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
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."
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.
you're coming in with additional clinical expertise, you should be paid more.
you're coming in with additional expertise in other areas that could benefit
your clients or the organization, you should be paid more.
doulas, lactation consultants, birth educators, and others have obvious areas
of expertise that can add years of "experience," and should equal higher base
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
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
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.
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.
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.
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.
you work additional hours, is there opportunity to earn more?
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.
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.