The Career Ceiling of Being a Nurse Practitioner

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If you like it or not, there is a professional and career ceiling for nurse practitioners. In most situations, you can only move up so high in your career. Once you hit that position, there is little upward movement other than hopes of receiving increases in your salary… which sadly salaries have gone DOWN in many areas which is absolutely insane when you consider the hyperinflation occurring in our economy. But I digress on that point. The point here is that once you hit the high of your career, there is little upward movement other than starting your own practice.

Nurse practitioner salaries have stayed fairly stagnant over the past 10-20 years. I was making about the same in 2011 as I was in 2021 in my employed positions. In any other professional setting, that is typically unheard of, but for the nurse practitioner profession it is the unfortunate norm. Even RNs typically will get yearly raises, but nurse practitioners? NOPE! Why is this?

The reason is that we are seen as work horses by healthcare administrators and physician overlords. We are seen as a disposable asset secondary to market saturation. Essentially, we can be replaced, and we can be replaced CHEAPLY and EASILY. This is the predominant reason why salaries are stagnant. It is absurd.

The only way to overcome this is by being as knowledgeable, confident, independent, and productive as you can in an employed position. If you are bringing in a million + dollars into a practice a year, then you are seen as valuable. You have leverage to make demands and increase your salary. This is what I did in all of my urgent care positions over the past 10 years. But for many nurse practitioners, they might only bring in $300,000-$500,000 a year. While an impressive number, it is a number that is replaceable. You do not have leverage to make demands, and this is where a big problem lies within healthcare:

The insurance game is dictated by set numbers from Medicare, Medicaid, and insurance carriers. These numbers usually are non-negotiable in any meaningful way. Therefore, your possible production is CAPPED right from the start. You are fighting a losing battle. The only way to increase your profitability is by seeing more patients and billing more. Which leads to burn out city for most. I know it led to my eventual burn out in urgent care when I had to see 30 patients in 2 hours… That was the moment I put my official resignation in. They can find another chump to do it.

With that said, this is a reason why there is little upward movement for the employed nurse practitioner. Most employed nurse practitioners are forced into the insurance game through their jobs. You will see very little in terms of raises in your career. Ask any nurse practitioner who has been working for the past 20 years. Seriously, ask them how much they were making in 2000 compared to now. It really is not THAT MUCH of a difference when adjusted for inflation and increases in cost of living… Then ask them what their job is. It will be the same job, just maybe with a different employer.

This is what I mean by a CEILING to your career. Once you are a practicing nurse practitioner, that is about all you can do. Sure, you can get into administration, and you can teach, but those jobs usually don’t pay much more than being in the clinical setting. Hell, they might pay less!

You graduate school, you become an employed nurse practitioner making a whopping $110,000 a year. In 10 years, you are performing the SAME duties as you did 10 years ago and might be making $120,000 a year. You are CAPPED. You have hit the ceiling and you are only 10 years into your career. There is little ADVANCEMENT in your career. This is no good.

Of course, there are outliers. I was able to make approximately $180,000 one year working in an urgent care. But I will tell you: I busted my ass for that money. I saw the same patients for the same complaints (so no intellectual stimulation), and I saw A LOT of them… It was one of the predominant reasons I burnt out, especially after I saw how much was taken out for taxes… It made it not even worthwhile (which is a reason you need to do everything you can to legally pay the minimum in taxes as you can!).

I have heard of other nurse practitioners who are treated fairly in their jobs and receive regular bonuses and raises. But these are the outliers. This is atypical for most nurse practitioners. For most nurse practitioners, you have reached your potential once you get your first job… It is a travesty honestly.

Now, can things change for the employed nurse practitioner? Sure… You can bounce from job to job looking for something better. You can move to an independent state where you provide more value than restrictive states. You can work in administrative roles. You will need to keep looking until you find the unicorn essentially. Many nurse practitioners find that amazing job. I know many employed nurse practitioners who make $200,000+ a year, but again, it is atypical.

And many of you might be thinking “Well then, we need to change the state of our profession! We need to demand change and lobby for change!” I personally think this is wishful thinking. Healthcare is a capitalistic enterprise in this country, and it is driven by profits. Do you think enough change will occur to trickle down more profits to the hard-working nurse practitioner? I doubt it. Plus, the market is saturated and remember, there is very little you can do about nurse practitioner market saturation…

So, how do you crash through the ceiling of being a nurse practitioner? You can look for better jobs sure, but the only meaningful way I know (and many other nurse practitioners know) is by starting your own practice. Seriously, it is the FASTEST way to break through the ceiling and advance your profession. Why? Multiple reasons:

You are in control of your job. As a business owner, YOU MAKE THE RULES.

You are in control of your finances. If you want to make more money as a business owner, you can.

You can practice outside of the standard healthcare model. You can learn skills outside of general medicine.

You can grow your practice as much as you want. You can only grow your career so much as a nurse practitioner. Sure, you can obtain more certifications and what not, but after that, you are still capped. You can obtain a DNP, but that will not advance your career in any significant way for most people who have obtained it. On the other hand, as a business owner you can grow and expand your business as much as you want! I own 3 practices and I am very content. I am actually looking for another nurse practitioner as my men’s health practice continues to grow. It is great! I would have never been able to reach that achievement being employed. NEVER!

The point of this article is to highlight the fact that for the majority of nurse practitioners in this country, your career has a ceiling, and you reach that ceiling pretty early in your career. As a lawyer, you can work your way through a law firm and become an eventual partner making $500,000+ a year. Same thing withing being an accountant. Same thing with being an engineer. But for the nurse practitioner? You are stuck…

If you want to break free, consider starting a side hustle at first while maintaining to work. Follow The Elite Nurse Practitioner Model. I designed it to help my nurse practitioner sisters and brothers to crash through the ceiling and to break free. You don’t need to spend tens of thousands of dollars to start this side hustle. All you need is an initial $5,000-$10,000 investment (depending on what you want to do). That is it my friends… Isn’t $5,000 a worthwhile investment to advance your career? It is, and it is much cheaper than obtaining an additional fruitless certification or degree. I guarantee it.

You can crash through the ceiling. I have and so have countless others. Don’t accept the norm. Don’t live by default, but instead live by your own design. You will never regret it. Ask any nurse practitioner entrepreneur.

4 Responses

  1. This article is true in so many ways. I noticed this during my first employment as an NP. I saw that no matter how many patients you treated, it was never enough. Honestly, the owner placed a “dangling carrot” in front of you, only to find out that the goal will never be obtained. Also, I think that they were not honest about how much money you were making for the company, to keep you from not getting a bonus. Being an entrepreneur ( I started my own practice 8 months ago) is hard work. But, you have to change your mindset. I encourage you before starting your side hustle, read about other successful entrepreneurs and how they started and circle yourself around people who think like you. It is a mindset, lifestyle, and sacrifice that is needed before making the initial start. Not everyone will be encouraged to start their own business, and that is ok. Everyone is different so do not feel bad if this is not for you so please do not take offense.
    Good luck to everyone!
    “Fear is the contamination of Faith” ~~~~ Denzel Washington

    1. Great post. I completely agree with you. It does take sacrifice and is not for everyone, but it is the best way to break through the ceiling.

  2. Good article. I’m currently nickel and diming my way to my own practice. My current hurdle is trying to work around my restrictive state. So I am looking into virtual mailboxes to expand my business into non restrictive states!! Eventually I will suceed!

    1. You will get there! It is just one step at a time and that is exactly what you are doing. Before you know it, you will have your own practice! Just stay consistent and keep moving forward.

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