Rural Midlevel Abuse

Specialties NP

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I'm sick of hearing and personally experience rural hospitals who are hiring PA and NPs to work in clinic and take hospital/ED call and bundling it all together. Administrators all think this is how it should be done, and NPs and PAs just accept it as the norm. Well, I'm here to tell you the norm is gonna have to change, and I'll form a rural NP/PA union if I have to.

I have seen these positions offered to PA/NPs for $75-$85K/yr to INCLUDE your call. DON'T DO THIS!!! You must realize that these hospitals pay $50-$100/hr round the clock for locum doc/pa/nps. So when they require you to do the common 2 days a week or one week per month, you are essentially volunteering all that time and getting woke up all through the night (and don't let them tell you you won't get called that much). Or at $50/hour and 2 days per week you are working in the clinic for FREE.

NPs and PAs now hear this: You are worth every bit of $75K/yr to work in the clinic alone to START. This should go up to $100k+/yr for clinic alone after you negotiate a productivity plan (you should get a fair amount of what you do.... somewhere around 1/3 of what you generate). Then, you also should get $40/hr for your call coverage if you are doing ANY call.

There are governmental cost-based reimbursement programs already in place to pay you this FAIR wage. If you are in this situation and are getting screwed, think about what I've said, and go to your docs/nps/pas that you work with and get them on the same page and go to admin and watch it fall on their deaf ears at first. But, if you play your cards right, you may just make it happen.

I work in an acute care hospital as a NP...it isn't easy and yeah, it is very stressful.

Get paid over 6 figures to do it, and that does not include the benefit package.

No weekends, no nights, no stat holidays

I wouldn't work in a clinic and take call/cover ER for 75,000/yr

I am amazed at how little the salaries are for NPs, even specialty NPs.

Seems as if only the NPs that do surgical procedures or do first assist

get anywhere near or over 6 figures.

An RN working selective OT can make 6 figures a yr...I know cause a colleague RN

told me that is what she made last yr.

:uhoh3:

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Specializes in Critical Care, Emergency, Education, Informatics.

I spent 6 yeas as a DON at one of those Critical Access Hospitals and my wife was employed as a PA in one. I hate to tell you this, but no one is making any money in a CAH. They are pretty much on a break even budget and some of what they can offer is based on a published pay scale, based on like pt population and your experience. I know for a fact the CRNA was making less than $100k. Of course to keep that in perspective I had a $250/month mortgage. Because the hospital was part of an alliance I have an idea what al lothers in that category were being payed, and it was comparable. The hospital only used local tenum when they had to at $100/hr on average.

Most people doing that kind of work are doing it for the lifestyle and not the money. Truly taking care of womb to tomb, is part of the attraction. Of course being on call 24/7 is a pain. People walking up to you in the grocery store and such.

As to opening your own practice in those communities. Well you better have lots of capital, it will be a long time before you break even. Remember the clinic down the street is a rural health clinic.

ANd again to keep it in perspective. I took a $15/hr cut in pay to move to rural KS from Baltimroe.

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Specializes in ER, critical care.
As a new grad I am sure that abusing the recruiters will get a lot of job offers. The way to get the proper pay is to go in armed with the average pay for the position. The other thing that you have to look at is the situation. If you are looking at a Critical Access Hospital or Rural health care situation then that may be reasonable. They may offer you 1/3 of your collections that may be much less than 57k per year. Also for rural physicians 57K is about 2/3 of what many of them make. There are some cases where rural providers do abuse NPP's, but a lot of these places are barely scraping by. Every dollar for salaries comes out of some other part of the budget whether it is nursing or supplies or electricity. This is why you frequently see rotating J-1 visas at these sites. The average NP new grad salary seems to be around $63-68k looking around. 57k for a new grad in a rural area is not far off from that.

My advice to any new grad is get a job. You have more negotiating power with a year or two under your belt. As long as the pay isn't awful and you are not asked to do anything illegal/unethical do what you need to do.

David Carpenter, PA-C

BS!!! There are jobs out there and if all of you (PAs included) would walk off laughing from those conversations, the salary will go up. Why, no supply increases demand. More demand equal more money. The just take any job mentality keeps the chains on for all involved. Went rural right out of school and laughed at 80K, they needed me more than I needed them and voila! a better offer appeared.

Some MLPs aren't even negotiating at all. An example of this was a girl I knew just took a job with a company that I also perform services for. She took the initial offer and I told them it wasn't even close to enough money for my services. I threw out a number even I thought was asurd and viola! I got the money.

The Little Clinic is one of those box clinics hailed as the second coming for NPs. But a little inside information would show you too that they hated having an NP in corporate and dissolved the position. They complained that we had the gall to try to negotiate our salary. I believe the quote was, "Just who do these nurses think they are."

