Until recently, I assumed the most lucrative NP specialty is PMHNP. However, now that I am job-hunting, it appears that Interventional Pain Mgt is also a very lucrative specialty. I'm in California, a little over 1 year experience, and was offered a job making $150K in Year 1 and $160K in Year 2 in Interventional Pain Mgt. There is another doctor advertising an Interventional Pain Mgt fellowship for NPs that is identical to the one offered MD residents - Year 1 and 2 pay aren't great, but the pay goes up to $270K per year in Year 3, after fellowship is finished.
Just wondered what others NPs thoughts and experiences are on the most lucrative NP specialties.
Specializes in mental health / psychiatic nursing.
On 8/26/2019 at 10:48 AM, FullGlass said:
No, it is Interventional Pain Mgt - procedures are the most lucrative part of pain mgt. Year 1 and 2 are not great pay because that is the fellowship portion. The job is in Fresno, you can search for it. Year 1 $72K, Year 2 $90K, then fellowship is done and pay goes up to $250K+, I assume based on some sort of productivity metric. Interventional Pain Mgt is not about meds, it is about procedures. Dispensing meds is not very profitable for doctors.
I would still be very hesitant. Are you sure this is NP salary and not MD? Also - what are the hours they are requiring one to work for that salary? How many patients and what kinds of procedures? If a salary seems way outside of what one would expect you need to ask why - either they can't hire anyone at all and are using high salary as incentive (in which case - why can't they hire anyone) or they have insanely high productivity and/or hour requirements.
If they are starting with low pay in year 1 and year 2 I would also question who actually makes it to year 3 and the high pay - are they consistently bringing in new providers at low wages and then firing them or working them so hard they resign before year 3?
I would still be very hesitant. Are you sure this is NP salary and not MD? Also - what are the hours they are requiring one to work for that salary? How many patients and what kinds of procedures? If a salary seems way outside of what one would expect you need to ask why - either they can't hire anyone at all and are using high salary as incentive (in which case - why can't they hire anyone) or they have insanely high productivity and/or hour requirements.
If they are starting with low pay in year 1 and year 2 I would also question who actually makes it to year 3 and the high pay - are they consistently bringing in new providers at low wages and then firing them or working them so hard they resign before year 3?
Bingo.
My ex's group did this rountinely. Hired on fellows or "junior partners" at 1/5th the salary of a "full partner" (there was no buy in or anything like that. just a fancy name) He had to work 3 years as a "junior partner" and then they mysteriously let him go. Just not fitting in. Just not working out. Took them 3 years to figure it out.
He was used as the work and call donkey. Weekends, call, overnights. Bahloney. If it's this kind of pay---which, by the way, my ex made $190K as a PHYSICIAN doing this type of scam--an NP isn't gonna make $300K after 3 years. My ex's specialty is one of the top 3 highest paid physicians in a hospital.
My ex's group did this rountinely. Hired on fellows or "junior partners" at 1/5th the salary of a "full partner" (there was no buy in or anything like that. just a fancy name) He had to work 3 years as a "junior partner" and then they mysteriously let him go. Just not fitting in. Just not working out. Took them 3 years to figure it out.
He was used as the work and call donkey. Weekends, call, overnights. Bahloney. If it's this kind of pay---which, by the way, my ex made $190K as a PHYSICIAN doing this type of scam--an NP isn't gonna make $300K after 3 years. My ex's specialty is one of the top 3 highest paid physicians in a hospital.
What you describe is very common in pain groups. A colleague of mine told be about it years ago. One of the biggest reasons he liked working at the VA in pain.
Specializes in Psychiatric and Mental Health NP (PMHNP).
14 hours ago, TitaniumPlates said:
Bingo.
My ex's group did this rountinely. Hired on fellows or "junior partners" at 1/5th the salary of a "full partner" (there was no buy in or anything like that. just a fancy name) He had to work 3 years as a "junior partner" and then they mysteriously let him go. Just not fitting in. Just not working out. Took them 3 years to figure it out.
