I'm gathering that this is a theme in our field, unfortunately...
So after graduating and spending nearly a year of applying for positions as an APRN, I finally scored several interviews and a couple of offers. I'm particularly interested in one of the positions, which offers amazing health insurance benefits for my family (employer pays 80% of premium) but the salary that they offered me is embarrassing. Let's just say it's less than $70,000, but more than $60,000. Large University (i.e. state) position in a city w/population of approximately 100,000 people.
There are other APRNs in this same practice, currently with 10 years experience, who are making $79,000 - $83,000.
- No CME
- No productivity bonus
- 33 days of PTO, including vacation, sick, and personal days
- very good health insurance plans w/employer paying 80+% of premium
- malpractice covered
- excellent potential for career advancement (I plan to advance my APRN education)
My instincts tell me this particular position is The One; this is the position I'm going to love, love what I do, love where I am, and love my coworkers. The health insurance is extremely appealing and I'm assuming that is a big reason why they offer such low salaries. The other position I've been offered is $10,000/year more, but employer only pays 20% of health insurance premium, so I have to automatically deduct $16,000/year from my salary just for that.
I plan to make a counter offer but that is where I'm struggling. I'm truly dismayed at the low salary but I also feel very strongly this particular position is my calling. I need to be able to justify why I'm asking for more $$, considering I'm a new NP. Aside from figuring in CME and license/certification costs, what other suggestions should I make?
Yes! For everyone's sake, don't pay a low paying job. We need to bring the profession up to the high standard it should be recognized for..vs a glorified nurse that will triage you (true story, friend got hired as a NP...she got to triage people.)
Yes, take what you can get to have that magical DEA number and first year under your belt but for all our sake don't keep a underpaying (that isn't even low...it's underpaid) gig.
The only problem with this strategy is that since you started low you will move up slowly and usually requires future job changes to actually see any money. In my experience most new jobs are willing to offer $5,000-$10,000 over present salary to woo a new employee after that its usually all just cost of living unless you are on a productivity model. That isn't all that impressive when you started at $105,000 and could take years to get up to a decent range, imo.
For your first job offer: they always lowball....if u accept, it will take a long time to make up the difference when pay increases are based on your current payscale.
Definitely counteroffer....here where I live, RNs who work specialized areas make more than new NPs..
Excellent salary survey - 3000 APRNs - would have liked to have seen more participation
I thought I participated, wonder if I got tossed out as outlier? The figures seem very low to me but other than that I thought the topics were excellent. I would have liked to see salary comparison between Masters and DNP although I'm sure I can imagine the outcome. How unfortunate that in the tag lines they felt necessary to highlight our codependent, whiney tendencies: "How many APRNs feel unfairly compensated for their work?" My advice continues to be if you feel unfairly anything either don't accept the position or leave.
Some things that stuck out to me:
1. Minimal difference in new and experienced providers salary which could support my ongoing assertion that new grads don't need to settle for crumbs, slide 6
2. Academia still lags $15,000 but looks so nice on your CV, lol, slide 8
3. Ongoing disparity between male and female between 10-22% which is pathetic. Clearly the money is out there so not openly discussing such unladylike topics is biting us in the butt. slide 10
4. Good news earnings are up. Bad news the largest reason for earnings going down was changing jobs? I can't imagine very many reasons I'd ever change a job even making a lateral move let alone a downgrade. slide 15
5. Percentage paying off loans was surprising to me but I should have expected it as it doesn't seem Americans save up for anything any more, slide 17.
6. Only 54-72% feel appropriately compensated so I'm surmising the rest continue doing it because if "I don't whoooooo will?" slide 18
If I got paid between $30 - $40/hr...........I'd just find a simple RN job somewhere............I'm usually the last person that supports a union......But NPs need to coordinate a union......................
Specializes in Obstetrics & Gynecology,Medical/Surgical.
WKShadowRN - thanks for the link to that article. Very interesting.
And for anyone who is actually paying attention to when I've updated -- in the above article on MedScape, on slide 11, "APRN Annual Earnings by Geographic Region," I'm in a yellow state; which, according to that pictograph, are states on the lowest end of the payscale.
It's very easy to tell someone they should keep looking, refuse to accept a job like that, "it's a disgrace," that NPs like us are to blame for the low salaries, etc. etc. But when you live in a region where this is the norm, and you've got bills to pay and mouths to feed, you do what you have to do.
Thank you all for your responses, especially the compassionate ones.
When a poster specifically thanks those who told them what they wanted to hear it speaks volumes so the following isn't surprising.
WKShadowRN - thanks for the link to that article. Very interesting.
And for anyone who is actually paying attention to when I've updated -- in the above article on MedScape, on slide 11, "APRN Annual Earnings by Geographic Region," I'm in a yellow state; which, according to that pictograph, are states on the lowest end of the payscale.
