Some Advanced Practice Nurses Earn More than Doctors

By Jennifer Larson, contributor

Advanced practice nurses are unquestionably among the highest paid in the nursing workforce. The average nurse practitioner working full time in 2007 made over $80,000. But some advanced practice nurses make salaries well into the six-figures—more than some doctors.
The median total compensation for a full-time CRNA in 2007 was $148,450. 

Just ten years ago, the average annual salary for a nurse practitioner in the United States hovered in the mid-$50,000 range. Over the course of the decade, the average salary inched upwards until it broke the $80,000 mark in 2007.

And for some advanced practice nurses, their take-home pay is even higher than that. Certified registered nurse anesthetists (CRNAs), who are among the highest-paid advanced practice nurses, routinely make well over $100,000 each year.

That topic even generated an animated discussion on the Wall Street Journal’s Web site recently. The fact that some advanced practice nurses are making more money than some primary care doctors, amazed many people, based on the dozens of comments by Wall Street Journal readers, some of whom objected to nurses making more than doctors because doctors are required to complete four years of medical school plus a residency. 

National staffing firm Merritt Hawkins & Associates recently published data that confirmed that some CRNAs are indeed making higher salaries than some primary care physicians. Their recent compensation study showed that CRNA salaries increased $35,000 to $156,000 from 2004 to 2006, while family practice doctor salaries dropped from $150,000 to $145,000 in the same time period.

But is it fair to compare a CRNA with a family practice doctor? Is it fair to expect their salaries to be comparable?

Perhaps not, some experts say.

The notion that any doctor should make more than any nurse is out of date, according to Mary Mundinger, Ph.D., RN, dean of the Columbia University School of Nursing. 

“I think it’s an old-time conventional feeling that a nurse is always second level to any physician on (the issues of) authority and pay,” said Mundinger. “That just isn’t true anymore.”

Christopher Bettin, senior director of communications for the American Association of Nurse Anesthetists, agreed. “I think it’s kind of that age-old…perception or belief that a doctor by virtue of being a doctor should make more than a nurse because the nurse is a nurse,” he said. 

Advanced practice nurses themselves have a great deal of education under their belts. The American Association of Colleges of Nursing defines an advanced practice nurse as “a licensed registered nurse prepared at the graduate degree level as either a clinical specialist, nurse anesthetist, nurse-midwife or nurse practitioner. All advanced practice nurses should hold a graduate degree in nursing and be certified.”

According to Bettin, a nurse anesthetist’s job “is extremely responsible and requires a tremendous amount of education. It’s a life and death situation, and they deserve to be compensated accordingly.”

Also, while they may be making more than some primary care doctors, it’s not as if nurse anesthetists are making the same salary that anesthesiologists are making, Mundinger said. Anesthesiologists routinely earn more than $300,000 per year, which far exceeds the typical family practice physician salary, as well as the annual CRNA salary.

“Providing anesthesia to a patient carries more salary than a family practice,” said Mundinger. “They’re different kinds of practice. An anesthesiologist makes more than family practice doctors.”

How much money do advanced practice nurses really make today? Here’s a look at recent salary statistics:

Nurse practitioners: The mean base salary for nurse practitioners working full time in 2007 was $81,060 and the total nurse practitioner income was $87,400. In 2008, that figure rose to $84,250, with an average total income of $92,110, according to the American Association of Nurse Practitioners’ 2008 National NP Compensation Survey. 

Nurse practitioners who have doctorate degrees typically make higher salaries than those without, according to Mary Jo Goolsby, EdD, MSN, director of research and education for the AANP.

NPs who work in acute care settings tend to make the highest salary by specialty; the NPs who worked full time in emergency departments made about $95,000 on average in 2007. “Nurse practitioners that practice in privately owned physician practices are toward the bottom of the pay scale,” Goolsby said. 

Nurse anesthestists: Nurse anesthetists tend to be compensated quite a bit more. The median total compensation for a full-time CRNA in 2007 was $148,450.

Nurse midwives: Certified nurse midwives tend to receive similar salaries to nurse practitioners. According to the American College of Nurse Midwives Compensation and Benefits Survey in 2007, the median salary for full-time certified nurse midwives was $79,093 to $89, 916. However, they can make much more. The 2007 compensation survey, which accounted for about 25 percent of the association’s membership, also found that a handful of nurse midwives made as much as $140,000 per year or more. 

As the Baby Boomers march toward retirement, the demand for health care is forecasted to increase. Just as the nursing shortage is expected to continue, so is the shortage of primary care physicians. Nurse practitioners can fill vital needs in such a health care climate, experts say, suggesting that the matter of nurse salaries and physician salaries shouldn’t be viewed as a competition or a zero-sum game. 

“Perhaps those family practice doctors and other doctors should be paid more,” Bettin said. And in such a health care environment, nurse practitioners, CRNAs and other advanced practice nurses should not be viewed as a threat to doctors.

“Advanced practice nurse are not trying to take over health care; they are not trying to be doctors,” Bettin said. “They are an answer to the growing demand for highly qualified health care providers to provide excellent care. They are an excellent complement to the care that physicians provide.”

© 2008. AMN Healthcare, Inc. All Rights Reserved.

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