He was used as the work and call donkey. Weekends, call, overnights. Bahloney. If it's this kind of pay---which, by the way, my ex made $190K as a PHYSICIAN doing this type of scam--an NP isn't gonna make $300K after 3 years. My ex's specialty is one of the top 3 highest paid physicians in a hospital.
Yes, I also found this suspicious. However, I was offered a job in interventional pain mgt for $150K in Year 1 and $160K in Year 2. This was legit and the only reason I didn't take it was because of the **** Nurse Corps Scholarship - one more year of public service to go. Note: I don't mind public service, and this practice treats a lot of Medicaid and Medicare patients, but the scholarship has strict requirments on what jobs can be taken.
Specializes in Psychiatric and Mental Health NP (PMHNP).
On 9/1/2019 at 3:41 PM, the VEGAN Professor said:
EXACTLY!!!!!!!!
On 8/29/2019 at 9:44 AM, CastiMcNasti said:
What sort of interventions/procedures?
This is very legitimate. The procedures include steroid injections, lidocaine injections, rhizotomies (buring off the nerve), stem cell regeneration, platelet rich plasma (PRP), minor surgeries (outpatient), draining excess fluid from joints, and trigger point injections, etc. Medications are also prescribed, but that is not the focus of the practice. From an economic perspective, prescribing meds is not very profitable. Procedures are what generate a lot of money, and really, in pain we should try to fix the cause of the pain, which procedures can do. Meds don't fix the pain, just reduce it.
This is very legitimate. The procedures include steroid injections, lidocaine injections, rhizotomies (buring off the nerve), stem cell regeneration, platelet rich plasma (PRP), minor surgeries (outpatient), draining excess fluid from joints, and trigger point injections, etc. Medications are also prescribed, but that is not the focus of the practice. From an economic perspective, prescribing meds is not very profitable. Procedures are what generate a lot of money, and really, in pain we should try to fix the cause of the pain, which procedures can do. Meds don't fix the pain, just reduce it.
I had RF on my lower back and the ONLY professional I would trust to do it is an Anesthesiologist specializing in Interventional Pain Mgmt.
I laugh when I hear about "all online" NP schools that allow the student to aquire preceptorships on their own. I worked with one such "NP student" in the ICU. He cultivated a friendship with one of the newly minted ICU DOs with whom he worked OPPOSING SHIFTS. The shift RN Charge was his buddy as well...and everything was always signed off correctly. We dis not have the kind of ICU that should have even qualified for a student experience, yet there you have it. I used to watch him ultrasound HIMSELF to get signed off on those requirements. Now he is schmoozing a level 1 ICU for a new grad job and has these two "friends" in his pocket to give him excellent references.
I wouldn't trust him to take my kids' temperature let alone work in a level 1 ICU.
This is what NP schools are churning out...and you don't know who that NP is burning the nerves in your cervical spine. Maybe they had the exact same preceptorship experience as my co worker does.
These invasive procedures are delicate and take years and years of specialized training to perform correctly. My ex does LPs and other semi invasive procedures, but just because he did a rotation in VIR does NOT mean he can do a Seldinger without perfing the artery. It takes daily practice for years to do these procedures.
NPs are being churned out by the hundreds with little to zero oversight on actual clinical experience. I for one would refuse to have an NP touch me for any invasive procedure.
I had RF on my lower back and the ONLY professional I would trust to do it is an Anesthesiologist specializing in Interventional Pain Mgmt.
I laugh when I hear about "all online" NP schools that allow the student to aquire preceptorships on their own. I worked with one such "NP student" in the ICU. He cultivated a friendship with one of the newly minted ICU DOs with whom he worked OPPOSING SHIFTS. The shift RN Charge was his buddy as well...and everything was always signed off correctly. We dis not have the kind of ICU that should have even qualified for a student experience, yet there you have it. I used to watch him ultrasound HIMSELF to get signed off on those requirements. Now he is schmoozing a level 1 ICU for a new grad job and has these two "friends" in his pocket to give him excellent references.
