Printer Friendly

Compensation and Benefits Surveys for Certified Nurse-Midwives and Certified Midwives.

The supply and variety of maternity care providers in the United States has waxed and waned over time. A critical element of a healthcare system is its sensitivity to the demand for access to safe and effective healthcare services that are responsive to evolving health needs. A substantial body of evidence has emerged that suggests a potential shortfall of primary healthcare providers generally, and for maternity care providers specifically, leading to congressional action designed to address this concern, such as the "Improving Access to Maternity Care Act," that was enacted on December 17, 2018 (S. Res. 628, 2018).

Workforce strengthening strategies include recruitment to the profession, education of new providers, and retention of the current workforce (Nei, Snyder, & Litwiller, 2015). Midwifery workforce retention is additionally impacted by a wide variety of factors that affect an individual's satisfaction with the context of the professional work responsibilities inherent in the midwifery practice role (specifically labor and birth services). Compensation and benefits are significant to this deliberation. These factors mirror a commonly held impression that compensation and benefits reflect the relative worth and value that is placed on the work (occupation or profession) itself.

The profession of midwifery is somewhat unique in this wider discussion of workforce retention and turnover, because there are two distinct groups within the profession: those with a nursing credential (nurse-midwife) and those without (certified midwife). Certified nurse-midwives (CNMs) are licensed independent healthcare practitioners who have graduated from a nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME) and passed a national certification examination to practice. CNMs are defined as primary healthcare providers under federal law. They have prescriptive authority in all 50 states, District of Columbia, American Samoa, Guam, and Puerto Rico (American College of Nurse-Midwives [ACNM], n.d.).

Certified midwives (CMs) are also licensed, independent healthcare providers who graduated from a midwifery education program accredited by ACME and have passed the same national certification examination as CNMs. CMs are usually not registered nurses. However, CMs, at this time, are authorized to practice in just five states and have prescriptive authority in only two states (New York and Rhode Island) (ACNM, n.d.).

Salary and benefits available specifically to CNMs and CMs are critical because this information is not accurately reflected in public data resources. This information has been generated and disseminated by the federal government (Spetz, 2013) and from professional organizations. Reported data generally include annual salaries (or wages) paid to nurses who serve in a wide variety of nursing positions in the United States, and some limited information about employee benefits. However, the identity of the midwife is underrepresented in these reports in which CNMs are generally accounted as a subspecialty of the advanced nurse practice workforce, although many CNMs/CMs identify midwifery as an autonomous profession apart from nursing. CMs, who do not hold a nursing credential, are also omitted in these reports. For example, in 2010 the U.S. Bureau of Labor Statistics (BLS) added two identifiers for the standard occupation category (SOC) of nurse-midwife (29-1160 and 29-1161). However, no SOC is available for certified midwives.

These comparisons to the nursing profession also do not reflect the workload that describes midwifery as distinct from the responsibilities of the wider primary care workforce. CNMs/CMs often provide services that extend beyond an 8-hour workday, and this variation is difficult to capture within the rubric of an hourly wage or annual salary figure. Similarly, the financial responsibilities of CNMs/CMs, such as the required limits of liability insurance, may not be transparent within a description of employment benefits.

Several studies were identified that focus on practice characteristics of midwives within selected states (Burpo et al., 2018; Hastings-Tolsma et al., 2018; Hastings-Tolsma et al., 2015; Vedam et al., 2018). These state-specific data do not necessarily provide the information needed by midwives who are seeking employment in other U.S. jurisdictions of practice. The American College of Nurse-Midwives, the national organization for CNMs and CMs, has, therefore, conducted surveys focused on compensation and benefits specifically for member CNMs/CMs. This nationally focused salary and benefit information can be used by midwives, employers, and other stakeholders in compensation negotiations.

The purpose of this article is to report salary data from compensation and benefits surveys of CNMs/CMs conducted over a 10-year period (2004-2014) and to present a comparison of salaries reported from the BLS for the SOCs of nurse-midwives (the BLS terminology), nurse-practitioners (NPs), and physician assistants (PAs), and to demonstrate patterns of salary equity or disparity among these three professional groups of practitioners who share certain core responsibilities for women's healthcare services (BLS, n.d.).

Nominal salaries (the simple dollar value amount an employee is paid for work) (Petryni, 2017), salary trends over the decade, and variations in salaries by employer type, education, and geographic location are described. A brief discussion of employment-associated benefits is also presented and the menu of reported benefits available to CNMs/CMs is explored.

