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).
Ondeev said:
Reimbursement at a minimum of 75% that of physicians for APRN provided services, and at times 100%, show a great wage disparity between APRN's and physicians. Salaries should reflect the same percentage as reimbursement.
Being an NP is not a sales job where we get a "commission" based on billings. Sorry, but that is the reality. There are some jobs out there where an NP can get paid a % of what they bill, but those are typically contractor roles. Some NPs may be able to negotiate such an arrangement with their employer. However, most NPs get paid a salary. Some also get a bonus based on productivity, etc.
For professions, salaries are based on a variety of factors, such as:
- education
- years of experience
- performance
- employer discretion
As everyone knows, MDs and DOs have A LOT more education and training than NPs. I have previously discussed this.
4 years of undergrad
4 years med school
2 to 10 years internship, residency, fellowship in addition
Interns and residents make crap money, way less than most NPs
So, a "brand new" MD that has finished all of the above, walks in the door with more education and MORE EXPERIENCE.
If you go to any corporation, that is how it is. Since many people here think people in high tech have it so great, let's imagine a computer programming pit - that is a big room where all the programmers sit, coding away. They are all going to be making a different amount of $!
Jane makes the most, b/c she is a Technical Architect (best analog to an MD). She went to MIT for undergrad, then Cal Poly for her Master's degree. She is the only programmer with the knowledge to do certain types of programming. She has 10 years of experience. She is an outstanding performer. She is a perm employee and makes $240K per year.
Joe is a contractor and he gets $150 per hour, but no benefits.
Jack is a contract programmer from India who needs his Green Card, so the company can get away with paying him $80K per year.
Susan just graduated from college and is making $100K per year.
Michael is a mediocre performer with 5 years experience. He makes $120K per year.
Rachel is a good, solid performer with 5 years experience. She makes $150K per year.
Xavier is an outstanding performer with 5 years experience, plus some specialized knowledge. He makes $200K per year.
That is life.
An NP that is unhappy with their pay can go be a contractor, try to negotiate a better arrangement, or go open their own practice and charge what they want and keep it all.
NPs working for large organizations like Kaiser, Adventist Health, etc., are not going to be received well if asking for a huge pay increase so they make the same as MDs. That is NEVER going to happen!
Also, not all MDs are making boatloads of money. There are MDs that make LESS than some NPs!
Urging NPs to demand pay parity with MDs is ridiculous (proportionate to billing rates) and doing most NPs a huge disservice.
I do not understand why some here are so disgruntled. NPs make excellent money! Far more than the average person. My goodness, they only need 2 years or less of graduate school to make up to $200K or more (based on location and specialty). That is a lot less effort than MDs or DOs have to put in to become a doctor.
I am grateful for what I have achieved. My life is far better than when I was a high tech executive. Yes, I'm making less than if I had stayed in tech, but I'm also way happier and healthier physically and mentally.
NPS ARE NOT THE EQUAL OF PHYSICIANS.
Here is how any NP here could make a boatload of money: go into sales and be great at it. No education required. An outstanding salesperson in any field can make $1 million per year or more. That is far more than most MDs. NPs certainly have the knowledge to be drug reps. Your earnings would be based solely on what you sell.
The other way to make a boatload of money: start your own successful business. No education required. Bill Gates didn't finish college. That is how people become billionaires.
Not a single person here is suggesting NPs are equal to physicians. Even reimbursements account for the education disparity. With a 15-25 percent premium, that is the "value" afforded the education and experience. There's no sliding scale in the eyes of insurance or CMS. Clinics are often not run like other businesses or have "experience" based pay systems like hospitals. New mid levels are often paid less berceuse of lack of experience, but also there's an expectation the clinic loses money on them the first few years because of ramp up and panel acclimatization. But in many cases, mid levels as a whole are reinforcing the bottom line while MDs can get paid a higher percentage of what they bring in. Their pay gap doesn't improve much despite more years as a clinician. A NP with 10 or more years still isn't making 15% of what a newly minted doctor makes.