I wouldn't trust him to take my kids' temperature let alone work in a level 1 ICU.
This is what NP schools are churning out...and you don't know who that NP is burning the nerves in your cervical spine. Maybe they had the exact same preceptorship experience as my co worker does.
These invasive procedures are delicate and take years and years of specialized training to perform correctly. My ex does LPs and other semi invasive procedures, but just because he did a rotation in VIR does NOT mean he can do a Seldinger without perfing the artery. It takes daily practice for years to do these procedures.
NPs are being churned out by the hundreds with little to zero oversight on actual clinical experience. I for one would refuse to have an NP touch me for any invasive procedure.
RFA is certainly a procedure I would never perform as an np and I might draw the line at steroid joint injections. Especially working in pain management as an RN and watching those doctors learn to perform those procedures. They are very technical and to be fair, I'm finding it's doctors who are more often wanting to train NPs in performing them than NPs actively seeking these opportunities. Some pain docs believe they can train anyone to do them and hope to profit off this model.
While I agree there are a number of all online programs churning out too many NPs, I did come from a mostly online program where I had to find my own preceptor and want to point out there are good online programs that have both a long history of both practice involvement and a solid evaluation of preceptor vetting. NP students do need to evaluate school histories and choose a school that has a vested interest in both the success of the student and have a curriculum commensurate with the education level. My school required online exam proctor's to ensure cheating didn't happen. This include a 360 degree camera and browser monitoring during exams when few other programs even considered the option. They had hard requirements through clinical for exams to include specific minimums of patient exams (50 paps, x number of ped visits within certain age range, x hours minimum, etc) and regional coordinators that visited you in clinic to ensure things were legit. Not to mention a rigorous 2 week skills check in person before we were even allowed to go to clinical. These are the kind of standards students and potential employers need to consider and look for.
Specializes in Psychiatric and Mental Health NP (PMHNP).
5 hours ago, TitaniumPlates said:
I had RF on my lower back and the ONLY professional I would trust to do it is an Anesthesiologist specializing in Interventional Pain Mgmt.
I laugh when I hear about "all online" NP schools that allow the student to aquire preceptorships on their own. I worked with one such "NP student" in the ICU. He cultivated a friendship with one of the newly minted ICU DOs with whom he worked OPPOSING SHIFTS. The shift RN Charge was his buddy as well...and everything was always signed off correctly. We dis not have the kind of ICU that should have even qualified for a student experience, yet there you have it. I used to watch him ultrasound HIMSELF to get signed off on those requirements. Now he is schmoozing a level 1 ICU for a new grad job and has these two "friends" in his pocket to give him excellent references.
I wouldn't trust him to take my kids' temperature let alone work in a level 1 ICU.
This is what NP schools are churning out...and you don't know who that NP is burning the nerves in your cervical spine. Maybe they had the exact same preceptorship experience as my co worker does.
These invasive procedures are delicate and take years and years of specialized training to perform correctly. My ex does LPs and other semi invasive procedures, but just because he did a rotation in VIR does NOT mean he can do a Seldinger without perfing the artery. It takes daily practice for years to do these procedures.
NPs are being churned out by the hundreds with little to zero oversight on actual clinical experience. I for one would refuse to have an NP touch me for any invasive procedure.
First, I am not sure how these comments pertain to this thread. We are not discussing the issue of some crappy NP schools being out there.
Second, I will clarify that I do not mean NPs perform all the procedures I listed that are common in interventional pain mgt practices - I was listing the procedures these types of practices offer. I am not aware of any reputable practice that would allow NPs to perform spinal injections or rhizotomies. The only APRN that might be qualified to do so would be a CRNA and they can generally make more money working in a hospital. So, for those of you unfamiliar with interventional pain mgt, an NP working for such a practice generally handles routine follow up visits, med refills, including intrathecal pump refills. With training, an NP can perform botox injections for migraines (and wrinkles), trigger point injections, and other simple procedures.
