bldavi2

NPs paid more than PA's at my job!!

31 posts in this topic

so I recently accepted a position in hospital medicine so that I could move back to my home town. I am coming from a position in Hospital medicine where I worked alone at night for two years doing 7 on 7off and busting my butt with 18-25 admits a night. It was a salaried rate 44.95/hr or 97.5K/year. First job out of school. My new job is 3 12's at the same hourly rate which did drop me down to 85/year but I get PTO and was told I could work as much extra as I wanted at time and a half. So I planned to work two extra days a month to be a few hundred over my previous monthly rate. Its not ideal but I though with the added PTO and extra shifts Id still  be working about 40 days less a year for about 6K more a year.

 

I was initially reluctant to take the position because of the prospective salary drop, but I was desperate to get back home and couldn't find anything else. They would not negotiate as the rate offered is on a set scale and they claimed to have given me the best offer available. Of note, this hospitalist group in a well established hospital in the area has never ever hired PAs before last year. There are 25 NPs and 3 PAs including myself.

 

Well I've been here for nearly a month and naturally Ive made friends and discussed a few things and found out that the NPs starting salary is based on their number of years experience as a nurse. For every 2 years they were a nurse counts as one year of NP experience. So for instance the PA on days who is amazing for a new grad is making a whopping 38/hr while a new NP who can barely get thru her notes is making 45/hr because she was a nurse for 10 years. They refused to count that particular PAs experience as an EMT.

 

I also found that with the invaluable 2 years of experience I had working autonomously as a new grad at a busy hospital in a big city, they still have me making literally 10K less than a new NP with 10 years nursing experience. Furthermore, I was told by one of the NPS that overtime is limited and me being able to work 2 extra days a month wont last long.

 

I feel insulted and discriminated against. I have never heard of nurse experience counting as NP experience and frankly it sounds like a ridiculous policy made up by some nurse administrator.

 

I like the job and the NPS and docs I work with but should I jump ship if they are unwilling to change this policy or increase the PA pay scale to match make it fair?

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Talk to HR and get the official policy in writing, read it, and then come back ready to discuss.

 

I don't think it's ridiculous that a hospital counts RN experience, but I do think if they're going to do that they absolutely must count your (and others') prior healthcare experience with equal weight. Does that mean you suddenly make more than the NP with 10 years nursing experience? Not necessarily, but it should at least be fair across both professions. And your experience as a provider in the field should definitely be weighted more than nursing and EMT experience.

 

I got about 6-7K more per year starting salary as a new graduate due to my years of experience as a physical therapy aide, and my NP colleagues got money for nursing experience. Non-provider healthcare experience is weighed equally. The experienced providers got more than us, and those with no healthcare experience got less. That seems fair to me.

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Perhaps the NPs are under a different contract/covered by the union?  At my hospital NPs employed by the hospital are covered by the nursing union (which offers various differentials for RN experience, certifications, etc. at all levels (RN/NP/CNS)), while the NPs employed by the university are not.  

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As far as I know, we are all hourly employees of the Hospitalist group. No contracts. They do not count any previous medical experience for PAs at all. I have emailed HR for further clarification. But I totally do not agree with being paid less for the same responsibilities with similar experience as an actual provider. Wiping butts and drawing labs does not equal clinical decision making.

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NPs make more at the VA because they are under nursing and nursing union and it drives the medical directors crazy.

 

They have a hard time recruiting PAs because of the fairly large gap and poor negotiating power. 

 

NPs and PAs report to different folks which I think is a mistake. If we are all "doing medicine" then we should all report to the MEDICAL director and board, not a nursing board.

 

Again a misnomer for our profession - we aren't assistant anything - we practice medicine......

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Nope NP's are hired the same by the group. Just got my email reponse. I was essentially told I shouldn't be discussing compensation with peers.

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Nope NP's are hired the same by the group. Just got my email reponse. I was essentially told I shouldn't be discussing compensation with peers.

 

 

I tried talking about this with an employer years ago.

Rumor and innuendo got all the PAs talking about a new guy hired in a multispecialty clinic - he was truly no big deal but told folks he got a moving expense that far outweighed any of ours and that his salary was NOT on the scale we were on.

We couldn't figure out why he got better treatment. Not a hard job to fill and lots of good candidates locally.

 

We tried to have a conversation with the medical director as a group about equality, transparency and making us feel valued. Yeah, we were idealistic and all.....

He threatened to fire us all for discussing salaries even though not one of us had provided an exact figure or a W2.

He told us we were all replaceable and should feel lucky to have a job - he was a charmer and real enthusiast for liking one's job ---- umm, not. 

 

I don't know how to make this better. NPs have the nursing lobby and are lumped with RNs even though they aren't supposed to be the same anymore - they somehow bargain for better wages.

PAs are either valued - as in my ortho job - and able to make a good wage and share in the process or are treated like drones making widgets on an assembly line with no skills. 

It is never enough to have education, skills, chutzpah or show steady progress. 

