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).
PMHNP in California. Working permanent job with benefits, telehealth. $95 per hour with "okay" benefits. I currently work 32 hours per week. This practice is very flexible, so most of our providers work part-time, but anyone who wants to can work full-time.
PMHNP in California. Working permanent job with benefits, telehealth. $95 per hour with "okay" benefits. I currently work 32 hours per week. This practice is very flexible, so most of our providers work part-time, but anyone who wants to can work full-time.
Seems low for California unless you're seeing only 1 patient per hour or it's a community health clinic?
Yikes, like you, I didn't negotiate and it really hurt me in the end.
I am with the same practice I started with 5.5 years ago.
I am now part time but will give you my FT specs before I decreased my hours.
As a NP with 5+ years experience.. Detroit MI, Cardio NP, M-F and every other weekend, all holidays except Easter and Christmas, 103k + 50% health insurance for me and my family, 401k with profit sharing (about 10-12k/year), paid maternity leave (4-8 weeks) see about 40 patients a day (Hospital rounds)
M-F AND every other weekend? Did you ever figure out your hourly pay, because it sounds like it would be very, very low. 40 patients a day, I cannot even imagine what you are pulling in revenue-wise.
I figured I would throw in a military perspective for an FNP. I returned to active duty Air Force. So there's a different breakdown compared to civilian. Bear in mind these numbers vary with location and nursing/NP experience.
I came on as a NP with 3 years NP experience and 9 years RN experience prior which hit me the rack of 03/capt.
base pay:4849.80/mo taxed to 3540.35
housing allowance (non taxed based on location/higher with dependents) 2082/mo
Monthly food allowance (not taxed):311.88/mo
speciality pay (all NPs have a specialty): 500/mo
total take home: 6434.23/mo
This is not including an accession bonus of $20000 for initial 3 year commitment or $30000 for initial 4 year commitment.
After your initial commitment, you're looking at a retention bonus structure dependent on amount of years of your commitment and specialty (up to $36k/yr for 6 year option on FNP scale).
My personal take home per paycheck is way more than when I finished as a civilian NP with a guaranteed 4 hours of weekly admin time and other patient load decrements based on actual military duties.
Hey, I am on the fence about joining as an experienced PMHNP. Can we chat, please?
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.
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.
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.
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.
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.
FullGlass, BSN, MSN, NP
2 Articles; 1,918 Posts
PMHNP in California. Working permanent job with benefits, telehealth. $95 per hour with "okay" benefits. I currently work 32 hours per week. This practice is very flexible, so most of our providers work part-time, but anyone who wants to can work full-time.