Methods

Study Design and Instrument Development

This study used a series of national surveys conducted between 2004 and 2014 and targeted to members of the ACNM. The compensation and benefits surveys were developed by ACNM's then senior staff researcher in collaboration with selected ACNM members and representatives from the then-independent entity, The Midwifery Business Network. The survey was modified, adapted, and augmented in each of the 4 survey years (2004, 2007, 2010, and 2014) to reflect contemporary and emerging marketplace trends, and in response to requests from respondents and stakeholders.

The 2004 survey contained 24 multiple choice, choose all that apply, and open-ended questions. Respondents answered only those questions that were relevant to their individual circumstance (controlled by skip logic). A parallel instrument construction was used in each subsequent year, so that similarly worded items would allow for comparisons and trending.

All surveys asked respondents to identify their status as a CNM or CM, highest academic degree, years of experience, and state of performance of midwifery-related work. Respondents were asked whether they were employed in midwifery and a definition of midwifery employment was provided. The broad definition encompassed a wide scope and focus of various areas of midwifery practice.

Selected surveys asked the type of employer, academic degrees, and years of experience. All surveys asked if the respondent was employed in midwifery-related work, and whether this work included the responsibility to be "on-call" (available to respond to a request for service). The on-call question was modified over time to seek clarification about the number of on-call hours and the ways in which respondents were reimbursed for that service. All surveys contained items pertaining to salaries and benefits for the employee and his or her family. Both salary and nominal wages were collected; salary in the form of categories and wages in the form of yearly amounts.

Additional survey items were added in later surveys to expand the information available. The survey increased to 32 items in 2007, 41 in 2010, and 55 in 2014. A question about work productivity (e.g., number and types of services provided) was added in 2007. A more expansive query about age, race, and ethnicity was added in 2010. The 2014 survey was the first to query separately about various combinations of full- and part-time employment, and also contained a larger profile of employee benefits.

Subjects. CNMs and CMs composed the study sample. Those who were active members of the ACNM at the time of each data collection period were eligible to participate in the respective survey.

Procedures. Invitations to participate in the on-line surveys were sent to all ACNM members who provided ACNM with an email address (98.5% of members) (F. Miranda, personal communication, January 2, 2019). Reminders to participate in the survey were sent monthly to all non-respondents during the 2-month period the survey was accepting responses, with one final reminder sent the last week the survey was open. The survey software accepted only one response from each e-mail address. Data were maintained by external software vendors (Websurveyor and Qualtrics); and then securely downloaded for purposes of research.

Ethics

Data for these analyses were gathered in compliance with the federal guidelines for ethical approval of survey research conducted without the support of federal funds (U.S. Department of Health and Human Services, 2016). This organizationally funded research was conducted in compliance with the ACNM data protection policy that was current in the respective survey years, and, in all cases, provided for informed consent and confidentiality of respondents (ACNM, 2008). All potential personal identifiers were removed prior to analysis. Submission of surveys was considered evidence of agreement to participate. Only anonymous and aggregate data were reported.

Data Analysis

Survey data were exported to IBM SPSS Statistics Version 21 and cleaned and transformed as needed. Data were analyzed using descriptive and inferential statistics. All respondents who reported their status as a CNM or CM and employed either part-time or full-time in midwifery were aggregated in each of the 4 survey years.

Demographic and salary information were reported for all survey years. Data from the most recent survey year (2014) were analyzed further for variations in salaries.

Because salaries in 2007 were collected in categories only, the grouped median and standard deviation were calculated in SPSS. Nominal wages were inflation adjusted to 2016 using the Consumer Price Index from the BLS (2017). Relative percentage changes were calculated to determine changes over time in adjusted wages. The term salary will be used throughout this article to refer to both salary and wages.

Respondents were grouped into the nine divisions defined by the U.S. Census Bureau (n.d.) corresponding to the reported states where midwifery work was performed. Census divisions represent aggregates of states that are illustrative of homogenous demographic clusters (U.S. Census Bureau, 1994).

One-way analyses of variance were conducted to compare CNM/CM 2014 salaries among subgroups containing at least 10 respondents (to satisfy statistical assumptions), including highest degree earned, race/ethnicity, gender, employer types, and U.S. Census divisions. Assumptions were tested and all pairwise comparisons of means were conducted using Dunnett's T3 because subgroups demonstrated unequal variances. Trends over times analyses were used to compare descriptively mean salaries reported for nurse-midwives, NPs, and PAs using data from the BLS for years 2014-2017, given these three categories of practitioners share a similar scope of practice for maternity outpatient care and selected primary health care services. (CMs are likely not included in the BLS data.)