There's nothing wrong with advocating for better pay. We may not be equal, but we can easily tell what we're worth. If you're comfortable with what you make in light that others are making more off your work then take your lot in life and move on. Let the rest of us be vocal and advocate about what we believe we're worth.
Specializes in Psychiatric and Mental Health NP (PMHNP).
djmatte said:
A NP with 10 or more years still isn't making 15% of what a newly minted doctor makes.
There's nothing wrong with advocating for better pay. We may not be equal, but we can easily tell what we're worth. If you're comfortable with what you make in light that others are making more off your work then take your lot in life and move on. Let the rest of us be vocal and advocate about what we believe we're worth.
I believe you meant 85%. I hope so.
Yes, NPs can advocate for better pay. However, I think there are some people on this forum that are very unrealistic, as I have repeatedly explained in agonizing detail. I am sorry, but NPs are not going to greatly increase their earnings in one fell swoop. You are in the military and you make less than a military MD.
Given that I will make $208K this year, with 3 years PMHNP experience, I'm doing quite well. I didn't have to go through internship or residency. At 3 years, a psychiatrist would still be in their residency and making a whopping $80k per year or so. As an employee at my current practice, I could make up to $249,600 per year under the current pay scale - which is the average pay for a shrink here. In California, I've seen average psychiatrist pay at $240K to $260K per year, so let's say $250K per year.
So, at this point, I am making way more than an MD with only 3 years of experience. WAY MORE. I'm also making 83% of what the average shrink makes in California, with only 3 years of experience!
Some NPs are in states with crap pay. I am sorry and don't know the answer to that.
There is a lot in the news about people leaving California, with one exception. One group is moving here in large numbers - RNs. That is because we have strict staffing ratios, good pay, and a union for RNs. Maybe that is the model for RNs and NPs to work towards in other states.
Right now, there are a lot of places that are "telehealth platforms" for NPs advertising up to $350K per year. So any NP can do that if they want right now. Those are contractor positions.
I do not see anyone here with realistic advice on how NPs can overall raise their pay. MentalKlarity shared what they negotiated with their employer, but the brutal truth is that most employers will not agree to such a deal, and certainly not large organizations like Kaiser, Adventist Health, etc.
So if someone has a game plan for all NPs to all collectively raise their pay successfully, I'd be very interested to hear it. However, that is not going to happen until we as a profession put the crappy for-profit schools out of business and enforce rigorous standards for becoming an NP, so we only get the best and the brightest. That is what MDs and DOs did.
Here is what I am concerned about: NP Susan makes $90K per year as a PMHNP in OK. The SE U.S. just pays crap for NPs and for most jobs in general. After reading some posts on this forum, NP Susan decides she should be making 85% of what an MD makes, based on billings and collections. She goes to her employer and requests a raise from roughly $45 per hour to $100-$110 per hour. What do you think her employer is going to say? They are going to say no! They might give her a raise, but nothing near what she is requesting. That is because all the other PMHNPs in OK will accept $45 per hour or less!
I am now recruiting PMHNPs. I just had a new grad PMHNP, with no other NP experience, tell me they expected $100 per hour. I told them that was not going to happen and I rejected them. The rejection was because this was someone who was completely clueless.
Yes, NPs can advocate for better pay. However, I think there are some people on this forum that are very unrealistic, as I have repeatedly explained in agonizing detail. I am sorry, but NPs are not going to greatly increase their earnings in one fell swoop. You are in the military and you make less than a military MD.
Given that I will make $208K this year, with 3 years PMHNP experience, I'm doing quite well. I didn't have to go through internship or residency. At 3 years, a psychiatrist would still be in their residency and making a whopping $80k per year or so. As an employee at my current practice, I could make up to $249,600 per year under the current pay scale - which is the average pay for a shrink here. In California, I've seen average psychiatrist pay at $240K to $260K per year, so let's say $250K per year.
