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?

[OncNP]

Heme/Onc NP with 8 years experience, was my first job out of NP school. I am in Upstate NY, private practice. 

I see 18-22 patients per day, 4.5 days per week. Call is 1:6. 

Salary is $103,000; no CME money. 24 days PTO. 6 paid holidays. No weekends other than call, and half day Fridays. 3% match 401k, about $1500 put into a pension each year, and $3000 profit sharing in a retirement in fund each year. Calls are first call only, don't have to go in, $1000 per weekend. 

PPD is significantly higher than in other oncology practices from what I hear, pay is lower.  Salary is significantly lower compared to other mid levels in community that work for local hospital system and are on productivity. 

[K.M.Lue]

Hospital Medicine Night NP (7P-7A) in Omaha NE 

6-12 admits nightly, 90 patient cross coverage list. Respond to all RRTs. No additional HMS provider or MD in house. 

Contracted salary. 130,000 annually with 20% bonus = 150,000 

CME 2,500. 

Create schedule with other night NPs in groups location. 12 shifts/month. 

[Tegridy]

K.M.Lue said:

Hospital Medicine Night NP (7P-7A) in Omaha NE 

6-12 admits nightly, 90 patient cross coverage list. Respond to all RRTs. No additional HMS provider or MD in house. 

Contracted salary. 130,000 annually with 20% bonus = 150,000 

CME 2,500. 

Create schedule with other night NPs in groups location. 12 shifts/month. 

Similar to the job I did in south east a while back

12 admit per night ish

cc for 40-100 usually 60-90

no doc

7/7 nights 6 to 6

Respond to whatever the hospital called rapids and codes

open ICU

125 but for doing this we had a side gig thru same employer as a treat for a few hours per week for med consults in psych center bringing up to 165 ish

Also took call for a nursing home and clinic but maybe got one call per week so not as bad as it sounds (at night only)

Free health insurance that covered almost everything

401k w match

[JBMmom, MSN, NP]

NP with almost one year experience in the ICU.

13 shifts per month, 12 hours

$116K plus $18K annual critical care bonus

Awesome benefits with free tuition for myself (not that I EVER plan to go back to school) and tuition waiver if my two kids attend state university. 

[Sun1]

28 minutes ago, ZyzzFan said:

I use Headway and Alma to bill insurance. It makes it easier to run everything since I do everything myself including phone calls, emails, prior auths, etc.  They let me bill Cigna, Aetna, United, Optum.

In my area there is a huge deficit of providers, so it has been very easy to fill my roster.  

This is great! What rate are they allowing you to bill at? 85% or more compared to the physician's rate? How many patients do you see on an average daily, and what kinds of treatment options are you offering?

[Mergirlc, MSN, APRN, NP]

Fnpyeayouknowme said:

I'm in rural PA. Brand new grad in a FQHC. $102,000. 40 hours a week. 4 weeks PTO, 1 week CME PTO. Full benefits. CME is only $1200 but increases every year until $4000 I think.

Thank you for this!!  I'm considering PA and this is really helpful information.  Much appreciated!

[nalie2, ADN, BSN, MSN, RN, NP]

Primary Care FQHC in Los Angeles. Average 21 patients per day. Full time. 4 weeks PTO plus 1 week CME, $3k CME, 4% 403b match, low cost health benefits. $160k

[Alicia777, MSN, NP]

NP219 said:

Question for the NPs that take call. Do you guys just have a base call pay or call pay plus extra when you actually have to go in? And if so, how much?

I'm a sub-surgical specialties NP inpatient. We get paid a measly $20/hour (this is weekends only 7a-7p) but if we get called in or have to go in assist with a case or even to round, we get 4 hours. If we get called in again later for a new consult for instance, another 4 hours. 

[rnBSN223]

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) 

[FullGlass, BSN, MSN, NP]

MentalKlarity said:

Seems low for California unless you're seeing only 1 patient per hour or it's a community health clinic?

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.

[FullGlass, BSN, MSN, NP]

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.

No, pay is set by the market, like it or not.  If you know of a bunch of PMHNPs making $95 per hour as an employee for seeing one patient per hour, please share that information with us and the source.  If the market rate for a PMHNP employee is $150K per year, then that is what most employed PMHNPs are going to make.  (I'm not talking about self-employed or contractor NPs).  

An individual NP can try to negotiate increased pay with their employer or they can decide to set up their own practice or become a contractor.  

The pay range I am seeing, and I am in California, which is the highest-paying state for NPs, is $150K to $200K per year for PMHNPs who are employees.  Benefits are worth money, too.

For independent contractor PMHNPs, I am seeing $90 to $240 per hour, depending on the insurer, type of work, etc.

The norm for all psych providers now, including MDs, is 15 to 20 minutes for a follow up appointment, and 40-50 minutes for a new patient intake.

