Which specialty compensated the most financially?

mammac5 · Apr 4, 2013

As far as I am aware, the CV surgery NPs/PAs earn the most here in my area. They work their hind ends OFF for that money, but most of them seem to enjoy being at the hospital to round before 6:00 and then in/out of surgery during the days. They take call and determine whether or not a given call should be bumped up to the docs. Weekends, holidays, etc.

Public health dept pays the least here. Outpatient family practice and peds are a close 2nd to the health dept for low wages.

myelin · Apr 4, 2013

Independent psych NPs who own their own practice make bank because of the low overhead, unfortunately primary care people have a lot of overhead and that really cuts into their profits. CRNAs obviously make a lot. People who do lots of procedures (surgery, acute care, etc.) probably make a good amount as well.

Truly, owning a clinic/practice and then hiring people to work under you (and taking a cut) is the clear way to make a large income.

harmonizer · Apr 10, 2013

NP in Emergency department starts >110K. If you don't want to own a clinic-- do you mind consulting in nursing homes-- you can be self-employed that way. One of the Geri - NP I know do consulting medical work work in nursing home-- making lots of money-- She can determine how many patients she sees.. but you need to have collaborating physician and pay them some percentage... and you must be willing to be self-employed

BlueDevil,DNP, DNP, RN · Apr 10, 2013

No, the OP indicated they live in a state with autonomous practice, therefore no collaborating MD needed. Wouldn't need one in my state either. I have no idea how much nursing home gigs pay here, I wouldn't step foot into one for a zillion dollars. I do know that owning a FP clinic may be either a sure fire way to easy street or bankruptcy court, it depends on a lot of things. I own a piece of a practice, we share the expenses for the office manager, the physical plant, cleaning, DME, office equipment, and sundry supplies. We each pay our own staff personally. It is the bet of both worlds. I would not want to be solely responsible for the upkeep of every aspect of the building and practice expenses. Minutia adds up fast. I just can't see enough patients to pay for endless amounts of copier toner, relandscaping, a new roof and a dozen brand new tablet computers for the whole staff all by myself! My children do need to eat.

I work 3/4 time and earn very well. With bonuses, I will make well over 150K this year. Probably not quite $170, but close. If I wanted to work my tail off, I could earn 200K. I do not choose to work that hard. That would entail 50 hour weeks including doing Sat morning walk-in hours, pouring over documentation to make sure I could get every dollar out of it, doing lots of procedures that pay well but that I send out because I don't want to spend the time doing them or documenting them. Sinus infections are fast and easy. No, I'm good. Don't need the money and don't care to work that hard. I like my cushy hours and my free time.

If you want the best lifestyle and the most money, I'd go into cosmetic derm. I have a colleague who does nothing but botox and juvaderm injections all day and she makes a bloody fortune.

FuturePsychNP · Apr 11, 2013

I believe CRNAs still command the highest salary (if you can find a position), but if you could get an NP position associated with cardiothoracic or neurosurgery you'd probably do well also. Additionally, as Corporal Klinger noted above a position where you could do something along the lines of plastics would likely be profitable.

TX RN · Apr 17, 2013

Interesting post.

I don't see it as much of a matter of specialty "type" but rather more of a contract negotiation skill.

Billing and reimbursement fee schedules is something you should try and become very familiar with.

Knowing what you can bring to the table at any practice is a sure way to negotiate a salary that is fair.

I've learned over the years that while medicare reimburses NP's at 85% of the physician rate, typically NP salaries at best are at the 40-50% range of what physician earn.

How is that possible?

But a more important question to ask is; why do we (NP's) put up with it?

TurtleLittle, BSN, MSN, DNP, RN, CRNA · Apr 15, 2014

It's interesting that people keep talking about making good profit of Cosmetic Derm, doing injections and fillers. I worked as a RN at a Derm clinic for a year and did not see how it could be a reality.

The high profile clients who often don't mind spending a lot of money to erase their wrinkles would more likely prefer to have a MD. And also if you are a guy, you would find a little harder time to relate to your patients and get them like you (which is the whole marketing key of Cosmetic). On the other hand, if clients refer more affordable price, they would then be willing to let a RN to do the injections rather than a mid-level for the matter. At some point I feel like doing purely Medical Derm would be more profitable (although no way it can be compared to Psych NP or Acute NP). However, the clinic I worked at was small and like one doc running the whole show kind of deal. So I wonder if anyone working in other Derm facility could correct me and give me more insights. Esp because the doctor wants me back there and is willing to train me to become his Derm NP now that he knows I am FNP school. However, I could not really see him being able to pay me up to 6 figures working there. Or maybe he really lowballs the salary to have me cheap? Should I go back for the exp or rather just venture out?

PG2018 · Apr 16, 2014

I don't know what subspecialties might pay, but alumni reports for my university indicate that, CRNAs yield the highest income often greater than that of primary care physicians (no surprise). The second runner up is actually the psychiatric-mental health graduates with the financial rewards coming in as a result of demand. The peds folks ranked ahead of the women's health NPs with the latter being the lowest earning, and I can't remember which came in third and fourth, the adult health or family practice folks.

CNSes of any type were actually the lowest "APRNs" surveyed, but there are very few of them reporting back in. Also, the position is nearly unheard of in my region. A rare nurse has it on her nametag, but I've yet to see a position dedicated to it.

resilientnurse · Apr 18, 2014

People frequently mention Psych, however where you work (State and setting) and what you negotiate matters too. I think that Psych NPs that work inpatient drug rehab that exclusively accept Medicare patients are paid very well.

Carlyjo · Apr 27, 2014

The South, except Mississippi, Alabama, and parts of TN (Memphis, Nashville) is terrible for PsychNP. This is horrible but true. FNP makes the same or more than Psych NP in most of the South. Derm is the best field, hands down. That is the area I am interested in and plan to return for my FNP to do derm. I have also decided that I will not accept another job as a Psych NP for less than six figures. As a new grad, I was scared to negotiate fully since new grad NPs have a difficult time in my area finding a job period. The next place I accept employment will be for six figures or I will not accept. I'll just stay right where I am. I believe if all Psych NPs do this in the South, wages will increase for experienced Psych NPs.

chillnurse, BSN, RN, NP · Apr 27, 2014

i like the start "i don't want to hear that doing your dream is worth more than the money"

i like your way of thinking. I also get tired of the cushy "ohhhhh do what you loveeee and youllllllll be suuuuuperrrr happpyyy. says the person heading to file for a foreclosure.