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The Biggest Problems With How Advanced Practice Providers Are Compensated

As APPs gain more autonomy, they administer care in an increasingly similar way to physicians. But the way that employers pay them hasn’t caught up.

As nurse practitioners and physician assistants gain more autonomy, they administer care increasingly similar to their physician colleagues. But employers’ compensation packages for these crucial clinicians haven’t caught up.

For example, many APRNs are compensated similarly to bedside nurses, says Christina Cardy, DNP, AGACNP-BC, Director of Advanced Practice Providers at USF Health. Dr. Cardy studied APP pay when pursuing her doctorate and researched it extensively for her hiring responsibilities.

The problem with this structure — where tenure, experience, and performance determine compensation — is that many APPs don’t receive adequate pay or incentive for what they can and do bring to the table, Dr. Cardy says. In addition, it “does not reflect the way APRNs practice in different settings, does not recognize the differences in labor markets for various specialties, and does not reflect variable levels of productivity,” she adds.

Here are some other significant problems with current, prevalent pay structures for NPs and PAs.

APPs Often Are Not Included in Performance Incentives

As a result, they typically only receive a cost of living raise or minor merit adjustment. This puts unnecessary pressure on starting salary because there isn’t bonus potential. According to Cardy, incentive measures for APPs should include patient satisfaction, financial goals, quality improvement, clinical outcomes, access to care, and contributions to an organization’s research and teaching missions when appropriate.

Minimal Pay Differentiation Based on Clinical Specialty and Acuity

Physicians earn vastly different amounts depending on the specialty because of varying educational requirements, technical skills, and more. Similarly, there are separate competencies and certifications for APPs working in primary care versus acute-care settings, but this doesn’t usually affect their pay.

Not Meeting the Market Demand for APP Specialization

There’s an increasing demand for APPs who take on additional education and certifications to practice in a specialty area. But without consistently paying these individuals more, the industry fails to “attract the best and brightest individuals to those specialties that are the most demanding,” Dr. Cardy notes.

No Recognition of Non-Billable Hours

When APPs are only paid for billable hours, the result is competition for patient volume. APPs should be rewarded for contributions like “preventing readmissions, participating in quality improvement, increasing access to care, and contributing to research,” Dr. Cardy argues.

Tips for APPs To Ask for Better Pay

While these problems persist, the best way to navigate them is to prepare yourself when applying for a new job or asking for a raise, Dr. Cardy says. 

As someone who’s frequently involved in hiring, she offers these tips:

  • Know your value. Consider what makes you special, what you bring to the table, and articulate these attributes.

  • Bring your metrics from previous jobs. You want to demonstrate your potential financial impact, so talk about your RVUs, average charges, collections, annual number of patient visits, procedures, etc.

  • Have a number in mind. You can respond when a potential employer asks what you expect to earn.

  • Justify your number with data. Research your local area’s average compensation, and share that data when you’ve received an offer. Dr. Cardy cautions that citing an anecdote of what “a friend” makes is not enough.

  • Never accept an offer right away. In response, do more research and negotiate. “The worst anyone can say is ‘no,’ but you guarantee yourself that you didn’t leave any dollars or benefits on the table,” she adds.

  • Ask around. There’s a deliberate lack of salary transparency for APPs, so if you know other comparable employees in the practice, ask about their starting rates. Again, the worst answer you can get is “no.”

So much of the advancement APPs have seen in recent years has come from individual practitioners advocating for change. And the issue of pay is no different. Dr. Cardy explains that “APPs are taking on larger, more autonomous roles in healthcare delivery and should be fairly recognized and compensated for their contributions.”

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