NP Salary/Pay Let's Be Transparent

Transparency is important so we can negotiate. As a new grad nurse practitioner I accepted a ridiculously low paying position and I assumed that was the pay in the new city I move to. I have grown over the past couple years and I understand I was taken advantage of. I hope that this doesn't happen to others. Therefore, I believe it is critical we know what other nurse practitioners are being compensated so we are able to negotiate our salary and benefits packages.

I'm an FNP-C in Houston area working in Surgery (first assist, preop, and follow up post op care) Salary is 110k (negotiating to 115k), 3 weeks pto, 9 paid holidays, 1500 CME/yr, paid DEA, malpractice, 401k without match, 4 day work week (40-50hrs), on-call practically all the time (but only get calls on surgery days 2-3days/week). Overall I'm happy with the work I do.

What is your compensation package look like?

[djmatte, ADN, MSN, RN, NP]

tt12345 said:

Hey, I am on the fence about joining as an experienced PMHNP. Can we chat, please?

Sure thing. Feel free to message me. 

[FullGlass, BSN, MSN, NP]

MentalKlarity said:

Seems low for California unless you're seeing only 1 patient per hour or it's a community health clinic?

Low?  Are you kidding?  $95 per hour = $197,600 per year if FT.  At 32 hours per week, that is $158,080.  I'm not aware of hordes of NPs in California making almost $200K per year as an employee.

[tt12345]

djmatte said:

Sure thing. Feel free to message me. 

working on those 15 posts....15 comments didn't do it. would you please email? t I f f [email protected]

[MentalKlarity, BSN, NP]

FullGlass said:

Low?  Are you kidding?  $95 per hour = $197,600 per year if FT.  At 32 hours per week, that is $158,080.  I'm not aware of hordes of NPs in California making almost $200K per year as an employee.

Depends on how many patients you see per hour. If it's one, great. If it's 2+, you'd make more getting a share of the collections. It's not about what other NPs make, it's about are you making a fair share of what you bring in.

[FullGlass, BSN, MSN, NP]

MentalKlarity said:

Depends on how many patients you see per hour. If it's one, great. If it's 2+, you'd make more getting a share of the collections. It's not about what other NPs make, it's about are you making a fair share of what you bring in.

No, pay is set by the market, like it or not.  If you know of a bunch of PMHNPs making $95 per hour as an employee for seeing one patient per hour, please share that information with us and the source.  If the market rate for a PMHNP employee is $150K per year, then that is what most employed PMHNPs are going to make.  (I'm not talking about self-employed or contractor NPs).  

An individual NP can try to negotiate increased pay with their employer or they can decide to set up their own practice or become a contractor.  

The pay range I am seeing, and I am in California, which is the highest-paying state for NPs, is $150K to $200K per year for PMHNPs who are employees.  Benefits are worth money, too.

For independent contractor PMHNPs, I am seeing $90 to $240 per hour, depending on the insurer, type of work, etc.

The norm for all psych providers now, including MDs, is 15 to 20 minutes for a follow up appointment, and 40-50 minutes for a new patient intake.

The average salary for a PMHNP in Calif is $160K per year.  That seems kind of low to me, but a lot of places do not pay well.  Also, a lot of mental health providers work part-time, which would pull the average down.

https://www.indeed.com/career/psychiatric mental-health-nurse-practitioner/salaries/CA

Frankly, I see a lot of PMHNPs who provide poor quality care.  Earnings should also reflect an employee's competence and value contributed to the workplace.  PMHNPs are not all created equal.  Unfortunately, all too many NPs seem to be choosing psych because they think they will make more money and it is "easy."  

As far as money, I am seeing incredibly good pay and benefits being offered to FNPs in states like California and Washington.  One FQHC here is trying to recruit FNPs and is offering salary based on experience, $75K sign on bonus, $75K mortgage subsidy, paid health insurance for employee, and is eligible for loan repayment.  

Even most psychiatrists do not make huge bucks.  The average psychiatrist salary in California is $236K per year.  Even in cities like San Francisco, it's not a huge amount:  $308K per year.  

A PMHNP is NOT worth as much as an MD.  I have yet to meet a PMHNP with the level of knowledge and expertise of a psychiatrist.

Frankly, NPs in California are paid VERY well for the level of their education and training.  Within a few years, many will have the option to set up their own practices, if that is what they want.  

The number of private medical practices in this country is declining rapidly.  MDs can make more money with their own practice, but they simply do not want the hassle.  It is not easy to have one's own business.  Yes, for those who can do it, they can make a lot more money, but it is also a lot more work.  

"In the past 10 years, there has been a dramatic shift in physician practice ownership as less than half of doctors now work in private practices, according to a new analysis . . . 

