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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

The True Worth of the NP

Do you realize that nurse practitioners are becoming the back bone of the American medical system? We are being utilized more and more within general medical care such as primary care, urgent care, woman’s health and emergency care.. Where does healthcare start? In these settings. We are becoming the driving force of medicine in this country.

Yet, we are still grouped into this “mid level provider” category. We are grouped as 2nd class providers. Many nurse practitioners simply accept this and just roll with it…

To many nurse practitioners undervalue themselves professionally. Many become stuck in the nursing mindset which is often times submissive and passive. This is not always the case, but it is a prevalent phenomenon. The result is a group of professionals not leveraging and utilizing their true power.

Consequently, nurse practitioner salaries are stagnant or have even decreased in many parts of the country as the market becomes more and more saturated. Desperate nurse practitioners are accepting insulting salaries or fail to negotiate the salary during the initial job process. This results in business owners, physicians, and administrators pocketing the money of your hard work. This should PISS YOU OFF.

Let’s run some hypothetical numbers. Let’s say Sally Jane NP applies to a new job and is offered the position at $94,000 a year. She fails to negotiate because she fears she will insult her new employer. She also doesn’t understand the power she actually yields in terms of revenue generation. She takes the position while the manager/owner laughs their ass off to the bank. What the owner actually knows is that Sally Jane NP will generate revenue that far exceeds her salary. Yes, there are expenses, but the owner will be profiting SIGNIFICANTLY.

Sally Jane NP ends up averaging about 20 patients a day, 5 days a week over a period of 48 weeks in her first year of employment. For simplicity purposes let’s say each visit reimburses $100. Her hard work generates $480,000 over the year for the clinic.

$480,000 – $94,000 – $100,000 overhead (This estimate is very exaggerated for one provider) = $286,000 profit that goes into the pockets of others.

What does the owner, supervising physician or the administrators actually do? Very little… Don’t be fooled… They just made $286,000 off your hard work, liability, sleepless nights, and stress.

Do you see how much financial power you have as a nurse practitioner? Far more than you think. The numbers are even worse for nurse practitioners in busy urgent cares, emergency departments, minute clinics, and specialty practices. Some nurse practitioners generate close to $1 million yet only make 10-15% of that revenue! This should PISS YOU OFF.

Here is another hypothetical scenario just as realistic as the one above. Jenny Elite NP owns 2 side practices that she spends about 10 hours a week each on while working a 1099 part time job to pay for her personal expenses. She owns a small aesthetic practice and another hormone replacement clinic. She sees about 10 patients a week in between these 2 businesses. Nothing crazy, nice and steady. Each encounter generates approximately $250. Over a period of 48 weeks she generates $120,000 working 10 hours a week (These numbers are being very modest by the way.)

$120,000 – $40,000 overhead = $80,000 profit. PART TIME!

If Jenny Elite NP owned a full-time practice where she was seeing 20+ patients a day, the profit would easily hit $300,000 or more. If she was smart, she would hire other nurse practitioners and expand further even making more money with little effort.

So, $94,000 or $300,000 a year for the same amount of work? It is a no brainer. This is why owning your own part time practice/business is such an awesome goal to strive for!

If you do not want to start your own side practice, which you really should consider, but want to negotiate a higher salary then consider the above numbers. Asking for another $10,000 a year from your employer should not be a burden to them, it is simply greed on their part if they do not want to give you a raise. If you are productive, then it shouldn’t be an issue. Show your current employer how much you generate. Show them how your extra work generates significant revenue to the practice!

If you are somewhat aggressive and demanding, they will fear you will leave and negotiate with you. Trust me.

If you are negotiating a salary for a new job, run the numbers by your potential employer. Ask them why they believe only giving you 15-20% of collections is reasonable considering you are the one in control of patient workflow and billing?

YOU ARE THE MAJOR REASON WHY THAT PRACTICE GENERATES MONEY. REMEMBER THAT!

The license you hold to practice advanced nursing as a nurse practitioner is VERY powerful. You can personally generate hundreds of thousands of dollars a year. Some generate close to a million. Yet so many in our profession bend over and take it? Why?

Why accept a position where you are given the left-over peanuts?

Why work your ass off with such little recognition?

Why stress yourself out to the max for such little in comparison to what others make?

WHY MAKE OTHER PEOPLE RICH?!

You are worth far more than you think! You have an ability that so many other entrepreneurs in other fields would kill for. You can diagnose and prescribe. THAT IS HUGE!

What power does some dime a dozen MBA have compared to you? Not much. They simply “manage” and “administrate” the medical practice. BIG DEAL! As do I with my practices. It takes 5 hours a week! It is not hard.

These people are sharks. The physician supervisor who does nothing yet makes tens of thousands of dollars off you is a shark. The person who owns your practice that has no medical experience is a shark.

They are using my fellow colleagues by the truck loads to unfairly richen their lives. This should PISS YOU OFF.

You are a nurse practitioner. You have a tremendous amount of economic power. Far more than many realize! Once you truly digest this, you will become aggravated knowing you are making others rich. You are the one bringing in the money, everyone else is disposable.

Without you, the practice shuts down!

Without you, the practice wanting to hire you cannot generate more money.

Without you, the medical system in this country would be overwhelmed!

You are important. You are valuable. You are powerful. Repeat this to yourself before a job interview or job negotiation. Repeat this to yourself before you go into your boss’s office and ask for a raise. Repeat this to yourself while your hesitating on starting that first side business. YOU ARE WORTH IT.

35 thoughts on “The True Worth of the NP

    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?

  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.

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