Why is our salary so low?

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Something I grapple to understand is how come our average salaries are in the $99k range. Is it because most NP's are new to the career and that skews it do the lower end?

If we are reimbursed 80% of what physicians get, why are we paid 1/4 of what physicians make? In independent states where you open up your own practice, how much do you make?

Specializes in Family Nurse Practitioner.
who are physicians to judge nurses. Are they any better. There is no joke nursing school any where. This is the kind of mentality some of us nurses carry that has made us look like asses( donkeys) before patients, families, doctors, administration and what have you. The schools are not even producing enough grads at every level in nursing. If you don't know what it means to become an NP after nursing school keep quiet and stop talking about the quality of school and how real a degree may be. Go even to the unreal and earn your own decree, then you will be able to tell us how easy that was.

I do not believe there is a shortage of RNs or NPs in most places but in any event the posts in this thread are largely written by those of us who have in fact gone on to become a NP after undergraduate nursing school.

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Specializes in Outpatient Psychiatry.
This is an interesting point. I'll argue, though, that from the employers perspective, they can't afford to have too many physicians on their payroll. This is especially true in Psychiatry, where reimbursement rates are ridiculously low. Many agencies, If they are small, will have just one doctor, and the rest APRN's. Otherwise, they would go bankrupt. Many do, and they get taken over by larger practices. Anyway,...it wouldn't be a smart move on our collective parts to price ourselves out of business.

if reimbursement rates improve, then maybe your right, we could start asking for a better portion of that. I don't see rates getting better in my area. Have you?

They should increase slowly with inflation.

You make a valid point about not pricing the employer out of business, but the better option is to cut costs and staff who serve less need, if applicable. We do need to maintain our worth and insist that we're paid what we're worth. In an organization, executive staff don't typically take pay cuts before gutting the business. We need to align ourselves with executive roles. We should take an active role in being leaders in our practice

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Specializes in Family Nurse Practitioner.
They should increase slowly with inflation.

You make a valid point about not pricing the employer out of business, but the better option is to cut costs and staff who serve less need, if applicable. We do need to maintain our worth and insist that we're paid what we're worth. In an organization, executive staff don't typically take pay cuts before gutting the business. We need to align ourselves with executive roles. We should take an active role in being leaders in our practice

I know I'm a loss leader most days at the OP practice where I work. They need prescribers to keep their therapists packed. Places without a prescriber lose clients to practices with prescribers. Although I charge top dollar I'm securing the weekly appointments of 10+ therapists so my income isn't whats driving the business profits its my ability to prescribe.

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Specializes in Outpatient Psychiatry.
I know I'm a loss leader most days at the OP practice where I work. They need prescribers to keep their therapists packed. Places without a prescriber lose clients to practices with prescribers. Although I charge top dollar I'm securing the weekly appointments of 10+ therapists so my income isn't whats driving the business profits its my ability to prescribe.

Yes, same here. Interestingly, the business skims more from the revenue of individual and group therapy than medication management as well as case manager interventions. In my region, I'm the sole "prescriber" for 20 +/-therapists.

Regardless, in our model, the therapists cannot see a patient for more than a few weeks without having a psychiatric evaluation to corroborate diagnoses, validate treatment plans, rule out and treat biological causes of mental illness, and the prescription of maintenance meds is an after thought. Without looking at my spreadsheet on Google Drive, approximately 55% of my appointments are evaluations.

Without us, the business grinds to a halt. And this, nurses, is why we are valuable. There is no business, employment, or service for the mentally ill without our participation. I've had around 1600 appointments this year, and that is with a painfully slow July. Without us, that's 1600 less services for the seriously mentally ill. So, friends, this is precisely why we need to demand more money.

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how hard are you working? Average salary for family Medicine physicians is 175-250k. They typically see twice as many patients as the NP. by that math and reimbursement rates either we should make less or they should make more.

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As a lot of us have been saying for a long time, our reputations (and earning ability) are being damaged by the proliferation of low-quality schools turning out hordes of minimally prepared graduates. Physicians are so aware of the ubiquity of on-line "diploma-mill" graduate programs in nursing that many assume that is the prevailing model of graduate education in nursing. I talk to physicians who are sincerely surprised to learn that I attended a "real" graduate program at a well-known and well-respected B&M school, and have a "real" degree; they didn't know there was such a thing. IMO, we should be v. alarmed about the fact that the physician community is starting to assume that all graduate degrees in nursing are a joke and don't need to be taken seriously.

