Lately, news from the salary front seems to have gone from bad to worse - but not for nurse practitioners. The 2003 National Salary Survey of Nurse Practitioners shows that NP salaries continued to rise over the past 2 years. The average salary in 2003 was $69,203 for full-time nurse practitioners, up 9.55% from the $63,172 average in 2001 (Table1), according to our data. The average part-time wage rose less dramatically, but it did increase from $32.53 per hour in 2001 to $33.89 in 2003 (Table2).
"This is a salary gain for us in a very soft economy, so it's good news," says Margaret Fitzgerald, NP, owner of Fitzgerald Health Education Associates in Andover, Mass. "Is it great news? I don't necessarily think so, but I do think that it reflects that finally the marketplace is starting to recognize the worth of an NP to a practice."
To help you assess the market value of NPs in different circumstances, we've analyzed data from 3,731 survey responses and produced the tables accompanying this article. These tables compare NP salaries with those of other health care professionals and break down NP compensation by practice setting, experience, education and gender. Geographic differences are reflected in tables that break down pay rates by region, state and population setting. Average salaries for select cities are included to illustrate the range of compensation even within the same state.
The National Salary Survey of Nurse Practitioners has been an exclusive service of ADVANCE for Nurse Practitioners - and one of the journal's most widely read and referenced features - since 1997. The 2001 survey, published in January 2002, won a silver award from the American Society of Healthcare Publication Editors. Our survey is conducted biennially, and the next survey will be published in January 2006. Data from the 2003 survey, as well as past surveys, is available online at www.advanceweb.com.
Besides increasing since our last survey, the average NP salary rose at a higher rate than it did during the previous 2-year period - 9.55% compared with 8.19%.
But NPs still aren't making what they should be, Fitzgerald points out. For example, an NP offers a family practice skills that are comparable to those of a physician. But the family practice physician makes $150,000 a year, while the family practice NP makes $66,276 (Table 3 and Table 4). "If someone doesn't think that an NP is worth that much, then they're not aware of how much an NP can bring to a practice," Fitzgerald notes. NPs need to make employers aware of their contribution to the bottom line so they will be better compensated.
"Another reason we [NPs] are not seeing the kind of income that a physician in family practice would is that at our practices we are not partners and we are not owners," Fitzgerald explains. Practice acts and state laws make it difficult for NPs to join physicians as equal partners in business. As laws and regulations change - and as they become more business savvy - NPs will see greater salary gains, she predicts.
Lucrative Practice Settings
Fitzgerald is on the mark when she says that owners make money. Once again, the most lucrative practice setting for nurse practitioners proved to be independent practice (Table 4). Nurse practitioners who own their own practice earned an average of $94,313 a year - $25,110 more than the average NP salary.
"I think that's right on target," says Bonnie Hill, NP, who owns Rowan Prime Care in Salisbury, N.C. "When you are hooked into working for someone else, rates and everything are pretty much automatically set. When you work for yourself, you can manipulate your hours and set your own rates."
Despite the lure of more money and improving scopes of practice nationwide, only 1% of survey respondents own an independent practice. The percentage remains unchanged since 2001. "I've actually seen a decrease [in NP-owned practices] in North Carolina," Hill remarks. "Even some that had set up what I thought were pretty viable practices, I'm not sure they're in practice anymore. I think it's because so many of the managed care companies will not let nurse practitioners onto their provider panels."
Hill's advice to nurse practitioners? Don't take no for an answer. When Rowan Prime Care staff attempted to get another NP credentialed with a major insurer that for years had reimbursed Hill, the insurer responded that it doesn't credential nurse practitioners. "And we said, 'Oh yes you do,'" she recalls. "We had an edge there, and we've worked to get empanelled with some of the other insurance companies too. We have two tenacious office workers here, and that's been a real plus."
Emergency departments also offer impressive NP salaries, according to survey results. In 2003, an NP working in an emergency department made an average of $80,697-almost $7,000 higher than the third most lucrative practice setting, neonatal units.
Beth Paton, NP, works in the emergency department at Le Bonheur Children's Medical Center in Memphis, Tenn. She wasn't surprised to hear that she makes more than other NPs. But she didn't start out making much. Paton worked at Le Bonheur as a certified emergency nurse while she was in graduate school, and she made some salary concessions to convince the hospital to hire an emergency department NP - her - when she graduated. The hospital decided to give it a try for 6 months but wouldn't pay her much more than she made as an RN.
