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ADVANCE Voice: NP

Comparing Nurses’ Salaries to Physicians’

Published March 16, 2010 10:17 AM by Jill Rollet
A March 11 article posted to cnnmoney.com taunts readers with the provocative headline "Some nurses paid more than family doctors." The point of the article is that primary care physicians are "struggling to make ends meet" on their average annual base salary of $173,000 in 2009, with the implication that they should be paid more. But the argument supposedly supporting that conclusion is that certified nurse anesthetists (CRNAs) earned an average annual salary of $189,000 last year.

It's clearly "nurse" that's the fighting word here, because if we focus on "anesthetist" we'd see that the comparison isn't valid. (The idea that any nurse should not make more than any physician is the unstated premise in the argument. After all, the article points out, anesthesiologists have 4 or 5 years more medical training than CRNAs do.)

Compared with salaries of nurses whose jobs are similar to those of family practice physicians, those with a medical degree come out ahead. According to the 2009 National Salary and Workplace Survey of Nurse Practitioners, family NPs made almost exactly half the average annual salary of a family practice physician -- $86,520 average ($83,000 median) (see Table 3).

And comparing the CRNA average salary cited in the article to the median salary for anesthesiologists ($378,000 according to salary.com), we see that the nurses make about half of what the physicians make.

So we can all relax now. When we compare apples to apples, we find that nurses do not make more than physicians.

In case you were wondering, according to the American Academy of Physician Assistants, PAs in family medicine made an average annual salary of $84,173 in 2008.

7 comments

Dear Mr. Duffy,

I am sorry for your personal anesthesia experience, but it is valid only to you, personally...Study after study has found that there is no significant difference in the outcomes between anesthesiologists and anesthetists...Please see reference below for your awareness...

"The Stanford Center for Health Care Research conducted a 17-hospital intensive study of institutional differences. A report of the study stated that: "Thus, using conservative statistical methods, we concluded that there were no significant differences in outcomes between the two groups of hospitals defined by type of anesthesia provider." See Forrest WH Jr. "Outcome-The Effect of the Provider."

joseph jacquemoud, Army Nurse Corps - LT/AN, Moncrief April 5, 2010 5:24 PM
Columbia SC

Why aren't NP's compensated the same as medical doctors and physician assistants for the care they provide their patients?

I have found that NP's historically don't want to get politically involved.  This is  one of the reasons that equity does not exist financially for Nurse Practitioners. It also happens to be our legacy. Look back to when physicians and hospitals formed organizations. Nurses at that time, were practicing independently in public health and didn't believe that their autonomy could be stolen out from underneath them in the public sector. But that's just what happened. Hospitals and doctors soon decided that nurses could only function under medical supervision.  No more autonomy.

So today, we deal with the fact that NP's often have families and feel that a "fight" over territory is too much effort.  Many NP's are parents and serve in a dual role. They've worked hard to become nurses and then to become NP's (often fitting school into their work and family situations).

When they started out as nurses they discovered there was no difference in pay for Associate degree'd RNs and Bachelor's prepared RN's. They often faced prejudice from RN's with less education when their name badge indicated their BSN.  They  didn't fight for pay differences for their additional nursing education, so why should we be  surprised now that even with their advanced NP education and role, NP's would fight for the pay they deserve as medical providers?

NPs still largely view themselves as "nurses" verses medical providers. It's obvious in the name. They function as primary care providers but they don't "view" themselves as such, often opting for the safety of being an employee or unionized verses striking out to be an independent provider where reimbursement from insurers is anywhere from 85%-100% of the physician rate.  

The unionization of NPs that is occurring now, is also taking away their independence and autonomy as well as their hopes for equitable reimbursement and compensation.

NPs don't often concern themselves with how to efficiently perform a visit, how to code (they often undercode), and how the business of medicine works.  They don't fight to be an associate member of the AMA (since they are delivering medical care) and they don't distinguish themselves as separate and different from other nurses.

They don't value the name "nurse" allowing anyone who happens to provide some sort of physical care to patients (from aides to chore workers) to be also referred to as nurses--even though their physician counterparts would sue if someone used their title of doctor similarly.

NPs don't even regard themselves as "real medical providers" because why would we want a DNP that is purely education based verses a DNP that focuses on additional medical residencies and expertise?  When the question of whether an NP should push for doctoral programs that would allow them to advance to a medical doctorate, most NPs become unglued claiming, "if you wanted to be a doctor, go to medical school".

How then, are we to expect that we would get financially compensated for our medical services to patients as employees of some entity?  If we don't really view ourselves as real medical providers, worth our salt and expertise, why would we fight to get what we deserve? Why would we fight to re-educate the public that we aren't "just nurses" but medial providers with the best wholistic nursing foundation?

The question isn't why aren't NPs financially compensated the same as family medical doctors and physician assistants, it's why don't NP's believe they provide a standard of care that is different and superior to nursing and at the level of physician providers?  

Until we stop willfully giving away our autonomy, start fighting for equity in reimbursent and employment, and really BELIEVE we are medical providers who deserve these things; then we will continue to be undercompensated and undervalued.

These are the truths I've come to know and sadly, I feel as if I am alone in working to change it.

