The Important Role of Nurse Practitioners in the Medical Field

The expertise of nurse practitioners is increasingly utilized in a variety of clinical settings, including primary and emergency care, pediatrics, and gynecology. Many patients recognize the importance of nurse practitioners, but America’s medical industry often takes NPs for granted. Here, Elite NP founder Justin Allan aims to help nurse practitioners recognize their worth and leverage their skills to gain financial and professional prosperity.

Why are nurse practitioners important?

Nurse practitioners are quickly becoming the back bone of the American medical system. According to the American Association of Nurse Practitioners (AANP), there are more than 385,000 nurse practitioners licensed in the U.S., and this number has steadily increased throughout the past decade. NPs can perform a wide range of clinical services, and often provide life-saving medicine in the absence of M.Ds.

However, the heavily profit-driven United States healthcare field often pigeonholes NPs—considering them unworthy of authority, underestimating their clinical capabilities, and frequently offering low salaries for skilled work. Since many nurse practitioners are motivated to enter the field because they love helping people, they may settle for less both financially and professionally. The result is a group of professionals not leveraging and utilizing their true power.

What is the revenue potential for NPs?

Nurse practitioner salaries are often stagnant or have even decreased in many parts of the country due to market saturation. Desperate nurse practitioners are accepting low salaries and failing to effectively negotiate livable wages during the initial hiring process. Nurse practitioners have the potential to generate hundreds of thousands of dollars per year for a practice, yet they are commonly paid far less. This results in business owners, physicians, and administrators pocketing the money generated from an NP’s hard work.

Is it better for nurse practitioners to establish their own business?

In many cases, owning a business as an NP can be more lucrative than a staff position. Let’s say Sally Jane NP applies to a new job and is offered the position at $94,000 per year. She fails to negotiate higher because she is afraid to jeopardize this new employment opportunity. Sally Jane also doesn’t understand the power she actually yields in terms of revenue generation. She takes the position, is paid a stagnant salary, and the practice owner pockets all surplus profits.

The owner realizes that Sally Jane NP will generate revenue that far exceeds her salary. Business expenses are a factor, but the disparity between nurse practitioner value and their salary is often quite large. Sally Jane NP sees an average of 20 patients per day, five days per week, over a period of 48 weeks during her first year of employment. Let’s say each visit reimburses $100. Her hard work generates $480,000 each year for the clinic.

$480,000 – $94,000 – $100,000 overhead = $286,000 profit that goes into the pockets of others.

While owners, administrators, and supervising physicians play an important role in a practice, they likely perform less “hands-on” work on a regular basis than a practicing NP. Yet they earn much more per year. These numbers are often worse for nurse practitioners in busy urgent cares, emergency departments, minute clinics, and specialty practices. Some nurse practitioners generate close to $1 million each year, but only receive 10 to 15% of that revenue! The importance of nurse practitioners should directly correlate with compensation, yet it rarely does. This may be discouraging, but NPs have the power to disrupt this pattern.

A lucrative alternative

Here is another hypothetical scenario: Jenny Elite NP owns two side practices. She works approximately ten hours per week at each practice, while holding a 1099 part-time job to pay for personal expenses. She sees an average of ten patients per week between these two businesses. Each visit generates approximately $250. Over a period of 48 weeks, she generates $120,000.

$120,000 – $40,000 overhead = $80,000 profit on a part time basis.

If Jenny Elite NP owned one full-time practice and met with 20+ patients per day, profits can easily hit $300,000 or more. Owning a full-time practice can also give Jenny the opportunity to hire assisting nurse practitioners, expanding the scope of the practice and generating even more revenue. This is why owning your own practice/business can be a great move for NPs!

How can nurse practitioners negotiate a raise?

While Elite NP generally recommends owning and operating an independent business, it’s also possible to boost earnings through strategic negotiation with employers. Asking for an additional $10,000 per year from an employer is typically feasible. If you are productive, a salary bump should not be an issue. Calculate how much you actually generate for your employer’s practice. By presenting this data, you will prove the value of your work in quantifiable ways.

Attitude matters. It’s important to appear confident, firm, and aware of your worth. Most practices will want to avoid losing a good employee. Use this to your advantage during negotiation.

You are important. You are valuable. You are powerful. YOU ARE WORTH IT!

