Supplement-Family planners see slight increase; staff levels steady
Advanced practice providers face crowded market
Good news for family planners: Salaries are moving up, and staffing levels remain steady to handle the influx of patients now coming to reproductive health facilities. (See chart, p. 2.)
While managed care continues to make its mark on the health care scene, salaries for the majority of family planning professionals show an increase from the previous year, according to results from the 1999 Contraceptive Technology Update salary survey. The survey was mailed in August 1999 to 1,357 readers and had a response of 136, for a response rate of 10%.
Median salaries for nurse practitioners (NPs), registered nurses, and health educators all rose in the last year, reversing a trend from 1998, according to survey results. (See chart of salary levels by title, p. 2.) The 1999 median pay level for nurse practitioners is listed at $42,500, rising from 1998's $41,111 figure.
Registered nurses responding to the 1999 survey earned a median pay level of $40,800, a hike from the $30,000 reported in 1998. The salary scene for health educators looks even brighter: Participants in the 1999 survey reported a median salary of $40,000, compared with an $18,748 level in 1998.
Administrators saw a slight dip in pay in 1999, with the median salary falling to $41,500 from the $45,000 figure reported in 1998. Pay levels for this survey category had held at a steady $42,500 level in 1996 and 1997.
Geographic location and practice setting play an important part when determining salary levels, says Susan Wysocki, RNC, BSN, NP, president of the National Association of Nurse Practitioners in Women's Health in Washington, DC. Almost 40% of nurse practitioner responses to the 1999 CTU survey came from the Midwest. When sorted by practice setting, nearly 40% of nurse practitioners indicated they work for a state, county, or city agency, with 23% in not-for-profit and college or other academic settings, respectively.
"If you look at the employers for those nurse practitioners responding to the survey, those tend to be the lowest salaries," Wysocki said of the results by practice setting.
The average salary for a nurse practitioner now stands at $52,532, according to a 1998 salary survey in the journal ADVANCE for Nurse Practitioners.1 Those in public health clinics (more than 40% of respondents to CTU's salary survey) earned an average of $45,807.
Advanced practice providers are gaining ground in the salary arena. A national survey of nurse midwives indicates these providers earn anywhere from an average of $71,632 in the East to $55,744 in the South.2 A 1998 survey conducted by the American Academy of Physician Assis tants in Alexandria, VA, shows a median salary of $62,175 for these clinicians.3
Physicians, on the other hand, may well be losing compensation. Salaries for OB/GYN physicians decreased 3.47% in 1997, from $217,549 to $210,000, according to an annual physician compensation survey by the Medical Group Manage ment Association in Denver.4
If you're thinking about changing jobs, you should know upfront that while positions are available, competition has increased, says Ted Young, who heads HealthCare Consultants in Lenexa, KS, a placement service for advanced practice clinicians. "There are a lot of new [NP] graduates," he says. "It is especially tough for new graduates, and it is making it tough on others as well."
Cindy Lenz, RN, PhD, who operates Health Care Solutions in Edisto, SC, agrees with Young's assessment. "The market for midlevel providers is flooded with new graduates entering the field," she says. "I'm seeing new graduates go in at $40,000."
The employment scene for physician's assistants is comparable to nurse practitioners, she comments. The salaries for certified nurse midwives may be inching downward as the number of such providers increases, she notes.
The picture for specialty providers, such as NPs with women's health certification, is brighter than for those with no additional training, Lenz says. Young has placed two women's health nurse practitioners in the last year. One salary offered $30 per hour, and the other paid an annual $65,000 salary.
If you are considering switching jobs, thoroughly check out your potential new employment scene to make sure it is viable, counsel Young and Lenz.
"If you do change jobs, make sure you have your new situation nailed down if you need to put a roof over your head," says Lenz. "That is what I tell all candidates, because the market is brutal out there."
When considering positions, what employer benefits mean the most to you? Medical coverage, pension plans, 401K or other savings plans, some freedom to choose work schedules, and dental coverage are the top-ranked items on CTU salary survey participants' wish lists.
Those benefits do not come without costs, however. Just over 40% of participants indicated that the cost of their medical benefits had increased this year. One-fourth said there had been no change in their plan's costs, while 17% said they did not contribute to their employer's coverage.
Wysocki says some freedom to choose work hours is an important benefit for many nurse practitioners. Some clinicians may opt for a lower-paying job if the hours meet their lifestyle demands, she says.
For providers looking for more from their jobs, be flexible and negotiate for things other than just salary raises, says Lorraine Bock, MSN, CRNP, who operates Bock CRNP Services, PC in Camp Hill, PA. Push for more educational time or an extra week of vacation, says Bock, who teaches nurse practitioner courses at Widener University in Camp Hill. While it may not represent direct money to the employer, it is a good benefit.
"I do think it is a good idea to look at other things outside salaries," Wysocki concurs. "Often over time, facility expenses go up while operating dollars stay fixed, and administrators' hands may be tied."
The value of advanced practice providers continues to grow, Wysocki says. With direct reimbursement of nurse practitioners under Medicare now in play, she advocates that those clinicians who can qualify for a Medicare number do so as soon as possible to take advantage of the situation.
Bock has opened her own practice with her collaborating physician, a family practitioner, in the same facility. Such an arrangement presents challenges in Pennsylvania, including the lack of independent prescriptive authority for NPs and the decision by health maintenance organizations not to recognize NPs as primary care providers. However, Bock is pleased with her decision.
"I think the main thing is to not limit yourself," she counsels. "You have to be open to something that might not be what you think is your specialty or your area of expertise."
References
1. Leccese C. Who's making what and where. ADVANCE for Nurse Practitioners 1998; Jan. 1.
2. Marcus CL. PA and NP salaries on the rise. Clinician Reviews 1997; 7:134-135, 137-138.
3. American Academy of Physician Assistants. 1998 AAPA Physician Assistant Census. Alexandria, VA; 1998.
4. Parker SG. Specialists' earnings hold steady as hours go up. Skin & Allergy News 1999; 30:53.
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