The results from the 2006 Salary and Practice Survey sponsored by The Nurse Practitioner are in. More than 500 (549 to be precise) nurse practitioners (NPs) responded to the survey, which asked about education, geographic location, practice and prescriptive patterns, and of course, current salary. Surveys were accepted between August and December of 2005.
In addition to answering our survey questions, many NPs offered their own insights into the profession. Their comments revealed both success and frustration in certain areas of practice, particularly compensation. Salary questions triggered the vast majority of comments, ranging from those who have seen an increase in the salary offered as well as an increase in the number of job offers, to one who claimed her hourly wage was $8 less than what she could earn as a hospital critical care nurse. A recent graduate, who was in the top of her class in the top-rated FNP program in the United States, had this to say: "It has been next to impossible for me to find an NP job in the city where I live that pays enough for me to cover my living expenses and student loans." Compensation and employment remain top concerns for many NPs.
Salary, Education, and a Gender Gap
The average annual salary for NPs working full-time was $70,960; 9.4% reported salaries more than $95,000, and only 2.8% reported salaries of $35,000 or less. Salaries varied based on geographic location, with the highest average annual salaries in urban areas ($74,510) and the Mountain States ($77,070), and the lowest in rural areas ($68,370) and the East North Central States ($68,140). The average hourly rate for NPs working part-time was $35.10, and 2.8% reported earning more than $50 per hour.
Experience was only partly rewarded with higher compensation. Those who had been NPs for more than 20 years earned an average salary of $77,460 compared with $67,850 for those with 1 to 2 years of experience. However, this amounts to a "reward" of less than $10,000 for nearly two decades of experience.
Respondents fared somewhat better when it came to education and compensation. There was more than a $30,000 difference in average salary between those with a diploma and those with a doctorate degree ($47,130 and $77,670 respectively). This advantage was less pronounced between other educational levels. The difference between a bachelor's and master's degree was less than $6,000 ($66,700 and $72,480 respectively), and the gap narrowed to $5,200 between those with a master's degree and a doctorate degree ($72,480 and $77,670, respectively).
Other factors in addition to experience and education affected earning power. According to one NP who worked in acute patient care, most of her RN colleagues are eligible for night/weekend differentials and time-and-a-half overtime pay. As a salaried NP, she is not eligible for either, and the RNs fare better financially with this arrangement. The 1.4% of NPs who practice in the neonatal specialty earn the highest average annual salary ($79,000), which is approximately $10,000 more than that earned by the majority of NPs in family practice (48.8%).
The salary data also revealed a gender gap. Although representing only 8.7% of survey respondents, men reported higher full-time salaries than women, with an average annual salary of $75,310 compared with $70,550 for women. Male family NPs earned an average annual salary of $74,800; females earned 7.9% less than males ($68,920). This trend was also seen in acute care, where males earned 8.2% more than their female counterparts ($81,860 and $75,660, respectively). Interestingly, no males in our survey sample were employed in the mental health, neonatal, pediatric, or women's health specialties.
Benefits are a key component of compensation. The top benefits that employers provided were health insurance (83.1%), malpractice insurance (78.9%), and continuing education (77.5%). More than two-thirds provided a profit sharing or retirement plan (65.8%) and paid conference travel (63.3%) Note that respondents could choose more than one benefit.
Demographics
The demographics for NPs followed the national patterns for RNs. Most respondents were females (91.3%) with an average age of 47.27 years. More than 70% were between 41 and 60 years old; only 5.9% were younger than 30 years old. Ethnicity responses were as follows: white (92.1%), black or African American (3.9%), Hispanic (1.9%), other or not specified (2.1%). Mean age was 47.27 years; more than 70.8% were between 41 and 60 years old and 5.9% were younger than 30 years old. More than half (54.6%) had been RNs for more than 20 years, with a mean of 17.79 years. Although the mean number of years as an NP was 8.08, almost half (48%) had been an NP for 5 years or less. Nurse practitioners generally worked in the area where they lived, with the largest group living (22.8%) and working (22.1%) in the East North Central states of Illinois, Indiana, Michigan, Ohio, and Wisconsin. More participants (40%) worked in urban areas; 32.7% worked in suburban areas and 27.3% in rural areas.