44 Responses

    1. Your employer is either lying to you or they are managing the clinic horribly and have way to many expenses. I am unable to break down the expenses of your practice without knowing anything about it. But I can assure you, you are making them a lot of money.

    2. Can someone running a practice give me an idea of a fair hourly rate for seasoned FNP
      That is PMHNP certified also? The market is flooded
      In my area but I feel l lack little supervision and am dual
      Certified I deserve a higher rate. I don’t take health care either but am compensated similarly to newer CRNPs

      1. Welcome to the new era, it sucks. It comes down to how much you could produce. I pay NPs that work for me 50% of collections. Try to negotiate a straight production model either being a % of collections or straight RVU production. That way you are paid for your work. Check out the production article for ideas.

  1. This is affirming to me. I started my own practice 5 years ago and once I realized my earning potential, it’s difficult to think about going back to work for someone else. The struggle has been renegotiating with my collaborating physician as I’ve needed him less and less over the years. He has never been happy about it but we’ve always come to an agreement as he’s always made a lot of money off me. I’ve learned a ton about my earning and negotiating power and what that looks like, it’s extremely eye opening and freeing. When you realize contracted rates with insurance companies and me as a nurse practitioner, that comes directly to me, and I get to manage it, it’s extremely empowering…along with owning my own practice and caring for my clients the way I want to of course…great article. My next venture is changing to a cash based practice :0)

    1. Good for you Carolyn. So many NPs have no idea how much they are actually producing in terms of revenue. People state we shouldn’t be paid the same as a physician. While this is correct in certain specialty areas, a NP can make just as much or even more as a physician by being a business owner. Go cash, it is even more freeing! I will never open an insurance accepting practice.

    2. Psychiatry practices tend to have low overhead expenses. You are fortunate you live in an area that has decent reimbursement rates for NPs. That’s absolutely not the case with other PMHNPs. The majority of their business is made up of Medicaid\Medicaid funded patients, because those are usually the patients who are mentally ill.

    3. Do you mind sharing the structure of your arrangement with your collaborating physician? Flat monthly amount? Percentage?

  2. Justin thank you so much. I look forward to reading your post every week. Thank you for giving me confident in myself and as a provider. Your rock!!!!

  3. Stimulating essay – learning the business of health care is so necessary for all APRNs no mater where they practice . I take issue with the description of nursing being passive and weak – would reframe as unrealized potential.Again taking classes on business management opens the APRN to new horizons whether as a employee or owner.Money is a tool is what I learned when I took a APRN business course doing my graduate studies at Vanderbilt. It was a tough course ,especially understanding the emotional relationship with money .

  4. I whole heartedly agree with your philosophy and appreciate your attempt to bolster the profession and professionals. However as you said, we are a-dime-a-dozen so if I demand more or negotiate beyond what my employer feels is reasonable, then they will just find another more malleable NP with or without experience to fill my spot and I am left jobless…
    Again, thank you for being real. I do think part of the problem is too many malleable women in the profession, and I can say that because I am one. We don’t know how to negotiate, we are still learning to stand up for ourselves and still try to eat the young. Until we take charge and act like professionals in every aspect, the NP profession as a whole won’t be able to move forward. I am an optimist though… thanks for being a progressive!

    1. Thanks for the comment Holly. Yes, it is time to start standing up for yourself. Consider opening a business on your own. Then you make what you want to make. Cut the middle man out!

  5. Sadly, we can only stand alone if we decide to truly stand alone, hang our own shingles so to speak. At the end of the day, we become “nurse practitioners” because the physicians we work with allow us to be NPs based on their practice need. The doctors’ endorsement of our titles remain the ultimate boost or bane of our existence. The moment that endorsement is non-existent, we are nothing. It has happened to me although I continue to practice with the title and the licensure of an NP. I do not mind practicing within the scope of my practice within the state that practice in. Unlike PAs who do work like MDs and who would not extend their patient care beyond what MDs typically do at the bedside, we run the gamut of taking care of our patients from cradle to grave, or more crudely from potty to morgue. Our true worth is primarily hinged on delivering concierge, patient-centered care. So I do not mind tons of care coordination, and all other diminutive tasks, in spite of the fact that I am supposed to practice at a “higher level” as some colleagues, who happen to have the good fortune of being associated with well-positioned collaborators, perceive our role to be. But we can talk the talk and walk the walk of an MD but if we do not get down to brass tacks to improve and elevate patient care, our higher education and our titles are worthless.
    Salary is always a sensitive topic and historically so. For one, majority of NPs are women. Right off the bat, our salary is already less for that reason alone. Secondly, we cannot be regarded beyond being nurses first and foremost. Until there is a shift in power and nurses truly take the reins in all the health care institutions (let us start reclaiming nursing homes, for example), our bargaining power is worth a grain of salt.
    It has been a great ride for me as an NP. My salary is not to be sneered at either. But at the end of the day, our resiliency to do the utmost for our patients against all barriers to practice is what determines our worth.

