NP Salary/Pay Let's Be Transparent

Specialties NP Nursing Q/A

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?

Specializes in Psychiatry.
FullGlass said:

You have made many posts about earnings and telling other NPs they are not making enough.  Please share information on your employment situation and how much you make.

Psychiatry, a 75-25 split with my employer, which works out to be about $250-$300 per hour on average. 6 weeks paid vacation (paid at $200 an hour) and additional 4 weeks unpaid vacation. 

Specializes in Psychiatric and Mental Health NP (PMHNP).
djmatte said:

I'm not advocating for equal pay. I'm advocating for pay based on presumed value of the education level. If the reimbursement rates were the same then I would absolutely be advocating for equal pay. But even at 85% reimbursement, we're being paid 1/3 or less of the MD salary. We. Are. Being. Exploited. 

I agree some NPs are being exploited, but not all of them.  Honestly, I am paid very well.  After 3 years as a PMHNP, I'm making $100 per hour.  If I worked FT, that would be $208,000 per year.  That's good money, more than some doctors make, in fact.  Also, consider that a psychiatrist 3 years out of med school would be a resident making about $70K per year.  Right now, if I wanted to, even though I have not yet qualified for FPA in Calif, I could register with one of those online telehealth platforms that provide back office functions and funnel clients to PMHNPs, like Headway, etc., I could make $200K to $350K per year.  That is well in line with what most psychiatrists make who are employees.  A PMHNP posted somewhere on here recently that she did just that and worked 10 hours a day, 5 days a week, and cleared $500K in one year!  Once California NPs have FPA and can set up their own practice, they can charge what they want!

MentalKlarity posted they negotiated a very good deal with their employer and how they did it.  I forget the specifics, but it is a lot more than what I make.

I think an NP who is a good performer and has some solid experience can do these things.

Unfortunately, in parts of the country like the Southeast, NP pay is horrible and I don't know what they can do about that.  Although pay in the Southeast is bad across the board.  I read recently that Florida is now the most expensive state to live in when what people are paid is taken into account, because they are paid so poorly and the cost of living has skyrocketed there.

Also, doctors are not making as much as some on this board think.  In this post from KevinMD today, this pediatrician was only making $170K per year.  A lot of NPs make as much, or more, than that.  They provided some good tips on how to increase one's salary that NPs can use, too:

https://www.kevinmd.com/2023/09/unlocking-your-full-earning-potential-a-physicians-journey-to-a-70000-salary-boost.html

Also, for some perspective, as a PMHNP with 3 years of PMHNP experience, I still do not have as much experience as a psychiatrist still in their residency.  A new PMHNP has 600? (something like that) of clinical hours.  If they are lucky, they went through 1 year NP residency, but those are rare.  A "new" psychiatrist has the greater clinical hours in med school, plus 4-5 years of internship/residency and then usually 1-2 years of fellowship.  So right out of the gate, the new MD psychiatrist has 6-8 years more experience than a new grad PMHNP.  And those are very intensive years of experience.  Their education is also far more intensive than PMHNP education.  Just pick up a copy of one of their board review manuals if you don't believe me.

Even in the military, and I believe you are now in the military, doctors make more than NPs and PAs.  

https://www.thepalife.com/pa-vs-md-the-life-and-salary-of-a-military-trained-physician/

So, in summary, I agree some NPs are being financially exploited.  There have good tips on this board for those NPs to increase their pay.  Some of them may simply have to move to a state which pays NPs well, unfortunately.

However, I don't agree that NPs are subsidizing MD pay, at least in my experience.  In my practice, the med mgt providers are subsidizing talk therapist pay somewhat, and I am OK with that.  Also, MDs are not all making boatloads of money.

Finally, I just don't agree that NPs should make the same as MDs.  We don't have the same level of education and training.  It isn't feasible anyway, because the MDs would howl and cry so much - you can imagine.  It would also drive MDs out of certain specialties like psych.  The med students would choose specialties where MDs are guaranteed higher pay, like those in which they can perform various procedures that NPs can't.  At least in CA, we already have a shortage of primary care MDs and psychiatrists.

Personally, I'd like to see a path for NPs to become MDs in an accelerated manner, especially in specialties like primary care and psych that aren't that attractive to med students, anyway, and where there is an MD shortage.

If anyone is looking for an NP job in psych, PM me.

 

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).
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!

There are infinite threads on wages and benefits which always seem to evolve into location wars. This will not be beneficial to use as a bargaining tool as pay is not consistent across the board due to the cost of living, saturation, and location. It's a good premise, but there are too many moving variables to get a concise, consistent range of wages.

I'm not a NP, but will be there some day.  I appreciate this post.

4 days a week 115k a year as a new grad!?!! 
most will say that's a good gig 

I mean Great  gig

I do not see any recent post specifically about NP salaries. Anyone can share they’re compensation packages from any state region and we can compare to those in our areas. I haven’t seen any NPs post salaries in my area, hence why I made this post. 

I am not a new grad any longer. I am 3.5 years practicing with this compensation in a Houston suburb. I believe it’s comparable to others in Houston, but I’m certain. I’m originally from San Francisco where NPs are payed significantly higher and cost of living is also significantly higher. 
 

Thanks for sharing

I'm not trying to be facetious. There was a post about this not too long ago and it turned into a location war and people posted salaries. You can do a search of salaries on AN and threads would come up. However, you're more than welcome to keep going in this thread. I just don't see many people posting in it because we've already seen this several times.

Specializes in Psych/Mental Health.
On 9/26/2020 at 9:15 AM, SurgicalNP said:

I do not see any recent post specifically about NP salaries. Anyone can share they’re compensation packages from any state region and we can compare to those in our areas. I haven’t seen any NPs post salaries in my area, hence why I made this post. 

I am not a new grad any longer. I am 3.5 years practicing with this compensation in a Houston suburb. I believe it’s comparable to others in Houston, but I’m certain. I’m originally from San Francisco where NPs are payed significantly higher and cost of living is also significantly higher. 

Thanks for sharing

A recent Reddit post might have some information that you're looking for:

Specializes in psych/medical-surgical.

As someone pointed out, there are a lot of factors that come into play and there are a lot of threads about this here already. Location is huge.

It's way more complex than most of what you see here though; in independent practice, you can negotiate everything. For instance, as a PLLC you can negotiate reimbursement rates. If you have a good relationship with a physician, you don't have to pay that much. You can also choose certain insurances after you build clients that pay more... etc.

TLDR; depending on how hard you advocate for yourself, your salary will be way off the average. I don't know if this applies in something like primary care as there are obvious differences.

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