NP Salary (independent practice vs. nonindependent)

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Specializes in Med/Surg, Ortho, ASC.

I'll be interested in the answers that are given, because I was not aware that a NP could practice independently. I thought that they were always required to practice under an MD's license/direction.

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Specializes in Emergency, Occupational, Primary.

I read on one of the nurse practitioner sites (can't remember which) that an NP can expect to double his/her net income by going into private practice. Not sure what the official source for that figure was, however.

--Equusz

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Specializes in Emergency, Occupational, Primary.
EDIT: I also read on the NYS website that NPs do not work under MDs in re: to having their own practice...only in collaboration. Hmmm..? :)

It depends on the state. In many states the NP can practice independently, in some states they have to have a collaborating physician agreement in place, and in a few states they have to be indirectly supervised by a physician. Check the scope of practice at your state's board of nursing website.

--Equusz

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Specializes in Emergency, Occupational, Primary.

Just as an example to the above, here's the excerpt from the NP Scope of Practice law in Oregon (you'll note the repeated use of the word "independently"):

Nurse Practitioner Scope of Practice

851-050-0005

(1) Purpose of Scope of Practice:

(a) To establish acceptable levels of safe practice for the nurse practitioner.

(b) To serve as a guide for the Board to evaluate nurse practitioner practice.

© To distinguish the scope of practice of the nurse practitioner from that of the

registered nurse.

(2) The role of the nurse practitioner will continue to expand in response to societal demand and new knowledge gained through research, education, and experience.

(3) The nurse practitioner provides holistic health care to individuals, families, and groups

across the life span in a variety of settings, including hospitals, long term care facilities

and community-based settings.

(4) Within his or her specialty, the nurse practitioner is responsible for managing health

problems encountered by the client and is accountable for health outcomes. This process

includes:

(a) Assessment;

(b) Diagnosis;

© Development of a plan;

(d) Intervention;

(e) Evaluation.

(5) The nurse practitioner is independently responsible and accountable for the continuous and

comprehensive management of a broad range of health care, which may include:

(a) Promotion and maintenance of health;

(b) Prevention of illness and disability;

© Assessment of clients, synthesis and analysis of data and application of nursing

principles and therapeutic modalities;

(d) Management of health care during acute and chronic phases of illness;

(e) Admission of his/her clients to hospitals and/or health services including but not

limited to home health, hospice, long term care and drug and alcohol treatment;

(f) Counseling;

(g) Consultation and/or collaboration with other health care providers and community

resources;

(h) Referral to other health care providers and community resources;

(i) Management and coordination of care;

(j) Use of research skills;

(k) Diagnosis of health/illness status;

(l) Prescribing, dispensing, and administration of therapeutic devices and measures,

including legend drugs and controlled substances as provided in Division 56 of the

Oregon Nurse Practice Act, consistent with the definition of the practitioner's

specialty category and scope of practice.

(6) The nurse practitioner scope of practice includes teaching the theory and practice of

advanced practice nursing.

(7) The nurse practitioner is responsible for recognizing limits of knowledge and experience,

and for resolving situations beyond his/her nurse practitioner expertise by consulting with

or referring clients to other health care providers.

(8) The nurse practitioner will only provide health care services within the nurse practitioner's

scope of practice for which he/she is educationally prepared and for which competency has

been established and maintained. Educational preparation includes academic coursework,

workshops or seminars, provided both theory and clinical experience are included.

(9) The scope of practice as previously defined is incorporated into the following specialty

categories and further delineates the population served:

(a)
Acute Care Nurse Practitioner (ACNP)
- The Acute Care Nurse Practitioner

independently provides health care to persons who are acutely or critically ill;

(b)
Adult Nurse Practitioner (ANP)
- The Adult Nurse Practitioner independently

provides health care to adolescents and adults;

©
Nurse Midwife Nurse Practitioner (NMNP)
- The Nurse Midwife Nurse Practitioner

independently provides health care to women, focusing on pregnancy, childbirth,

the postpartum period, care of the newborn, and the family planning and

gynecological needs of women. The scope of practice includes treating the male

partners of their female clients for sexually transmitted diseases, and reproductive

health. Counseling related to sexuality, relationship, and reproductive issues is

included in this scope.

(d)
Family Nurse Practitioner (FNP)
- The Family Nurse Practitioner independently

provides health care to families and to persons across the lifespan;

(e)
Geriatric Nurse Practitioner (GNP)
- The Geriatric Nurse Practitioner independently

provides health care to older adults;

(f)
Neonatal Nurse Practitioner (NNP)
- The Neonatal Nurse Practitioner independently

provides health care to neonates and infants.

