March 26, 2023
March 26, 2023
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Clinics generally consider four sources to determine APP salary:
The most important takeaway for APRNs and PAs who receive an offer from a clinic is to use reliable salary data and negotiate in order to achieve a competitive salary.
Hospitals generally establish salaries by tiers. For example, Tier 1 may represent a base salary for a Monday through Friday schedule, Tier 2 will then add a fixed dollar amount for weekend days and evenings, and Tier 3 adds an additional dollar amount for 24/7 coverage.Each tier can represent a $3,000 to $5,000 difference. Additionally, many hospitals adjust base amounts by years of experience. For example, some hospitals pay new graduate APRNs for years of RN experience at a rate of 1 year of APP experience for every 2 years of RN experience, with a cap generally at 10 years of RN experience. The salary differential given for each year of experience can vary by role and is included in the chart below.
The data in the 2021 Salary Guide aligns with Central United States, make the following adjustments by location:
The simple answer is COVID. According to Becker's Hospital Review, "About 40 percent of respondents reported dips in their overall income, and 31 percent reported lower number of hours worked." For Acute Care PNPs (ACPNPs), salaries decreased with experience,which is most likely attributed to the number of hospitals that did not provide a salary increase. In particular for this role, children's hospitals were hit hard, losing as much as $40 million a month during the height of COVID.
Primary care NPs are catching up to Acute Care NPs in salary. We did not see an increase in bonus plans, which means that salaries are going up for primary care.
PA newer provider salaries fell. Due of the large number of furloughed providers, this is not surprising. PA average salaries remain higher than most of the NP salaries, with the exception of CRNA and PMHNPs.
PA First Assist providers continue to receive substantial annual increases despite operating room shut downs. Many hospitals recognized that they needed to get the ORs open quickly, therefore continuing to employ and provide increases were in their best interest to keep this valuable workforce.
The average Salary for APPs is $120,973.
As Advanced Practice Providers (APPs,including APRNs and PAs) you have difficult, yet rewarding jobs, and deserve to be paid well for your work. The more you know about the salary structure, the better your ability to discuss alternatives. The cost of turnover for an employer is 2.5 times the cost of compensation, so it is worthwhile for employers to pay APPs well. To ask for incentive pay, APRNs and PAs need to start by gathering information.
Discuss with your employer their approach to salary. Understand salary structure - what is the range for your role? What is the max /cap salary for your role at the institution? Explore expected salary increases. Do they offer them? Why or why not? Does the organization provide annual raises? What is the average percent increase? Does your employer provide inflation or merit based raises, or a combination of both? If it is merit based, what is the criteria for earning your raise? Does your organization regularly assess and provide market adjustments? For example, if the organization provides an annual percent raise, but it is lower than salary increases throughout the rest of the market, then overall salaries will be lower than other places. How will they account for this discrepancy? Ask your employer if there is consideration for a base plus bonus model based on productivity. Download from here for reference.
Gather and ask for objective data of your performance measures (i.e. number of patients seen, billing, collections, and even patient satisfaction). You can also ask for visibility into other providers in the practice or to benchmark your practice against national data.Visibility can change behavior for the better when providers realize they are behind their colleague’s measures. When individuals are aware that their work is being observed and that their performance is impacting institutional revenue,their productivity and the quality of their work improves. Then, ask to use this information to set up a base plus a bonus pay model. Use your current salary as your base and then ask for a percentage of your revenue based on your productivity. Many APPs have found that they are actually the highest producer in the office once they receive visibility.
You can present, as an alternative, a straight inflation based annual increase such as 2%. However, this is actually riskier for the practice because it commits them to a fixed salary no matter how much you produce. A base plus a bonus means that you will only be paid when you are producing more than your base. It also helps the employer to know that you are incentivized to code, write accurate and thorough notes, and work efficiently to see patients. Presenting this alternative and then advocating for a base plus a productivity based bonus is an effective way to negotiate for an incentive salary model.
All APPs should consider advocating for incentive pay. If you are considering talking with your employer about salary at your next annual review, start by:
Each cell represents total compensation,which is Salary plus a percent of the total Compensation allocated to benefits.Find your nearest salary on the left and your total compensation in the cell under the total amount of benefits you receive as a percent of your compensation (below).
Average Pediatric Nurse Practitioner (PNP) Salary:
Average PNP salary -$109,498.
Average AC PNP salary- $114,946.
Average AGNP salary -$116,133
Average AGACNP salary- $116,042
Average Family Nurse Practitioner (FNP) salary - $113,103
Average Neonatal Nurse Practitioner (NNP) salary - $121,716
Average Certified Nurse Midwife (CNM) salary - $115,148
Average Certified Registered Nurse Anesthetist (CRNA) salary - $184,000
Average Psychiatric Mental Health Nurse Practitioner (PMHNP) salary - $128,596
Average Woman's Health Nurse Practitioner (WHNP) salary - $105,000
Average Nurse Practitioner Registered Nurse First Assist (NP RNFA) salary - $124,167
Average Clinical Nurse Specialist (CNS) salary - $112,868
Average Registered Nurse (RN) salary - $103,223
Average Physician Assistant (PA-C) salary - $120,680
Average Physician Assistant First Assist (PA-C First Assist) salary - $127,253
Average academic APP salary - $109,000
Leadership structures can be built from the bottom up or top down. A bottom up build means that the organization hires APP leads, and then managers, and eventually a director or Chief Advanced Practice Officer (CAPO). A top down approach is when the organization starts by hiring a Director of Advanced Practice or Chief Advanced Practice Officer (CAPO) and supports that person as they build out leaders, such as managers and leads over service lines. There is organizational variation regarding APP leadership and support for the roles through salaries, titles, and administrative time.
The first is reporting to the Chief Nursing Office (CNO), however the challenge being that PAs do not fit well within that model and having a single reporting structure can be beneficial. The next model includes reporting to the Chief Medical Officer (CMO). Generally,APP leaders align most with this structure and find it supportive.The final model is through the Chief Executive Office (CEO) or Chief Operating Office (COO), a model in which some find the highest level of empowerment and support within the organization. However,a downside of this structure may be that these individuals do not have a clinical background.
This report was originally published on Melnic by Jill Gilliland. Melnic was recently acquired by DirectShifts.