Results

Response Rate

A total of 1,304 CNM/CM members responded to the survey in 2004. ACNM's total active CNM/CM membership that year was 5,708, which was a response rate of 22.8%. The response rate in 2007 was 24% (1,386/5,772); in 2010 it was 16.2% (972/6,009), and in 2014 it was 27.8% (1,789/6,435) (see Table 1).

Demographics

Respondents in 2010 and 2014 were predominately female and White, which is consistent with surveys conducted among ACNM members over the prior decade (Schuiling, Sipe, & Fullerton, 2010, 2013). In 2014, the mean age was 49.5 years (SD 11.9) (see Table 1). Approximately equal proportions of respondents reported additional certification as a women's healthcare NP or family NP in both 2010 and 2014. More than one-half of respondents in 2014 reported they had acquired one or more clinical specialty advanced skills or certifications that could expand services for clients, such as first-assisting at operative delivery (33.3%), ultrasound (20.5%), or colposcopy (10.1%) (see Table 1).

The most prevalent academic degree reported by respondents across all 4 years was the master's degree; however, in 2014 the percentage of respondents reporting a doctoral degree as the highest academic degree surpassed 10%. Nearly half of respondents reported 16 or more years of experience working as a midwife in 2014 (see Table 2).

Salary Data

The majority of respondents worked full-time (35 or more hours per week) versus part-time across survey years. Approximately half of the respondents who worked full-time clustered in the salary categories of $60,000-$80,000 in 2004; $70,000-$90,000 in 2007; $80,000-$100,000 for 2010; and $90,000-$120,000 in 2014 (see Table 3). The annual nominal salary among those working part-time was more evenly distributed across the categories.

The mean annual nominal salary across survey years, inclusive of overtime work and bonus compensation, is also depicted in Table 3. There was an approximately $30,000 increase in mean nominal salary over the decade for full-time respondents and a $25,000 increase for those who reported working part-time.

Salaries that were inflation-adjusted to 2016 have had a relative percentage change of 10.7% from 2004 to 2014 (see Table 4). The relative percentage change was greatest from 2007 to 2010 (9.6%); however, from 2010 to 2014 the relative percentage change of the inflation-adjusted wages was close to zero (-0.37%).

The Relationship Between On-Call Responsibilities and Salary

More than 70% of respondents in each of the 4 survey years reported on-call responsibilities. One-half (49.3%) of 2014 respondents indicated they took call from their home and nearly one-fourth (23%) took call within the hospital setting. Two-thirds of the respondents in each of the 4 survey years reported their annual income was inclusive of these on-call responsibilities. For those working full-time in 2014 and taking call, 85% of 1,049 respondents worked in excess of 40 hours per week. However, neither the number of call hours per week nor the number of hours per call were collected.

An expanded query on the 2014 survey indicated nearly 90% reported their salary was inclusive of call time. A very few respondents (1.4%) were paid one rate for being on call and a different rate for responding to the call. An additional 2.1% said this rate differed depending on where the respondent was required to go (hospital, office, birth center, or home) to provide care when responding to the call.

The Relationship Between Academic Degrees and Salary

Annual mean salaries for those employed full-time were significantly different among respondents holding research doctorate degrees such as PhD (M=$117,278, SD=37,867), practice doctorate degrees such as DNP (M=$105,968, SD=45,128), or master's degrees (M=$102;576, SD=32,109) F=4.233, df=2, 1079, p=0.01). Multiple comparisons revealed the difference to be between the research doctorate degree and the master's degree (p=0.04). Annual mean salaries for those employed in 2014 did not differ significantly by race/ethnicity (p=0.22) or gender (p=0.57).

The Relationship Between Type of Employer and Salary

Annual mean salaries for those employed full-time in 2014 were highest for those self-employed, employed by hospitals/medical centers, or physician-owned practices and there were significant differences among groups F=7.17, df=5, 951, p<0.0001) (see Table 5). Respondents employed by hospitals/medical centers earned significantly more than respondents employed by community health centers, federally qualified health centers, and midwifery-owned practices. Respondents employed by physician-owned practices earned significantly more than respondents employed by midwifery-owned practices. The 47 respondents who owned their own midwifery practice or birth center reported a mean salary of $102,608; however, there was a large variance in the minimum and maximum salaries reported ($22,000 to $516,169), so this distinction could not be tested statistically.

