NP residency and salaries

core0 · Apr 20, 2020

13 hours ago, Sun1 said:
Can you please share your opinions about np residency and salaries....
1. How much more can one expect to make after doing a residency?
2. Can one bill the same rate as a physician after doing a residency?
3. How long are these residencies usually?
4. Which residency would you say gives you the most advantage (jump) salary-wise, and how long would it have taken without doing a residency?
Many thanks in advance for your kind help in this matter.

1. Depends on your organization. Our organization gives you 1 year experience - which leads to a raise one year earlier and $20k a year for the first two years (which sort of makes up the difference between the resident salary and the normal starting salary). The bonus also serves as a retention mechanism to help ensure we get our costs back.

2. For Medicare, the reimbursement is 85% of the physician fee. APP residency doesn't change this.

3. Most are a year. Some are six months. We published data this year that knowledge skills were similar between the two groups but confidence was much higher for the 12 month group. The confidence was also higher for residents compared to OJT

Abide, A., Carpenter, D., Xu, K., Gregg, S., Byrd, C., Stein, D., & Meissen, H. (2020). 57: DIFFERENCES IN ADVANCE PRACTICE PROVIDER RESIDENCY LENGTH: 12-MONTH VERSUS 6-MONTH TRAINING. Critical Care Medicine, 48(1), 29.

Carpenter, D., Abide, A., Meissen, H., Xu, K., Byrd, C., Stein, D., & Gregg, S. (2020). 111: MEASURING ADVANCED PRACTICE PROVIDER CRITICAL CARE KNOWLEDGE AND CONFIDENCE: OJT VERSUS RESIDENCY. Critical Care Medicine, 48(1), 38.

4. I doubt anyone has an answer for this. In our specialty its not necessarily about salary jump. It's about a guaranteed job and opportunities that the residency gives you. For example US instructor, Running the infectious disease ICU, doing research. We pretty much guarantee a job for anyone that comes out of our residency (as long as they are a personality fit).

BedtimeEnforcerRN, BSN · Apr 26, 2020

What residency programs are you looking at?

A lot of them are privately funded because GME funding has not been approved for NP fellowship/residency. I am interested in completing as well to help with transitioning and confidence in practice.. not so much for the rise in income, per sa.

Sun1 · Apr 26, 2020

Not sure....at the moment....still trying to understand which ones are the right ones to do...and get the proper return for it!

allnurses Guide · Apr 27, 2020

On 4/19/2020 at 6:37 PM, Sun1 said:
Can you please share your opinions about np residency and salaries....
1. How much more can one expect to make after doing a residency?
2. Can one bill the same rate as a physician after doing a residency?
3. How long are these residencies usually?
4. Which residency would you say gives you the most advantage (jump) salary-wise, and how long would it have taken without doing a residency?
Many thanks in advance for your kind help in this matter.

1. I don't think you can expect to make "more" after a residency necessarily - it's more that you have a mostly guaranteed job when you're done, and theoretically improved skills and confidence. As above, a lot of places give "extra credit" so you advance to the next pay level sooner which attract residents to stay after their program. You also generally do more hours as a "resident" APP than as a salaried one, so that is an effective pay bump after completing a residency if you have less hours.

2. Only physicians can bill at physician rate (at least per CMS, which most private payers follow). APPs can bill at 85% physicians fee (if the payer credentials APPs, as some do not).

3. Most are 12 months

4. Again not a salary thing but for critical care I think it's hugely attractive as the residents get to rotate through different specialty ICUs and gain broad experience, make connections with providers/nurses/other staff in several areas, and have a guaranteed job when they are done.

I know my hospital system is planning to expand our APP residencies, mostly as a recruiting and retention tool for APPs, as there are a lot of jobs here and a lot of competition.

Sun1 · Apr 27, 2020

6 minutes ago, ghillbert said:
1. I don't think you can expect to make "more" after a residency necessarily - it's more that you have a mostly guaranteed job when you're done, and theoretically improved skills and confidence. As above, a lot of places give "extra credit" so you advance to the next pay level sooner which attract residents to stay after their program. You also generally do more hours as a "resident" APP than as a salaried one, so that is an effective pay bump after completing a residency if you have less hours.
2. Only physicians can bill at physician rate (at least per CMS, which most private payers follow). APPs can bill at 85% physicians fee (if the payer credentials APPs, as some do not).
3. Most are 12 months
4. Again not a salary thing but for critical care I think it's hugely attractive as the residents get to rotate through different specialty ICUs and gain broad experience, make connections with providers/nurses/other staff in several areas, and have a guaranteed job when they are done.
I know my hospital system is planning to expand our APP residencies, mostly as a recruiting and retention tool for APPs, as there are a lot of jobs here and a lot of competition.

