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?

[Rnis, BSN, DNP, APRN, NP]

FullGlass said:

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.

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.  

[FullGlass, BSN, MSN, NP]

Ondeev said:

Interestingly, you've provided the answer to advocating for better pay industry wide. In a comment to your own article (https://allnurses.com/nurse-practitioners-new-grads-especially-t753937/) buried in the responses, you stated:

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]

Rnis said:

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.  

I am sorry you are feeling this way, it is understandable.  However, I have not seen any jobs that are advertising $100 per hour to new grad PMHNPs.  There may be some such jobs out there, but that is not the norm.  Also, are those perm jobs or contracting roles?

California has the highest pay of any state for PMHNPs and it is still rare to see jobs listed for $100 per hour or more.  There are some and more than previously, but it is still not the norm.

People on facebook groups can say what they want, but have any new grad PMHNPs received offers for $100 per hour or more?

I'll try to find the facebook groups you mentioned.  Here is a Reddit thread on this topic:

Actually, I am going to rescind an offer to a new grad PMHNP.  We have a telehealth practice with normal out-patient hours.  After spending a lot of time on multiple calls, texts, and emails with a new grad candidate, we made a very generous offer.  They came back and wanted to know if they would get a relocation stipend!  (It's telehealth).  Also, if they would get weekend and evening shift differential.  (Told the candidate multiple times our office hours and that we do not do evenings or weekends).  So, no gratitude for a good offer and questions that clearly indicate they were not listening to answers previously given or read emails/texts that answered questions.

As a hiring manager for many years, I will say that only about 5% of candidates are good.

[MentalKlarity, BSN, NP]

FullGlass -as a hiring manager I think you're a little biased. You keep saying "an NP who demands $200K will not be hired" - why is that? I will tell you why - because there is an NP willing to do it for less. The only reason NP salaries are not higher is simply because there are enough NPs willing to accept lower salaries that people like you can "rescind offers" or lowball pay because there will always be more fish in the sea. Do you know why MDs get paid higher salaries? Because NONE OF THEM are willing to be lowballed. Offer an MD $120K annually and see what happens. It is not done because hiring managers know that they will not find another MD willing to accept that. If MDs DID start to accept that, they would no longer be able to command higher salaries. Their profession, as a whole, has learned how to stay united in demanding certain lifestyle demands - they accomplish this by setting high salary expectations from the start, as a group, and limiting the number of graduates.

 

Here's a secret - if every NP in America did in fact demand a starting salary of $130K minimum - every hiring manager would have to meet that. A hiring manager on here telling NPs to "accept lower salaries" is really giving away the game.

[FullGlass, BSN, MSN, NP]

MentalKlarity said:

FullGlass -as a hiring manager I think you're a little biased. You keep saying "an NP who demands $200K will not be hired" - why is that?

I was referring to new grads.  No, they are not going to be hired for $200k per year, because they don't deserve it.  While there may be some paragons of new grad abilities, most new grad NPs need a lot of hand holding.  They have a lot to learn, are going to have to look stuff up, and are going to be asking a lot of questions.  New grads can't "hit the ground running" and it would be unreasonable to expect them to do so.  With all the talk of pay parity with MDs, a new grad NP is the equivalent of an MD intern, and interns make crap pay.

I am all for NPs making good money, but there appear to be some very unrealistic expectations on this forum.  The reality is that it takes time to increase one's pay, in most cases.  I have explained why at some length, repeatedly.

Let's go through it again.  Let's say Susan NP is making $100K per year in a state that pays poorly overall.  However, even in her state, it would be reasonable for her to make $120K per year.  Few employers would give her a 20% raise in one year.  Susan can certainly ask for that, especially if she is a good performer that has been with her employer for awhile.  She might get it, but she might not.  However, no harm in asking.  If, however, Susan were to go in and ask for $200K per year, she is not going to get it.  That's a 100% increase and very, very few employers would grant that, unless there is a dire shortage of NPs in the area.  

