How the Way You are Paid Affects Your NP Job Satisfaction

There are a few different ways nurse practitioners are paid.  No, we don’t all earn a flat salary.  Each of these payment models presents unique advantages and disadvantages to the NP.  Let’s take a look at how you might be paid as a nurse practitioner and what these payment systems mean for your job satisfaction.

Flat Salary

The flat salary is pretty straightforward.  You show up to work, diagnose and treat patients and get a paycheck every other week, or maybe once a month depending on your contract.  Your check is the same each pay period regardless of how much or how little work you do.

Pros: There are no surprises regarding pay with a salary.  You know exactly how much you will make and when.

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Cons: You will have less day to day flexibility within a salaried structure.  Your time off is typically strictly outlined in your contract.  Looking to earn extra money?  A salary does not lend itself to extra pay for picking up additional shifts.

Satisfied?  Since nurse practitioner salaries are clearly outlined in a contract, NP’s employed under this model know what to expect leading to a relatively high level of job satisfaction.  The main complaint of NP’s dissatisfied with this model is that they are not compensated for staying late or performing additional job responsibilities.  Make sure your contract outlines how many hours you are expected to work to avoid this pitfall. 

Hourly Rate

Hourly pay is another straightforward, common payment method.  You get paid depending on how long you are present on the job.   

Pros: Like the salaried payment model, there is no ambiguity surrounding how much you will make with hourly payment.  You show up, you get paid.  Hourly pay allows for scheduling flexibility.  If you want to earn extra money, you may be able to pick up extra shifts.  Need a day off?  Under an hourly payment structure, you may be able to give your shift away to another NP forgoing pay for added flexibility.

Cons: Hourly payment gives employers flexibility in staffing.  If you aren’t there, they don’t have to pay you.  This can work against you.  If the clinic or hospital gets slow, your employer may ask you to leave early or call you off of a shift directly affecting your income.  

Satisfied?   The flexibility awarded by being paid hourly is invaluable and leads to a high level of job satisfaction.  Just make sure you have specified a minimum number of hours you will work in your employment contract to avoid losing hours to slow days.

Productivity- The RVU Payment Model

RVU, or productivity payment, essentially awards “points” for the number of patients you see and their level of acuity.  These “points” each have a specific dollar value determined by your employer.  The more patients you see and theoretically the harder you work, the more money you make.

Pros: Under the RVU payment structure you are rewarded for hard work.  If you are an efficient, experienced NP this can work in your favor.  This model is most beneficial for the nurse practitioner in a busy work environment.

Cons: If your clinic or hospital is slow and there are few patients, under the RVU payment system you will earn significantly less.  Also, if you are a new nurse practitioner graduate and work at a slower pace, this system will work against you.  

Satisfied?  The RVU payment system can make your job significantly more stressful.  Slow days mean a lower income.  With each provider’s income directly tied to the number and acuity of patients, this system can also lead to competition among fellow nurse practitioners and physicians.  If you have the personality type to deal with additional stress and handle a potentially competitive environment, the RVU model will likely be more lucrative than other payment structures.  Your job satisfaction will be tied to the balance of stress level vs. income your specific job provides. 

Mixed Models

Mixed payment models combine elements of the above three systems.  For example, you may be a salaried employee with the opportunity for a productivity bonus.  Personally, I am paid based on a combination of an hourly rate plus RVU’s.  I earn flat hourly pay plus additional income based on my level of productivity.  

Pros: Mixed models often eliminate the negatives of other payment systems while keeping the positives.  For example, my hourly rate plus RVU payments eliminates many of the stressors common in the RVU system while still rewarding me for hard work.  

Cons: Mixed payment models are a bit more complex and can lead to ambiguity.  Make sure your compensation, including any bonuses, are clearly outlined in your employment contract.  

Satisfied?  Because mixed models highlight the positives of multiple payment structures, they typically lead to the highest level of job satisfaction.  Mixed models provide a stable base-level income while still offering financial incentive for performance.

How are you paid as a nurse practitioner?  Does the way you are paid make you more or less satisfied with your job?

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