Four of five physicians flagged the need to better negotiate favorable payment rates with payers as a very important or important reason in the decision to sell their practice to a hospital or health system, the analysis found.

Doctors who participated in the survey also highlighted the need to improve access to costly resources and the need to better manage payers' regulatory and administrative requirements. Each was flagged by about 70% of physicians as a very important or important reason.

The AMA's biennial analysis of physician practice arrangements found that economic, administrative and regulatory burdens have driven physicians to shift traditional business models for medical practices."

https://www.fiercehealthcare.com/providers/docs-shift-larger-hospital-owned-practices-have-more-negotiation-power-payers-ama#:~:text=In the past 10 years,from 60.1% to 46.7%.

 

[djmatte, ADN, MSN, RN, NP]

tt12345 said:

working on those 15 posts....15 comments didn't do it. would you please email? t I f f [email protected]

Just a heads up, I sent an email a few days ago. 

[FullGlass, BSN, MSN, NP]

MentalKlarity said:

Depends on how many patients you see per hour. If it's one, great. If it's 2+, you'd make more getting a share of the collections. It's not about what other NPs make, it's about are you making a fair share of what you bring in.

You have made many posts about earnings and telling other NPs they are not making enough.  Please share information on your employment situation and how much you make.

[FullGlass, BSN, MSN, NP]

MentalKlarity said:

Psychiatry, a 75-25 split with my employer, which works out to be about $250-$300 per hour on average. 6 weeks paid vacation (paid at $200 an hour) and additional 4 weeks unpaid vacation. 

Thank you for your response.  And good for you!  However, your pay is on the high side for a PMHNP and way above the general market.

[MentalKlarity, BSN, NP]

FullGlass said:

Thank you for your response.  And good for you!  However, your pay is on the high side for a PMHNP and way above the general market.

Of course! And yet my employer is still making a profit off of my services. Think about that when saying NP salaries should be close to the norm. The norm exists because so many people are bad negotiators.

 

The only benefit of seeing all these low salaries is that I know when I open my own practice an hire NPs one day I will make a fortune as they will be happy making 10~30% of their collections. 

[FullGlass, BSN, MSN, NP]

MentalKlarity said:

Of course! And yet my employer is still making a profit off of my services. Think about that when saying NP salaries should be close to the norm. The norm exists because so many people are bad negotiators.

 

The only benefit of seeing all these low salaries is that I know when I open my own practice an hire NPs one day I will make a fortune as they will be happy making 10~30% of their collections. 

I'm glad you were able to come to agreement with your employer on a good compensation package.  However, not all employers would agree to this.  In addition, different employers are going to have different profit margins and overhead expenses.  For example, a mental health telehealth organization will have lower overhead than a bricks and mortar practice.  Therefore, I would caution readers of your posts not to run out and determine similar comp packages from their employers without a lot more information and an honest appraisal of their own worth to the practice.  In addition, experienced PMHNPs requiring little supervision are the ones in a position to demand better compensation.  New grads that need a lot of supervision and correction are not.  

I've seen bad PMHNPs operate and the impact of their poor practice on an organization.  It takes a lot of time and supervision to try and help them, but many stubbornly refuse to change.  This can also result in patients leaving the practice or demanding to switch to a different provider.  It can also result in patients refusing to pay for an appointment, because the provider did nothing or refused to simply refill an existing prescription.  Insurance companies can also start refusing reimbursement for poor quality service.

Finally, if a PMHNP is working for a large bureaucratic organization like Kaiser, they are not going to be able to get this type of comp.  These organizations are not flexible in that way.  Even a private practice may have difficulty with this, as then all the providers are going to want this type of comp which could cause other issues.  

I'm also not sure I agree with your numbers.  Perhaps you have access to your practice's financial records and can 100% accurately make calculations, but most of us do not.  

For simplicity, I am going to assume a private practice that only takes cash and also has a physical office.

Overhead:

Office expense (this can be considerable, depending on location)

Medical assistant(s)

Utilities - power, telehealth

EHR costs, also will need occasional tech support

Miscellaneous

Cost of paying employee for vacation, sick time, CME, tuition reimbursement for things like getting a DNP

Cost of employee benefits like health insurance

Sunk cost of building a practice that enables employer to hire a PMHNP

Administrative/supervisory time

Costs involved in hiring and training new PMHNP.  Most new PMHNPs are not billing a lot right off the bat.  They need time to get up to speed and build up their patient panel.  

If the practice takes insurance, then billing staff or a service that does this will be required.  There can also be a lot of time and hassle involved in dealing with insurance hassles and denials.