Kimmer Collison-Ris, Family Practice & Wound Ostomy Continence Speciali - MSN, FNP-C, WOCN, Private Practice April 4, 2010 5:12 PM
Edmonds WA

My comments are as a lay person; I'm an airline pilot not a doctor or a nurse.  Everyone should have the freedom to select their medical practitioner; I fly to the west coast to make sure that my anesthesia is done by an anesthesiologist not a CRNA because I think that anesthesia is the domain of physicians, not nurses. Evidently the good people of Los Angeles agree since there is a abscence of CRNA's in their hospitals.  As it happens, my primary care provider is a NP; when I first met Michelle my first comment was "please get me a physician".   I was totally wrong.  In the last 10 years, she has been a wonderful primary care provider; my salary is above that of specialty physicians and I can see any medical provider that I choose.  My NP is the best; hands down.  My airline requires physical exams every 6 months and there are supposed to be complete; what a joke.  My NP does a much better job.  My NP works with an internist, but she practices independently.  My internist says that she could not do a better job than Michelle does; these 2 women will probably keep me alive forever.  Salaries?  I haven't the foggiest idea who makes more; my internist or my NP.  And I could care less.  I'm a lousy patient; if I was my own health-care provider, I would have fired myself; especially when I told my NP at our first visit that i thought that she was a "watered down doctor".  Her response was simple" she offered to turn my care over to a physician, but she asked me to give her a chance first.  She said that if I didn't like her exam, that it was free and that she would refer me to the physician.  Long story short: she was totally professional and really, really good.   Actually, she saved me from possible prostate/colorectal cancer; I'll spare you the details.   I had a terrible experience with a CRNA who thought that she was an anesthesiologist and the experience almost killed me; I'm not sure why nurses don't fit the anesthesia scenerio (IMHO), but they don't.  But for primary care, my NP is the best.  She says that I'm a control freak because of my job; but she prefers an anesthesiologist for her own surgery.  Interestingly enough, my NP freaked out when I declined sedation for the colonoscopy that she ordered; when I found out that the sedation would be administered by a CRNA, I decided to do it without drugs.  One terrible CRNA experience has convinced me that nurses should not administer anesthesia. Go figure.  I don't understand the preoccupation with salaries, nurse vs MD.  Money doesn't equal skill.  Do you think that I'm a better pilot than the guy who made an emergency landing in the Hudson because my salary is higher than his?  Not by a long shot.

jerry duffy, airline transport - captain, us airline March 22, 2010 1:39 PM
new york NY

I totally agree that NPs should be on par with pay when providing same services as Family Practice physicians.%0d%0a%0d%0aHow do we get that to happen?  National NP organizations (we have 2, so is that a problem in that we are split?) are somewhat limited in their financial ability to advance the cause of NPs because of limited membership.  Do you belong to your national NP organization?  Take a look @ how many physicians belong to the AMA.  They support their organization that does battle for them.  There is power in numbers (money as well).  If you belong to your national organization, do you contribute to the PAC?  These committees spend your monies trying to change legislation to insure NP fair treatment.  %0d%0a%0d%0aNot only are we divided in our professional organizations but:  Let's take a look @ 3 separate NPs.  All three attended and graduated from the same program, same date, same year.  All three sit for the same certification exam and are certified by the same national certifying agency.  One NP practices in State A, one in State B, and one in State C.%0d%0a%0d%0aThe NP in State A practices independently in a clinic he/she owns without physician oversight.  The NP in State B practices in a clinic he/she owns but must have a Collaborative Practice Agreement (and typically pays a stipend to the physician to "be available" should consultation be needed).  In State C the NP must practice in a physician's clinic/office with his/her oversight.%0d%0a%0d%0aNow where is the equality?  Same education, same school, same certification.......practices totally differently dependent on the state within which one practices.  Each state legislatively regulates NP practice.  So not only do we have issues nationally, but we have major issues in our own backyard.  There is much discrepency from state to state.%0d%0a%0d%0aJust some food for thought.......but if we are to advance we must belong and support our national and state professional organizations. We must encourage participation from our fellow colleagues.  We must not have infighting over academic preparation (if you remember NP preparation was initially a certificate program, then moved to MSN, now moving forward to DNP.  Progress is painful sometimes and those NPs who saw the change from certificate to Master's preparation must have felt the same as many of our fellow NPs are feeling today about the DNP).  We must move on and be supportive of NPs regardless....%0d%0a%0d%0aWe must come together in order to be a strong profession to insure parity and fair treatment for the quality of care we provide.  The challenge lays before us. What will you do today, tomorrow, in the future to impact the profession as a whole?  It is up to us as individuals to take charge of our profession.  We need to make sure we regulate ourselves so that others do not.

Cindy Cobb, Aesthetics - Nurse Practitioner, Allure Enhancement Center March 18, 2010 1:42 PM
Lafayette LA

NP's are underpaid because they are Np's. Np organizations need to make a national effort for salary parity. we do the same job, take call and accept the same responsibilities as md's.

karen kattwinkel March 18, 2010 12:32 PM

The fact that family physicians make twice as much as nurse practitioners is a crime.  Nurse practitioners in a primary care role, for example, provide the exact same service as their physician colleagues.  Why shouldn't there income be the same?

The Equal Pay Act of 1963 states that if you provide the same effort, skill and responsibilty in you occupation that the compensation must be equal.

No one can successfully argue that nurse practitioners cannot fulfull the primary care provider role.  Therefore it is indeed a crime that physicians make twice as much as nurse practitioners.

Jeff Guillory, Primary Care - RN, FNP, NP Health Clinic, PLLC March 18, 2010 5:42 AM
Lumberton TX

Headlines such as "Some nurses paid more than family doctors" are meant to arouse and entice the public to read the article.  Unfortunately, many never read beyond the headline, then repeat the statement as fact because it came from CNN Money.  Thanks, Advance for NPs, for cutting to the chase and keeping the facts clear! We are already a misunderstood profession and need the truth to be told as often as possible.

Kristina, Women's Health - Nurse Practitioner, CHN March 16, 2010 2:40 PM
Berlin WI

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