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).
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.
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.
Specializes in Psychiatric and Mental Health NP (PMHNP).
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.
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.
Specializes in Psychiatric and Mental Health NP (PMHNP).
MentalKlarity said:
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.
I agree NPs should work on long-term action to improve the quality of NPs, which would mean doing what the AMA did, NO "for profit" medical schools, despite pressure to allow those. That means it would be harder for people to become NPs which would increase quality and decrease quantity. In addition, NP schools should be required to provide clinical placements and preceptors. NPs should also be required to have a 1 year residency, funded by a combination of private, local, state, and federal funding. We should also unionize.
However, in the here and now, NPs need a job. My focus is helping NPs in the here and now. In your own example, Susan is stuck b/c there are plenty of other NPs who will take the offer. That is why one NP at a time demanding much higher pay is not going to work.
Over and over, I have provided ways for NPs to make more $ right now. I am not going to repeat them.
No one so far has offered to start doing the long term things required to increase NP pay. Complaining here is not going to do anything. I'm old and tired and don't have the energy I used to. So instead of endless complaining about pay, how about someone stepping up and helping to lead efforts on the long term actions required? People here have agreed with what I laid out needs to happen, but those things take time and effort. We need some NP leaders.
What would be useful would be for some NP leaders to develop a game plan to improve NP quality and pay, then lead other NPs on what they can do to help. Similar to how FPA was successfully lobbied for and continues to be.
As for Susan, I'd say keep looking. She could also consider moving to an area where NPs are paid decently. That would create a shortage in crap pay states over time, which would gradually increase NP pay in those places.
From the media, one would think everyone was moving to TX and the southeast states because they are cheaper. They really aren't anymore. Housing prices in those areas have skyrocketed. In FL, home insurance has skyrocketed to ridiculous levels. People are paid crap there. So when one looks at affordability relative to income, those states are among the most unaffordable in the country. NPs can also vote with their feet and move.
Also, please stop misinterpreting me. I have never said NPs should just meekly accept crap pay. I have repeatedly provided advice on how NPs can increase their pay in the here and now, as well as the steps needed for NPs to increase their pay in the long run.
As a hiring manager, good organizations don't view NPs, or any other job candidates, as interchangeable widgets. If they do, don't work there. If I really want a candidate, I am willing to negotiate, within reason. If my budget allows me to pay an NP $150K to $180K per year, then that is the budget! I just will not be able to accommodate an NP that wants $200K per year, no matter how great they are.
That brings me to another point. Cash pay is not the only part of comp. In the paragraph above, if an NP candidate I really wanted came back and said they want $180K per year and additional PTO and CME time, then that is doable. That is a very valuable benefit. Or perhaps the NP says OK, I really like it here, so I'll negotiate $180K the first year, and then an increase to $200k the second year if I perform well. Negotiation is a powerful tool. If and organization refuses to negotiate, then look elsewhere!
Specializes in Psychiatric and Mental Health NP (PMHNP).
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.
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.
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.
Specializes in Psychiatric and Mental Health NP (PMHNP).
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.
Specializes in OR, Nursing Professional Development.
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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 $$?
PMHNP graduated Oct 2019 working in the Seattle area on pace to earn around 250K three days per week seeing patients. No benefits 1099. Also I work from home and see clients only through telemedicine. My SO has been a PMHNP since 2016 and sees Medicaid patients (mostly few Medicare and private pay) in Arizona and earns $85.00/hr no benefits 1099 also working from home.
Do FP NP make less than PMHNP's? On the whole I mean?
FullGlass, BSN, MSN, NP
2 Articles; 1,950 Posts
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.