But, again, like so many problems in nursing, this is something we (collectively) are doing to ourselves.

Exactly! Online nursing degrees are a joke and it is a widely talked about joke. I would be embarrassed if a patient asked me where I got my degree and I told them xzy online school. How could I gain the respect and trust of my patients? As a former RN, I have several friend that went the online NP route. The education was a joke. The education consisted of reading journal articles that were obviously pro NP and discussion boards. They arranged their online clinical rotations which were a total cake walk. My friends are incredibly smart wonderful compassionate people. But I feel like they were tricked by the allure of online NP degrees. My friends passed their board exams with flying colors but could not find jobs. One went back to bedside nursing and the other had a series of failed NP jobs. She was not properly educated or trained and could not handle the workload. She is now a stay at home mom. This is why I urge nurses to really do thorough research before jumping in.

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Specializes in Neurosurgery, Neurology.
Exactly! Online nursing degrees are a joke and it is a widely talked about joke. I would be embarrassed if a patient asked me where I got my degree and I told them xzy online school. How could I gain the respect and trust of my patients? As a former RN, I have several friend that went the online NP route. The education was a joke. The education consisted of reading journal articles that were obviously pro NP and discussion boards. They arranged their online clinical rotations which were a total cake walk. My friends are incredibly smart wonderful compassionate people. But I feel like they were tricked by the allure of online NP degrees. My friends passed their board exams with flying colors but could not find jobs. One went back to bedside nursing and the other had a series of failed NP jobs. She was not properly educated or trained and could not handle the workload. She is now a stay at home mom. This is why I urge nurses to really do thorough research before jumping in.

Which school(s) did your friends go to?

Would you be embarrassed if you went to Georgetown University, which has some online NP programs?

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Specializes in Emergency Room.

This sounds so ridiculous and angry. Its a shame that nursing has come to this. I am very proud of my accomplishments as a professional nurse. If I ever feel like this, then it would be time for another career.

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I don't think doctors are paying less because they think quality of online programs is low. If they thought so, they would not hire you in the first place. Of all the people, doctors don't want a lawsuit because of poor quality of care. Let not those who went to brick and mortar schools bash those in online schools. It all depends on who is teaching and who is learning. Schooling at the NP level is inadequate in both models. That is why they want you to come with an x number of years experience, while medical students are recruited off the street. Most NP's learn via experience and doctors know it. That is the major reason for low salaries. Most nurses don't go to graduate school to make money. A AD prepared nurse can make close to 100K in some specialties if they want. Most of us do it to get away from the bedside grind, burnout or need for growth and meaning.

What needs to be addressed is, why do NP salaries reach a plateau? Why are so many NP's leaving practice and taking pay cuts to teach? Why is it so difficult for a new NP to get hired? Why are there so few NP internship programs?

A lot of what you say is true. Long ago, when I was a brand new RN I used to think that I could save the world, be the perfect nurse,... And I was REALLY good at the bedside. But after a few years I got bored with it. It became less and less about helping people to get well, and more and more about corporate profits and making sure that one clicked all the boxes on the computer screen by the end of the shift. I could not stand the know-it-alls in the ICUs or pettiness and back-stabbing attitudes, the gossiping, and the ridiculous politics anymore. I knew that I was going to have to quit. I thought about it MANY times but before I actually did I began to look into going back to school for an advanced nursing degree. I wasn't interested in nursing administration or management so I applied to CRNA school. I got into the program and went to shadow with a CRNA for a while before I actually started. I did not like the confinement of the OR or the unbelievable rudeness of the surgeons towards the CRNAs so I bailed out of that real quick. I asked to be transfered to the FNP program, and that was a much better fit.

When I left bedside nursing I was earning $90k and that was a while ago. I know NPs now who are earning much less than that. I don't see any reason why I should accept less money to work as a nurse practitioner when I am a provider who's doing billable work and bringing in large amounts of revenue into the business. The altruism and lovey-dovey stuff is alright for Jean Watson et al, but in my mind a part of being a good nurse is taking care of myself also. I work hard and I expect to get paid for it. For me, the money is a big part of it and I'm not ashamed to say it. If they're not willing to pay me what I think I'm worth then I tell them goodbye and move on to other opportunities.

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