Five years later, her salary has almost doubled, she gets quarterly "good job" bonuses, and the hospital is looking for another NP. "I blazed the trail," she says.
Education, certification and experience also affect NP salaries. As a general rule, the more you have, the more you make. While less than $3,000 separates nurse practitioners with associate's ($66,330), bachelor's ($67,951) and master's ($69,144) degrees, nurse practitioners with doctorate degrees pocket substantially more, earning an average of $77,243 a year (Table 5). Interestingly, nurse practitioners working in academia earn a much lower average salary of $62,865, indicating that nurse practitioners with doctorates are finding work in settings outside the classroom.
Meanwhile, second certifications hike salaries an average of $3,428 (NPs with two or more certifications earn an average of $71,923, compared with an average of $68,495 for those with one or none). Experience increases average NP salaries to a point: Salaries steadily rise through the 11- to 15-year range, then level off in the low- to mid-$70s after nurse practitioners have more than 15 years' experience (Table 6).
In a gender-related salary gap that continues to affect the profession, men score an average annual income of $75,483, compared with the $68,556 average among women - a difference of $6,927 a year, or $133 a week (Table 7). Fitzgerald attributes the pay difference to job setting. "My impression - based on observation alone - is that there are more male NPs in subspeciality and emergency department practice [than in general practice]," she offers. "And it looks like those are the folks who are making more money."
M.J. Henderson, NP, of Los Gatos, Calif., has another theory. "I think sometimes men are more assertive in expressing what they want [in terms of salary], and women NPs agree to work for what they're offered," says Henderson, who went to her accountant for advice when she was less than thrilled about a bonus plan offered by her employer. Her accountant worked with her to produce a more appealing payment plan, which Henderson's employer subsequently adopted.
Not knowing how to negotiate, or who to consult for help, likely hinders nurse practitioners - no matter what their gender. "Grad school did not prepare NPs to negotiate wage and benefit packages, particularly with private practice physicians," noted one survey respondent. To gain some guidance on the matter, ADVANCE asked a recruitment expert and NP graduate program advisers how nurse practitioners can more skillfully enter into salary negotiations. Their advice appears in the sidebar.
In a state-by-state salary breakdown, New Jersey emerged as the state where nurse practitioners earn the most (Table 8). Employers in New Jersey pay NPs an average of $78,214 in 2003, followed by Washington, D.C. ($77,846), Alaska ($77,273), California ($76,710) and New Mexico ($76,603).
In a regional breakdown, the Western and Pacific areas yield the highest average salaries at $72,938 and $72,877, respectively (Table 9). A California resident, Henderson expected to hear that her area was among the higher-paying localities. "I'm not surprised. With Silicon Valley and the Los Angeles area here, it's so costly to live," she says. "Salaries have to be higher."
In a comparison of urban, suburban and rural settings, nurse practitioners working in urban areas once again make more ($70,040), followed closely by nurse practitioners working in suburban areas ($69,835). NPs who practice in rural areas make an average of $66,842 (Table10).
ADVANCE for Nurse Practitioners published its fourth national salary survey questionnaire in the July, August, September and October 2003 issues. The journal received a record 3,731 valid responses.
To ensure the accuracy and specificity of our data, ADVANCE did not tabulate any surveys filled out by people who were not nurse practitioners, such as clinical nurse specialists or nurse midwives who were not also certified as NPs. To further ensure that average salaries were calculated accurately, we averaged the salaries of full-time and part-time NPs separately.
Statistical expert William B. Smith, executive director of the American Statistical Association, once again confirmed the validity of our survey methods.
Will nurse practitioner salaries continue to rise? Fitzgerald predicts that a substantial jump in compensation is due as fallout from the RN shortage. She remembers the effects of the last nursing shortage in the early 1990s. "NP salaries took a huge jump about 2 to 3 years after the RN salaries did," she says. As financially burdened nurse practitioners discovered that they could make more money as RNs, they left their NP positions. "Employers started saying, 'We need the NPs; we can't afford to lose them,'" Fitzgerald recalls.
Henderson notes that data from the National Salary Survey of Nurse Practitioners can have a positive effect on salaries by empowering more NPs to demand better pay: "You may renegotiate for a salary increase because you read the survey last year and thought, 'Geez, why am I getting $55,000 when I could be making $69,000?' It might be the survey itself that's the impetus for people to renegotiate."
Jolynn Tumolo is the senior associate editor, and Jill Rollet is the associate editor and online editor. Reach them at firstname.lastname@example.org and email@example.com, respectively.