In such practices, procedures generate the most revenue. So, the more procedures a doctor performs, the more money. That means they want NPs or PAs to handle routine visits and simple stuff, so the docs can focus their efforts on the procedures that generate the most revenue and require a doctor's expertise.
I don't understand the knee-jerk negativity that some readers here have. Pain is a very important problem, and the over-reaction to opioid abuse has resulted in many chronic pain patients undergoing undue suffering. The best solution to chronic pain is to address the root cause, and procedures and some surgeries can do so, and this will greatly reduce or eliminate opioid use. RPM and stem cell therapies are new and offer great promise - I have met many patients who swear by these treatments. I did a clinical rotation in school at an outstanding interventional pain mgt practice, run by a DO, which is why I have such a favorable view of this specialty. His goal was to eliminate opioid use by fixing the problem, or to at least get the patient down to a low dose. One example: male patient had below the knee amputation, which is very painful and he got hooked on opioids. He also suffered through some poorly fitting prostheses, which amplified his pain. This DO, over the course of a year, got him on a plan of regular sizing and fitting of good quality prostheses, and got the patient off of opioids entirely. That is how good pain mgt works and we should all be supportive of such practices.
I do not agree that an anesthesiologist is the only type of doctor that should be in interventional pain mgt. We need to fix the pain, not mask it. I prefer a DO or MD with deep understanding of joints and neurology, as those are the root causes of pain. Interventional pain mgt is a board-certified specialty, and I would also look for a doc with orthopedics, physiatry, or sports medicine-type experience. There are now minimally invasive surgeries that are quite effective at fixing spinal disc issues. I am leery of major back surgeries, as they are very high risk and view them as a last resort. Most doctors agree with that view.
I am tired of us trashing our NP colleagues. NPs are not all created equal. It's a bell curve and normal distribution, like anything else. That also applies to MDs, so don't assume that just because a provider is an MD that they are going to provide high quality care. The clinic I worked at just had to fire an MD, who after 6 months, could not perform basic primary care - absolutely shocking to me. Of course, they also have an MD who misdiagnosed an obvious ear infection as a mental disorder! As a primary care NP, I have had better experiences with my NP colleagues than MDs.
Patients should always inquire about a provider's backgound, experience, and education, whether they are an MD, DO, PA, or NP. I know many NPs who have been practicing for 30 years or more, who are fantastic, and MDs consult with them regularly. Practice websites generally provide the background of every provider - review these. Ask around the community and check the internet for the provider's reputation and other patient's experiences with that provider. When you see a provider, as an NP, you can gauge if they are properly performing an H&P, ordering appropriate tests, etc.
I believe I have seen an NP here either ask or suggest those procedures could be done in the past. But not something I will take the time to look for. I only remember because I specifically asked an anesthesiologist colleague about this and he said it isn't unheard of where pain trained docs try to make money by training NPs to do them. Still not something I would ever do or go to an NP for.
Highest paid specialty? Own your own business. Enough said. You can make tens of thousands a month passively owning multiple part time practices and businesses. It is what I do and what I advocate for.
If you do not wish to start your own practice, then urgent care with a production base salary. I make $180k a year working 3 days a week at a busy urgent care. You work for it though.
verene, MSN
1,793 Posts
I would still be very hesitant. Are you sure this is NP salary and not MD? Also - what are the hours they are requiring one to work for that salary? How many patients and what kinds of procedures? If a salary seems way outside of what one would expect you need to ask why - either they can't hire anyone at all and are using high salary as incentive (in which case - why can't they hire anyone) or they have insanely high productivity and/or hour requirements.
If they are starting with low pay in year 1 and year 2 I would also question who actually makes it to year 3 and the high pay - are they consistently bringing in new providers at low wages and then firing them or working them so hard they resign before year 3?