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).
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 truly appreciate you for starting this important discussion. You have made me do a lot of thinking and research.
A lot of NPs are undoubtedly underpaid. At least in the Western U.S., I am seeing pay going up across the board, due the shortage of providers, including in primary care. In fact, I am seeing primary care compensation going up the fastest, as there is a dire shortage of PCPs.
What is interesting, is that the same is not true of mental health. California has a terrible shortage of mental health care providers. PMHNP pay used to be significantly higher than for PCPs, but that is no longer the case. One would think that due to supply and demand, mental health care pay would be increasing a lot, but it isn't. The only way for PMHNPs to make a lot more money is to essentially open their own practice by signing up for platforms will provide the billing services, along with some referrals.
I also remembered that PMHNPs and psychiatrists may be subsidizing the pay of talk therapists. The talk therapy shortage is far worse than for med mgt, at least in California. My experience has been working in FQHCs and practices that provide both med mgt and talk therapy. The problem is that insurance companies pay really poorly for talk therapy, so most talk therapists have private practices that are cash pay only. In organizations like mine, the med mgt providers are providing subsidies to increase talk therapy pay so the organization can attract therapists to work for them. I'm OK with some of this, as I have a personal commitment to working with underserved populations. Those populations can't afford to pay cash for talk therapy or any other health services. In the long run, PMHNPs and psychiatrists should be advocating for increased insurance reimbursement for talk therapists.
As a management consulting executive, I ran my own practice, and our target profit margin was around 30-40%, for gross margin. That's before expenses, which were considerable. A health organization also needs to have some savings for unexpected events and downturns.
Personally, I think that once NPs in California have FPA, we should be getting insurance reimbursements that are equal to MDs' if the NP is truly practicing independently and does not require MD supervision. I believe this is the case in Oregon.
At this point in time, I am happy where I am. I just got a raise to $100 per hour with 18 days vacation, 5 days sick time, and 5 days CME time. That's almost 30 days per year paid time off total. I don't need to worry about getting patients or billing. In addition, my current employer is very flexible, so I can work as little as 8 hours per week or all the way up to 40 hours per week - it is up to me. That flexibility is very important to me right now. I have gone through the wringer personally in the past several years and just don't have the mental and emotional energy to do what would be needed to make a boatload of money by going a more independent practice route via 1099. I've been practicing solely in mental health for about 3 years now and want to focus on building my expertise as a PMHNP. In a few years, I plan to open my own practice. Finally, I won a HRSA scholarship and my current employer qualifies to fulfill the public service obligation.
So, I suggest PMHNPs consider what things are most important to them. For example, a job like mine would be ideal for a parent who wants more time with their child(ren), or someone who is pursuing further education, so they can work part-time and still get benefits.. It would not be the best choice for someone who wants to max out their income. PMHNPs that won a HRSA scholarship or who want to pursue state or federal student loan repayment will also have employment constraints for a few years.
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.
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 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!
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 Physical Medicine & Rehabilitation.
About to approach my first year as a "working NP." Started my first job earlier in 2023 doing contract work doing annual wellness visits, in home ($125) and tele ($90). I was too excited at first, but after a few weeks starting, I realized my covering area had little patients under the insurances we were with. Stuck it out (didn't really make much money since patient census was ungodly low) until my contracting company received a contract with the VA to do medical exams for their disabilities benefits program. It was was $100 per hour (2 patients at most per hour) and this became my full time gig until, well, there was some sort of nationwide system error in August/September that messed up their whole system and nearly wiped out scheduling and appointments. Basically held on the last few months holding out primarily on the VA gig to go back to a normal full time scheduling. After waiting until mid December, I realized that I can't just sit around forever.
I was just recently was offered and accepted a position as an Physical Medicine & Rehabilitation (PM&R) provider for a sizeable, MD owned PM&R company to see patients at one to two SNFs. They offered $128k/year, full benefits, and $1500 per year for CME. Since I was considered a new grad, I did not mind at all as I literally had no experience except doing physical exams for the VA and the annual wellness visits. Included was a paid 4-8 week training (shorter or longer depending on my needs) which including precepting/shadowing different physicians and providers including the CEO in addition to learning from videos/lectures and reading material.
While this process was going on, the VA gig started to pick up so I had started to schedule myself for Saturdays (and hopefully Fridays too in the future) for 7 hours every week which on paper ends up being an addition 33k/year.