Annual mean salary data for 2014 are provided for each of the nine U.S. Census divisions where midwives performed their work (see Table 6). There was at least one respondent from each state for each survey year. There were also responses from Puerto Rico in 2014. Highest annual mean salaries for midwives working full-time in the 2014 survey year were noted in the Pacific division (Division 9) followed closely by the West South Central (Division 7) and New England (Division 1) and there were significant differences across divisions (F=3.637, df=8, 1114, p<0.0001). Pairwise comparisons pinpointed the differences as Divisions 1 and 9 significantly different from Divisions 3, 5, and 6 and Division 2 significantly different from Division 6.

Comparison of Salaries Among Nurse-Midwives, NPs, and PAs

Using a common data source from the BLS, mean salaries among nurse-midwives, nurse practitioners, and physician assistants for the years 2014-2017 were similar in 2014 and all increased over time, with the exception of a lower mean salary in 2015 for nurse-midwives. Annual mean salaries were less than $800 different among the three SOCs in 2014. NP salaries had the largest gain and in 2017 were nearly $4,000 higher than nurse-midwives (see Figure 1).

CNM and CM Benefits

Sixteen specific types of benefits along with an overview of those received by survey respondents who worked full-time in each survey year are identified in Table 7. Benefits are organized into six main categories: three types of insurance (health, life, and professional liability), professional development, paid leave, and post-employment income. The vast majority (86.8%) of respondents in 2014 stated they received at least one type of benefit in their midwifery-related employment. There was an increase in the proportions of respondents reporting dental and vision insurance benefits from 2004 to 2014.

A small proportion of respondents who worked full-time indicated they did not receive benefits (3.3% in 2004; 2.4% in 2007; 1.8% in 2010; 4.7% in 2014), or were self-employed and paid for their own benefits (3.8% in 2010; 2.0% in 2014; data not available for 2004 or 2007).

Health insurance, professional liability insurance, paid vacation, and paid time off to attend continuing education conferences were reported by more than 75% of respondents working full-time across the survey years. Less than half of respondents reported long-term disability insurance and tuition reimbursement.

Discussion

Findings from this study indicate a steady increase in nominal wages for CNMs/CMs over time. There was a large gain in CNM/CM salaries between 2004 and 2010 that exceeded the degree of inflation; but in 2010 and 2014, salaries have only kept pace with the rate of inflation, consistent with the interpretation of economists that the United States was in a period of wage stagnation (Shambaugh, Nunn, Liu, & Nantz, 2017).

Glied, Ma, and Pearlstein (2015) examined the factors that underpin pay differentials among professional and nonprofessional members of the health workforce, and other non-health sector employees. The higher salaries paid to professional healthcare workers (doctors, nurses), compared to the nonprofessional healthcare workers (e.g., employees of hospitals, physicians' offices, and nursing homes), and workers outside of health care, were linked to education, experience, and demographics. Our own data show that self-employment, employment by hospitals/medical centers or by physician-owned practices offered the highest salaries.

Salaries differed by U.S. Census division. Highest salaries were earned by those who resided in the Pacific, West South Central, and New England divisions.

There were no differences in salaries among different race/ethnicity or gender groups in the 2014 survey year. However, respondents in 2014 were predominantly female and White. Therefore, caution is needed in interpretation due to few numbers in other racial subgroups.

In the current study, researchers compared nurse-midwives' 2014-2017 wages reported by the BLS with the two cadres of practitioners (NPs and PAs), who have wider responsibilities for primary healthcare service delivery (Park, Cherry, & Decker, 2011), but whose scope of reproductive and women's health services is comparable in some domains of practice. Essential parity was found in 2004 among the annual mean salaries reported for the BLS data. The increase in nurse-midwife wages has kept pace with increases also reported for PAs although NPs appear to have had more gains in mean salary with a $4,000 difference by 2014. (Information about CMs is not available.)

Edmunds (2015) suggested salary comparisons for NPs should be analyzed at the level of the various services rendered by the practitioner. Actual billing (cost or charge) data for CNM/CM services are needed to make the argument about the economic value of including additional services within a provider's scope of practice

(e.g., obtaining ultrasound certification) (Altman, Murphy, Fitzgerald, Andersen, & Daratha, 2017). Edmunds (2015) noted every NP needs to know how much money is billed in his or her name and the percentage of billings collected. There are many challenges inherent in identifying the midwife as a unique provider of services within electronic medical record and billing systems (Diers, 2007). A unique billing number that is used to identify the individual as the service provider is the first step in identifying actual billing generated for CNM/CM services, so that data linked to a precise and distinct discussion of cost and quality outcomes for midwifery services can be generated (Sonenberg, 2010). In those cases where regulations prohibit or restrict such individual billing, an internal mechanism for proper attribution of services billed under another practitioner (e.g., the collaborating physician) is needed (J. Slager, personal communication, August 9, 2017). Another challenge is that midwifery services are both tangible and intangible in nature, making it difficult to measure their true worth and value. However, the responsibility for assisting women in childbirth needs to be both financially and professionally valued.

