NP Pay

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I've been perusing the threads on NP salaries and I continue to get more and more frustrated. NPs bill at 85% of the physician rate on Medicare/Medicaid, correct? And is this the case for most private insurances as well?

I'm becoming a bit disenchanted by NP pay in my state in the Tristate area of the Northeast, where we have extremely high taxes and high cost of living. How did these salaries get established so low in the first place? I know some fairly new grad RNs that make 85k right out of school and many NPs are starting at this level. It's a disgrace that people accept these salaries. They are taking on, essentially, doctor responsibility, but are given nurse pay, who take on very little responsibility compared to providers, legally speaking. Why do NPs settle for such low pay? I realize we don't have an MD after our name, but medicine is a BUSINESS. In my state we have independent practice on top of this. So, why is there such a pay disparity? OK, throw the doc a bone and pay them more just for having the degree and put in the years in residency and having the MD after his/her name. He/she deserves more. HOWEVER they are not worth DOUBLE, which is what I find is the case. I know because we received a salary report for our practice. The new doc who had 1 year of experience as a doc in internal med was making 208k, I was making 108k. If we see essentially the same number of patients, and we bill at 85% for Medicare and even higher for some commercial plans, how does this make sense? I'm SICK of the NPs/PAs getting out of school and thinking "WOW! 80k or even 100k is a LOT of money!" Yeah, compared to your job as a cashier it is. The NP is much more profitable than the doc, which is why most ads say Looking for NP or MD for the same position.

I started as a new grad NP (after 5 years of ED RN experience) at around 110k in internal medicine and Urgent Care with a hospital practice and ended up clearing $125k my first year with some OT, but not a LOT of OT. I was just switched to salary (no more OT) and I decided to interview around to see what other hospitals are offering. One of the more famous and prestigious hospitals is offering $102,000 with my level of experience and that is for 40 hours in urgent care. They even said "we know you make more at the hospital you came from, but this is what we offer." Very frustrating: that's a huge pay cut.

How can I make more money? How do I push for a higher salary? Why can't NPs lobby for higher pay and stop accepting GARBAGE pay?

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Specializes in Vascular Neurology and Neurocritical Care.

The problem is that many very famous institutions pay lower because they can - they believe that it is a privilege just for you to be able to list them on your CV. Don't patronize them. Often times you can negotiate better with private practices than with hospitals because hospitals are often very rigid with their pays calls. Continue to look around. Sometimes it is actually the smaller or medium sized institutions that actually have the better compensation packages from my knowledge and experience.

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Specializes in Family Nurse Practitioner.

How can I make more money? How do I push for a higher salary? Why can't NPs lobby for higher pay and stop accepting GARBAGE pay?

1. You can make more money by refusing crap paying jobs. Know what NPs in your area are making and not by googling, ask around get the dialogue opened and when you have that information use it to your advantage. Note: don't bother bluffing because if you say XYZ practice is paying their NP $123 they will likely check.

2. Know what you bill, know what you bring to the table. At this time I make $25 an hour more than a NP with their DNP and more experience at the same clinic. I told them my rate and refused the first cheap offer they made me. My colleague won't consider telling them to pay me more or I'm leaving so I'd guarantee they will be making that wage the rest of their working career there, bummer. BTW they know what I make and still don't have the stones to rock the boat.

3. Most beneficial in my experience is establishing a killer rate early and parlay that into all future offers. I have had two places raise my rate both by $20 an hour to match a new part time job I got with higher wages because they were afraid I'd quit.

4. Have professional contacts, usually Docs who want you on their team. They tend to have the most pull. I have had more than one physician who wanted me hired throw their weight around when admin attempted to get cheap with me. Tell the doc who wants you how much you will be requiring they will think its peanuts and usually insist they pay up.

5. Lastly be prepared for all the above to be useless going forward as our supply actually exceeds demands and there will no longer be a need for anyone to pay NPs more than $100,000 a year. I'm bracing myself and counting on the one physician I work for who I know has a low idiot threshold and will be willing to continue overpaying me because I don't get on his nerves or do stupid stuff, too often, lol.

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5. Lastly be prepared for all the above to be useless going forward as our supply actually exceeds demands and there will no longer be a need for anyone to pay NPs more than $100,000 a year. I'm bracing myself...

THIS^^^

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supply and demand baby. Hence why i dropped NP and went back to the med school.

Cant wait for that pay increase. will prob be at least 100k more if not 150-200.

woot woot

Residency caps the amount of physicians that can be trained so even if they for some reason open up 500 new med schools you still cant have overflow. Even though they wont open up 500 new med schools because the physician credentialing people know better than the nursing variant how supply/demand works.

Twice salary is on the low end too and only for primary care. Specialties it can be like 4-5-6-7-+ x what they pay the NP in the group.

Cards Bro raking in 800k where I am from paid his NPs like 95k and they were happy with the 95.

I do not forsee NP salaries going up in the future. More supply and lower quality graduates due to many sloppy schools, and people are catching on that many NPs are not ready for practice when they graduate, or really ever. There are some good ones though so not group bashing here.

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Specializes in Family Nurse Practitioner.