So, at this point, I am making way more than an MD with only 3 years of experience. WAY MORE. I'm also making 83% of what the average shrink makes in California, with only 3 years of experience!
Some NPs are in states with crap pay. I am sorry and don't know the answer to that.
There is a lot in the news about people leaving California, with one exception. One group is moving here in large numbers - RNs. That is because we have strict staffing ratios, good pay, and a union for RNs. Maybe that is the model for RNs and NPs to work towards in other states.
Right now, there are a lot of places that are "telehealth platforms" for NPs advertising up to $350K per year. So any NP can do that if they want right now. Those are contractor positions.
I do not see anyone here with realistic advice on how NPs can overall raise their pay. MentalKlarity shared what they negotiated with their employer, but the brutal truth is that most employers will not agree to such a deal, and certainly not large organizations like Kaiser, Adventist Health, etc.
So if someone has a game plan for all NPs to all collectively raise their pay successfully, I'd be very interested to hear it. However, that is not going to happen until we as a profession put the crappy for-profit schools out of business and enforce rigorous standards for becoming an NP, so we only get the best and the brightest. That is what MDs and DOs did.
Here is what I am concerned about: NP Susan makes $90K per year as a PMHNP in OK. The SE U.S. just pays crap for NPs and for most jobs in general. After reading some posts on this forum, NP Susan decides she should be making 85% of what an MD makes, based on billings and collections. She goes to her employer and requests a raise from roughly $45 per hour to $100-$110 per hour. What do you think her employer is going to say? They are going to say no! They might give her a raise, but nothing near what she is requesting. That is because all the other PMHNPs in OK will accept $45 per hour or less!
I am now recruiting PMHNPs. I just had a new grad PMHNP, with no other NP experience, tell me they expected $100 per hour. I told them that was not going to happen and I rejected them. The rejection was because this was someone who was completely clueless.
The military is a completely different and unrelated pay structure. It's not reality in terms of what actual clinics face in terms of pay and function. Doctors sometimes get paid more as they will come in as higher ranks and certain fields that are in high demand will command retention bonuses after an initial service commitment. But not everyone gets those as some don't want the long term obligation. A new doctor will typically come in as a captain, but I came in at the same rank and pay with 3 years of NP experience and 7 years of RN. The civilian world won't even consider that RN experience. We don't bill. We don't charge for services. We pull from a predetermined pot.
But that doesn't change on the outside. Doctors historically would make a percentage of what they bring in based on the clinic profit goals. When they worked there long enough, they may be offered partnerships where they could profit share. That's how they historically "made more" based on experience. Mid levels changed that game as clinics could pay those doctors more on the backs of mid levels, never offering those doctors profit sharing partnerships with longevity, and still maintaining a sizable profit margin. Many of those docs they are losing money on because of mid level numbers. Many institutions have 4or more mid levels for every doctor employed. They are making more of us and it has nothing to do with training or billing. And advocating for a minimum of 85%of what they make is not a far cry. Especially since the billing system clearly believes that 15% is an appropriate difference for training/experience.
Being an NP is not a sales job where we get a "commission" based on billings. Sorry, but that is the reality. There are some jobs out there where an NP can get paid a % of what they bill, but those are typically contractor roles. Some NPs may be able to negotiate such an arrangement with their employer. However, most NPs get paid a salary. Some also get a bonus based on productivity, etc.
Who on earth said anything remotely indicating that being and NP was a sales job? I referenced state and federal organization reimbursement rate policies determined by whether a physician or NP provided the services. That is the reimbursement rate that goes to the employer based on the service provided (and hopefully properly coded for reimbursement purposes), regardless of NP/physician experience. This is where my basis of comparison lies when stating compensation should be comparative to reimbursement.
Specializes in Psychiatric and Mental Health NP (PMHNP).
djmatte said:
And advocating for a minimum of 85%of what they make is not a far cry. Especially since the billing system clearly believes that 15% is an appropriate difference for training/experience.
Thank you for explaining military pay. That was interesting.
