure you that even in the smallest Midwestern town, 96K it’s not worth the NP credential. hell I would not even interview (regardless of location) if the starting pay is under six figures even with bonus potential!
I can tell you for this for sure, if you are in any large city in California and you are making under 170K as an LIP NP...you should move.
stop being taken advantage of, NP’s are one of the few pathways in nurse that brings in revenue!
It’s basic economics, supply and demand. Too many NP’s in the hiring pool, most NP’s are scared to negotiate, and honestly most HCO’s do not negotiate due to how easily replaceable an NP is.
I have hired new grad pharmacists for 30k-50k a year more than an experienced NP. That makes my stomach hurt!
I see the comments on here saying that 96k is decent depending on location...how many MD providers who do the same job would state that? Look, if you are OK with being a nurse practitioner, diagnosing and treating patient and subsequently following their care for that amount, good on you. I am not an NP, but I worked as a nurse and now in operations and leadership all throughout the United States, and I can assure you that even in the smallest Midwestern town, 96K it’s not worth the NP credential. hell I would not even interview (regardless of location) if the starting pay is under six figures even with bonus potential!
I can tell you for this for sure, if you are in any large city in California and you are making under 170K as an LIP NP...you should move.
stop being taken advantage of, NP’s are one of the few pathways in nurse that brings in revenue!
This! When we become revenue producers we are a net profit! Most of us bring in 300K+ annually to our practice so don't settle for working for a fraction of that! Ask to see your collections after 6-12 months and make sure you're getting a decent percentage of it.
The victim mentality ("I'm just happy to have a job!") should stop.
So you are saying it is better to refuse job offers and risk become stale and unhireable.
Any experience can be used to leverage for higher pay in the next job and so on. So yeah, I am totally willing to take the 70k, work a year, and then hop off and demand 90k at my second job and so on.
That’s exactly what I am doing. I took a job making $72K per year in primary care and after a year I will either re-negotiate or look for something else. Right now I am lucky to get a call back much less an interview. But I am in an area where there are a lot of FNPs with experience who are out of work. It took me 6 months to get this job.
That’s exactly what I am doing. I took a job making $72K per year in primary care and after a year I will either re-negotiate or look for something else. Right now I am lucky to get a call back much less an interview. But I am in an area where there are a lot of FNPs with experience who are out of work. It took me 6 months to get this job.
This makes me sad. Why not move for better pay? It’s a pain, but you are leaving 1000’s on the table, like way of life changing money! Plus they are already shitting on your value...the altruistic nursing mindset is tough to get past due to compensation, being an NP is business not virtue signaling.
It’s basic economics, supply and demand. Too many NP’s in the hiring pool, most NP’s are scared to negotiate, and honestly most HCO’s do not negotiate due to how easily replaceable an NP is.
I have hired new grad pharmacists for 30k-50k a year more than an experienced NP. That makes my stomach hurt!
I see the comments on here saying that 96k is decent depending on location...how many MD providers who do the same job would state that? Look, if you are OK with being a nurse practitioner, diagnosing and treating patient and subsequently following their care for that amount, good on you. I am not an NP, but I worked as a nurse and now in operations and leadership all throughout the United States, and I can assure you that even in the smallest Midwestern town, 96K it’s not worth the NP credential. hell I would not even interview (regardless of location) if the starting pay is under six figures even with bonus potential!
I can tell you for this for sure, if you are in any large city in California and you are making under 170K as an LIP NP...you should move.
stop being taken advantage of, NP’s are one of the few pathways in nurse that brings in revenue!
You seem to say one thing and then change it up. Either it’s “basic economics (supply and demand)” or it’s not. If it is that simple, then even knowing your worth or value won’t get you that job. 96k isn’t bad for some markets depending on bonuses. I had one Midwestern hospital group offer me 90k flat with a reduction to 85k and a specific bonus structure claiming by 1 year time, I should have enough patients regularly for rvu generation. Which is becoming way more common in some bigger Midwest establishments. You suggest 6 figures is your minimum entry, but in an over saturated market you know a company can just get the next person in over the equivalent of $153 a pay period without hesitation. You only stop being taken advantage of if you do your own thing and control your own income. Past that, you are subjected to clinical expectations of income, overhead, and factored in profit which you can’t personally control.
My last clinic factored my overhead at $284000 annually. They weighed everything from my salary of 103k, MA cost, cost of my benefits, facility costs, and whatever unknown percent of profit they expected. At the end of the day, I still don’t believe those numbers as I’m fairly certain I could do the same, provide better quality, and still make a profit for much less. with an overhead of 284k, I could rent a place myself, pay the bills, pay an MA and an office manager, and still have a smaller panel that isn’t pushing more and more output. Especially with a direct primary care environment.
This makes me sad. Why not move for better pay? It’s a pain, but you are leaving 1000’s on the table, like way of life changing money! Plus they are already shitting on your value...the altruistic nursing mindset is tough to get past due to compensation, being an NP is business not virtue signaling.
I have a family with needs to consider. I own a home where there is road construction going on for the foreseeable future. This makes it difficult to sell right now. I can’t in good conscience only consider myself. Had I not been able to get a job at all, maybe. In a year I will re-evaluate.
C.Love, MSN, NP
48 Posts