Came across this video as I was surfing Youtube:
Is this right? Does a Psych NP in private practice make $250K+?
Is this right? Does a Psych NP in private practice make $250K+?
Psych NP Salary
- Thread starter nsilster
- Start date
- Status
- Joined
- Jun 24, 2019
- Messages
- 791
- Reaction score
- 885
sure i don't see why not. CRNA's make 300k+ in some areas.
Yep, we can. Or more. And it drives some residents nuts to hear that!
I don’t think it’s quite as easy as that guy implies. I’m not in my own private practice, and certainly don’t make that much working for someone else like I do, but I’ll probably run my own thing on the side where I bill for my own services at some point. That is my future when I get around to it, and I’ll have plenty of work waiting for me when I do.
I had a physician friend of mine ask me if I wanted to come work for him/her, and I politely declined, and he/she said something like “yeah, I figured you wouldn’t settle working for me when you could just go out and make as much as a doc doing your own thing. Got any friends that don’t have that figured out? Ha ha ha.”
The only thing that perplexes me is how the guy in that video keeps his overhead low, and manages to not have the time handling the business side bleed over into more days per week. He may see patients for 3 days a week, but if he’s not spending at least another full day handling the management part of his operation, then he has to pay someone quite a bit to do that part correctly. My guess is that he does cash pay, and has patients that are loyal to him. He probably picks his clients very carefully, and has a system to avoid no shows where he charges a fee if they don’t show up, or maybe has a deposit system where he keeps the fee that they pre pay to him.
So many folks in the biz are moving to cash only, and that opens up a ton of options, including charging whatever you want to for your services. But think of it this way.... the NP in the video needs to clear about $192 an hour gross to make $300k per year before his expenses. He might accomplish that by charging $300 for a new patient eval, which runs an hour. And then he can charge his subsequent visits $96 for a half hour followup. If he averages 1 new patient per day, and sees 19 followup patients, then he’s actually making as much as he suggests, which is around $292k gross. That’s not at all unheard of for a cash pay operation. The hard part is stacking your appointments full enough to do that, but if you have a large enough panel and just work 3 days per week, you can cram everyone in to those days and make it work. And maybe he prescribes suboxone, and in that case, he is definitely able to fill slots and has potential to make even more. If the guy sees patients faster than every half hour, then there’s even more money he can bring in. Not every patient needs a full half hour for followup, and with Telehealth visits, you can expand access to lots more people, and make no shows even less common.
If that surprises you, you gotta think of it this way... in a place like Oregon, with a law requiring insurance and Medicaid pay parity with physicians, which ensures NPs are able to bill the same as a physician for the same services rendered, an NP working in their own shop is able to make as much as a physician that is doing the same thing. Anywhere else that doesnt have parity, NPs will be able to bill around 85% of what a physician does under those circumstances. In my case, for my main job, I’m certainly not being paid 85% of what my physician colleagues in the office are making, because my employer is paying me a good deal less, and then pocketing the difference between what I make, and what a doctor makes for the same services rendered. But even being able to bill at 85% of what my colleagues do, I’m still much more profitable than than the doctors. Consequently, they have hired their last doctor for quite some time, and will only hire NPs, and keep a doctor on hand as a figurehead. We will never hire more than an absolute minimum number of physicians going forward. Physicians should get ready for more of that as PAs push an agenda called “optimal team practice” in every state. What you’ll see is PAs that are no longer supervised by physicians, but instead will only have to “collaborate” with docs, and have their oversight provided at the practice level. Practices will hire one doc to collaborate with all the PAs in the office or system, and they will be cut loose to have everything manned only by PAs, with just one doc. That doc doesn’t have to supervise anyone, or be liable for any PAs mistakes. NPs currently are part of those kinds of arrangements, but now PAs will add to the mix.
- Joined
- Aug 27, 2019
- Messages
- 266
- Reaction score
- 121
CRNA’s can make 300k?
In some areas. Where I’m at they can easily make about $180k, but I live in a place people want to live. Go out a little farther, and the wages go up. Some CRNAs fly in to places like California and work a week, then fly home while another CRNA flys in to work the alternating week. Those guys can be making plenty.
I wouldn’t say that $300k for a CRNA is the norm. For PMHNPs, $250k isn’t the norm. I know PMHNPs making close to $400k, but most of my friends and classmates make between $145k and $180k. Most CRNAs I know make between $150k and $180k. Most FNPs I know make between $85k and $120k. Most PAs I know make between $90k and $130k.
- Joined
- Aug 27, 2019
- Messages
- 266
- Reaction score
- 121
Can PA’s make 150k plus?