  6. I would really like to see more professional language, thoughtful analysis, and proofreading for articles representing NPs. We can do better.

  7. Justin,
    Respectfully, I think you are unrealistic.
    1) Current NP’s – are not financially stable. Many have a lot of student and
    other debt and are not able to take on
    a risky business condition.
    2) Current NP’s – many are not performing at a level of quality that
    warrants demanding and commanding
    a certain salary.
    3) Current NP programs – many are
    lackluster. They were slapped together to meet a demand. The
    programs accept anyone who will pay
    the tuition and then a mail order education is provided.
    4) Your $286,000 gap is far from accurate.
    ($400,000 minus $94,000 equals
    $306,000. $306,000-$20,000=$286,000.)
    The physician or company who owns the
    practice is absorbing many different
    expenses. These are much greater than
    $20,000 a year.
    Rent, utilities, salaries for office staff,
    answering service, cleaning service,
    medical technicians. Medical billers
    usually receive 6% of the collections if
    I am not mistaken in addition to their fee.
    A few stellar NP’s perform at levels of
    quality and quantity as well as clearly
    have a sense of “what it takes” to run
    a business, create a product line. the

    1. 1. I had massive amounts of student loan debt as well. That is why starting a business is “risky.” You must take on risk to succeed in this world. Nothing comes easy. It is not for everyone and that is fine.
      2 and 3. Yes, a large amount of NPs are not capable of practicing independently or starting a practice on their own. NP programs are doing a great disservice to many people. It should be a crime.
      4. I own multiple practices. I see the numbers. It does not cost as much as you think to operate a practice. If the practice you are working for has high overhead, then they are horribly managed to begin with. The numbers I quoted were: $480,000 – $94,000 – $100,000 overhead = $286,000 profit. 100k of overhead per provider is totally realistic. I am not sure where you are getting the numbers you quoted from.

      Right, a few NPs out there are capable of what I advocate for. That is why I created the name “The Elite NP.” This is not for everyone, but for those that are willing to take a risk and want to succeed, can. Many people are content working, receiving a paycheck, and going home. That is fine. But there are others that are not content with our current practice environment.

  8. That’s fine and all, but how is it realistic? For example, student debt of almost 80,000, new np with less than 6 months experience. How in earth are you suppose to start your own business in that kinda debt, let alone barely any experience?

    1. I did it. I had the same amount of debt as you. Listen, never start a business with debt, therefore a business loan shouldn’t even be a thought. This is totally realistic. You can start a small side practice with less than $5,000. Hell, you could get away with $2,000. Not much experience? Consider a low liability practice that is relatively easy. Prescribing medications that have few contraindications does not require a tremendous amount of experience. I go over this exact issue in my book I will be releasing soon just FYI.

  9. You are going to phase yourself out of healthcare entirely with this mindset. We are all subject to simple supply-side economics. NPs justify their existence based precisely on their cost. Why pay an NP what you would a physician? If I am a clinic proprietor or a health system, if I have to pay 50% of revenue generated +/- a base salary, I am of course going to choose the physician every time. Why pay a provider with a fraction of the training the same as one who attended medical school?

    This would be akin to walking into Nordstrom and expecting to pay Walmart prices. The value to cost ratio is in favor of NPs only when they realize that approximately $100,000 is more than fair for their amount of training.

    For example, you mention Jenny NP and her hormone-replacement practice and aesthetics clinic, but you mentioned nothing of her extensive residency training in endocrinology AND plastic surgery.