So what could Susan do?  She could look for another job - switching jobs is a good way to get a major pay increase.  She could continue to switch jobs every 2 years or so until she reaches a more satisfactory level.  People who switch jobs generally increase their pay faster than someone who stays put for many years.

If Susan is in a specialty that lends itself to telehealth, she could get licensed in the states that pay the most and get a job working for a practice in one of those states.  Or she could work for one of the telehealth platforms as a contractor and maximize her earnings that way.

If Susan is in an FPA state, she could open her own practice.

If Susan does not practice in a telehealth specialty, she could consider moving to a state that pays more or to an area in her own state that pays more.  Many doctors in the Western states will practice during the week in an area that pays well, then commute back home on weekends.

In the long run, if NPs keep leaving areas with bad pay, that will create a shortage, which should increase pay.

Some seem to think I am saying NPs should make a pittance.  I'm not.  I'm just saying to be realistic, while providing suggestions on what NPs can do now and also in the long run to improve earnings.

For all the talk about pay, it is also important to keep in mind that pay is one element of total comp.  Different people have different priorities.

Here are some scenarios:

1.  Jane is a PMHNP who is focused on maximizing her pay.  She signs up for telehealth platform as a contractor.  She works 5 days a week, 10 hours a day and makes $500k a year.

2.  Cathy is a PMHNP with 2 young children.  She would like a position where she can work from home and also work less than 40 hours per week, so she has more time with her children.  She also needs benefits.  She takes a telehealth PMHNP job in another state and makes $100 per hour.  Her job allows her to set her own hours and she works 32 hours per week, while still being eligible for benefits.  Her gross income is $166,400, but she is only working 32 hours per week.  It is important to recognize that most NP jobs require FT work and most perm jobs require 36 hours per week in order to get benefits, so Cathy has a good deal.

3.  John is an FNP that is near retirement age.  He really wants to be able to travel more and is looking for a job with a lot of PTO, that is relatively low stress.  He gets a job for a community college making $115K per year, but he has 6 weeks of PTO per year, plus 1 week for CME.  He also gets a 1 month Winter break.  During the Spring and fall semesters, he works 40 hours per week, but during the Summer semester he works a reduced schedule.  As a state employee, he gets excellent benefits, including a good retirement plan.  While his take home pay is lower, he now has the time he wants for more travel.  As a government employee, he also has great job security.

In general, more risk = more reward.  That is why a contractor gets a higher hourly rate than a perm employee.  That is also why government employees generally get paid less than the private sector.

Also, more benefits also tends to mean lower pay.  Benefits are a type of comp.

Everyone has different needs and priorities.

I am expressing my views.  People don't need to take my advice.  NPs are free to go demand from their employers huge pay increases.  No one is stopping them.

 

 

[MentalKlarity, BSN, NP]

FullGlass said:

I was referring to new grads.  No, they are not going to be hired for $200k per year, because they don't deserve it.  While there may be some paragons of new grad abilities, most new grad NPs need a lot of hand holding.  They have a lot to learn, are going to have to look stuff up, and are going to be asking a lot of questions.  New grads can't "hit the ground running" and it would be unreasonable to expect them to do so.  With all the talk of pay parity with MDs, a new grad NP is the equivalent of an MD intern, and interns make crap pay.

I am all for NPs making good money, but there appear to be some very unrealistic expectations on this forum.  The reality is that it takes time to increase one's pay, in most cases.  I have explained why at some length, repeatedly.

Let's go through it again.  Let's say Susan NP is making $100K per year in a state that pays poorly overall.  However, even in her state, it would be reasonable for her to make $120K per year.  Few employers would give her a 20% raise in one year.  Susan can certainly ask for that, especially if she is a good performer that has been with her employer for awhile.  She might get it, but she might not.  However, no harm in asking.  If, however, Susan were to go in and ask for $200K per year, she is not going to get it.  That's a 100% increase and very, very few employers would grant that, unless there is a dire shortage of NPs in the area.  