Currently, I work for a standard practice that accepts insurance.  Insurance reimbursement varies widely by payor.  My practice has a lot of Medicare and Medicaid patients, and that pays less, especially Medicaid. 

While I was in NP school, during one of my clinical rotations, my MD preceptor, who owned his own practice, shared a lot of his financials with me, due to my prior business background.  He was losing money!  His goal was to sell his practice to a larger entity, which he eventually did.  So don't assume all practices are making a huge profit.

[djmatte, ADN, MSN, RN, NP]

MentalKlarity said:

Of course! And yet my employer is still making a profit off of my services. Think about that when saying NP salaries should be close to the norm. The norm exists because so many people are bad negotiators.

 

The only benefit of seeing all these low salaries is that I know when I open my own practice an hire NPs one day I will make a fortune as they will be happy making 10~30% of their collections. 

Being more realistic on what we bring in and what our value is to a clinic is something hugely lacking in any NP discussion regarding pay. Sadly too many are willing to settle or are unfamiliar with the fact that  $100k salaries are subsidizing both clinics and in many cases MD salaries. They believe there's a "market" rate to justify their own poor choices or current lack of knowledge about their profession. Good on you for being up front coming about your own income and the reality that clinics are making money hand over fist at the expense of mid level providers who *SHOULD* be making 85% of what an MD brings in. Full. Stop.  

[FullGlass, BSN, MSN, NP]

MentalKlarity said:

Of course! And yet my employer is still making a profit off of my services. Think about that when saying NP salaries should be close to the norm. The norm exists because so many people are bad negotiators.

 

The only benefit of seeing all these low salaries is that I know when I open my own practice an hire NPs one day I will make a fortune as they will be happy making 10~30% of their collections. 

I truly appreciate you for starting this important discussion.  You have made me do a lot of thinking and research.  

A lot of NPs are undoubtedly underpaid.  At least in the Western U.S., I am seeing pay going up across the board, due the shortage of providers, including in primary care.  In fact, I am seeing primary care compensation going up the fastest, as there is a dire shortage of PCPs.  

What is interesting, is that the same is not true of mental health.  California has a terrible shortage of mental health care providers.  PMHNP pay used to be significantly higher than for PCPs, but that is no longer the case.  One would think that due to supply and demand, mental health care pay would be increasing a lot, but it isn't.  The only way for PMHNPs to make a lot more money is to essentially open their own practice by signing up for platforms will provide the billing services, along with some referrals.  

I also remembered that PMHNPs and psychiatrists may be subsidizing the pay of talk therapists.  The talk therapy shortage is far worse than for med mgt, at least in California.  My experience has been working in FQHCs and practices that provide both med mgt and talk therapy.  The problem is that insurance companies pay really poorly for talk therapy, so most talk therapists have private practices that are cash pay only.  In organizations like mine, the med mgt providers are providing subsidies to increase talk therapy pay so the organization can attract therapists to work for them.  I'm OK with some of this, as I have a personal commitment to working with underserved populations.  Those populations can't afford to pay cash for talk therapy or any other health services.  In the long run, PMHNPs and psychiatrists should be advocating for increased insurance reimbursement for talk therapists.

As a management consulting executive, I ran my own practice, and our target profit margin was around 30-40%, for gross margin.  That's before expenses, which were considerable.  A health organization also needs to have some savings for unexpected events and downturns.

Personally, I think that once NPs in California have FPA, we should be getting insurance reimbursements that are equal to MDs' if the NP is truly practicing independently and does not require MD supervision.  I believe this is the case in Oregon.

At this point in time, I am happy where I am.  I just got a raise to $100 per hour with 18 days vacation, 5 days sick time, and 5 days CME time.  That's almost 30 days per year paid time off total.  I don't need to worry about getting patients or billing.  In addition, my current employer is very flexible, so I can work as little as 8 hours per week or all the way up to 40 hours per week - it is up to me.  That flexibility is very important to me right now.  I have gone through the wringer personally in the past several years and just don't have the mental and emotional energy to do what would be needed to make a boatload of money by going a more independent practice route via 1099.  I've been practicing solely in mental health for about 3 years now and want to focus on building my expertise as a PMHNP.  In a few years, I plan to open my own practice.  Finally, I won a HRSA scholarship and my current employer qualifies to fulfill the public service obligation.

So, I suggest PMHNPs consider what things are most important to them.  For example, a job like mine would be ideal for a parent who wants more time with their child(ren), or someone who is pursuing further education, so they can work part-time and still get benefits..  It would not be the best choice for someone who wants to max out their income.  PMHNPs that won a HRSA scholarship or who want to pursue state or federal student loan repayment will also have employment constraints for a few years.

Again, MentalKlarity, my thanks to you.