Why is our salary so low?

RunNP · Oct 2, 2016

No, potential employers don't look at what kind of school we graduated from: Ivy League, State University, Hands on, online..... They do look at years of experience, type of experience, how you present yourself, and how you fit into the culture of the clinic, or facility. Then there's location and specialty.
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I had three interviews and each one asked me about each school I attended. I did the whole Jr College to ADN then BSN before attending Vandy for my DNP. I think graduating from a well respected DNP program was looked upon in my favor.

Damselle · Oct 2, 2016

But here's the deal you're being reimbursed for work done. Whatever the % a physician gets, unless an owner, should be the same % a NP or PA gets from revenue. Whether Medicare pays 100% or 85% is irrelevant.
So for example, I generally retain 93 +/- 2% of my revenues. The practice takes the rest to pay other overhead.

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?

Damselle · Oct 2, 2016

I had three interviews and each one asked me about each school I attended. I did the whole Jr College to ADN then BSN before attending Vandy for my DNP. I think graduating from a well respected DNP program was looked upon in my favor.

well, since this is online, know I frame this in the genltest of ways. If you've just graduated, then, of course, a prospective employer will talk about your education. I honestly can't remember that far back, they may have talked about mine too. Most interviewers will be kind an try to focus on your strengths.

If if you have some working experience, and they are still talking about what school you attended....there's a problem.

Jules A, MSN · Oct 2, 2016

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?

Two or more different problems.

1. Being afraid of being "too demanding" is sad and exactly what employers love to hear. You be a good little girl and don't make waves. I'm fine being known as demanding or arrogant or whatever but I will also continue to command top dollar and will not do anything a physician doesn't do. Bottom line is my salary is $100,000 a year cheaper than a psychiatrist and I am without a doubt better than the bottom 50% of them so thats why I continue to be in high demand. I'm not looking for a Mommy friendly job, I take call and do exactly what the physicians do.

2. As for the fear of being undercut wage wise, we should be lifting up our peers. Tell them how much they can expect to make as a new grad. And if schools weren't so greedy and actually required nursing experience new grad NPs wouldn't be so incompetent and need or expect a 6 month orientation which as also become a nifty tool for employers to use against new grads as a way to keep salaries low.

Jules A, MSN · Oct 2, 2016

I still make over $100,000....

If you are in psych I pray you are making well over $100,000 like min $150,000.

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?

I'll argue that from my perspective employers are cheap and love NPs with no business savvy who will work for peanuts. I have worked for large and small agencies and none of them have been of the mindset that psychiatrists are too expensive. Psychiatrists are the Gods and in fact employers in my area clamour over top of each other attempting to woo new docs. One of the hospitals where I work has tried to use more NPs for inpatient work and it was unsuccessful due both to a lack of ability to manage the acuity as well as most NPs wanting the mommy schedule, no call, no weekends, no holidays etc.

I'm not going to worry about pricing myself out of the market unless eventually my fears of the large number of new NP graduates in upcoming years drive all specialities down. In the meantime however I'm going to continue making over $200,000 a year for as long as I'm able and figure that at least two of my employers would rather overpay me than be aggravated by a NP with zero psych experience prescribing whatever it is the substance abusing patients demand and increasing Zoloft by 12.5mg every 6 months.

Goldenfox · Oct 2, 2016

I don't expect to make what a doctor makes. I didn't go to school for eight years and do four plus or even more years of residency. I don't have hundreds of thousands of dollars in student loans.
common guys. Let's get real here.

Someone else in this thread said that what we get out of this profession largely depends on our own mindset, and I believe that your post just made a good case for that theory. Honorific titles are not as important as many of us believe. And just because a physician spends many more years in training and owes more money in student loan debt doesn't automatically mean that he/she is a good clinician at all. I've known some who were terrible and more motivated by money than care about their patients. I used to work with a doctor whose patients often requested to see me rather than him. Mind you, I've also known nurses and nurse practitioners who were pretty bad too.

But what's really important are the skills and experience that one brings to the table. Whether we are NP, DO, MD, or PA, the same quality and safety standards are billed for when we diagnose and treat a patient. And I don't see anything at all wrong with an NP or PA expecting to be compensated fairly for their productivity. When a practice bills for an encounter they don't bill according to how long the doctor was in school or how much student loan debt he/she owes, they bill for the service that was rendered. And although most of us are not expecting doctor pay, at the same time, it would be naive and self-effacing to not see that some of them are taking advantage of us by offering salaries that are, in many cases, even less than what a bedside RN earns. Sadly, if we don't believe that we are worth more then they probably won't either.

babyNP., APRN · Oct 2, 2016

This makes no sense and exactly how high is the base salary of a super RN even with 25 years of experience? $90,000? Although I do not think we should be compensated equally to physicians due to our underwhelming education there is no way I'd take on the added responsibility of diagnosing and prescribing medications without making at least $150,000 a year. That our profession has been willing to take this on for less is incredulous to me although I would bet it goes back to the large portion still acting as glorified RNs or nursing's version of physician's assistants rather than independent practitioners.

