New Grad NP hourly wage in Bay Area

shibaowner, MSN, RN, NP · Sep 14, 2017

$60 per hour is $121,800 per year. 2030 hours x 60 = 121,800. That is good money for a new grad. No one is taking advantage of you. You are not going to be as productive as an experienced NP. Since your screen name is "dermnp" I'm assuming you are in dermatology.

You can certainly renegotiate your pay based on your productivity. Are you now carrying a full patient load? Are you working without any supervision? It's perfectly reasonable to say, "I am now at full productivity and generating $_____ revenue. Therefore, I am requesting $_____." Be professional and logical.

Also, no one cares that you were an RN. You are now starting all over in a new career as an NP. So you are not going to make as much as you were as an RN. You should have known this before making the career change. However, in a few years you should be making way more than an RN.

Good luck.

JellyDonut · Sep 14, 2017

RN experience will help you get that first job as an NP but it is not a factor in starting salary. In a specialty you really do not know squat when you walk in the door and in my experience it takes about a year to get up to speed. You will have many questions and be looking up stuff all the time and that makes you less productive. Use the first year to learn and build your experience and then you can request an increase as your value in the specialty has increased.

Dermnp33 · Sep 14, 2017

Helpful.

for what it's worth I'm seeing a full load, every 15 mins or if not I'm billing a 99214 or 99215. I wonder what reimbursement is on that...

also not getting any benefits.

I do get that being an RN makes no case for higher pay though.

My other colleagues who graduated from same program seem to all be making around 80-90 per hour but they are all in big hospitals. I always thought specialty paid more!

Advanced Practice Columnist / Guide · Sep 14, 2017

60/hr would be considered low end in the Bay Area if benefits are not even offered. What I do notice is that there are some variation in pay and some private practices do pay lower even in high revenue specialties like Derm. It may be partly due to the high degree of saturation of NP's in the area. You are right in noticing that your friends working in bigger hospital systems get paid around 80-90/hr (which is average for an experienced NP).

Few factors make that salary higher - some places factor in your RN experience in the salary determination and in some settings were the union dictates the market pay, the salaries tend to be higher (such as in the hospitals in San Francisco which justifiably tries to match salary to cost of living). You have the option to seek employment somewhere else or negotiate for a higher pay based on your RVU's and productivity.

shibaowner, MSN, RN, NP · Sep 14, 2017

I helped a specialty doctor with his own practice recruit and hire NPs and PAs. He was super nice and had very long term employees. He told me that one of his pet peeves is NPs and PAs who come to him to learn the specialty and then leave after one year for more money after he spent all that time training them. What irked him even more was that most of them didn't even try to negotiate a better package or if they did, it was just "I want more money," without any justification or business case. He was open to someone who could make a good case for what they wanted.

You need to be able to make the business case for an increased pay package. What is your hourly billing rate? $200 an hour? You need to know this. You also need to know what the reimbursement rate is for procedures that you do. Ask the office manager or ask the MD. When you have that information, you can put together your business case. You can also consider some combination of salary plus bonus based on mutually agreed conditions.

You can also think about ways to increase your pay at the end of Year 2. Are there procedures you could learn and add to your skill set that would increase your billing and benefit the practice? You could ask for CE money for those and then have a basis for continued career and salary growth.

I'm surprised about the lack of benefits. How big is this practice? If there are no benefits then you can also use this as a justifiable reason for increased pay or you can ask for some benefits as part of your new pay package.

Take a positive approach and explain why increasing your pay makes sense for the doc. In addition, emphasize you want a long term position and you want to work with him to increase your value to the practice, etc., etc. Ask him/her their advice on how to grow your derm skills and career.

However, you can't compare private practice to hospital in terms of salary and benefits. Depending on how many practitioners there are, a small practice financially cannot provide the benefits package of a hospital.

If the doc is unreceptive to any of this, then start looking for a new job after you have one year under your belt. Good luck and let us know what happens.

gcupid · Sep 17, 2017

I helped a specialty doctor with his own practice recruit and hire NPs and PAs. He was super nice and had very long term employees. He told me that one of his pet peeves is NPs and PAs who come to him to learn the specialty and then leave after one year for more money after he spent all that time training them. What irked him even more was that most of them didn't even try to negotiate a better package or if they did, it was just "I want more money," without any justification or business case. He was open to someone who could make a good case for what they wanted.
You need to be able to make the business case for an increased pay package. What is your hourly billing rate? $200 an hour? You need to know this. You also need to know what the reimbursement rate is for procedures that you do. Ask the office manager or ask the MD. When you have that information, you can put together your business case. You can also consider some combination of salary plus bonus based on mutually agreed conditions.
You can also think about ways to increase your pay at the end of Year 2. Are there procedures you could learn and add to your skill set that would increase your billing and benefit the practice? You could ask for CE money for those and then have a basis for continued career and salary growth.
I'm surprised about the lack of benefits. How big is this practice? If there are no benefits then you can also use this as a justifiable reason for increased pay or you can ask for some benefits as part of your new pay package.
Take a positive approach and explain why increasing your pay makes sense for the doc. In addition, emphasize you want a long term position and you want to work with him to increase your value to the practice, etc., etc. Ask him/her their advice on how to grow your derm skills and career.
However, you can't compare private practice to hospital in terms of salary and benefits. Depending on how many practitioners there are, a small practice financially cannot provide the benefits package of a hospital.
If the doc is unreceptive to any of this, then start looking for a new job after you have one year under your belt. Good luck and let us know what happens.

I'd be in the group that would request more money if I enjoyed working at the place. But Why should NP's waste time coming up with business proposals when it's clear that he recognizes the trend of workers leaving during a certain time period mark and they inevitably add profit to the company? Who has time to play games?

Why not proactively beat employee's to the punch with offers to show a greater appreciation? or provide counter offers before exit interviews to weigh the risk of retention vs cost of training again. The courtesy can extend both ways. Unfortunately we are not in that generation in which you stay loyal for years & years and we benefit from pensions, part ownership etc.

Business is cut throat. I bet each one of them Np's have been walked off from a job in the past that they had loyalty too for something trivial. It just doesn't pay to be like that in this society in my eyes.

shibaowner, MSN, RN, NP · Sep 17, 2017

I'd be in the group that would request more money if I enjoyed working at the place. But Why should NP's waste time coming up with business proposals when it's clear that he recognizes the trend of workers leaving during a certain time period mark and they inevitably add profit to the company? Who has time to play games?
Why not proactively beat employee's to the punch with offers to show a greater appreciation? or provide counter offers before exit interviews to weigh the risk of retention vs cost of training again. The courtesy can extend both ways. Unfortunately we are not in that generation in which you stay loyal for years & years and we benefit from pensions, part ownership etc.
Business is cut throat. I bet each one of them Np's have been walked off from a job in the past that they had loyalty too for something trivial. It just doesn't pay to be like that in this society in my eyes.

Why should the NP show some initiative? Because the MD is her BOSS. Also, he is not a mind reader. Is it such a hardship to ask for what you want and be able to justify it?

I am sick of NPs bashing their MD employers. The MDs I know with a private practice work like dogs. Not only do they have a full patient load, they have to take care of the administration. They have the responsibility to pay the rent, salaries, buy and maintain equipment, etc. And a lot of them do extra work on the side to improve cash flow.

A successful professional takes responsibility for their own career.