I explained that NPs can now make 85% of what a typical MD makes. And in states with full practice authority they can open their own practices, just like MDs do. More and more states are granting FPA. They can also go be a contractor for one of those places that pays based on billings and collections.
I explained that an NP that just goes and asks for a lot more money is not likely to succeed, which you completely ignored.
How are NPs supposed to advocate for more pay? How likely is that to succeed? If you have a plan for this, please share it.
Frankly, I read a lot of complaining on this site about pay, but no real practical suggestions that are likely to be successful for most NPs.
Few people here are ignorant to *how* salaries are determined. We certainly don't need another long winded post about the why for most of these topics. Clinics are paid on reimbursement. While we aren't "sales people", we are cthe revenue generators for the clinic. How we bill matters to the bottom line. It's what justifies our salaries and reinforces us to strive for more adequate pay in line with the 85%margin of a physician.
Thank you for explaining military pay. That was interesting.
I explained that NPs can now make 85% of what a typical MD makes. And in states with full practice authority they can open their own practices, just like MDs do. More and more states are granting FPA. They can also go be a contractor for one of those places that pays based on billings and collections.
I explained that an NP that just goes and asks for a lot more money is not likely to succeed, which you completely ignored.
How are NPs supposed to advocate for more pay? How likely is that to succeed? If you have a plan for this, please share it.
Frankly, I read a lot of complaining on this site about pay, but no real practical suggestions that are likely to be successful for most NPs.
"In summary, I believe the long-run solution to better NP compensation is:
1. Collective action, I.e. unions
2. Reimbursement parity
3. FPA
4. NPs voting with their feet and leaving crappy pay states. When those states have a shortage of providers, they will have to increase pay."
The thing NOT to do in order to advocate for better pay is to write articles on community websites as an NP, that employers, board members, local politicians, etc. read when doing research on wage comparisons or determining political platforms at the state level. When employers see articles such as the one in the hyperlink above, that are written by an NP advocating for NP's to accept lower wages, this doesn't help. Seeing people in the profession, that cannot maintain a view and reverse their own views rapidly on topics such as pay, does not help.
An interesting thing that happened is that my HR manager, who is also a close friend outside of work, sent me some of the articles and wage comparisons he used for the company to determine the new NP wage scale they implemented earlier this year. The hyperlinked article above was on the list... So thank you, personally, for directly helping employers make the decision to keep wages for NP's lower than they may otherwise would have.
There were women in the 50s who advocated that women should not be paid the same as men because men are inherently better, have a family to provide for etc etc. The arguments were similar to what we're seeing here for why it's "ridiculous" that anyone dare suggest a NP make the same as a MD. Some people are simply their own worst enemy.
Yes, NPs can advocate for better pay. However, I think there are some people on this forum that are very unrealistic, as I have repeatedly explained in agonizing detail. I am sorry, but NPs are not going to greatly increase their earnings in one fell swoop. You are in the military and you make less than a military MD.
Given that I will make $208K this year, with 3 years PMHNP experience, I'm doing quite well. I didn't have to go through internship or residency. At 3 years, a psychiatrist would still be in their residency and making a whopping $80k per year or so. As an employee at my current practice, I could make up to $249,600 per year under the current pay scale - which is the average pay for a shrink here. In California, I've seen average psychiatrist pay at $240K to $260K per year, so let's say $250K per year.
So, at this point, I am making way more than an MD with only 3 years of experience. WAY MORE. I'm also making 83% of what the average shrink makes in California, with only 3 years of experience!
Some NPs are in states with crap pay. I am sorry and don't know the answer to that.
There is a lot in the news about people leaving California, with one exception. One group is moving here in large numbers - RNs. That is because we have strict staffing ratios, good pay, and a union for RNs. Maybe that is the model for RNs and NPs to work towards in other states.
Right now, there are a lot of places that are "telehealth platforms" for NPs advertising up to $350K per year. So any NP can do that if they want right now. Those are contractor positions.
