Members are discussing the salaries and job opportunities for nurse practitioners in different specialties, such as primary care and psychiatric mental health. Some members are comparing the pay differences between different NP specialties, while others are sharing their personal experiences and reasons for choosing a specific specialty. Overall, the discussion revolves around the factors influencing NP career choices, including salary, job satisfaction, and personal interest in a particular field.
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.
Specializes in Psychiatric and Mental Health NP (PMHNP).
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.
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.
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.
Specializes in Psychiatric and Mental Health NP (PMHNP).
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.
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.
Specializes in Psychiatric and Mental Health NP (PMHNP).
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.
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.
Specializes in Psychiatric and Mental Health NP (PMHNP).
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.
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.
You're very welcome! I agree, there is more to the picture than pay - flexibility and work-life balance are so important! In my case, I made it clear to my employer I needed generous paid and unpaid vacation as I want to have vacation time - I actually took a slight paycut in exchange for some more flexibility with time off so I could enjoy my life and not just work.
That said, agree that many NPs simply do not know what they bring in and that is a big issue. I can tell you that the clinic I work in has a fairly low overhead (we have one MA and one front office person), the building rent is cheap, and there are numerous providers. I actually requested to review my collections with my employer and saw that on average the insurance companies were reimbursing at nearly $250+ per patient (2 per hour, so bringing in sometimes $500 an hour depending on their insurance provider) that I was seeing. I requested either an hourly rate that gave me a substantial portion of that, accounting for people who don't pay or don't show or have inferior insurance, or to give me a fair split of what I bring in. We settled on a split, which is at 75%. My employer is still making a profit off of me, and I am happy with that because everyone can win and benefit in the end. There is absolutely no reason why some nurse practitioners are out there billing for $300K-$500K or more depending on specialty and getting $100K in salary.
Ask yourself - why would clinics hire more nurse practitioners over physicians? Which brings more prestige, etc? It's because the physicians are asking for a salary that is closer to what they bringing in. Paying a physician who brings in $500K a salary of $375K is a LOT less attractive to a clinic than hiring an NP who bills for $400K but is happy at $120K salary. They can literally make double on the NP, because NPs do not know their worth like physicians do.
Specializes in Psychiatric and Mental Health NP (PMHNP).
MentalKlarity said:
You're very welcome! I agree, there is more to the picture than pay - flexibility and work-life balance are so important! In my case, I made it clear to my employer I needed generous paid and unpaid vacation as I want to have vacation time - I actually took a slight paycut in exchange for some more flexibility with time off so I could enjoy my life and not just work.
That said, agree that many NPs simply do not know what they bring in and that is a big issue. I can tell you that the clinic I work in has a fairly low overhead (we have one MA and one front office person), the building rent is cheap, and there are numerous providers. I actually requested to review my collections with my employer and saw that on average the insurance companies were reimbursing at nearly $250+ per patient (2 per hour, so bringing in sometimes $500 an hour depending on their insurance provider) that I was seeing. I requested either an hourly rate that gave me a substantial portion of that, accounting for people who don't pay or don't show or have inferior insurance, or to give me a fair split of what I bring in. We settled on a split, which is at 75%. My employer is still making a profit off of me, and I am happy with that because everyone can win and benefit in the end. There is absolutely no reason why some nurse practitioners are out there billing for $300K-$500K or more depending on specialty and getting $100K in salary.
Ask yourself - why would clinics hire more nurse practitioners over physicians? Which brings more prestige, etc? It's because the physicians are asking for a salary that is closer to what they bringing in. Paying a physician who brings in $500K a salary of $375K is a LOT less attractive to a clinic than hiring an NP who bills for $400K but is happy at $120K salary. They can literally make double on the NP, because NPs do not know their worth like physicians do.
Good points. However, the places I've worked and work now are always happy to hire MDs or DOs. They've never turned down an MD they liked who wanted a job there, assuming salary was in line, etc.
I'd be interested in trying your negotiating tactic once I have 5 years PMHNP experience.
Frankly, I've had a lot of heartburn due to subpar PMHNPs. They simply are not worth even $100K per year, IMHO. They cause a lot of patient churn and anger, trouble for other providers, and open the practice up to massive liability issues.
I'm very frustrated that the NP profession does not police itself and does little to maintain education standards. I'm sick of these crappy schools, and I'm not just talking about for-profit schools, that will accept anyone with a pulse and evidently fail to teach even the basics of good clinical practice and professional behavior and ethics. *sigh* I'm seeing a lot of people decide they want to become a PMHNP because they think it is "easy" and they will make a lot more money. These schools do not even require the ability to speak and write in understandable English, which can be very dangerous, as it leads to patient confusion and frustration.
So, yes, I agree a good PMHNP with at some solid experience under their belt should be making a better percentage of their billing.
You're very welcome! I agree, there is more to the picture than pay - flexibility and work-life balance are so important! In my case, I made it clear to my employer I needed generous paid and unpaid vacation as I want to have vacation time - I actually took a slight paycut in exchange for some more flexibility with time off so I could enjoy my life and not just work.
