Earnings for CRNAs, the Highest-Paid APRNs, Top $200K: Survey

Marcia Frellick

November 24, 2020

Certified registered nurse anesthetists (CRNAs) again were the highest-paid advanced practice registered nurses (APRNs) in the latest Medscape APRN Compensation Report.

A total of 3294 responses were received, including from 2002 nurse practitioners (NPs), 500 clinical nurse specialists (CNSs), 401 nurse midwives (NMs), and 391 CRNAs. Respondents were asked to report their incomes from 2019. All groups saw an increase from the previous year.


Table 1. Pay Increases From 2018–2019

APRN type 2018 pay 2019 pay
NP $108,000.00 $113,000.00
CNS $102,000 $107,000
CRNA $188,000 $202,000
NM $107,000 $115,000


The authors of the report note that the numbers show that the investment in further education pays off. In all four categories, nurses with more education received significantly more pay than the $81,000 average pay for full-time registered nurses.

At the top end of the education spectrum, APRNs with a doctorate averaged about a 4% more. In this survey, 80% of APRNs had a master's degree (down from 85% the previous year), and 17% had a doctorate (PhD or DNS).

NPs made up by far the largest group of APRNs. The highest-paid NPs worked in the acute-care hospital setting. The next highest-paid worked in hospital-based outpatient facilities or clinics.

Table 2. NP Pay by Setting

Setting 2018 pay 2019 pay
Hospital-inpatient $116,000.00 $122,000.00
Hospital-based outpatient facility or clinic $109,000 $115,000
Public health/community health $107,000 $108,000
Academic setting $107,000 N/A*
Non-hospital-based medical office/urgent care facility $106,000 $110,000
*Number of respondents was insufficient for analysis.


NPs in the United States must have advanced practice certification. The largest group (53%) are those certified in family medicine.

The highest paid by certification are adult gerontology acute care NPs ($123,000), followed by psychiatric/mental health NPs ($122,000) and adult gerontology primary care NPs ($115,000).

Men Make More

The gender pay disparity continues among APRNs, especially for NPs and CRNAs. Male NPs this year made 8% more than their female counterparts, and CRNAs earned 15% more. Both of those percentages are larger than they were last year, suggesting the gap may be widening.

Men in the survey were more likely to work in higher-wage acute care hospital settings (63% vs 45% of women) and were more likely to supplement their regular income (63% vs 47%). They were also twice as likely to own their own practice than were female APRNs (12% vs 6%).

Fewer APRNs Working Full Time

Survey responses show a long-term trend of fewer APRNs working full time (at least 36 hours a week). In 2019, 79% worked full time, compared with 85% in 2015. Similarly, for CRNAs (the APRNs most likely to work full time), the number working full time was 82%, down from 87% in 2015.

"We don't know the reason for this," the authors write, "but it could be related to large numbers of NPs and CRNAs reducing their work hours as they near retirement."

The authors note that Medscape has surveyed APRNs each summer for the past 6 years. This year, it was apparent that the COVID-19 pandemic had dramatically changed the professional lives of many.

This report addresses salary; a second report will detail COVID-19's effect on APRNs.

APRNs are paid either by the hour or by salary. For all the groups except CNSs, hourly pay may be a financial advantage.

Salaried CNSs earned $107,000 a year, compared with $101,000 for those paid hourly. But salaried NPs earned $112,00, whereas those who were paid hourly earned $114,000. Salaried CRNAs earned $192,000 compared with $203,000 for those paid hourly. The number of NMs who responded was too small to make a direct comparison.

Compensation also differed by type of employment. NPs in private practice earned the least, at $101,000. Those who are self-employed or are independent contractors earned $110,000, and those employed by a medical group or hospital earned $114,000.

Incomes were slightly higher for APRNs who worked for the government ($127,000 vs $123,000 on average.) The most who worked in government were CNSs, at 11%. NMs were the fewest (5%).

Increases in Income Tend to Max Out at 20 Years

Generally, the more years APRNs work, the higher the pay. But that tops out at about 20 years. Those with 11 to 20 years' experience averaged $128,000, whereas those with 21 or more years of experience averaged $124,000.

Income also varied significantly by region. APRNs in the Pacific region (California, Nevada, Oregon, Washington, Alaska, and Hawaii) made the most, with an average $138,000. Those in the East South Central region (Kentucky, Tennessee, Mississippi, and Alabama) made the least, at $110,000.

Union or collective bargaining unit membership continues to be rare among APRNs. Only 9% reported belonging to those groups. But pay was slightly higher for those who did ($128,000 vs $123,000).

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune and Nurse.com and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.


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