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

For example, many APRNs are compensated in a similar structure 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 researches it extensively as part of her hiring responsibilities.

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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 tells Florence Health. 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 major 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 a lot of unnecessary pressure on starting salary because there isn’t bonus potential. Incentive measures for APPs, according to Cardy, should include: patient satisfaction, financial goals, quality improvement, clinical outcomes, access to care, and contributions to research and teaching missions of an organization when appropriate.

Minimal pay differentiation based on clinical specialty and acuity.

Physicians earn vastly different amounts depending on 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 is failing to “attract the best and brightest individuals to those specialties that are the most demanding,” Dr. Cardy notes.

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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. Think about what makes you special, what you bring to the table, and articulate these attributes.

Think about 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 and collections, annual number of patient visits, number of procedures, etc.

You want to demonstrate your potential financial impact, so talk about your RVUs, average charges and collections, annual number of patient visits, number of procedures, etc. Have a number in mind. That way, you can respond when a potential employer asks what you expect to earn.

That way, 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 it’s not enough to cite an anecdote of what “a friend” makes.

Research your local area’s average compensation, and share that data when you’ve received an offer. Dr. Cardy cautions that it’s not enough to cite an anecdote of what “a friend” makes. 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.

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 what their starting rate was. Again, the worst answer you can get is “no.”

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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. As Dr. Cardy explains it: “APPs are taking on larger, more autonomous roles in healthcare delivery and should be fairly recognized and compensated for their contributions.”