I don’t know many that do, but one that I do know that makes that much is a derm PA that has been in the game a while. This person has a very loyal following of patients who actually want to see that person, and refer friends to that PA. The boss doesn’t mind letting that PA keep more of their own profits because it’s essentially generated by that PA. Most PAs I know feel like they a Pa is doing great if they are pulling in $130k or above. I’ve heard all the stories of unicorn PAs making $200k or more in my area, but usually that involves working a ton over two or 3 jobs. You don’t hear of it for folks working 36 hours a week and having awesome work life balance. I could easily make $250k as a PMHNP, but it wouldn’t be easy for ME, because I don’t want to work 45+ hour weeks, holidays, nights, or weekend. I don’t want to chart outside of my regular work day. I like that my employer takes care of everything, and all I have to do is show up and work. That allows me to focus on what’s at hand, and improves my productivity so that I nail all of my bonuses. I don’t have to work more than I don’t work.... which means I don’t spend more waking hours per week working vs not working... for them. I use spare time at another gig. The other gig is very lucrative, but it’s another place where I just have to go work, and not worry about things. If I were running it as my own project, I’d have more money coming in, but I’d also have more stress, etc.
Also, PAs in psyche, that I know, don’t make as much as any PMHNP that I know. All of the psyche PAs in my orbit make what other PAs typically make, if not less. I could tell you a lot about why I chose to become an NP vs PA, and I had the choice of what to do, as I had prereqs for both. It’s a good career, but the overall picture is complicated by a lot of factors that will hold them back.
It’s always best to expect to make the kind of money that most people in a field make. If you are banking on being the exception, you’ll be surprised when certain life variables hit you head on. You also have to factor in expenses, and the job market. If you come out of school with a ton of debt, that debt will drive your options. Derm jobs are hard to find, and even if you find them, it doesn’t mean you’ll even be paid the big money. I know folks in derm that don’t make much at all. They are telling themselves “I’ll spend a few years doing this and then make the jump to a better paying employer.” Well, maybe the will. Or maybe their next employer will say “you are too expensive, I’ll hire a cheap new grad instead”, or “I’ll hire some burned out ER PA and train her to do this and she will be happy to make $100k for a fraction of the stress”. So yeah, the difference between the best paid PA and a cheap PA for a dermatologist is the difference between buying their daughter a Porsche for her sweet 16, and buying her a Subaru. And that’s every year that they have a cheap PA onboard vs and expensive one. And that’s money they wouldn’t even have to think about. They could put $50,000 per year into apartments and have a retirement income waiting for them.
So the lesson there is, expect to make what everyone is making. If you do better than that.... sweet.
School expenses:
Just school, not counting living expenses... to become a PA... $90k-$150k.
To become an NP....at least $30k for RN school, then at least $30k for NP school... if you go to cheap programs. My program was more than $30k by a decent amount.
To become a CRNA..... $100,000 at least. I’ve heard as high as $200k. And add on the cost to become an RN. I’m more confident of the lower number to become a CRNA. I don’t know what program costs $200k.
Also, PAs in psyche, that I know, don’t make as much as any PMHNP that I know. All of the psyche PAs in my orbit make what other PAs typically make, if not less. I could tell you a lot about why I chose to become an NP vs PA, and I had the choice of what to do, as I had prereqs for both. It’s a good career, but the overall picture is complicated by a lot of factors that will hold them back.
It’s always best to expect to make the kind of money that most people in a field make. If you are banking on being the exception, you’ll be surprised when certain life variables hit you head on. You also have to factor in expenses, and the job market. If you come out of school with a ton of debt, that debt will drive your options. Derm jobs are hard to find, and even if you find them, it doesn’t mean you’ll even be paid the big money. I know folks in derm that don’t make much at all. They are telling themselves “I’ll spend a few years doing this and then make the jump to a better paying employer.” Well, maybe the will. Or maybe their next employer will say “you are too expensive, I’ll hire a cheap new grad instead”, or “I’ll hire some burned out ER PA and train her to do this and she will be happy to make $100k for a fraction of the stress”. So yeah, the difference between the best paid PA and a cheap PA for a dermatologist is the difference between buying their daughter a Porsche for her sweet 16, and buying her a Subaru. And that’s every year that they have a cheap PA onboard vs and expensive one. And that’s money they wouldn’t even have to think about. They could put $50,000 per year into apartments and have a retirement income waiting for them.
So the lesson there is, expect to make what everyone is making. If you do better than that.... sweet.
School expenses:
Just school, not counting living expenses... to become a PA... $90k-$150k.
To become an NP....at least $30k for RN school, then at least $30k for NP school... if you go to cheap programs. My program was more than $30k by a decent amount.
To become a CRNA..... $100,000 at least. I’ve heard as high as $200k. And add on the cost to become an RN. I’m more confident of the lower number to become a CRNA. I don’t know what program costs $200k.