So what could Susan do?  She could look for another job - switching jobs is a good way to get a major pay increase.  She could continue to switch jobs every 2 years or so until she reaches a more satisfactory level.  People who switch jobs generally increase their pay faster than someone who stays put for many years.

If Susan is in a specialty that lends itself to telehealth, she could get licensed in the states that pay the most and get a job working for a practice in one of those states.  Or she could work for one of the telehealth platforms as a contractor and maximize her earnings that way.

If Susan is in an FPA state, she could open her own practice.

If Susan does not practice in a telehealth specialty, she could consider moving to a state that pays more or to an area in her own state that pays more.  Many doctors in the Western states will practice during the week in an area that pays well, then commute back home on weekends.

In the long run, if NPs keep leaving areas with bad pay, that will create a shortage, which should increase pay.

Some seem to think I am saying NPs should make a pittance.  I'm not.  I'm just saying to be realistic, while providing suggestions on what NPs can do now and also in the long run to improve earnings.

For all the talk about pay, it is also important to keep in mind that pay is one element of total comp.  Different people have different priorities.

Here are some scenarios:

1.  Jane is a PMHNP who is focused on maximizing her pay.  She signs up for telehealth platform as a contractor.  She works 5 days a week, 10 hours a day and makes $500k a year.

2.  Cathy is a PMHNP with 2 young children.  She would like a position where she can work from home and also work less than 40 hours per week, so she has more time with her children.  She also needs benefits.  She takes a telehealth PMHNP job in another state and makes $100 per hour.  Her job allows her to set her own hours and she works 32 hours per week, while still being eligible for benefits.  Her gross income is $166,400, but she is only working 32 hours per week.  It is important to recognize that most NP jobs require FT work and most perm jobs require 36 hours per week in order to get benefits, so Cathy has a good deal.

3.  John is an FNP that is near retirement age.  He really wants to be able to travel more and is looking for a job with a lot of PTO, that is relatively low stress.  He gets a job for a community college making $115K per year, but he has 6 weeks of PTO per year, plus 1 week for CME.  He also gets a 1 month Winter break.  During the Spring and fall semesters, he works 40 hours per week, but during the Summer semester he works a reduced schedule.  As a state employee, he gets excellent benefits, including a good retirement plan.  While his take home pay is lower, he now has the time he wants for more travel.  As a government employee, he also has great job security.

In general, more risk = more reward.  That is why a contractor gets a higher hourly rate than a perm employee.  That is also why government employees generally get paid less than the private sector.

Also, more benefits also tends to mean lower pay.  Benefits are a type of comp.

Everyone has different needs and priorities.

I am expressing my views.  People don't need to take my advice.  NPs are free to go demand from their employers huge pay increases.  No one is stopping them.

 

 

Thank you for the detailed response. Again, I will give you two scenarios:

1. Susan is offered $100K with no vacation and a 50 hour work week. She declines - the clinic says fine and hires a Walden grad willing to work that job with no negotiation. Susan spends another 6 months looking for someone willing to pay her a fair wage.

2. Susan is offered the same job, but says no that is ridiculous. The employer tries to find someone else but because the for-profit schools no longer exist pumping out 15,000 new grads a year and NPs have banded together demanding to be paid fair wages because they DO NOT listen to advice on this board from hiring managers saying they are not worth it, the employer has no replacement. He comes back to Susan and offers her $145K, 6 weeks PTO, and a 36 hour work week.

 

I want a world where number 2 is the norm. We are falling into a world where number 1 is our future because of a combination of oversupply and people who naysay and attack NPs that demand all of us, as a group, demand better wages and that we should be paid a rate close to what MDs make, minus the difference in reimbursement. Attacking the profession as a whole and being the epitome of a "pick me!" nurse is not helping anyone except those who wants to line the pockets of medical facilities at the expense of NPs.

[FullGlass, BSN, MSN, NP]

MentalKlarity said:

Attacking the profession as a whole and being the epitome of a "pick me!" nurse is not helping anyone except those who wants to line the pockets of medical facilities at the expense of NPs.