The general public doesn't get it. The people recruiting and hiring dont get it. These people won't ever get it unless we show it to them.

I would go back to bedside nursing before I would work a second for less than 100K, with the only exception being if I was starting my own adventure. Which is on my list for the next year.

In short..... Just walk away. Next in line walk away. Just keep walking away until they get it.

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BS!!! There are jobs out there and if all of you (PAs included) would walk off laughing from those conversations, the salary will go up. Why, no supply increases demand. More demand equal more money. The just take any job mentality keeps the chains on for all involved. Went rural right out of school and laughed at 80K, they needed me more than I needed them and voila! a better offer appeared.

Some MLPs aren't even negotiating at all. An example of this was a girl I knew just took a job with a company that I also perform services for. She took the initial offer and I told them it wasn't even close to enough money for my services. I threw out a number even I thought was asurd and viola! I got the money.

The Little Clinic is one of those box clinics hailed as the second coming for NPs. But a little inside information would show you too that they hated having an NP in corporate and dissolved the position. They complained that we had the gall to try to negotiate our salary. I believe the quote was, "Just who do these nurses think they are."

The general public doesn't get it. The people recruiting and hiring dont get it. These people won't ever get it unless we show it to them.

I would go back to bedside nursing before I would work a second for less than 100K, with the only exception being if I was starting my own adventure. Which is on my list for the next year.

In short..... Just walk away. Next in line walk away. Just keep walking away until they get it.

That sounds good in theory, but some of us actually have to eat and pay our mortgage.

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Specializes in Critical Care, Emergency, Education, Informatics.
That sounds good in theory, but some of us actually have to eat and pay our mortgage.

Soem of the problem is the different definition of rural. It might be better to use the rural vs frontier descripter. In a rural place, you might be ablt to get 100k if that's what your looking for, in a frontier ( and htis is still mid america) 100k as a new grad is out ofhte question. There really isn't any money in the budget for that. When my wife and I went to rural KS I made almost asmuch as she did as the DON for the hospiital, But we bought a 2000 square foot house for 56k and she got 100% loan repayment. GOt a ton of experience. WHen people carry on about $$$ you have to realize that it is all a little relative. DIfferent people are looking for different things. If $$ is all you care about then yes, walk away, there will be another job out there. IF you looking for a safe place to raise your kids, live comfortably, then getting $56k starting out maybe be a good thing. Now I do agree about those Doc/NP/PA in a box places. milk as much money out of them as possible. :)

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Soem of the problem is the different definition of rural. It might be better to use the rural vs frontier descripter. In a rural place, you might be ablt to get 100k if that's what your looking for, in a frontier ( and htis is still mid america) 100k as a new grad is out ofhte question. There really isn't any money in the budget for that. When my wife and I went to rural KS I made almost asmuch as she did as the DON for the hospiital, But we bought a 2000 square foot house for 56k and she got 100% loan repayment. GOt a ton of experience. WHen people carry on about $$$ you have to realize that it is all a little relative. DIfferent people are looking for different things. If $$ is all you care about then yes, walk away, there will be another job out there. IF you looking for a safe place to raise your kids, live comfortably, then getting $56k starting out maybe be a good thing. Now I do agree about those Doc/NP/PA in a box places. milk as much money out of them as possible. :)

The real problem is that there is no way for an outsider to determine which places just don't have any money and which are using the NPP to milk the system and make as much money for themselves as possible. I would guess there are more of the former, but there are enough of the latter to make it a real problem.

David Carpenter, PA-C

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Specializes in ER, critical care.
That sounds good in theory, but some of us actually have to eat and pay our mortgage.

What were you eating before. You can make 75K at the bedside in the terribly paying Southeast. So at these pitiful low rates for NPs you can at least eat and pay the mortgage as well as you ever have if you just wait for the offer to go up. And when someone is really in need, the offers most certainly WILL go up.

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This forum is so real. I work in a rural health clinic. I am still officially a new grad. I graduated last May. I went to work for a rural clinic that offered $60K, which is a pay cut of what I was making as a RN. They promised me many things and sugar coated their actual plan for me. I went into the position like a kid in a candy factory and now I am truely bitter about the entire practitioner field. Thanks rural health for making my first year as a nurse practitioner a living disaster.:banghead: I am thinking about returning to nursing, at least I will get more money.

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I am amazed at how little the salaries are for NPs, even specialty NPs.

Seems as if only the NPs that do surgical procedures or do first assist

get anywhere near or over 6 figures.

What kinds of NPs do surgical procedures? I thought surgery was out of the scope of practice for nurses, except OR nurses/first assist.

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