    What’s stopping a licensed chemical engineer from saying “Oh! I can just read UptoDate and start my own Botox clinic”?

    1. We live in a capitalistic economy. I am not saying a NP should be paid what a physician does. I am just trying to highlight the fact of what NPs can produce. You are paid based off what you produce. Welcome to a free market healthcare system. A NP, chiropractor, MD, DO, or a physical therapist can open up their own business/practice and make a substantial amount of money. I have seen a OB/GYN work at a men’s health testosterone replacement clinic. I have seen family physicians run aesthetic practices. They do not have residencies in endocrinology or plastic surgery. They took a course, self studied and opened up a practice.

      1. Yes, and they are providing the same garbage, basement quackery, race to the bottom medicine that you are encouraging NPs to provide on this site.

        MDs/DOs at least attend medical school and complete >10000s hours of directed clinical training.

        Just because something is currently poorly regulated does not make it good medical care. You are commoditizing medical treatments in a way that is unethical and concerning.

        1. Does this garbage not deliver results that patients are willing to pay for? Are you saying every cash type practice in this country is basement quackery?

        2. I think he is promoting independence in the NP and learning to have the backbone to fight for your worth. If you think you are valued less as a provider vs an MD, that is on you. Yes they have more clinical training. But I have over 16 years as a nurse and 9 as an NP, working full-time, in various areas of practice. Surely that accounts for something???????? i provide excellent care to my patients everyday. For me to accept a low ball salary, is just accepting that I am not worth more, and neither is my hard work and credentials. I have four college degrees. my highest a doctorate. Is my worth 55$ an hour??? Hell, no!
          Your thought process is the reason we have to continue to fight for our worth.

        3. First off I have 20 years total in healthcare. 11 of those as a RN and 9 as a NP. I have experience in management in ER, med surg and urgent care. I do not think I am a doctor but I have training and experience that has prepared me to care for my patients. I spent 7 years in school working on a BSN then my MSN as a FNP. Lets do the math 2 years for my ADN +7 more on to my MSN and FNP that is 9 years of school. And lets not forget 11 years as a Nurse doing bedside, managing staff as a hospital executive and learning all about that side of healthcare and all this before I ever took care of a patient as a provider. I am trained and know my worth and my place.

  10. My spouse and I absolutely love your blog and find nearly all of your post’s to be exactly I’m looking for. Do you offer guest writers to write content for yourself? I wouldn’t mind writing a post or elaborating on a number of the subjects you write with regards to here. Again, awesome weblog!

  11. This is really good information. I am a gerontology adult acute care nurse practitioner with most of my experience in cardiac. I graduated and took a position in rheumatology because I wanted to stay in the same health care system. Covid 19 came along and I was furloughed and then let go. My masters in acute care np doesn’t let me own a practice and work. I think I can manage a practice and hired FNPs to work for me. I have 2 that would. As a Acute NP I can only work in a specialty or in the hospital.

    1. That is the downside about these specialty NP licenses… It really holds you back like you described. I think the idea of starting your own practice, managing it, and hiring other FNPs is a great idea! Just be cautious with who you hire. Employees tend to bring complication.

    1. Sure you could do DOT physicals independently if your state allows independent practice. There is not a lot of money in it but you could provide those services out of any practice. Just advertise your services in truck stops etc., and charge a flat fee for it.

  12. Hi! I’ve been following your weblog for some time now and finally got the courage to go ahead and give you a shout out from Austin Tx! Just wanted to say keep up the great job!

  13. Ugh, I feel this! I see 35-45 pediatric patients a day and made my clinic over $1Mil last year. I did not make anywhere close to $1mil, or even half that. It sucks!

  14. I have had my own PMHNP clinic since 2003. Started with me and my flip phone and black appt book.
    To date I have 2PA’s, LPC, and FNP working as independent contractors on a percentage of collections basis. I pay all overhead.The clinic progressed to collecting over one million per year a few years ago. The take home pay for my providers is well above the average. One NP, for example sees 25 pts a week over two days and gross take home income is $125,000.
    I was never out to get rich but make a fair wage for my efforts and pass that on to anyone that works for my company.
    I am now financially reaching my retirement goals. My collections are only 20% of my total income.
    There is a strategy to a successful practice.generally not written in a book.

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