Well, at my particular hospital, a nurse at that level was making $110k. I made about $65k with no OT with 6 years of experience. The neos made a bit over $200k, as they were in academic medicine, not private medicine. I think it's a bit skewed in academic medicine because the nurses at my current facility (another academic center) seem to make a pretty decent amount of money in comparison to NPs and MDs. Maybe it's different out in community.

escapebigd · Oct 2, 2016

I have discovered the B&M vs Online is a big deal obviously. Many complaints about lack of quality... so on and so forth. There are online programs out there that require every test to be proctored, skills check offs to be done in person or proctored by the instructor, and clinicals are still necessary. I go to one of those schools that require all of the above, and I have spoken with many students who attempted to attend and moved on to other online schools due to the difficulty even though it's an online school. Now having said that, as mentioned previously we all must still pass the boards to become a nurse practitioner, and for these other students just skirting through school I hope repeatedly failing boards will help them learn a valuable lesson that the plethora of posts on here have not taught thus far.

I believe the primary issue with our low pay is our lack of demand for higher pay. If we continue to accept these first offers and fail to even negotiate compensation outside of base pay we will drive the base rate even further down. I am a huge fan of negotiation despite the feeling my heart will explode every time I must do it. I believe part of the problem lies within the school though; they must educate their students on how to negotiate, what to expect after graduation, and what comes next in terms of applying for DEA, credentialing, and so forth.

Long...sorry, but my two cents!

Jules A, MSN · Oct 2, 2016

I have discovered the B&M vs Online is a big deal obviously. Many complaints about lack of quality... so on and so forth. There are online programs out there that require every test to be proctored, skills check offs to be done in person or proctored by the instructor, and clinicals are still necessary. I go to one of those schools that require all of the above, and I have spoken with many students who attempted to attend and moved on to other online schools due to the difficulty even though it's an online school. Now having said that, as mentioned previously we all must still pass the boards to become a nurse practitioner, and for these other students just skirting through school I hope repeatedly failing boards will help them learn a valuable lesson that the plethora of posts on here have not taught thus far.
I believe the primary issue with our low pay is our lack of demand for higher pay. If we continue to accept these first offers and fail to even negotiate compensation outside of base pay we will drive the base rate even further down. I am a huge fan of negotiation despite the feeling my heart will explode every time I must do it. I believe part of the problem lies within the school though; they must educate their students on how to negotiate, what to expect after graduation, and what comes next in terms of applying for DEA, credentialing, and so forth.
Long...sorry, but my two cents!

I enjoyed your post and agreed with most everything except the board exam being some sort of quality control mechanism. I've seen the arguments and reluctantly agree that there isn't a better way I can think of to efficiently show competence but the nursing board exams I have taken and coming from LPN to ADN to two NP exams as well as a GRE in between I have to say nursing boards are rather pathetic. Neither of my NP exams had more than 10 medication questions on them but plenty of culturally appropriate care fluff. I would bet someone who is naturally a decent test taker could pass any of them with a few months of study materials.

Jules A, MSN · Oct 2, 2016

And just because a physician spends many more years in training and owes more money in student loan debt doesn't automatically mean that he/she is a good clinician at all. I've known some who were terrible and more motivated by money than care about their patients.

Although I don't find only caring about the money offensive if a provider is excellent I totally agree there are providers of all professions who are bad. In fact I have come across at least as many terrible physicians as terrible NPs but I just find it more distasteful when it is a NP peer who is thought to be incompetent because I think we are scrutinized more and need to hold ourselves to a higher standard.

carolinapooh, BSN, RN · Oct 2, 2016

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.

This doesn't explain the proliferation of direct entry MSNs - and it also doesn't allow that a huge chunk of an MD's knowledge isn't gained in school either. School teaches them the background and the mechanics. While an intern is still a student, they're also doctors, and are paid as doctors (yes, I know it's a pittance, but who's monitoring that floor at 0200? In a teaching hospital, you're calling the intern).

Jules A, MSN · Oct 2, 2016

This doesn't explain the proliferation of direct entry MSNs - and it also doesn't allow that a huge chunk of an MD's knowledge isn't gained in school either. School teaches them the background and the mechanics. While an intern is still a student, they're also doctors, and are paid as doctors (yes, I know it's a pittance, but who's monitoring that floor at 0200? In a teaching hospital, you're calling the intern).

There is absolutely nothing except acknowledging the universities' business savvy and desire to increase their bottom line that could explain the proliferation of direct entry MSNs to my satisfaction.

You are correct that fellows and residents are also learning from their clinical experiences however they are not technically working as doctors and their required hours before they become independent providers are massive compared to the pitiful 500-1,000 hours NPs do.