- Joined
- Jun 23, 2019
- Messages
- 33
- Reaction score
- 33
I think follow-up appts can be more than the $96 you mentioned. Most of these private practice folks bill 99214 + add-on therapy (90833) for a 30-min follow up. A 99214 would be ~$100-$130 and 90833 would be an additional $70 or so (per medicare). An 8-hour day with all f/u would generate be
~$290-$340 per hour (85% for NP). If he works 3 days a week for 48 weeks a year, that would be >$300k gross revenue. I agree that there must be a lot of strict rules about no-shows, and I think the patient population has to be committed and fairly high functioning (cash pay or good private insurances).
D
deleted6669
Not that uncommon for senior specialty PAs working in EM, ortho, derm, or surgery.
D
deleted6669
easily. especially in independent states. THE CRNA at my primary job makes more than any of the docs or the CEO of the hospital.
There are police officers and firefighters in my area that are making above $300k. I looked online and have seen cops making $400k. They work a hella ton of hours. Basically they pick up everyone’s shifts, and any overtime. The last few years of a firefighters career, everyone hands off shifts to the guys getting ready to retire to jack up their income that is calculated for retirement. I could tell the same stories as you about NPs and CRNAs making oodles of cash, but the part everyone leaves out is the time commitment. But indeed, it is possible. But very quickly it becomes an issue of what is probable, healthy, maintainable, safe...
I could make a lot of bonus money doing 15 minute appointments with my patients, which would mean shoddy documentation and maybe 8-10 minutes of face to face for followups, but all that stress on the process wouldn’t be good for me or the patients. So many things fall by the wayside when someone operates that way. It just adds up.
Yeah, I kept it simple for non provider folks to visualize, and presented a hypothetical cash practice, because that seems to allow for the least amount of headaches. Insurance companies seem to be the bane of every independent NP practice as far as getting them to pay you, and not low balling reimbursement. NPs that hire someone to bill have those same billers usually take the low hanging fruit, and then you find out they aren’t chasing down every dollar, nor disputing any rejected claimes. They look at it in terms of bulk collections across all the providers that they have as clients. The result is that they could care less chasing down $300 here and there for you because they landed you to r $1000 that you noticed, and yet there you are missing out on a lot of money over time. The biller figures it’s all good because that last mile of work isn’t worth it to the biller, when for the NP that’s a significant amount to leave on the table. The alternative is to do it yourself, which means you have a second job dealing with that. It can be an either or proposition for many of my friends. And personally, like I say, I don’t deal with ANY of that in my current roles. I go in, work, go home, get paid. And right now that works for me. But the devil is in the details. If an NP is in private practice, then getting PAID is a lot different than BILLING. Cash pay is a trade off, where you can have them pre pay, or you can bill penalties to them, but you also have to deal with that interaction with the patients. I’ve got great patients, but that being said, there are a lot of complications that the office personnel deal with as part of the day to day. I don’t know how someone working in psyche limits that, because it comes with the territory, no matter how agreeable the patients are.
I know it’s possible to make that kind of cash because I know people doing it. It’s just a question of whether it’s worth it. There are trade offs. You have to pay GOOD office staff to allow things to run smoothly, or else it bogs you down personally. That is a bite of the apple. Yeah don’t see any way around that. You have to decide how you want to get paid... insurance (headaches) or cash (which has its own issues). Then there’s rent for a location. If you have some arrangement with some office space for cheap, then you get what you pay for. I can think of downsides to the model of traveling light and working out of say, one of those office space conglomerates like “we work”. I could do everything I need to do from a laptop, my home office, and theoretically with some temp office space, but I think there are wrinkles and expenses to that too.
So after expenses, and taxes, how much of that $300k is left, and how much is worth it? I’m probably going to try that at some point in my future. It’s not that it can’t be done, but how easy it is to do. For me, I pull in around $200k+ with a no stress <40 hour work week. No intrusion into my free time. Lots of free time, and full benefits for me and the family, along with generous retirement. Paid time off is plentiful, and compensated.
D
deleted6669
I make good money, but work way too much (60-65 hrs/week) and drive too much to work.
I also have to buy all my own benefits as I am a 1099 employee.
I also have to buy all my own benefits as I am a 1099 employee.
If you are NP, PA or doc, you can make a lot of $$$ in medicine to an extent... Medicine is about location, savviness and how much you want to work.
I know an ED PA that makes over 200k/yr. The guy make $85/hr and work 4-12 hrs/wk. He has been doing for over 3 yrs now. I wonder how sustainable is that in the long run.
D
deleted6669
48 hrs/week? sure. 65 hrs/week....not so much...that is what I have been doing since last april....
I don't know know... I did 1 month rotation at the ED as an IM PGY2 and it was taxing doing these 40 hrs/wk seeing only 1 patient per hours. I am sure PA see more than that.