Do the salaries in any way follow what the speciality dictates, I.e. some MD specialities pay more....

allnurses Guide · Apr 27, 2020

Salary is determined more by supply and demand than specialty, and varies widely by location. In my area, acute care jobs tend to pay more than family NP jobs, but they also often involve evenings/nights/weekends/call, so they demand more $$. Again in my area, the various hospitals have had separate pay scales for "staff NP", "senior NP" based on experience, and then a separate one for "specialty NP", "surgical NP" or "critical care NP" to permit a higher range to hire into those niche roles.

Sun1 · Apr 27, 2020

6 minutes ago, ghillbert said:
Salary is determined more by supply and demand than specialty, and varies widely by location. In my area, acute care jobs tend to pay more than family NP jobs, but they also often involve evenings/nights/weekends/call, so they demand more $$. Again in my area, the various hospitals have had separate pay scales for "staff NP", "senior NP" based on experience, and then a separate one for "specialty NP", "surgical NP" or "critical care NP" to permit a higher range to hire into those niche roles.

Is it fair to say that procedure heavy jobs, tend to command more salaries?

Also, can np's do surgical procedures like pa's do without any problems? And can they bill more because they are allowed to practice independently in that state?

allnurses Guide · Apr 27, 2020

I don't work in a full practice authority state, so I can't speak to that. I would NOT say procedure heavy jobs necessarily command more money - most NP jobs in my area at least are based on experience and negotation rather than the job tasks, and I don't know any acute care NPs here that get anything extra based on billing (such as procedures). Whether NPs can work as a first assist depends on the state, they usually need RNFA as well.

OhioCCRN, MSN, NP · Apr 30, 2020

On 4/20/2020 at 8:37 AM, core0 said:
1. Depends on your organization. Our organization gives you 1 year experience - which leads to a raise one year earlier and $20k a year for the first two years (which sort of makes up the difference between the resident salary and the normal starting salary). The bonus also serves as a retention mechanism to help ensure we get our costs back.
2. For Medicare, the reimbursement is 85% of the physician fee. APP residency doesn't change this.
3. Most are a year. Some are six months. We published data this year that knowledge skills were similar between the two groups but confidence was much higher for the 12 month group. The confidence was also higher for residents compared to OJT
Abide, A., Carpenter, D., Xu, K., Gregg, S., Byrd, C., Stein, D., & Meissen, H. (2020). 57: DIFFERENCES IN ADVANCE PRACTICE PROVIDER RESIDENCY LENGTH: 12-MONTH VERSUS 6-MONTH TRAINING. Critical Care Medicine, 48(1), 29.
Carpenter, D., Abide, A., Meissen, H., Xu, K., Byrd, C., Stein, D., & Gregg, S. (2020). 111: MEASURING ADVANCED PRACTICE PROVIDER CRITICAL CARE KNOWLEDGE AND CONFIDENCE: OJT VERSUS RESIDENCY. Critical Care Medicine, 48(1), 38.
4. I doubt anyone has an answer for this. In our specialty its not necessarily about salary jump. It's about a guaranteed job and opportunities that the residency gives you. For example US instructor, Running the infectious disease ICU, doing research. We pretty much guarantee a job for anyone that comes out of our residency (as long as they are a personality fit).

Do you have a DOI for those articles? Cant seem to find them and I'm interested in your methodology and outcomes

core0 · Apr 30, 2020

10 hours ago, OhioCCRN said:
Do you have a DOI for those articles? Cant seem to find them and I'm interested in your methodology and outcomes

They are both in the abstract supplement of Critical Care Medicine. Presented at the last SCCM conference.

https://journals.lww.com/ccmjournal/FullText/2020/01001/111__MEASURING_ADVANCED_PRACTICE_PROVIDER_CRITICAL.79.aspx

https://journals.lww.com/ccmjournal/Fulltext/2020/01001/57__DIFFERENCES_IN_ADVANCE_PRACTICE_PROVIDER.60.aspx

Neuro Guy NP, DNP, PhD, APRN · Apr 30, 2020

On 4/27/2020 at 1:52 PM, ghillbert said:
I don't work in a full practice authority state, so I can't speak to that. I would NOT say procedure heavy jobs necessarily command more money - most NP jobs in my area at least are based on experience and negotation rather than the job tasks, and I don't know any acute care NPs here that get anything extra based on billing (such as procedures). Whether NPs can work as a first assist depends on the state, they usually need RNFA as well.

Not sure I would agree completely. ICU jobs most certainly tend to pay more than primary care NP jobs.