The 16 benefit categories listed on the 2014 Compensation and Benefits survey and depicted in Table 7 represent a common menu of benefits typically offered to employees, and may have been standard within the place of employment (one size fits all). The responses may, however, reflect a report of the benefits that they had personally selected from optional choices (a cafeteria or flexible benefit plan). In a cafeteria-style plan, an employer establishes a range of benefits that will be offered, and monetizes the value of the benefits package (sets a maximum dollar amount that the employer will contribute to the overall plan). The employee then selects particular components of the benefits plan and designates, from among several options, those benefits that are most important at the particular time in the individual or family life, up to the employer maximum. The employee may choose to assume personal responsibility to pay additional premium costs in order to select higher coverage for certain benefits. Employer contributions toward these plans are not counted as gross income, and are not subject to federal, state, or social security taxes (Heathfield, 2019). Weathington and Jones (2006) noted that employee perceptions of benefits provided by an organization were as critical in determining employee satisfaction with, employee commitment to, and worker retention within an organization, as were the actual benefits themselves.

More than 80% of respondents employed full-time in each survey year indicated they received professional liability insurance coverage as an employee benefit.

Professional liability insurance, also called professional indemnity insurance, helps protect CNMs/CMs from bearing the full cost of defending against a negligence claim made by a client and damages awarded in a civil lawsuit (McCool, Guidera, Sakala, & Delaney, 2007). A study of 1,340 ACNM-member CNMs/CMs indicated 32% of these respondents had been involved in litigation at least one time (Guidera, McCool, Hanion, Schuiling & Smith, 2012), underscoring the value of liability coverage as an employee benefit.

Limitations

Identifying comparable annual mean salary data for both NPs and PAs was challenging. Professional association survey data for NPs were available for only 3 of the 4 matching years of the CNM/CM surveys, and were not at all available for PAs from the professional associations' publicly accessible sources. Salary surveys conducted by private entities (e.g., employment recruitment sites) rarely noted the survey response rates and varied widely in their findings. BLS data were not available for all three groups prior to the 2014 survey year; as identification codes for NPs, separate from nurses, and for nurse-midwives (but likely not CMs, according to the BLS definition) were created in 2010 or later. Pay scales for federal employees were available for PAs, but NP data were aggregated with all other categories of nurses; and were, in any event, noted to be lower than private sector wages (Congress of the United States, Congressional Budget Office, 2012; "Pay Rates," 2016). Therefore, we chose to use BLS data for comparison of the three cadres of nurse-midwives, NPs, and PAs.

Further analysis of gender and/or ethnic differences in salaries would have been of great interest. However, low numbers of respondents in each of these categories did not permit this level of inquiry. Therefore, it was not possible to analyze any potential association between annual mean salaries for CNMs/CMs and these demographic characteristics, although such an association has been demonstrated for both NPs and PAs (Coombs, 2014; Rollet & Lebo, 2008).

Conclusion

The findings from a series of compensation and benefits surveys conducted over the decade 2004-2014 indicate that large relative increases in CNM/CM salaries were gained from 2007-2010; since 2010, salaries are keeping pace with the rate of inflation, and further gains are not observed. Moreover, national BLS data indicate nurse-midwives are earning salaries comparable to that of their NP and PA workforce colleagues. Competitive wages are important in retaining employed midwives and attracting new midwives to the profession.

Similarly, the consideration of benefits, including professional liability coverage, is of great importance. The majority of CNMs/CMs employed full-time reported receiving one or more of 16 types of a standard menu of employment-related benefits in each of the 4 survey years 2004-2014.

Employers and employees use national salary and benefit information during contract negotiations to secure optimal and equitable salaries and benefits. Information about the salaries and benefits of midwives has been a gap in the national data publicly available for these negotiations. This study fills that gap. The information presented here also can be useful to educators when teaching students the business aspects of professional practice and the importance of having evidence available for successful negotiations. $

Note: The views expressed in this article do not necessarily reflect the opinions or official policies of the American College of Nurse-Midwives. Data used with permission.

Acknowledgments: The authors thank Michelle Cook, PhD, FNP; Mary Jo Goolsby, EdD, FNP; and Joan K. Slager, DNP, CNM, for their contributions about salary determinations and salary data on nurse practitioners; and Verughese Jacob, PhD, MPH, for his contribution regarding adjusting salaries for inflation.

