Why is our salary so low?

divobari · Oct 1, 2016

I think that most people, even in other careers, generally don't know how to negotiate salary package. Think about all of the craziness that we put up with. I mean, look at the above comments about schools, Med vs NP school, Online vs Brick and Mortar... What does it matter? Everyone comes from different walks of life. NPs do work that many physicians wont do. Also, they are scrambling for NPs, because of the high standard of care that NPs bring to the table. I believe that if you can diagnose and manage care(including knowing what is out of your scope and when to refer/consult) at a high standard, you are qualified - basta! If you know how much you will potentially bring in, acknowledge this to your employer. I will cautiously say that I've been to practices - even in an ED where the NP(well experienced ER nursing) took way too long(up to 1 hour) with patients, while in the meantime, the physicians and PA were complaining about her. I also know another instance where the NP would take 45-1hour with patients, making other patients wait up to two hours for an appointment. Some would leave!... For me, the concession that we did not go to med school is an admission that we are expected to give inferior care to our patients. As a patient, I would hate to hear "the doctor is not in, but the less educated/less qualified NP could see you.(should shrug)"

AAC.271 · Oct 1, 2016

For me, the concession that we did not go to med school is an admission that we are expected to give inferior care to our patients. As a patient, I would hate to hear "the doctor is not in, but the less educated/less qualified NP could see you.(should shrug)"

While I am all for NP's with a DNP introducing themselves to patient's as Dr. So and so and saying that they are the doctor, I'm not sure if it is a good idea to say to them that you went to medical school as well.

JellyDonut · Oct 1, 2016

Why? They do the same job. And it's the one I force down.

That is hardly the case with any new NP especially one with very little clinical experience. Even the best prepared newly licensed NP will face a learning curve to get up to speed. I think new graduated should expect a lower pay scale and once they have a year or two under their belt it is time to renegotiate or find an employer that will value the experience you have gained.

elkpark · Oct 1, 2016

While I am all for NP's with a DNP introducing themselves to patient's as Dr. So and so and saying that they are the doctor, ...

I'm all in favor of NPs with doctorates using the "Dr." honorofic, but I think introducing oneself as "the doctor" would get people in a lot of trouble in a lot of places. It's important that NPs identify themselves as nurse practitioners (just as it's important that every other healthcare professional identify themselves clearly to clients). Referring to yourself as "Dr. XYZ, the nurse practitioner" is one thing; saying "I'm the doctor" is something entirely different.

elkpark · Oct 1, 2016

For me, the concession that we did not go to med school is an admission that we are expected to give inferior care to our patients. As a patient, I would hate to hear "the doctor is not in, but the less educated/less qualified NP could see you.(should shrug)"

If you didn't actually go to med school, it's not a "concession." It's just the truth, and suggesting otherwise would be lying and misrepresenting yourself. I can't imagine that there is anywhere in the US where anyone is actually saying, ""The doctor is not in, but the less educated/less qualified NP could see you." In my own experience, there have been times when I've asked to be worked in at my PCP's office for something acute and the office has told me, "Dr. PCP is booked up (or not in), but the nurse practitioner could see you." I'm sure that's what every practice does. Be honest, no healthcare practice is going to tell people (or even suggest) that some of the providers in the office might be providing inferior care. And the general public doesn't care or worry about this stuff nearly as much as many of us do. I'm pretty sure that the majority of the general public doesn't hear it any differently than if the office person said, "Dr. PhysicianA is out, but Dr. PhysicianB has an opening."

divobari · Oct 1, 2016

I'm all in favor of NPs with doctorates using the "Dr." honorofic, but I think introducing oneself as "the doctor" would get people in a lot of trouble in a lot of places. It's important that NPs identify themselves as nurse practitioners (just as it's important that every other healthcare professional identify themselves clearly to clients). Referring to yourself as "Dr. XYZ, the nurse practitioner" is one thing; saying "I'm the doctor" is something entirely different.

Again, with all do respect, we do it to ourselves... Firstly, even if you have earned a doctorate in circus arts, you are a "DR." It is an academic title - not a physician copyrighted title. Physicians weren't always called "Dr", either. It was only when they introduced the MD education from Europe to improve their standard of care. Prior to this, they actually practiced quackery (look at physician notes from the 17-18 hundreds about the practice of bloodletting). Even the lab coat was an attempt to be taken more seriously. Look at old pics - they wore all black.

lastly, the confident physicians actually admire DNPs for what they bring to the table. And the confident DNPs will introduce themselves either by their first name or "Dr. XYP and I'm an NP"...

In regards to salary negotiation, you can also offer to work at the agreed salary with the expectation that you get a increase after a few months, because you will likely not be as productive in the orientation/beginning phase. Then, just start knocking them out. ;-) if they don't agree, find another job, which is actually another way to increase your salary. You will be more competitive. Good luck!!

Quickbeam, BSN, RN · Oct 1, 2016

Many of my friends who went on to get their NP/APNP/DN degrees are making less than I do (with a brick and mortar BSN). They traded off for intangibles like hours they wanted and no call. Those who actually were driven by cash mostly went back to floor nursing.

I'm in case management and make just under 100K a year. It all depends on your skill set and what you offer. I bring 30 years of experience and got an entire program off the ground.

RisaW · Oct 1, 2016

This is a great question, andI've really enjoyed reading many of the responses. I've often wondered the same, why do NP salaries seem to plateau? Even with several years' experience, compensation doesn't seem to change much. I think the better question would be "What can we as individuals do to negotiate better salaries for ourselves".

It's easy to blame ourselves/other NPs, for accepting lower compensation but demanding better is easier said than done. Particularly for those of us living and working outside of large cities, where employment options are scarce and wages are low. There is the very real fear of being labelled "too demanding" and consequently being passed over for someone cheaper but with similar credentials. We need to know our worth and acknowledge what we bring to the table, but how can we know our worth if everyone else is lowering our market price?

feelix, RN · Oct 1, 2016

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?

RisaW · Oct 1, 2016

I think NP compensation is low because we aren't in control of our own practice. Depending on where we live, state legislation requires that we practice in collaboration with a physician and thus are dependent upon that arrangement for our employment. We are seen as "physician extenders" and "mid-level providers". Why should they pay us more if they don't have to?

urbanrn328 · Oct 1, 2016

Hey Jelly look at the degree that John Stumpf got - you know the CEO FROM Wells Fargo who makes 19 mil a year. A C average fringe student he was who happened to get an mba from a non name school. Your comment is ridiculous and demeaning to your professional peers. If the school meets accreditation standards, she's in. And the salary too.

urbanrn328 · Oct 1, 2016

If everyone just says no to the lower pay scale, they'll get the hint. Panic they will but get the hint. Be brave, it's liberating. Just negotiated hourly at 125$ - I just said it, and they took it.