I do not see anyone here with realistic advice on how NPs can overall raise their pay. MentalKlarity shared what they negotiated with their employer, but the brutal truth is that most employers will not agree to such a deal, and certainly not large organizations like Kaiser, Adventist Health, etc.
So if someone has a game plan for all NPs to all collectively raise their pay successfully, I'd be very interested to hear it. However, that is not going to happen until we as a profession put the crappy for-profit schools out of business and enforce rigorous standards for becoming an NP, so we only get the best and the brightest. That is what MDs and DOs did.
Here is what I am concerned about: NP Susan makes $90K per year as a PMHNP in OK. The SE U.S. just pays crap for NPs and for most jobs in general. After reading some posts on this forum, NP Susan decides she should be making 85% of what an MD makes, based on billings and collections. She goes to her employer and requests a raise from roughly $45 per hour to $100-$110 per hour. What do you think her employer is going to say? They are going to say no! They might give her a raise, but nothing near what she is requesting. That is because all the other PMHNPs in OK will accept $45 per hour or less!
I am now recruiting PMHNPs. I just had a new grad PMHNP, with no other NP experience, tell me they expected $100 per hour. I told them that was not going to happen and I rejected them. The rejection was because this was someone who was completely clueless.
If you go on PMHNP salary groups on facebook this what people are being told to ask and expect and that (100 /hour as a new grad) and that taking anything less is a disservices to the profession as a whole. I don't agree with that philosophy, but I am a fan of advocacy. I watch the payscale in my local market closely and it is adjusting quickly due to APP demand.....
There are only a few PMHNPs in my department and one just left. when we are working full time and a new Dr working .8 is making more than double our salary and we are also not eligible for the bonsues they are... It's easy to see why they felt undervalued. They were able to leave to do more concierge medicine working less hours for equivalent pay. I feel like I am overall fairly compensated for what I am doing and my training but the discrepancy feels a little out of proportion.
The thing NOT to do in order to advocate for better pay is to write articles on community websites as an NP, that employers, board members, local politicians, etc. read when doing research on wage comparisons or determining political platforms at the state level.
1. Yes, I did provide the answer for overall better pay. I just wanted to see if anyone else could come up with it. No one did. However, all those things will take a lot of time and effort. That's not going to help someone looking for a job now. When I give job search and compensation advice, my focus is on what is doable in the here and now.
However, Ondeev, why don't you work on the things you agreed would increase NP pay in the long run? There is nothing stopping you from working to start an NP union. You could also find out how to effectively lobby the ANCC to stop credentialing crappy for-profit schools and schools that don't provide NP clinical placements, then educate the rest of us on this forum on how to assist with this.
2. Just stop. I can write anything that is within the rules of this forum, whether or not you agree with it. As I have repeatedly said, unrealistic demands are a disservice to NPs. My goal is help NPs actually get a job. And the reason the post you linked to was taken seriously is that it is realistic. I wrote a good post and stand by it.
3. Here is what will NOT be effective in getting increased pay in the short term: A new grade NP demanding $200K per year. That is completely unrealistic and undeserved. That new grad will not get the job. Or an NP making $100K per year marching in to her employer and demanding $200K per year. "The thing NOT to do in orer to advocate for better pay" is to complain endlessly on this site w/o any practical advice to help people in the here and now. To Ondeev: What are you doing to advocate for better pay for NPs, besides posting here with complaints? I have provided 4 answers over and over again, and yet again later in this post, on what some NPs can do now to increase their pay.
4. Brutal truth about pay raises: they don't happen in one fell swoop. Looking at recent strikes, unions can get hefty pay raises, but those occur over a number of years, in general. They don't go from $25 per hour to $45 per hour immediately, but over 3 to 5 years. I started 3 years ago in my current job at $70 per hour. After 3 years of incremental raises, and excellent performance, I am at $100 per hour. That's a 43% increase over 3 years. Most people would be pretty happy with that. My earnings will continue to increase.