References

Altman, M.R., Murphy, S.M., Fitzgerald, C.E., Andersen, H.F., & Daratha, K.B. (2017). The cost of nurse-midwifery care: Use of interventions, resources, and associated costs in the hospital setting. Women's Health Issues. 27(4), 434-440. doi:10.1016/j.whi.2017.01.002

American College of Nurse-Midwives (ACNM). (n.d.). The credentials CNM and CM. Retrieved from http://www. midwife.org/The-Credential-CNM-and-CM

American College of Nurse-Midwives (ACNM). (2008). Policy on protection of membership data used for research purposes. Retrieved from http://www. midwife.org/ACNM/files/ccLibraryFiles/ Filename/000000000205/Research_ Policy_Protection_of_Membership_ Data_6_09.pdf

Burpo, R.H., Nodine, PM., Hastings-Tolsma, M., Brucker, M.C., Griggs, S., Wilcox, S, ... Callahan, T (2018). A comparative workforce study of midwives practicing in the state of Texas. Journal of Midwifery & Women's Health. 63(6), 682-692. doi:10.1111/jmwh.12739

Congress of the United States, Congressional Budget Office. (2012). Comparing the compensation of federal and private-sector employees. Retrieved from https://www.cbo.gov/ publication/42921

Coombs, J. (2014). Salary differences of male and female physician assistant educators. Journal of Physician Assistant Education, 25(3), 9-14.

Diers, D. (2007). Finding midwifery in administrative data systems. Journal of Midwifery & Women's Health, 52(2), 98-105.

Edmunds, M. (2015). Another task for NPs: Gender salary disparity. Journal of Nurse Practitioners, 11(10), A21-A22

Glied, S., Ma, S., & Pearlstein, I. (2015). Understanding pay differentials among health professionals, nonprofessionals, and their counterparts in other sectors. Health Affairs, 34(6), 929-935. doi:10.1377/hlthaff.2014.1367

Guidera, M., McCool, W., Hanlon, A., Schuiling, K., & Smith, A. (2012). Midwives and liability: Results from the 2009 nationwide survey of certified nurse-midwives and certified midwives in the United States. Journal of Midwifery & Women's Health, 57(4), 345-352. doi:10.1111/j.1542-2011.2012.00201.x

Hastings-Tolsma, M., Foster, S.W., Brucker, M.C., Nodine, P, Burpo, R., Camune, B, ... Callahan, T.J. (2018). Nature and scope of certified nurse-midwifery practice: A workforce study. Journal of Clinical Nursing, 27(21-22), 4000-4017.

Hastings-Tolsma, M., Tanner, T., Hensley, J.G., Anderson, J., Patterson, E., Dunemn, K.N., & Purcell, S.K. (2015). Trends in practice patterns and perspectives of Colorado certified nurse-midwives. Policy, Politics & Nursing Practice, 16(3-4), 97-108. doi: 10.1177/1527154415601477

Heathfield, S. (2019). Cafeteria-style benefit plans. Retrieved from https://www.the balance.com/what-is-a-cafeteria-plan-1919082

McCool, W., Guidera, M., Sakala, S., & Delaney, E. (2007). The role of litigation in midwifery practice in the United States: Results from a nationwide survey of certified nurse-midwives/certified midwives. Journal of Midwifery & Women's Health, 52(5), 458-464. doi:10.1016/j.jmwh.2007.03.013

Nei, D., Snyder, L.A., & Litwiller, B.J. (2015). Promoting retention of nurses: A meta-analytic examination of causes of nurse turnover. Health Care Management Review, 40(3), 237-253.

Park, M., Cherry, D., & Decker, S.L. (2011). Nurse practitioners, certified nurse midwives, and physician assistants in physician offices. NCHS Data Brief No. 69. Retrieved from https://www.cdc. gov/nchs/data/databriefs/db69.pdf

Pay rates for physician assistant. (2016). Federal Pay.org. Retrieved from https://www.federalpay.org/employees/ occupations/physician-assistant

Petryni, M. (2017). Nominal wage definition. Retrieved from https://bizfluent.com/ about-6724872-nominal-wage-definition.html

Rollet, J., & Lebo, S. (2008). A decade of growth. Salaries increase as profession matures. Advance for Nurse Practitioners, 16(1), 28-32, 34-35.