It was encouraging to see that 84.5% of NPs surveyed had master's degrees; 2.7% had earned diplomas and 2.9% held a doctorate degree. For 95.0%, the highest degree attained was in nursing.
All specialties were represented in the survey: family, 48.8%; adult, 20.1%; women's health, 7.8%; pediatric, 6.6%; acute care, 5.8%; geriatric and mental health, each 4.8%; and neonatal, 1.4%. Nurse practitioners with more than 20 years of experience tended to specialize in women's health (27%) or pediatrics (20%), while those with 2 years experience or less were more likely to specialize in acute care (34.5%) and adult (29%). This pattern may portend a future shortage of NPs in some specialties.
Most NPs were employed full time (79.1%) and more worked in a hospital (16.9%) than in a family practice setting (14.7%). Pediatric, elementary/secondary school, health maintenance organization, and mental health settings each represented 2% or less. Although the survey choices did not distinguish between private practice as owned by an NP versus a physician, 8.9% indicated they worked in private practice; some noted that they own a private practice. Nurse practitioners are a mix of stability and mobility. The majority of respondents (68.9%) have been in their current position for 5 years or less, while 38.9% have held their current position for 1 to 2 years. Only 2.9% have been in their current position for more than 20 years.
Daily Practice
Respondents saw an average of 16 patients per day and spent an average of 15 to 20 minutes (mean 21.66 minutes) with each patient. Approximately 28% of NPs saw between 11 and 15 patients each day; 26.7% saw 10 or fewer; and 9% saw more than 26 patients. Attention to productivity matters; respondents commented on pay for performance and bonus pay, neither of which the survey specifically inquired about. One NP stated that she did not receive a salary-her income was based solely on a percentage of the collections from patients she saw. Others noted that they received a quarterly bonus based on patient numbers or worked within a bonus system worth up to 15% of annual base salary based on patient satisfaction, coding properly, and volume. However, some NPs did not receive any bonuses, regardless of productivity.
The survey also asked about patients' means of paying for bills by type of insurance coverage (self-pay, private insurance, federal or state insurance, and other) and whether NPs billed patients under their own provider number. Most (58.9%) NPs had their own provider number for billing with 70.2% issued by Medicare. In addition, 34.2% held provider numbers issued by Medicaid, and 29.1% by an insurance company. Nearly 10% of NP practices did not have any self-pay patients; less than 1% were in a practice where 100% of the patients were self-paying. Some 2.8% did not have any patients with private insurance; 2.2% had 100% of patients insured privately. Only 3.2% of NP practices did not have any patients insured through either federal or state insurance plans; 6.9% had 100% of patients insured through a government plan. And 11.6% of NP practices had patients who managed their medical bills through "other" means (the survey did not ask for explanation of what "other" included). Data indicate there was a mix of patients in different situations.
Prescribing Patterns
Nurse practitioners who can prescribe typically have their own Drug Enforcement Administration (DEA) number (70.3%) (reasons for not using one's own DEA number were not collected in this survey). Of the cumulative 2,939 prescriptions written in a given week by all survey participants, the greatest number were for infectious diseases (400). Almost half of NPs (43.3%) prescribe between 1 and 5 medications per week, with 66.3% of these prescriptions for dermatologic conditions. Nearly one-quarter (22.7%) prescribe 6 to 10 medications per week, with 31.1% for gastrointestinal disorders. Nurse practitioners who write between 11 and 15 (13.9%) and 16 and 20 (9.4%) prescriptions per week most commonly prescribe medications for infectious diseases. The 10.6% who write more than 20 prescriptions a week most often prescribe medication for conditions other than those classified in the survey choices.
Looking Forward
It was encouraging to see that most NPs are well educated, compensated fairly well, and prescribing independently. A good patient-provider relationship has always been the goal of the NP and even with financial pressure to limit the amount of time spent with patients, most are able to allot at least 15 to 20 minutes per patient. That bodes well for our profession. Areas of improvement include eliminating the gender gap, increasing diversity, and providing better financial rewards for experience and education. We will be sure to report on these subjects in a future survey.