Just sharing my insight, I think Nurse Practitioners (NPs) don't even make enough compared to nurses, but I guess it's because they have less bedside load. I have been working as a Pediatric Intensive Care Unit (PICU) nurse for 20 years and I am now a new PNP with experience in both acute and primary care. As a PICU nurse (MD) in a big hospital, my base pay is $49 per hour plus a 10% night differential, a $4 location benefit, and a 15% weekend differential. I also get 40 hours of vacation time and 5 days of sick leave. If I do overtime, I get paid 1.5 times my regular rate and I may also receive a bonus for the shift, like $200.
Now, as an NP, I have given three interviews and have received nearly the same offer from each.
1. If I work in the same hospital's outpatient department, my pay will be $52 per hour, with no differential or location allowance. I will receive $1000 for Continuing Medical Education (CME), one-time DEA and CDS. Other benefits will be the same as every staff member in the organization, such as discounted medical insurance and vacation and sick leave. I will work for 30 hours.
2. Another hospital ,If I work as a Peds Inpatient ICU NP, I will earn a flat rate of $62 per hour with no benefits. I will only work for 12-hour shifts but only one shift at a time. I guess this may be a start, but I was hoping for better, as being an NP would be a serious hit in pay.
Please don't keep your hopes high, as the pay for new NP in MD is around $50-60 per hour.
Specializes in Psychiatric and Mental Health NP (PMHNP).
gcupid said:
I'm sorry but this is horrible.
$50-60 per hour is about $100-120K per year if FT. That is not bad for a brand new NP. Pay will go up with experience.
Unfortunately, pediatrics tends to be a poorly paid specialty, even for MDs.
This highlights the importance of doing research on pay per NP specialty when deciding whether or not to become an NP. Also, new grad NPs with RN experience may take a pay cut or only make a little more at first because they are starting a brand new career.
FullGlass, BSN, MSN, NP
2 Articles; 1,950 Posts
I truly appreciate you for starting this important discussion. You have made me do a lot of thinking and research.
A lot of NPs are undoubtedly underpaid. At least in the Western U.S., I am seeing pay going up across the board, due the shortage of providers, including in primary care. In fact, I am seeing primary care compensation going up the fastest, as there is a dire shortage of PCPs.
What is interesting, is that the same is not true of mental health. California has a terrible shortage of mental health care providers. PMHNP pay used to be significantly higher than for PCPs, but that is no longer the case. One would think that due to supply and demand, mental health care pay would be increasing a lot, but it isn't. The only way for PMHNPs to make a lot more money is to essentially open their own practice by signing up for platforms will provide the billing services, along with some referrals.
I also remembered that PMHNPs and psychiatrists may be subsidizing the pay of talk therapists. The talk therapy shortage is far worse than for med mgt, at least in California. My experience has been working in FQHCs and practices that provide both med mgt and talk therapy. The problem is that insurance companies pay really poorly for talk therapy, so most talk therapists have private practices that are cash pay only. In organizations like mine, the med mgt providers are providing subsidies to increase talk therapy pay so the organization can attract therapists to work for them. I'm OK with some of this, as I have a personal commitment to working with underserved populations. Those populations can't afford to pay cash for talk therapy or any other health services. In the long run, PMHNPs and psychiatrists should be advocating for increased insurance reimbursement for talk therapists.
As a management consulting executive, I ran my own practice, and our target profit margin was around 30-40%, for gross margin. That's before expenses, which were considerable. A health organization also needs to have some savings for unexpected events and downturns.
Personally, I think that once NPs in California have FPA, we should be getting insurance reimbursements that are equal to MDs' if the NP is truly practicing independently and does not require MD supervision. I believe this is the case in Oregon.
At this point in time, I am happy where I am. I just got a raise to $100 per hour with 18 days vacation, 5 days sick time, and 5 days CME time. That's almost 30 days per year paid time off total. I don't need to worry about getting patients or billing. In addition, my current employer is very flexible, so I can work as little as 8 hours per week or all the way up to 40 hours per week - it is up to me. That flexibility is very important to me right now. I have gone through the wringer personally in the past several years and just don't have the mental and emotional energy to do what would be needed to make a boatload of money by going a more independent practice route via 1099. I've been practicing solely in mental health for about 3 years now and want to focus on building my expertise as a PMHNP. In a few years, I plan to open my own practice. Finally, I won a HRSA scholarship and my current employer qualifies to fulfill the public service obligation.
So, I suggest PMHNPs consider what things are most important to them. For example, a job like mine would be ideal for a parent who wants more time with their child(ren), or someone who is pursuing further education, so they can work part-time and still get benefits.. It would not be the best choice for someone who wants to max out their income. PMHNPs that won a HRSA scholarship or who want to pursue state or federal student loan repayment will also have employment constraints for a few years.
Again, MentalKlarity, my thanks to you.