That said, agree that many NPs simply do not know what they bring in and that is a big issue. I can tell you that the clinic I work in has a fairly low overhead (we have one MA and one front office person), the building rent is cheap, and there are numerous providers. I actually requested to review my collections with my employer and saw that on average the insurance companies were reimbursing at nearly $250+ per patient (2 per hour, so bringing in sometimes $500 an hour depending on their insurance provider) that I was seeing. I requested either an hourly rate that gave me a substantial portion of that, accounting for people who don't pay or don't show or have inferior insurance, or to give me a fair split of what I bring in. We settled on a split, which is at 75%. My employer is still making a profit off of me, and I am happy with that because everyone can win and benefit in the end. There is absolutely no reason why some nurse practitioners are out there billing for $300K-$500K or more depending on specialty and getting $100K in salary.
Ask yourself - why would clinics hire more nurse practitioners over physicians? Which brings more prestige, etc? It's because the physicians are asking for a salary that is closer to what they bringing in. Paying a physician who brings in $500K a salary of $375K is a LOT less attractive to a clinic than hiring an NP who bills for $400K but is happy at $120K salary. They can literally make double on the NP, because NPs do not know their worth like physicians do.
Arguably many clinics are utilizing NPs to subsidize the salaries of physicians. They can justify paying a physician closer to or even above what they bring in on the backs of much lower paid NPs who are paid a third or less of ever they actually see. With there technically being a physician shortage, this is how physicians are lured in and kept. We're subsidizing their salary and having that token doctor on board gives the clinic a selling point. .
Specializes in Psychiatric and Mental Health NP (PMHNP).
MentalKlarity said:
Paying a physician who brings in $500K a salary of $375K is a LOT less attractive to a clinic than hiring an NP who bills for $400K but is happy at $120K salary. They can literally make double on the NP, because NPs do not know their worth like physicians do.
I'm not sure where these numbers are coming from. I guess it depends on location. In California, a FT PMHNP is going to make $150K to $220K per year, in general. There are some outliers below and above, of course. It is extremely rare now for a FT PMHNP to make less than $160K per year here, and that is for someone with little experience.
In California, a FT psychiatrist MD (who is an employee) is going to make $250K to $400K per year. Again, there are some outliers. Most of the psychiatrist jobs that are posted are in the $250K to $350K range.
Psychiatrists here are not having any trouble finding jobs because we have such a shortage of mental health care providers. Psychiatry is still not the most desirable specialty for med students (although that is improving) and the majority of psychiatrists are older and will be retiring over the next 10-20 years without enough MD replacements.
My experience in a large mental health practice is that most PMHNPs are kind of a pain and require a lot of supervision. Sorry, but that is the brutal truth. So not only are they not billing as much, they require a lot more hand-holding. They have also lost a lot of patients from the practice due to poor care. Not only do they not follow clinical guidelines, they are also completely lacking on common sense. Frankly, most of them are lucky to be making as much money as they are.
I'm not sure where these numbers are coming from. I guess it depends on location. In California, a FT PMHNP is going to make $150K to $220K per year, in general. There are some outliers below and above, of course. It is extremely rare now for a FT PMHNP to make less than $160K per year here, and that is for someone with little experience.
In California, a FT psychiatrist MD (who is an employee) is going to make $250K to $400K per year. Again, there are some outliers. Most of the psychiatrist jobs that are posted are in the $250K to $350K range.
Psychiatrists here are not having any trouble finding jobs because we have such a shortage of mental health care providers. Psychiatry is still not the most desirable specialty for med students (although that is improving) and the majority of psychiatrists are older and will be retiring over the next 10-20 years without enough MD replacements.
My experience in a large mental health practice is that most PMHNPs are kind of a pain and require a lot of supervision. Sorry, but that is the brutal truth. So not only are they not billing as much, they require a lot more hand-holding. They have also lost a lot of patients from the practice due to poor care. Not only do they not follow clinical guidelines, they are also completely lacking on common sense. Frankly, most of them are lucky to be making as much money as they are.
Well that I agree with, and the unfortunate truth is that within the next 10-20 years nurse practitioners will likely make less than they do now as lack of regulation by the nursing organizations has allowed poor quality programs to flourish that lack any sort of oversight and admit anyone with a pulse. The result is a huge cohort of nurse practitioners who are borderline ignorant and incapable of managing complex patients and overtime they will cause the public and other professionals to sour on nurse practitioners and "demand" to see a psychiatrist. I already see ads at local mental health clinics that say patients will "only ever see a psychiatrist" because of public distaste. The nursing organizations are chasing short term gain (more money from more students going to school, taking board exams, paying dues) over the long game plan and will eventually see it blow up in their faces. Quantity over quality is a losing game.
FullGlass, BSN, MSN, NP
2 Articles; 1,950 Posts
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.