 

The last corporate I worked for had a scale for each specialty for NONPhysician providers - never heard that NPs made less or more - your years of experience were plugged into some calculator for that specialty and the wage range established by magic and MSMA information - it churned out a number and that was what you were offered. Then the nebulous bonuses for being nice and the occasional cost of living. It worked for me because we all got crunched by the same calculator. No negotiations - good and bad. 

 

Sounds like you need a better job, though.

 

Keep us posted.

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I have spoken to another PA that works on days. She was a dietician for 10 years before becoming a PA. They refused to  count her healthcare experience. However a new NP with 10 years nursing experience makes more than me as PA with 3 years experience. Who should talk to about this.

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Well yes if NP has more relevant experience than they will make sufficient money than PA in some states especially in Kentucky :)

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Whoa there. RNs do quite a bit more than wipe butts and draw labs. I don't agree with what your company is doing, but don't discount their work. RN is one of the closest health care professionals to that of PA/NPs. However, I am baffled why a registered dietician is not getting their experienced counted.

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I USED to be a PA in KY.  You guys are now the only state in the country that don't permit PAs to write controlled substances (thus FULLY providing access to all patients in the state), and NPs are kicking you guys butts.  True statement?  There is a huge glut of mid levels everywhere, at least anywhere someone would want to live, but I have watch in the last 10-15 years there the number of NP and PA programs have DOUBLED.  The newest one, the University of the Cumberlands I think?  Graduated 100 new PAs last year.  50% of all new grads have to leave the state.  NPs now have bridge programs for them to get MD degrees now too.  Government statistics predict by 2025 there will be NO under supply of mid levels and indeed expect there to be 20,000 surplus of mid levels.  Bottom line?  The day of getting out and going down the street from where you live is over, if that is what you expect.  Also, if you expect to get out and then work part time?  Not a ton of part time positions being made either.  I mean if you want to go to Po Dunk, Nebraska or practice in Alaska then places that have insane numbers of people and expectations of you then that will be around for a while.  If you want to be in a sunny clinic seeing 20-25 patients/day then those are going to be much more rare.  I've been out for 20 years so trust me, I have seen this coming.  This isn't "sour grapes" or anything like that.  If med schools had shot up in new schools and enrollment the way the new NP and PA schools have then there wouldn't even be a market for us but med schools know better than to do what the institutions are doing to us.

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Changing our name to Physician Extender, Practitioner, or Associate is at the crux of this demeaning crap.  Until we change that poorly named title of "Assistant" its always going to an uphill battle.

 

The title sucks and is demeaning.  Time to change and change it STAT or we will always be the Red Headed step children of the provider world. 

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I think physician associate, or medical practitioner. Physician extender sounds just as bad as physician assistant. 

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Come on, "Assistant" is horrible.  One person asked me once what I do, and said P. Assistant and he said "oh you hand doctors stuff?"  It is the worst name one could ever come up with for a profession.  Demeaning with a capital "D."

 

what would you name it then?

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(Nurse) Practitioner is much more of a dignified title IMO.  Name is very important and it affects public awareness and perhaps even salaries (?).  Just my opinion though. 

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Yes perception is key. ESPECIALLY to people who don't know anything about the differences between PAs and NPs. I'm willing to bet that if you took a poll of the public, they would overwhelmingly believe that NPs have better schooling and are better practitioners based solely and COMPLETELY on the name! 

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On 5/13/2017 at 4:20 AM, bldavi2 said:

so I recently accepted a position in hospital medicine so that I could move back to my home town. I am coming from a position in Hospital medicine where I worked alone at night for two years doing 7 on 7off and busting my butt with 18-25 admits a night. It was a salaried rate 44.95/hr or 97.5K/year. First job out of school. My new job is 3 12's at the same hourly rate which did drop me down to 85/year but I get PTO and was told I could work as much extra as I wanted at time and a half. So I planned to work two extra days a month to be a few hundred over my previous monthly rate. Its not ideal but I though with the added PTO and extra shifts Id still  be working about 40 days less a year for about 6K more a year.

 

I was initially reluctant to take the position because of the prospective salary drop, but I was desperate to get back home and couldn't find anything else. They would not negotiate as the rate offered is on a set scale and they claimed to have given me the best offer available. Of note, this hospitalist group in a well established hospital in the area has never ever hired PAs before last year. There are 25 NPs and 3 PAs including myself.

 

Well I've been here for nearly a month and naturally Ive made friends and discussed a few things and found out that the NPs starting salary is based on their number of years experience as a nurse. For every 2 years they were a nurse counts as one year of NP experience. So for instance the PA on days who is amazing for a new grad is making a whopping 38/hr while a new NP who can barely get thru her notes is making 45/hr because she was a nurse for 10 years. They refused to count that particular PAs experience as an EMT.

 

I also found that with the invaluable 2 years of experience I had working autonomously as a new grad at a busy hospital in a big city, they still have me making literally 10K less than a new NP with 10 years nursing experience. Furthermore, I was told by one of the NPS that overtime is limited and me being able to work 2 extra days a month wont last long.