Cards Bro raking in 800k where I am from paid his NPs like 95k and they were happy with the 95.

I do not forsee NP salaries going up in the future. More supply and lower quality graduates due to many sloppy schools, and people are catching on that many NPs are not ready for practice when they graduate, or really ever. There are some good ones though so not group bashing here.

Yes in addition to all the above, a huge part of the problem lies with US! Your line about the NPs being happy with $95k makes me cringe because I know its true. I bet many haven't even figured out just how little that is on an hourly basis. I made $80k easily as a RN.

If you pursue neuro or psych as planned you will definitely be fat. Email me because I suspect you will be one of the Docs who is willing to pay a respectable wage for a decent NP, like I'm insinuating I am lol, because at $100 an hour I'm still a bargain compared to even a brand new psychiatrist's rates :D

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Specializes in Internal Medicine.

I really wouldn't stress too much about starting pay. Like your first nursing job, companies and private practices want to start you off at a lower amount because they don't know what you're capable of. Particularly as providers where revenue is key, they take on a certain amount of risk hiring you without knowing if you will cover your own costs. Most NP's will cover their costs several times over, but I've also worked with a couple that are lucky to get through 8 patients a day. Within 6 months of starting, you'll quickly realize what you bring to the table.

As other's have also said, supply and demand in your region will be crucial. I'm fortunate that my area pays NP's pretty well, but some friends living on the east coast had to struggle early on working in the poop mine before they traded up to more lucrative positions. If you're in an area churning out hundreds or thousands of new grads every semester, don't be surprised by the lowball offers.

The reality is somewhere in the middle and I would take what you read on this website with a grain of salt. People are more likely to complain about their offers versus coming here and bragging about them, so the sample size is likely leaning more negative. Talk to real NP's working in your area. Talk to your fellow students. In the end, remember that your first NP job will likely not be your last NP job, and like when you were an RN, sometimes you gotta hop around a bit to get that extra cheddar.

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I really think the cause of low pay is multifactorial.” The supply and demand does not explain everything. There are other health professions where supply and demand are quite in equilibrium but the pay is still pretty decent. The example are pharmacy and psychology. Well.. I guess they have more student loan so they are more adamant in demanding higher salary. One of the issue with us is the lack of negotiation and willingness to accept low pay and the fact that we all come from lower paying scale RN job does not help. Many new grad NP already feels grateful with 10k or 20k more for salary as a provider but they did not consider the added responsibility, stress, and the percentage comparison with MD pay.

For example, in my specialty, there is still” demand in my area but the full-time salary is still staggering at low 100k-120k. Some private practices pay more but with poor benefits. One of my colleague told me I should settle down for salary job of $110 because of benefits and stability bla.. bla.. bla.. I am tired of hearing the similar comments. The number did not add up to the difference of 70k difference with my current contract even with insurance, PTO, retirement and etc. I am giving up on finding a decent salary job and continue to accept the instability as a contractor. Some places still give you like 2 week PTO with salary. Even with contract job, we are still making only 60% of MD contractor counterpart. I want to move to Southwest or Northwest in the future for better pay but I like where I am living now.

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Specializes in Cardiac (adult), CC, Peds, MH/Substance.

The word is the bird, and in my area, the bird is that small community hospitals and private practice often pay NPs better than larger hospitals. The cawcawcaw also is that it helps to network instead of throwing resumes against the floor with an emphatic expression on your face.

Doesn't help the larger issue. But helps.. some people who have ears.

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I'm a new grad and recently had an interview with a smaller hospital. I would be responsible for the patients in their 2 SNF's. The interview went really well and I got positive feedback from the recruiter that they would be in touch within a week. Today she called and said they were asking what my salary requirements were. I told her based on what some of my classmates have disclosed and what I have found online that 100 to 105k is reasonable. There was a long awkward pause and she was like ok I will let them know but from the few new grads I have placed in the past they usually start at 85 to 90k. I don't know where she is pulling her numbers because I have spoken to new grads in the area and they are in fact making 15 to 20k more than that. I guess we will see if and what they offer me. It's so hard as a new grad to not jump at first offer because you're so scared you won't find something else but I don't think I can sell myself short.

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Specializes in Cardiac (adult), CC, Peds, MH/Substance.

The recruiter gets paid a percent of salary. It's in their interest to spend less time by low balling 3 NPs than spend the same amount of time getting 20 percent more for one NP.

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It's so hard as a new grad to not jump at first offer because you're so scared you won't find something else but I don't think I can sell myself short.

I would say jump the offer if you are not satisfied with the pay. First, unless the benefits and PTOs are great, it is better to start high because you can use your salary to negotiate for next job for even higher pay. Secondly, you do not know how long you would be stuck with your first low-paying job as a new grad just to get experience. You may end up liking the place and not wanting to move. I had this problem. I moved across the state to accept a job that paid better but I did not realize that I was underpaid by 15k or more. It was a great place to start with great working environment but I was stuck with that low pay for more than a year before I can move on. I regret that I did not negotiate and counteroffer at the time. I think you are worth more than you think as a new grad. Lastly, you do not know the demand/supply in the future. It might be harder to move between jobs even after obtaining experiences at your first job..

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