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The Latent Phase: Show me the money!

By Stephanie Tillman, CNM, MSN

Outside of fast food and retail, I had only ever worked in small non-profit groups before becoming a midwife. Understanding health care salaries was beyond my reach. Thus, my earning expectations were minimally grandiose: get paid enough to 1. live, 2. pay off student loans, and, ideally, 3. make more than I did with my jobs straight out of undergrad, given all the extra education and borrowed loans. But what should I, and other full-time entry level midwives, expect to be paid?

Per the most recent ACNM Compensation & Benefits Survey, the average midwife's full-time salary in 2010 was $114,152, with a median salary of $88,000. About 1/4 of midwives reported that they received productivity bonuses, and it was unclear whether these average salaries were the base pay or annual pay after bonusing - a factor which may conflate the actual figures. From the 2007 survey, we know that years of experience and academic degree correlate with higher levels of pay, showing that the longer you work as a midwife, the more money you make. The implication is that new midwives start at the bottom of the baseline. What does that mean? My former classmates estimate that our entry salaries ranged from $79,000 to $90,000 between people working in private practice, federally qualified health centers, Indian Health Service, birth centers, etc. That's a pretty tight range given the facets of experience we each brought to the table: we were doulas, PhDs, nurses, MPHs, researchers...

Most in midwifery come with laudable backgrounds, and that brings important negotiating power! Given these varied backgrounds, it would be helpful to break down entry level salaries, previous experience in the field, and, importantly, gender. Perhaps ACNM should consider these areas of focus for the next Compensation and Benefits Survey! Nota Bene: ACNM has not previously broken down salary results by gender, possibly due to the low numbers of midwives who identify as male. Looking to our nurse practitioner colleagues, research shows that male-identified NPs consistently make around $12,000 more than NPs identifying as female. It is well-documented that men not only make higher salaries, but also negotiate higher salaries and better benefits than women. One might consider this factor in salary differential beyond pure gender discrimination. I would also argue that women are taught less about the benefits and bonuses for which they should argue (and thus this post came to be). Regardless of any individual's background or characteristics, it benefits the profession of midwifery to have well-paid, appropriately paid, midwives in the workforce.

Let's talk details.

There are important considerations in baseline salary anticipation for new midwives. Remember to focus on what is working for you already. I like to call this category "Because you're worth it."

  • Nursing background: If you've got it, flaunt it. I did not find this aspect necessary in my search for CNM positions, but other places either require it or will pay you more for it. If you have it, make sure you point it out and let those years of experience add to your baseline.
  • Dual certification: If you're coming in with additional clinical expertise, you should be paid more. Period.
  • Prior degree(s): If you're coming in with additional expertise in other areas that could benefit your clients or the organization, you should be paid more.
  • Applicable experience: Former doulas, lactation consultants, birth educators, and others have obvious areas of expertise that can add years of "experience," and should equal higher base pay.
  • Languages: It greatly benefits an organization in terms of patient satisfaction, operational flow, and division of workload to have a provider who can directly communicate with patients. A provider who speaks the dominant language of the patient population saves incredible amounts of money, and an uptick in base salary is important.

You should also negotiate for other factors that tie into an annual salary. The worst outcome is that Human Resources, or your communicator at the practice, could say no. I categorize this list as "Negotiate, because if the money is there it's yours for the taking."

  • Signing bonus: Knowing that you may have a few job offers, a signing bonus can sweeten the deal. Some non-profits are not able to offer this amenity, but it is worth asking.
  • Relocation package: If you are moving a distance to join a group, ask about the relocation assistance options. Often this is an option even for groups that cannot offer a signing bonus, because they can write it off in some regard. Moving expenses add up, and you will never know if you could have been reimbursed for those costs if you don't ask.
  • CME and professional licenses: These cost a lot of money, at the beginning and every 1-3 years after. Ask if this is something you'll need to budget, or if you get automatic reimbursement.
  • Cell phone: This will be used for work activities unless you receive a phone just for work. So ask if some or all of your bill will be reimbursed monthly or annually.
  • Vacation and sick time: How much, when, how long to accrue, etc. Time is money; so is time off.

When you think that's all the money you can make, remember: there's more. This category shall forever be called "Show me the money! No, really, all the money!"

  • Call: Will you have personal time during which to utilize the money you've earned? Or are you always on call? Perhaps a baseline salary of someone who constantly takes call should be higher than someone who has a scheduled shift.
  • Extra shifts: If you work additional hours, is there opportunity to earn more?
  • Productivity bonuses: Based on births, total number of patient encounters, or quality measures. Check-in on what your opportunities are or will be to make the extra cash.
  • Loan reimbursement: If the baseline salary is low, but the opportunity for loan reimbursement is high, factor that into your equations. Loan reimbursement opportunities can vary based on state, practice type, or patient population. Ask if any other providers are receiving reimbursement, and look into it yourself before finalizing an offer.

Every individual will have different needs in terms of minimal salary based on life requirements. It is important to start with a basic budget based on consistent needs prior to accepting or turning down a job. To find out more about midwifery earnings specifically in your area, Glass Door is an online resource to see salary ranges at local organizations. If you contribute your own salary to this resource, others can have an idea of what to expect and possible areas of negotiation. Best of luck as you search for jobs and negotiate salaries!

What advice do you have for new midwives seeking to understand salaries, benefits, and negotiating the numbers? Let us know your advice!


Stephanie Tillman is a recently-graduated Nurse-Midwife now practicing full-scope midwifery in the urban United States, at a Federally Qualified Health Center (FQHC) and as a member of the National Health Service Corps (NHSC). With a background in global health and experience in international clinical care, the impact of public health and the broader profession of midwifery are present in all her thoughts and works. Stephanie's blog, Feminist Midwife, discusses issues related to women, health, and care. Find out more at www.feministmidwife.com and follow her on Twitter at @feministmidwife.


Posted By Barbra Elenbaas | 6/26/2013 12:41:27 PM
 

 

 



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