It's very easy to tell someone they should keep looking, refuse to accept a job like that, "it's a disgrace," that NPs like us are to blame for the low salaries, etc. etc. But when you live in a region where this is the norm, and you've got bills to pay and mouths to feed, you do what you have to do.
If you were looking for a job for an entire year with no offers and are convinced you received a fair offer for your geographic location I don't think you would get any criticism here. What I would suggest for all those who feel defensive when it comes to accepting low salaries is that they are transparent with peers regarding salary expectations and support their state NP organization to empower our profession.
I was just offered 40 bucks/hr (I made more as an RN), no benefits, no nada. They want to work-horse me to death. In trying to negotiate I was told that that was industry standard. Ha! Needless to say I'm not getting out of bed for that. This is internal medicine BTW, and seeing like, 25 pts a day! I would sooner take an RN weekend position. That sounds pretty good right now. As far as justifying your salary? Go look up the figures on how much income you bring to a practice. Seeing 10 pts. a day, you will add about $350,000.00 to their income. You are practicing medicine, and billable at a rate of 85% of the physician. How can they justify trying to get you for nothing? There are positions out there that offer fair and decent pay for new grads with impressive benefits. Look into large corporate healthcare. In Texas, we have Texas Health, Baylor Scott & White etc..Wherever you are, there is a big system. Avoid the mom and pop shop practices. They will be sucked under soon by the by big health anyway. You deserve much more. Honestly, your offer is worse than mine, and I;m so offended by mine, if they call and offer something better, I'm still saying no thank you. We have to, as a group (NP's) stand up and demand to be paid and treated as professionals. Hang in there, something good is coming.
I was just offered 40 bucks/hr (I made more as an RN), no benefits, no nada. They want to work-horse me to death. In trying to negotiate I was told that that was industry standard. Ha! Needless to say I'm not getting out of bed for that. This is internal medicine BTW, and seeing like, 25 pts a day! I would sooner take an RN weekend position. That sounds pretty good right now. As far as justifying your salary? Go look up the figures on how much income you bring to a practice. Seeing 10 pts. a day, you will add about $350,000.00 to their income. You are practicing medicine, and billable at a rate of 85% of the physician. How can they justify trying to get you for nothing? There are positions out there that offer fair and decent pay for new grads with impressive benefits. Look into large corporate healthcare. In Texas, we have Texas Health, Baylor Scott & White etc..Wherever you are, there is a big system. Avoid the mom and pop shop practices. They will be sucked under soon by the by big health anyway. You deserve much more. Honestly, your offer is worse than mine, and I;m so offended by mine, if they call and offer something better, I'm still saying no thank you. We have to, as a group (NP's) stand up and demand to be paid and treated as professionals. Hang in there, something good is coming.
Not sure where you get the numbers, but you are way off the mark.
Here are the payments for outpatient visits:
Code Description wRVU No fac PE Fac PE MalTotal
99203 Office OP New Lvl 3 1.42 1.47 0.60.163.05
99213 Office OP established Lvl 30.97 1.01 0.40.072.05
99214 Office OP established Lvl 41.5 1.43 0.620.13.03
The total if four outpatient private practice and total wRVU + Non Facility Practice Expense + Malpractice. This is the generic cost and Practice expense and malpractice vary by area.
If you do 10 patients a day and see 4 x level 3 new patients, 3 x level 3 followups, and 3 x level 4 followups (unusual to see that many new people). Your total would be 3142 work RVUs and the practice would receive 6585 total RVUs. At Medicare rates that would be around $97k for wRVUs and $204k total RVUs. To bring in $350k you would have to see 24 patients per day 1/2 level 3 follow up and 1/2 level 4 follow up (consistent with metrics for FP). If you work in an area with good insurance (lots of private payers) it will be more. If you take in a lot of Medicaid it will be a lot less (depending on the state).
I pulled the numbers from a a Texas workforce report, and it's based on billables. That number is repeated from many agencies. I'm not off the mark at all. This is a great book, and offers up how you would get to a number of $347,000 of additional practice income utilizing an NP. Nurse Practitioner's Business Practice and Legal Guide, Fifth Edition: I found it quite illuminating. Maybe you will too. It's one of the many required texts in NP school. As a group, we are trying to promote professionalism and educate others as to what we do and our value to a practice, and society as a whole. Spread the word. We are not on the clearance rack. I'm impressed by your billing code knowledge. Unfortunately, we are speaking of different things here.
slide 18
GOGOKTFNP, MSN, APRN, NP
1 Article; 12 Posts
Yes! For everyone's sake, don't pay a low paying job. We need to bring the profession up to the high standard it should be recognized for..vs a glorified nurse that will triage you (true story, friend got hired as a NP...she got to triage people.)