 

I feel insulted and discriminated against. I have never heard of nurse experience counting as NP experience and frankly it sounds like a ridiculous policy made up by some nurse administrator.

 

I like the job and the NPS and docs I work with but should I jump ship if they are unwilling to change this policy or increase the PA pay scale to match make it fair?

And do you really think the bean counters at a hospital haven't weighed it out? Kind of hard for me to believe an EMT and a nurse are both equal as well. Let's give credit to where credit is due. I find it an insult quite frankly. My sister-in-law is an ICU nurse and went to 4 years at U of Wa. So how many years of college do you need to become an EMT? Right, a nurse needs an associates or a bachelors. EMT, a high school diploma. They are both very equivalent of course. It's outrageous they pay EMT peanuts next to nurses too will be your next argument. Should we pay a 15 year old EMT veteran the same as a first year PA? 15 years, must have seen everything and can do about 80% what a PA can do right? It's one thing to have professional, but logical and lucid, disagreements or arguments. It's another to make inane arguments. I get it. You are pissed because you make less and realize that you work a lot and make less. Guess what? Welcome to the world of medicine. I just heard an OBGYN complain about her workload and paycheck after being bought out by another health orgo. She is sad she can't afford a million dollar home.

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FYI- when I started at my first job 21 years ago the organization did count my 5 years as a paramedic when setting up the wage scale. they didn't count my 5 years as an ER tech before that though.

RN experience is good and valuable prior hce. It is not the only way to get valuable prior experience though. paramedics and Resp therapists also bring a lot to the table.

CNAs and EMT basics, not so much.

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11 hours ago, EMEDPA said:

FYI- when I started at my first job 21 years ago the organization did count my 5 years as a paramedic when setting up the wage scale. they didn't count my 5 years as an ER tech before that though.

RN experience is good and valuable prior hce. It is not the only way to get valuable prior experience though. paramedics and Resp therapists also bring a lot to the table.

CNAs and EMT basics, not so much.

Same here, negotiated my medic experience + fellowship experience into starting salary. Started on 7 year experience pay scale and am credentialed to do procedures no other PA/NP is credentialed to do at hospital. Prior experience and fellowship/residency = respect. No other way around it in today's world. 

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2 hours ago, JDayBFL said:

Same here, negotiated my medic experience + fellowship experience into starting salary. Started on 7 year experience pay scale and am credentialed to do procedures no other PA/NP is credentialed to do at hospital. Prior experience and fellowship/residency = respect. No other way around it in today's world. 

doctorate helps too....:)

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On 10/1/2017 at 7:07 PM, runforhotdogs said:

And do you really think the bean counters at a hospital haven't weighed it out? Kind of hard for me to believe an EMT and a nurse are both equal as well. Let's give credit to where credit is due. I find it an insult quite frankly. My sister-in-law is an ICU nurse and went to 4 years at U of Wa. So how many years of college do you need to become an EMT? Right, a nurse needs an associates or a bachelors. EMT, a high school diploma. They are both very equivalent of course. It's outrageous they pay EMT peanuts next to nurses too will be your next argument. Should we pay a 15 year old EMT veteran the same as a first year PA? 15 years, must have seen everything and can do about 80% what a PA can do right? It's one thing to have professional, but logical and lucid, disagreements or arguments. It's another to make inane arguments. I get it. You are pissed because you make less and realize that you work a lot and make less. Guess what? Welcome to the world of medicine. I just heard an OBGYN complain about her workload and paycheck after being bought out by another health orgo. She is sad she can't afford a million dollar home.

We should make the same as NPs as we are doing the same "job" even if you were a nurse prior (which is NOT a provider). I disagree that 2 years of nursing = 1 year as a NP. Not the same role. Should a MD cardiologist fresh out of residency make more then the DO cardiologist fresh out of residency? MD = DO and PA = NP. I can see having prior HCE can get you quicker into doing procedures/different skill set, but not pay. That is why an ASN gets less pay than a BSN due to education, but doesn't gain them anymore practice rights. PAs and NPs (mostly) have a master's degree, which should start off at the same $, if the NP has a DNP (which is another talk for another day) then yes the bean counter's could say they get more pay for more education which I can respect (solely based off the education, not that most PAs with a Masters have more credit hours than DNPs). 

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i was just using EMT as an example to make my point. and I totally disagree with DNP making more than PA for the same role. the DNP does NOT require any more clinical experience, fellowship/residency etc. They have to write a paper and attend a few seminars..pathetic. 

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20 minutes ago, bldavi2 said:

i was just using EMT as an example to make my point. and I totally disagree with DNP making more than PA for the same role. the DNP does NOT require any more clinical experience, fellowship/residency etc. They have to write a paper and attend a few seminars..pathetic. 

Oh I completely agree that is the same as ASN vs BSN as my wife is a FNP and went through a BSN program, and she stated herself that ASN students were more prepared clinically as all she did in school was write papers, but gets paid more. I am just looking at what the bean counters look at. 

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