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?
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.
I do a little bit more than coding. What I do know is that billablles are largely irrelevant. You can bill whatever you want. What you really want to know is collections. Lets say you bill $500 for a mid level follow up visit. If you submit it to Medicare you will receive around $65. If you submit it to Aetna for example you will be paid whatever they are contractually obligated to pay. If you have negotiated 130% Medicare then you will receive $84. Note none of these are $500.
We have five hospitals in our system. We set billing slightly above our average costs. Our urban hospital collects 30% on billings. Our academic medical center collects around 80% on billings. Our suburban hospitals collect around 110% of billing. The smaller even more suburban hospitals collect around 120% of billing. By way of comparison the urban safety net hospital collects around 10% of billing. What that means is in our system the suburban hospitals support the urban hospitals and our academic medical center breaks even with academic income. The safety net hospital exists due to fairly large subsidies from community government
When I worked in private practice I brought in more money but the costs were also much more due to the inability to spread it over as much income. In an 8 partner practice, one partners collections went to pay insurance on the practice (health, malpractice, building etc.).
To look at another way, for example if you bring in $300k then approximately $150k would go to support your practice (building, consumable, MA, billing etc) using standard Medicare valuation. That leaves $150k for you. Standard business models are employees cost 140% of salaries. This means after deducting benefits it leaves $107k to pay your salary.
I have read Carol Bupert's book and its good. I will have to review it but I don't remember the particular model where you see 10 patients a day and bring in $300k. I showed with normal patient population you can bring in $300k but you would have to be much more productive. As an alternative fraud will get you there (10 level 5 follow ups per day).
An APP can bring in $300k per year but not seeing 10 patients per day (my original point) and even when they bring in that much, its not pure profit. In fact depending on salaries that might not cover the cost of employment.
I do a little bit more than coding. What I do know is that billablles are largely irrelevant. You can bill whatever you want. What you really want to know is collections. Lets say you bill $500 for a mid level follow up visit. If you submit it to Medicare you will receive around $65. If you submit it to Aetna for example you will be paid whatever they are contractually obligated to pay. If you have negotiated 130% Medicare then you will receive $84. Note none of these are $500.
We have five hospitals in our system. We set billing slightly above our average costs. Our urban hospital collects 30% on billings. Our academic medical center collects around 80% on billings. Our suburban hospitals collect around 110% of billing. The smaller even more suburban hospitals collect around 120% of billing. By way of comparison the urban safety net hospital collects around 10% of billing. What that means is in our system the suburban hospitals support the urban hospitals and our academic medical center breaks even with academic income. The safety net hospital exists due to fairly large subsidies from community government
When I worked in private practice I brought in more money but the costs were also much more due to the inability to spread it over as much income. In an 8 partner practice, one partners collections went to pay insurance on the practice (health, malpractice, building etc.).
To look at another way, for example if you bring in $300k then approximately $150k would go to support your practice (building, consumable, MA, billing etc) using standard Medicare valuation. That leaves $150k for you. Standard business models are employees cost 140% of salaries. This means after deducting benefits it leaves $107k to pay your salary.
I have read Carol Bupert's book and its good. I will have to review it but I don't remember the particular model where you see 10 patients a day and bring in $300k. I showed with normal patient population you can bring in $300k but you would have to be much more productive. As an alternative fraud will get you there (10 level 5 follow ups per day).
An APP can bring in $300k per year but not seeing 10 patients per day (my original point) and even when they bring in that much, its not pure profit. In fact depending on salaries that might not cover the cost of employment.
All very interesting but where exactly are these jobs requiring NPs to see only 10 patients per day?
I said nothing of pure profit. You are exhausting. I was just sharing info that I read, and agreeing with the terrible offers out there. Good luck to you in your endeavors.
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..
I think it is a disgrace
True, but ask yourself why that is. We must remember that RN and NP are two very different professions and stop comparing them. The principles of economics don't change. Supply vs demand. It really is as simple as that.
The corporate hogs and private practices earn vast amounts of money off an NP when they offer an NP a cheap salary and no benefits. They are billing the insurance companies/Medicare/Medicaid for clinician rates and they simply put all of the difference into their pockets while telling you, the NP, that if you work harder you might get a raise in a couple years. If you are an NP who is struggling to find a job in an oversaturated job market you might be tempted to take a low paying job that is offered to you. That is exactly what happens in many situations but some are too embarassed to admit it so they often exaggerate their income when talking about it.
On the other hand, RNs are not revenue generators but the very experienced ones who work efficiently and minimize errors (and potential lawsuits) AND are willing to put up with the insane politics and other BS in the hospitals are getting harder and harder to find. So the RN pay is likely to go up more in the future.
Wow! I don't understand why people take these low salaries. As a new grad my first year was 135K with yearly bonus and great benefits package in the southeast.
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I do a little bit more than coding. What I do know is that billablles are largely irrelevant. You can bill whatever you want. What you really want to know is collections. Lets say you bill $500 for a mid level follow up visit. If you submit it to Medicare you will receive around $65. If you submit it to Aetna for example you will be paid whatever they are contractually obligated to pay. If you have negotiated 130% Medicare then you will receive $84. Note none of these are $500.
We have five hospitals in our system. We set billing slightly above our average costs. Our urban hospital collects 30% on billings. Our academic medical center collects around 80% on billings. Our suburban hospitals collect around 110% of billing. The smaller even more suburban hospitals collect around 120% of billing. By way of comparison the urban safety net hospital collects around 10% of billing. What that means is in our system the suburban hospitals support the urban hospitals and our academic medical center breaks even with academic income. The safety net hospital exists due to fairly large subsidies from community government
When I worked in private practice I brought in more money but the costs were also much more due to the inability to spread it over as much income. In an 8 partner practice, one partners collections went to pay insurance on the practice (health, malpractice, building etc.).
To look at another way, for example if you bring in $300k then approximately $150k would go to support your practice (building, consumable, MA, billing etc) using standard Medicare valuation. That leaves $150k for you. Standard business models are employees cost 140% of salaries. This means after deducting benefits it leaves $107k to pay your salary.
I have read Carol Bupert's book and its good. I will have to review it but I don't remember the particular model where you see 10 patients a day and bring in $300k. I showed with normal patient population you can bring in $300k but you would have to be much more productive. As an alternative fraud will get you there (10 level 5 follow ups per day).
An APP can bring in $300k per year but not seeing 10 patients per day (my original point) and even when they bring in that much, its not pure profit. In fact depending on salaries that might not cover the cost of employment.