S. Res. 628, 114th Cong., 115 Cong. Rec. (2018). (enacted). Retrieved from https://www.congress.gov/bill/114th-congress/senate-bill/628/all-info

Schuiling, K.D., Sipe, T.A., & Fullerton, J. (2010). Findings from the analysis of the American College of Nurse-Midwives' membership surveys: 2006-2008. Journal of Midwifery & Women's Health, 55(4), 299-307.

Schuiling, K., Sipe, T., & Fullerton, J. (2013). Findings from the analysis of the American College of Nurse-Midwives' membership surveys, 2009 to 2011. Journal of Midwifery & Women's Health, 58(4), 404-415.

Shambaugh, J., Nunn, R., Liu, P, & Nantz, G. (2017). Thirteen facts about wage growth. Retrieved from https://www. brookings.edu/research/thirteen-facts-about-wage-growth

Sonenberg, A. (2010). Medicaid and state regulation of nurse-midwives: The challenge of data retrieval. Policy Politics & Nursing Practice, 11(4), 253-259. doi:10.1177/1527154411398137

Spetz, J. (2013). The research and policy importance of nursing sample surveys and minimum data sets. Policy Politics and Nursing Practice, 14(1), 33-40.

U.S. Bureau of Labor Statistics (BLS), Department of Labor. (2010). 2010 Standard occupational classification system. Nurse-Midwives. Retrieved from https://www.bls.gov/soc/2010/ 2010_major_groups.htm

U.S. Bureau of Labor Statistics (BLS), Department of Labor. (2017). Consumer price index: 2017 in review. Retrieved from https://www.bls.gov/opub/ted/ 2018/consumer-price-index-2017-in-review.htm

U.S. Bureau of Labor Statistics (BLS), Department of Labor. (n.d.) Occupational employment statistics. Retrieved from https://www.bls.gov/oes/tables.htm_

U.S. Census Bureau. (n.d.) Census regions and divisions of the United States. Retrieved from https://www2.census. gov/geo/pdfs/maps-data/maps/ reference/us_regdiv.pdf

U.S. Census Bureau (1994). Statistical groupings of states and counties. In U.S. Census Bureau (Eds.), Geographic areas reference manual (pp. 6-2). Retrieved from https://www2.census.gov/geo/ pdfs/reference/GARM/Ch6GARM.pdf

U.S. Department of Health & Human Services. (2016). Chart 2: Is the human subjects research eligible for exemption? Retrieved from https://www.hhs.gov/ ohrp/regulations-and-policy/decision-charts/index.html#c2

Vedam, S., Stoll, K., MacDorman, M., Declercq, E., Cramer, D.R., Cheyne, M, ... Powell Kennedy, H. (2018). Mapping integration of midwives across the United States: Impact on access, equity and outcome. PLOS ONE 13(2), e0192523. doi:10.1371/journal.pone.0192523

Weathington, B., & Jones, A. (2006). Measuring the value of nonwage employee benefits: Building a model of the relation between benefit satisfaction and value. Genetic, Social and General Psychology Monographs, 143(4), 292-328.

Kerri D. Shuiling, PhD, CNM, WNCNP

Provost and Vice President Academic Affairs

Northern Michigan University

Marquette, MI

Therese Ann Sipe, PhD, MPH, CNM

Adjunct Faculty

Rollins School of Public Health

Emory University

Atlanta, GA

Judith T. Fullerton, PhD, CNM

Retired Consultant

San Diego, CA

Caption: Figure 1.

Annual Mean Salaries for Nurse-Midwives (NM), Nurse Practitioners (NP), and Physician Assistants (PA) Using Bureau of Labor Statistics Data 2014-2017
Table 1.
Demographics and Certifications Held for Those Employed in
Midwifery 2010-2014

                                     CNM/CM 2010   CNM/CM 2014
                                       (N=972)      (N=1,789)
Characteristic                          n (%)         n (%)