(g)
Pediatric Nurse Practitioner (PNP)
- The Pediatric Nurse Practitioner independently

provides health care to persons newborn to young adulthood;

(h)
Psychiatric/Mental Health Nurse Practitioner (PMHNP)
- The Psychiatric/Mental

Health Nurse Practitioner independently provides health care to clients with mental

and emotional needs and/or disorders;

(i)
Women's Health Care Nurse Practitioner (WHCNP)
- The Women's Health Care

Nurse Practitioner independently provides health care to adolescent and adult

females. The scope of practice includes treating the male partners of their female

clients for sexually transmitted diseases and reproductive health. Counseling

related to sexuality, relationship, and reproductive health is included in this scope.

There's no requirement in there for a collaborating physician. Other states my vary.

--Equusz

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Is it true that a NPs salary varies dramatically when they work for themselves? (ie. own clinic, practice, etc.)

I know that NPs in hospital settings (and elsewhere) still do quite well, but I have heard that many NPs can make as much, or even more, than MDs. Is there any truth to that?

I'm not in nursing for the money, but I am a very motivated individual and would like to see if the salary outweighs benefits, etc. I know that running your own practice is a huge responsibility..anything in life that is worth...is generally a big responsibility IMO. ;)

EDIT: I also read on the NYS website that NPs do not work under MDs in re: to having their own practice...only in collaboration. Hmmm..? :)

According to Advance for NP owning their own practice was the third best paying specialty after EM and NNP.

http://nurse-practitioners.advanceweb.com/article/2007-salary-survey-results-a-decade-of-growth-3.aspx?CP=2

I think that people dramatically underestimate the amount of money that can be made here. Essentially its a small business. Also unfortunately the way that medicine is currently set up, the areas that pay the most are the ones that do procedures. Most clinic work has very few procedures.

To answer the other question its not uncommon for an NP to make more than a physician (especially one new to practice). The average peds salary is around $140k and FP isn't a whole lot more. So if you break into six figures as an NP you may be making more than some of the local physicians.

Probably your best bet for your own practice would be mental health. Very little overhead and the ability to charge cash and have your patients balance bill their insurance company. Of course it also depends on the local practice environment. The other place is rural clinics in federally designated shortage areas. You get higher Medicare and Medicaid reimbursement and costs are usually low.

As for independence, even in states where supervision or collaboration is required its still possible to own your own practice. It just requires different mechanics. The catch is that even in states where nurses don't require physician supervision or collaboration, Medicare requires a collaborating physician to bill.

David Carpenter, PA-C

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Wow! What plethora of information. You guys are great! Thank You so much. This is very encouraging/interesting :).

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Some have their own practice and hire an MD.

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Yes, that's what I have heard as well. I just think it would be great to have my own practice. I have always been business-minded and this allows the best of both worlds. It's something I can start researching WAY in advance :).

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I think Dave's post said it all. Also, I think if you were going to practice independently, I would keep in mind that you might have to work more hours initially and work harder in the beginning to build up your practice, but I think it would definitely be worth in the long run.

I work at a teaching institution where of course I'm not completely independent, however, I regular hours and there's no call, no weekends and no holidays. So I really like my schedule and the salary is pretty good too. So, I think it just it depends on what's most important to you in this season of your life. I would say if you're young and ambitious, go for it! Sounds really exciting too! Good luck!

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According to Advance for NP owning their own practice was the third best paying specialty after EM and NNP.

http://nurse-practitioners.advanceweb.com/article/2007-salary-survey-results-a-decade-of-growth-3.aspx?CP=2

I think that people dramatically underestimate the amount of money that can be made here. Essentially its a small business. Also unfortunately the way that medicine is currently set up, the areas that pay the most are the ones that do procedures. Most clinic work has very few procedures.

To answer the other question its not uncommon for an NP to make more than a physician (especially one new to practice). The average peds salary is around $140k and FP isn't a whole lot more. So if you break into six figures as an NP you may be making more than some of the local physicians.

Probably your best bet for your own practice would be mental health. Very little overhead and the ability to charge cash and have your patients balance bill their insurance company. Of course it also depends on the local practice environment. The other place is rural clinics in federally designated shortage areas. You get higher Medicare and Medicaid reimbursement and costs are usually low.

As for independence, even in states where supervision or collaboration is required its still possible to own your own practice. It just requires different mechanics. The catch is that even in states where nurses don't require physician supervision or collaboration, Medicare requires a collaborating physician to bill.

David Carpenter, PA-C

I don't think that is true anymore. NPs can bill independently but they are only reimbursed at 85% of what a physician makes even if for the same diagnosis and treatment.

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