NP Pay

[googs]

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?

[Palliative Care, DNP]

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.

^^^This! I was less than thrilled to discover my new partner in palliative care earned her degree through a for profit, completely online, and no supervision aka Degrees For Everyone U:nailbiting:

[shibaowner, MSN, RN, NP]

People shouldn't become NPs in order to become rich. That said, it is up to you to do the research on what starting salaries are for NPs in your area of the country. You can also negotiate in a positive manner. I am a new grad NP with no prior RN experience. I was just offered a job in rural Northern Calif, in an outpatient mental health setting, where the cost of living is extremely reasonable. $45 hour during the intensive training period of 2-3 months, then once I can start seeing patients, $50 hour, then once I have a full patient load $60 hour, then 1 year after that $70 hour. So I would be making $140k per year within 2 years of starting, in a very low cost of living area. I know their top pay for NPs is currently $190K per year, so the income growth in this setting has a lot of potential. I also got $5,000 relo. So, I would negotiate a pay package. Also, some places have bonuses, you can negotiate that. Finally, I was offered a job with my last clinical preceptor, a doctor with his own private practice. For personal reasons, I could not take it, but he was willing to pay the going market rate, plus a bonus. And he said after 1 or 2 years, if I made an offer to be paid based on my productivity, he would be open to it. He also told me what he personally made. These doctors are not rolling in dough! So don't act so entitled. You didn't go to 4 years of med school plus internship plus residency. And a doctor who has to run his own practice is working way more than 40 hours per week - that doc was working 12-13 hours per day plus one day on the weekend.

Finally, I'm sick of hearing that there is a surplus of NPs. Be willing to move! There is shortage in rural areas and other parts of the country. An area with shortage will absolutely pay you more. I just spoke with a recruiter who said he is having a hard time finding qualified NPs, including new grads.

If anyone complains that they are getting crappy pay when they are making $100,000 + per year, they need a reality check. If you just want to make $, you are in the wrong field.

OH, and if you want the hassle of setting up your own practice, then you can make more. Just do the math. Take the billable rate and multiply x2000 to get rough annual income. If you can charge $100 per hour, then you can make $200K per year, but you have to cover all your overhead - office, assistant, malpractice insurance, etc.

If you want to make a boatload of $, then go back to school and get an MBA, then go to Wall Street and become a hedge fund manager.

[sgtrnff]

I am a recent graduate,May 2017 out of a Northeast College as an AGNP-PC. I have a background as an ER RN for 10 years, I have to say the salaries have been varied as far as offers. One specialty practice offered 100,000.00 and involved working as a second in a few(yes a few local hospitals) urban area.. That did not include any reimbursement for travel, wear and tear. The partner who made the offer did so with a smiling face, thats when I told him my salary as an RN was 107,000.00 Then I moved on to a second interview with a very large organization. Their salary? Told my an NP in practice starting was about 95,000 with 4 weeks vacation. The next position was as a Cath Lab NP , starting salary 90-95. I settled on a internal medicine practice which will give me autonomy and quite an education. Owned by a large NY provider, starting salary is 120,000 not salaried. Cap is set at 40 hour then above time and a half with 28 days a year.I think it is a good salary to start with. Friends are getting 160-170 per year in the city and some bargain up to 150 after experience. I think it is insane on how the diversity of salaries are across the board. What I do not agree with is the assumption "you shouldn't be in it for the money". Well, I went into healthcare for caring and I agree, if one is not apt to being compassionate toward the sick , wrong profession. With that said, yes we should be paid. I find unfortunately that NP's are very soft in negotiating their contracts. The burden of needing to taking a job available I am sure comes into play. I found that I went on many interviews, and was pretty forward on my qualifications and what I expected salary wise. I know many NP's that settle under 100,000 thats crazy after paying so much for school and working so hard to achieve their goals. Even college professors would soapbox stating I would expect 2 weeks vacation at $47 for the NYC area. Insane. Hold your ground. You are worth the money. Know your strengths and promote yourself on those interviews. It is nice to hear what they are looking for, but it is also important for them to hear what YOU are looking for. Our salaries are varied because we are RN's and typically were unionized (sorry) and expected very little in salary changes and benefits with the assumption of a high workload. All I can say is keep pushing, promoting yourself and the NP worth. You are worth the extra money, once people start realizing that across the board, I think salaries will get more competitive. (I think they are definitely starting to). Hospital ANM and NM are making well over 120 for a BS degree. You now have a MSN and a NP cert. Think of all the training and hours invested into reaching your goal. Not to mention, administrators and what they are making. We are a commodity , a HOT commodity. Our experience does entitle us to greater expectations all around. Good Luck and push forward!!!

[God'sSon]

@sgtrnff: probably the most logical take i've read thus far around NP pay.