Median total cash compensation for physician assistants and nurse practitioners increased by 4.5%
Chicago, IL | December 7, 2022
SullivanCotter, the nation’s leading independent consulting firm in the assessment and development of total rewards programs, workforce solutions, and data products for health care and not-for-profits, has released the findings from its 2022 Advanced Practice Provider Compensation and Productivity Survey.
With median total cash compensation (TCC) up by 4.5% over last year for nurse practitioners (NPs) and physician assistants (PAs) across all major specialty categories – primary care, medical, surgical and hospital-based – this year’s results reflect a dynamic market requiring organizations to develop more competitive approaches to advanced practice provider (APP) compensation. As the health care workforce crisis continues and projected physician shortages remain a concern in this post-COVID environment, APP utilization is increasing as hospitals and health systems look to minimize disruptions to patient access, service and quality of care.
Total Cash Compensation
APP compensation continues to increase year-over-year. While all major specialty areas have seen median TCC — which includes base pay plus performance incentives — grow by over 7.3% or greater since 2019, primary care (up 10.1%) and hospital-based specialties (up 9.1%) have seen the single largest increases over this same period. After several years of minimal growth, TCC for hospital-based specialties increased by 7% from last year alone – likely due to a combination of factors such as changes in work effort, staffing shortages and delayed market increases from 2020 as a result of the pandemic. Although nearly half of organizations (48%) reported utilizing incentives for at least some of their NPs and PAs, it is important to note that this type of compensation as a percentage of base pay ranges from only 4.2% – 6.1% across all specialty categories.
Certified registered nurse anesthetists (CRNAs) have experienced even more rapid TCC growth with the median hourly rate increasing from $86.54 in 2019 to $95.57 (up 10.4%) in 2022 alone. This is driven by a continued shortage of anesthesiology providers as well as a spike in demand as post-pandemic surgical volumes increase and the need for anesthesiology support outside of the traditional operating room rises. Many organizations are experiencing CRNA recruitment and retention challenges, and this is expected to continue during the next three to five years.
“The demand for CRNAs continues to outpace supply, requiring health care organizations to reevaluate their CRNA recruitment and retention strategies in order to ensure effective and sustainable staffing and coverage. A critical cornerstone of these strategies is the establishment of competitive compensation packages and desirable practice environments aligned with evolving CRNA preferences and market trends. We believe the demand and supply mismatch will continue for the next three to five years and organizations should plan accordingly,” said Zachary Hartsell, Principal, SullivanCotter.
Work RVU Productivity
To help organizations assess the ongoing impact of the Centers for Medicare & Medicaid Services’ Physician Fee Schedule (PFS) changes, SullivanCotter includes two sets of benchmarks in the 2022 survey based on work RVU values from both the 2020 and 2021 PFS. The results show the most significant variation within primary care and some medical specialties, while productivity in hospital-based and surgical specialties remains more consistent between the 2020 and 2021 schedules.
Combined median work RVUs for NPs and PAs in 2022 are the highest in primary care at 3,620 (utilizing 2021 PFS) and 3,220 (utilizing 2020 PFS) and the lowest in surgical specialties at 1,812 and 1,725 respectively. “The market data on APP productivity continues to evolve and become more robust. When analyzing this information, however, it’s important for organizations to keep practice variation in mind – this can vary widely based on specialty and organization-specific patterns. While APPs in primary care often practice more independently and may have their own patient panels, surgical APPs spend the majority of their time conducting pre- and post-operation visits or serving as a first assist in the operating room – extremely important roles, but ones that don’t generate as many work RVUs,” said Amy Noecker, Principal and APP Workforce Practice Leader, SullivanCotter.
Planning for 2023 and Beyond
APPs continue to play a critical role in achieving greater patient access, lowering the cost of care and addressing the growing physician shortage. The market for APPs has grown increasingly dynamic and this is expected to continue in the coming years.
As it relates to APP compensation and workforce strategy, organizations should consider the following:
- Plan for pivotal regulatory changes impacting APPs including split/shared billing and additional Physician Fee Schedule modifications to the inpatient E&M codes by enhancing programs that support documentation and coding compliance, formally assessing compensation plan implications, and defining (or redefining) care team responsibilities.
- Support recruitment and retention with the establishment of competitive compensation packages and desirable practice environments focused on improving patient access and top-of-license practice for APPs. Ensure rates are competitive with local and national markets and evaluate care delivery models so that APPs have the appropriate scope of practice.
- Evaluate the effectiveness of alternative care delivery models such as virtual medicine to help address issues with patient access due to staffing and space constraints. Important considerations involving scheduling, staffing, patient demand, variation in state law and overhead costs should all be taken into account.
- Understand how changes in care delivery are affecting hospital-based providers. Due to the pandemic, burnout is on the rise and many APPs in coverage specialties are requesting either an increase in compensation or changes to annual work effort expectations. Many organizations are still short-staffed in these areas and continue to manage limited resources with additional premiums.
- Address current and future anesthesiology care team challenges by regularly assessing physician-to-CRNA staffing ratios, reviewing CRNA and physician deployment and paying special attention to work effort expectations and scheduling preferences.
SullivanCotter’s 2022 Advanced Practice Provider Compensation and Productivity Survey provides critical benchmarking data on compensation levels and pay practices. As one of the most comprehensive resources of its kind for hospitals and health systems nationwide, the survey includes information from nearly 700 organizations representing more than 100,000 individual APPs.
About SullivanCotter
SullivanCotter partners with health care and other not-for-profit organizations to understand what drives performance and improve outcomes through the development and implementation of integrated workforce strategies. Using our time-tested methodologies and industry-leading research and information, we provide data-driven insights, expertise, and data products to help organizations align business strategy and performance objectives – enabling our clients to deliver on their mission, vision and values.
For more information on SullivanCotter’s surveys, please visit our website at www.sullivancotter.com, or contact us via email or by phone at 888.739.7039.
Note to media: Additional data and interviews are available on request.