D
deleted6669
depends on the site. I work all rural sites. some avg 0.5 pts/hr, some avg 2 pts/hr. for the 24 hr shifts I get a call room, so am often paid to sleep.
You must be doing great... You are probably one the PA that are making banks.
D
deleted6669
make more than I need. Mostly working this many shifts due to covid and provider shortages. will try to cut down to 200 hrs/mo after april.
So, I came across another thread on this NP, and it was interesting because all the docs were like “oh this is totally possible”. Which of course isn’t disputed. My only point is that it’s not effortless. I haven’t tracked down any details on the $250k NP, but from what other folks have said they found out, he’s capitalized on medical cannabis and concierge type stuff. So yeah, if you are the candy man, then you can make that kind of money. If you are like me, and doc shopping patients fire you almost immediately because you won’t give them the controlled substances in the exact form and fashion that they demand, then it’s harder to make that kind of cabbage without stretching.
A newer NP like that guy should be extra careful about the way he rolls, because he’s putting himself out there to lose his license for a host of reasons. A new psychiatrist isn’t new compared to an NP.... they’ve been practicing in residency for 4 years, and their work weeks were busier by far than any NP clinical. Add a fellowship on top, then you are dealing with someone who has the chops to handle anything they come across. Consider 4 years of med school, and they are up to speed on other conditions that could confound their treatment.
I guess the other thing that guy might be up to is trying to make money selling his “system” to other NPs.
A newer NP like that guy should be extra careful about the way he rolls, because he’s putting himself out there to lose his license for a host of reasons. A new psychiatrist isn’t new compared to an NP.... they’ve been practicing in residency for 4 years, and their work weeks were busier by far than any NP clinical. Add a fellowship on top, then you are dealing with someone who has the chops to handle anything they come across. Consider 4 years of med school, and they are up to speed on other conditions that could confound their treatment.
I guess the other thing that guy might be up to is trying to make money selling his “system” to other NPs.
- Joined
- May 5, 2021
- Messages
- 55
- Reaction score
- 22
Do you not document during the patient encounter? If I don't, I can't remember a single thing they said. It helps me identify them too. I'll note interesting observations or things said that may or may not be treatment related which helps me remember who they are months later.
Unlike an investor model, say Rich Dad Poor Dad, we can all create a lot of income by working a lot of hours so at some point we're still going to max for a variety of reasons unless we do become investors, get a shop and take our contractor's payments. I've always arranged more work, contracting, academics, consulting, telework, etc around my clinic hours to increase income. I think it's why I have premature burnout (I chuckle but I'm serious) but I'd rather put in the sweat now than later while the fields are still ripe for earning. I've seen the market contract in just the last four years.
I haul butt and document afterword and utilize templates. I get behind at some point in the day, and have a few things to finish before I leave. I get to know folks pretty well because the first few appointments are usually close together while I get meds squared away and adjusted. By the time appointments are spaced out farther, I have a decent memory of them burned into my mind. I don’t always remember them by name, but once I see them or read the chart, it comes back really quick.
Patients don’t forget that face to face interaction where they have your full attention, even if it’s briefly. They are used to providers looking at a screen saying “mmhhhmmmm”, so if you don’t do that, you look like a rockstar. Just today, two patients told me I “listen”. They will do what I ask them to if they have that evidence that I care. Everyone I personally trained with.....several doctors and a handful of NPs.... did it that way, so I never knew any other way to roll. I have friends who have patients that are turned off by them utilizing the computer in the interaction, and they can’t figure out why. I’m pretty sure that’s probably the only reason they aren’t more popular.
Im fairly new in the last few years, and I’ve seen the market contract where I’m at as well. But that’s ok, because when others burn out because they are more stressed, which is what happens particularly when one doesn’t know what one is doing, I’ll still be chugging away content with my career. Burnout will be different for me than them.
Another burnout preventer.... I got the right job with the right staff. They help me look good, and I don’t tick them off. I see VIP clients in the health system I’m in. When you take care of problems for family members of the top brass, they give you latitude that isn’t extended to other people. Also.... I didn’t start out working myself to oblivion. Already lived that life as a new nurse where I was excited to be a thousandaire, with all that sweet overtime coming in when I’d pick up a shift. I added it all up at the end of a couple years, and it was meager compared to what I gave up on. So I threw myself into working smarter and not harder. I networked like mad and found better jobs like the one I have that didn’t live and die according to pure production. They exist. Gotta find them. They are given to people the bosses like. Bosses do like to see you hustle, but they also like to see human beings doing human being things.
- Joined
- Nov 4, 2011
- Messages
- 28,454
- Reaction score
- 54,243
This thread can be followed here: Psych NP Salary
- Status