The average salary for a PMHNP in Calif is $160K per year.  That seems kind of low to me, but a lot of places do not pay well.  Also, a lot of mental health providers work part-time, which would pull the average down.

https://www.indeed.com/career/psychiatric mental-health-nurse-practitioner/salaries/CA

Frankly, I see a lot of PMHNPs who provide poor quality care.  Earnings should also reflect an employee's competence and value contributed to the workplace.  PMHNPs are not all created equal.  Unfortunately, all too many NPs seem to be choosing psych because they think they will make more money and it is "easy."  

As far as money, I am seeing incredibly good pay and benefits being offered to FNPs in states like California and Washington.  One FQHC here is trying to recruit FNPs and is offering salary based on experience, $75K sign on bonus, $75K mortgage subsidy, paid health insurance for employee, and is eligible for loan repayment.  

Even most psychiatrists do not make huge bucks.  The average psychiatrist salary in California is $236K per year.  Even in cities like San Francisco, it's not a huge amount:  $308K per year.  

A PMHNP is NOT worth as much as an MD.  I have yet to meet a PMHNP with the level of knowledge and expertise of a psychiatrist.

Frankly, NPs in California are paid VERY well for the level of their education and training.  Within a few years, many will have the option to set up their own practices, if that is what they want.  

The number of private medical practices in this country is declining rapidly.  MDs can make more money with their own practice, but they simply do not want the hassle.  It is not easy to have one's own business.  Yes, for those who can do it, they can make a lot more money, but it is also a lot more work.  

"In the past 10 years, there has been a dramatic shift in physician practice ownership as less than half of doctors now work in private practices, according to a new analysis . . . 

Four of five physicians flagged the need to better negotiate favorable payment rates with payers as a very important or important reason in the decision to sell their practice to a hospital or health system, the analysis found.

Doctors who participated in the survey also highlighted the need to improve access to costly resources and the need to better manage payers' regulatory and administrative requirements. Each was flagged by about 70% of physicians as a very important or important reason.

The AMA's biennial analysis of physician practice arrangements found that economic, administrative and regulatory burdens have driven physicians to shift traditional business models for medical practices."

https://www.fiercehealthcare.com/providers/docs-shift-larger-hospital-owned-practices-have-more-negotiation-power-payers-ama#:~:text=In the past 10 years,from 60.1% to 46.7%.

 

[FullGlass, BSN, MSN, NP]

MentalKlarity said:

Of course! And yet my employer is still making a profit off of my services. Think about that when saying NP salaries should be close to the norm. The norm exists because so many people are bad negotiators.

The only benefit of seeing all these low salaries is that I know when I open my own practice an hire NPs one day I will make a fortune as they will be happy making 10~30% of their collections. 

I'm glad you were able to come to agreement with your employer on a good compensation package.  However, not all employers would agree to this.  In addition, different employers are going to have different profit margins and overhead expenses.  For example, a mental health telehealth organization will have lower overhead than a bricks and mortar practice.  Therefore, I would caution readers of your posts not to run out and determine similar comp packages from their employers without a lot more information and an honest appraisal of their own worth to the practice.  In addition, experienced PMHNPs requiring little supervision are the ones in a position to demand better compensation.  New grads that need a lot of supervision and correction are not.  

I've seen bad PMHNPs operate and the impact of their poor practice on an organization.  It takes a lot of time and supervision to try and help them, but many stubbornly refuse to change.  This can also result in patients leaving the practice or demanding to switch to a different provider.  It can also result in patients refusing to pay for an appointment, because the provider did nothing or refused to simply refill an existing prescription.  Insurance companies can also start refusing reimbursement for poor quality service.

Finally, if a PMHNP is working for a large bureaucratic organization like Kaiser, they are not going to be able to get this type of comp.  These organizations are not flexible in that way.  Even a private practice may have difficulty with this, as then all the providers are going to want this type of comp which could cause other issues.  

I'm also not sure I agree with your numbers.  Perhaps you have access to your practice's financial records and can 100% accurately make calculations, but most of us do not.  

For simplicity, I am going to assume a private practice that only takes cash and also has a physical office.

Overhead:

Office expense (this can be considerable, depending on location)

Medical assistant(s)

Utilities - power, telehealth

EHR costs, also will need occasional tech support

Miscellaneous

Cost of paying employee for vacation, sick time, CME, tuition reimbursement for things like getting a DNP

Cost of employee benefits like health insurance

Sunk cost of building a practice that enables employer to hire a PMHNP

Administrative/supervisory time

Costs involved in hiring and training new PMHNP.  Most new PMHNPs are not billing a lot right off the bat.  They need time to get up to speed and build up their patient panel.  

If the practice takes insurance, then billing staff or a service that does this will be required.  There can also be a lot of time and hassle involved in dealing with insurance hassles and denials.

Currently, I work for a standard practice that accepts insurance.  Insurance reimbursement varies widely by payor.  My practice has a lot of Medicare and Medicaid patients, and that pays less, especially Medicaid. 

While I was in NP school, during one of my clinical rotations, my MD preceptor, who owned his own practice, shared a lot of his financials with me, due to my prior business background.  He was losing money!  His goal was to sell his practice to a larger entity, which he eventually did.  So don't assume all practices are making a huge profit.