1.  I have never attacked the NP profession as a whole.  Please explain how you arrived at this conclusion

2.  "Being the epitome of a 'pick me' nurse" - what do you mean by that?  I do not understand.

3.  No helping anyone - I give practical advice for NPs that need a job in the here and now and also want to make decent $.  My posts are not geared to the long term actions needed to increase overall NP pay, as I have repeatedly explained.

4.  You clearly have strong feelings on NP pay - why not become a leader and come up with a plan for long term action?  Then you could tell the rest of us how we can help.  In the meantime, though, most NPs here who need a job do not have the luxury of waiting a long time to get the perfect job with super high pay.  They need to get a reasonable job quickly.  

[MentalKlarity, BSN, NP]

To all NPs reading this, just ignore the noise and push for the highest salary you can. If we all refuse to settle for peanuts and getting taken advantage of, salaries will go up for everyone. Everytime an NP "settles" for low pay, crappy PTO, no benefits, or crazy hours just because they need to "hurry and get a job" - we all lose. 

[djmatte, ADN, MSN, RN, NP]

MentalKlarity said:

To all NPs reading this, just ignore the noise and push for the highest salary you can. If we all refuse to settle for peanuts and getting taken advantage of, salaries will go up for everyone. Everytime an NP "settles" for low pay, crappy PTO, no benefits, or crazy hours just because they need to "hurry and get a job" - we all lose. 

Keep on pushing for better. My first company offered me 10k less than my asking and 5 days less in PTO.  they met my negotiation easily.  God knows what the women were lowballed in a clinic run by men who gave our female mid levels zero respect in my tenure there.  I learned from experience my real value in billing and think more nurses here need to know and understand how they fit in. They are REVENUE GENERATORS and if billing correctly can easily meet or exceeded the salary/charges of a lot of physicians in gross charges.  
 

We. Are. Supplementing. Politician. Incomes. Period. This is not right. We should have an equal stake in the company in terms of charges and they appropriate percentage. if a physician is getting reimbursed $65 per RV, we should be reimbursed $55. That's in wine with the appropriate reimbursement value per the insurance companies that reimburse us. 85% of a physician charge is what we're valued at. We should be receiving 85% of what what they make on a like by like, caseload by caseload, and complexity by complexity basis.

[FullGlass, BSN, MSN, NP]

MentalKlarity said:

Everytime an NP "settles" for low pay, crappy PTO, no benefits, or crazy hours just because they need to "hurry and get a job" - we all lose. 

That is not helpful.  Most NPs who need a job need to find one within a reasonable period of time.  While I agree NPs shouldn't "settle," you aren't providing any practical advice.  In addition, the definition of "low pay" is not settled - different NPs will have a different idea of this.  You told me I was not paid enough, and I make $100 per hour as an employee.

In a nutshell, what irks me about your (and a few others') advocacy for much higher pay for NPs is that it is about the collective losing when an individual makes a decision.  That is a very elitist attitude.  If an NP needs a job quickly, and they have a family to support, they will take the first decent job they can get.  That is not the end of the world and it is the correct decision in the moment.  It is always easier to find a job when someone already has a job.  If an NP has to take a less-than-ideal job quickly, fine, they can continue to search for a better job.

It's interesting that when I challenged you to take on a leadership role in improving NP pay, you responded with an exhortation that will accomplish nothing.  It's easy to make grand pronouncements, but not so easy to cause real change.

I continue to look forward to leadership from you in taking the long-term actions needed, like forming an NP union.  There are many here, including me, that would be happy to help out.  Please keep us apprised of your progress.

[Rose_Queen, BSN, MSN, RN]

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[jnb1740, BSN]

MikeFNPC said:

Primary care, 40 hours, 150k after bonus, 5k CME, 150 hours PTO not including about 8 holidays, 5 yrs experience, Texas. Lots of opportunities for OT, but would rather spend time with the family.  

Wow, 180K after 2 yrs as an NP in Upstate NY.  Looks like you work 10hrs/day + some call.  What % of your last yrs income was call $$?