5. Plenty of NPs make good money. And in specialties that lend themselves to telehealth, there is nothing stopping any NP from getting licensed in states with higher pay and working remotely for facilities within those states right now. And as I have stated ad nauseum, there are also telehealth platforms that NPs can sign up for which can pay up to $300-$350K per year. One PMHNP on this forum stated she made over $500K per year doing that, by working M-F 10 hours per day. Finally, in FPA states, an NP can open their own practice. Something that takes more commitment is to physically move to a state that needs more NPs and pays them well. Or move to an area in your present state that pays better.
But hey, you all don't have to believe me. Let's have some volunteers of new grad and experienced NPs demand immediate pay raises to 85% of what MDs make and get back to us. I'd be very interested in seeing the results.
What's apparent is that most reading this are not running out to work through a telehealth platform or open their own practice.
FullGlass, BSN, MSN, NP
2 Articles; 1,950 Posts
Being an NP is not a sales job where we get a "commission" based on billings. Sorry, but that is the reality. There are some jobs out there where an NP can get paid a % of what they bill, but those are typically contractor roles. Some NPs may be able to negotiate such an arrangement with their employer. However, most NPs get paid a salary. Some also get a bonus based on productivity, etc.
For professions, salaries are based on a variety of factors, such as:
- education
- years of experience
- performance
- employer discretion
As everyone knows, MDs and DOs have A LOT more education and training than NPs. I have previously discussed this.
4 years of undergrad
4 years med school
2 to 10 years internship, residency, fellowship in addition
Interns and residents make crap money, way less than most NPs
So, a "brand new" MD that has finished all of the above, walks in the door with more education and MORE EXPERIENCE.
If you go to any corporation, that is how it is. Since many people here think people in high tech have it so great, let's imagine a computer programming pit - that is a big room where all the programmers sit, coding away. They are all going to be making a different amount of $!
Jane makes the most, b/c she is a Technical Architect (best analog to an MD). She went to MIT for undergrad, then Cal Poly for her Master's degree. She is the only programmer with the knowledge to do certain types of programming. She has 10 years of experience. She is an outstanding performer. She is a perm employee and makes $240K per year.
Joe is a contractor and he gets $150 per hour, but no benefits.
Jack is a contract programmer from India who needs his Green Card, so the company can get away with paying him $80K per year.
Susan just graduated from college and is making $100K per year.
Michael is a mediocre performer with 5 years experience. He makes $120K per year.
Rachel is a good, solid performer with 5 years experience. She makes $150K per year.
Xavier is an outstanding performer with 5 years experience, plus some specialized knowledge. He makes $200K per year.
That is life.
An NP that is unhappy with their pay can go be a contractor, try to negotiate a better arrangement, or go open their own practice and charge what they want and keep it all.
NPs working for large organizations like Kaiser, Adventist Health, etc., are not going to be received well if asking for a huge pay increase so they make the same as MDs. That is NEVER going to happen!
Also, not all MDs are making boatloads of money. There are MDs that make LESS than some NPs!
Urging NPs to demand pay parity with MDs is ridiculous (proportionate to billing rates) and doing most NPs a huge disservice.
I do not understand why some here are so disgruntled. NPs make excellent money! Far more than the average person. My goodness, they only need 2 years or less of graduate school to make up to $200K or more (based on location and specialty). That is a lot less effort than MDs or DOs have to put in to become a doctor.
I am grateful for what I have achieved. My life is far better than when I was a high tech executive. Yes, I'm making less than if I had stayed in tech, but I'm also way happier and healthier physically and mentally.
NPS ARE NOT THE EQUAL OF PHYSICIANS.
Here is how any NP here could make a boatload of money: go into sales and be great at it. No education required. An outstanding salesperson in any field can make $1 million per year or more. That is far more than most MDs. NPs certainly have the knowledge to be drug reps. Your earnings would be based solely on what you sell.
The other way to make a boatload of money: start your own successful business. No education required. Bill Gates didn't finish college. That is how people become billionaires.