2003 Salary Survey Results

Little gain seen in salaries for family planning providers

Are you making strides on the salary front? If the answer is "no," count yourself among the majority of family planning providers. According to results of the 2003 Contraceptive Technology Update Salary Survey, about half (46.6%) of respondents said they are earning just 1%-3% more than in 2002. The survey was mailed in July 2003 and had a response of 105, for a response rate of 8%.

More than half (52.3%) of 2003 survey responses came from nurse practitioners (NPs). A closer look at survey results shows that average salary for NPs fell to $51,472 in 2003, compared to $55,710 in 2002 and $53,043 in 2001. Median salaries for NPs dipped to $52,368 from 2002’s $55,313 figure. Average salary for administrators/coordinators rose to $66,735, jumping from $49,230 in 2002. Median salary for this group, which comprised 16.1% of 2003’s total responses, also increased from $52,778 in 2002 to $59,000 in 2003.

It is hard to know what accounts for the fluctuation in salaries, observes Susan Wysocki, RNC, NP, president and chief executive officer of the Washington, DC-based National Association of Nurse Practitioners in Women’s Health.

"It could be the economy in general, increases in costs without increases in grant monies for those in the public sector, or the state of the health care system," she surmises.

Check national figures

Tight financial times aren’t just limited to those in the family planning field. According to annual income surveys conducted by two medical group associations, the trend of physicians working harder for about the same or even less pay continues for many.1 Obstetricians/gynecologists recorded an average salary of $231,000 in 2001, a 3.5% increase over the previous year.2

Advanced practice providers are noting an increase in salaries. Respondents to the 2002 census from the Alexandria, VA-based American Academy of Physician Assistants (AAPA) showed a salary mean of $72,241, up from $63,168 in its 2001 census.3

What are you worth?

To get your salary dollars moving, know what you are worth, says Wysocki.

"Most NPs do not know how much reimbursement they bring into the practice or know what it costs, separate from them — overhead, etc. — what it costs a practice to see a patient," she states. "NPs can ask the practice’s manager or the billing person to help them get an idea of what his/her average day brings in — from routine exams to counseling visits to high-level procedures, like colposcopy."

Most offices can generate reports of NP productivity through billing software. Many practices will furnish NPs with this information; however, if you want to generate your own records, take a look at the following formula, offered by health care employment expert Carolyn Buppert, JD, an attorney in Annapolis, MD:

1. Write down the number of encounters per day by CPT code. Keep a notebook with a page for each day worked. An example:

Tuesday, March 14

• Office visit, level 3, established patient — 8

• Office visit, level 4, established patient — 5

• Office visit, level 2, established patient — 5

• Office visit, level 2, new patient — 3

• Office visit level 4, new patient — 1

• Immunization — 3

• Wet mounts — 2

• Cryosurgery , 1 lesion — 1

2. Obtain the office charge for each of the procedures listed above.

3. Multiply the procedure charge by the number of encounters conducted.

4. Sum the charges for the procedures conducted that day.

5. Sum the charges per week, per month, and per year.4

Also, take a look at productivity-based compensation. Under such an arrangement, a compensation package is based on a percentage what your position generates. If aiming for this form of compensation, Buppert suggests NPs ask the following questions:

• Does the percent cover my benefits?

• Who pays various practice expenses?

• How efficient is the practice at collections?

• What is the differential between the practice’s charges and actual receipts?

• How often is the accounting done?

• How is the draw against earnings handled?

• How are the appointments triaged at the front desk?

• How can I review the accounting?4

Check your agreement

Still steamed about your salary? Know that in today’s health care environment, it takes effort to push the numbers forward.

Check your employment agreement for what is known as an "evergreen provision." While such a provision is useful since it prevents annual contract negotiations, if your agreement doesn’t provide for an annual salary review, you may be getting stuck with an automatic salary renewal.

Look for language similar to this wording: "This agreement shall last for a period of one year from Jan. 1, 200__ , through Dec. 31, 200__ , and shall continue from year to year thereafter."5

Also, if your agreement asks for you to "devote all time and energies" to your job, see if you can negotiate for more pay. If you consent to give full time and energies to your current employer, you are not pursuing other paying, available positions in your off hours. Negotiating on adhering to such an agreement may be an opening to more dollars in your paycheck.6

Just remember the road to progress begins with that first step. Take a tip from Wysocki: "I sometimes hear people complain that they haven’t gotten a raise, and when I ask them the last time they asked for a raise, they haven’t," she states. "Ask."

What’s the job outlook?

If you decide to change jobs, know that the demand for advanced practice providers, including nurse practitioners, physician assistants, and certified nurse midwives (CNMs), is increasing. The versatility and cost effectiveness of such clinicians are making them attractive to practices, according to national reports.3

Demand is keeping up with the supply: only 1.2% of respondents in the AAPA’s 2002 annual census reported being unemployed and looking for work.3 The AANP reported about 5,400 NP program graduates in 2002, with at least that many graduates anticipated for 2003.3 The AAPA saw an increase in PA graduates in 2003: about 4,600, compared with 2002’s 4,300 figure.3

The employment outlook for advanced pro-viders such as nurse midwives is good, agrees Deanne Williams, CNM, executive director of the Washington, DC-based American College of Nurse-Midwives (ACNM). For nurse midwives, the profession is reaching a tipping point, where the mid-1980s influx of CNMs is evolving toward those looking at retirement plans, she states.

The national shortage of registered nurses has not yet translated into the world of advanced practice providers, but it may be coming, says Williams.

"I don’t think there’s a relationship between the nursing shortage and the demand for nurse midwives," she states. "We do think that over time it will hit us, because if there are fewer people entering the nursing profession, there will be fewer people to choose from to become nurse midwives."

References

1. Norbut M. Physician compensation surveys offer little encouraging news. AMNews; Sept. 15, 2003. Accessed at www.ama-assn.org.

2. Lowes R. Earnings survey: More hours, more patients, no raise? Med Econ 2002; 22:76.

3. Norbut M. Physicians finding plenty of NPs, PAs — but at a price. AMNews; May 5, 2003. Accessed at www.ama-assn.org.

4. Buppert C. Asking for a raise. Green Sheet 2001; Accessed at: http://www.medscape.com.

5. Burke MR. Demystifying common terms in employment agreements. Fam Pract Manag 10:38-40, 2003.

6. Buppert C. What should I expect when I renegotiate my contract? Medscape Nurses 2000; Accessed at: www.medscape.com.