CNM                                  967 (99.5)    1,770 (99.1)
CM                                      5 (0.5)        16 (0.9)
Sex
  Female                             960 (98.8)    1,763 (98.5)
  Male                                 10 (1.0)        15 (0.8)
  Transgender                            NA             3 (0.2)
  Missing/choose not to respond         2 (0.2)         8 (0.5)
Race
  American Indian or Alaska Native      4 (0.4)         4 (0.2)
  Asian Indian                          1 (0.1)        17 (1.0)
  Black or African-American            22 (2.3)        46 (2.6)
  Native Hawaiian/Pacific Islander      3 (0.3)         0 (0.0)
  White                              897 (92.3)    1,651 (92.3)
  Other (a)                            26 (2.7)        36 (2.0)
  Missing/choose not to respond        19 (1.9)        35 (2.0)
Race/Ethnicity
  Yes, Hispanic/Latino                 26 (2.7)        56 (3.1)
Certifications Held
  None                               673 (69.2)    1,300 (72.7)
  Women's health care nurse          128 (13.2)      262 (14.6)
    practitioner
  Family nurse practitioner            45 (4.6)       76 (4.2)
  Adult health nurse practitioner      13 (1.3)        9 (0.5)
  Pediatric nurse practitioner          2 (0.2)        2 (0.1)
  Certified registered nurse            1 (0.1)        0 (0.0)
    anesthetist
  Clinical nurse specialist              NA           26 (1.5)
Age in Years
  Mean (SD)                         50.2 (10.3)    49.5 (11.9)
  Min/Max (in years)                    23-84         25-87
                                        5 (0.5)       39 (2.2)

(a) Other predominantly includes multi-racial categories

CM = certified midwife, CNM = certified nurse-midwife, NA = Data
not available for survey year

Table 2.
Education and Years of Experience for Those Employed in
Midwifery 2004-2014

                                  CNM/CM         CNM/CM
                                   2004           2007
                                (N=1,304)      (N=1,386)
Characteristic                    n (%)          n (%)

CNM                               1,304          1,386
                                 (CNM/CM)       (CNM/CM)
CM                                  NA             NA
Highest Academic Degree
  Diploma/ADN                      66 (5.1)       62 (4.5)
  BSN                              56 (4.3)       56 (4.0)
  BS (other)                       29 (2.2)       20 (1.4)
  MSN, MPH, MM                 1,025 (78.6)   1,106 (79.8)
  Master's (other)                 48 (3.7)       41 (3.0)
  Doctorate practice focused       30 (2.3)       16 (1.2)
    (e.g., DNP, ND)
  Doctorate research focused       10 (0.8)       72 (5.2)
    (PhD, DNS, DrPH)
  Other doctorate                  25 (1.9)        NA
  Missing                          15 (1.2)       13 (0.9)
Years of Experience
  0-5 years                      418 (32.1)     333 (24.1)
  6-10 years                     318 (24.4)     310 (22.4)
  11-15 years                    202 (15.5)     253 (18.3)
  16+ years                      348 (26.7)     488 (35.2)
  Missing                          18 (1.4)        1 (0.1)

                                 CNM/CM        CNM/CM
                                  2010          2014
                                (N=972)      (N=1,789)
Characteristic                   n (%)         n (%)

CNM                            967 (99.5)   1,773 (99.1)

CM                                5 (0.5)       16 (0.9)
Highest Academic Degree
  Diploma/ADN                    28 (2.9)       20 (1.1)
  BSN                            33 (3.4)       33 (1.8)
  BS (other)                      7 (0.7)       16 (0.9)
  MSN, MPH, MM                 765 (78.7)   1,420 (79.4)
  Master's (other)               31 (3.2)       52 (2.9)
  Doctorate practice focused     18 (1.9)      106 (5.9)
    (e.g., DNP, ND)
  Doctorate research focused     56 (5.8)       93 (5.2)
    (PhD, DNS, DrPH)
  Other doctorate                  NA            5 (0.3)
  Missing                        34 (3.5)        5 (0.3)
Years of Experience
  0-5 years                    188 (19.3)     490 (27.4)
  6-10 years                   148 (15.2)     248 (13.9)
  11-15 years                  200 (20.6)     203 (11.3)
  16+ years                    433 (44.5)     818 (45.7)
  Missing                         3 (0.3)       30 (1.7)

ADN = associate degree in nursing, BS = bachelor of science, BSN =
bachelor of science in nursing, CM = certified midwife, CNM =
certified nurse-midwife, DNP = doctor of nursing practice, DNS =
doctor of nursing science, DrPH = doctor of public health, NA =
data not available for survey year, MM = master of midwifery, MPH
= master of public health, MSN = master of science in nursing, ND
= nursing doctorate, PhD = doctor of philosophy

Table 3.
Annual Nominal Salary Categories and Means for Full and
Part-Time Midwifery Work 2004-2014

                         CNM/CM        CNM/CM
                        2004 (b)      2007 (b)
Nominal Salary (a)       n (%)         n (%)

Employed Full-Time     (n=1,033)     (n=1,098)
  < $60,000            130 (12.6)      50 (4.6)
  $60,000--$69,000     238 (23.0)    155 (14.1)
  $70,000--$79,000     324 (31.4)    254 (23.1)
  $80,000--$89,000     179 (17.3)    284 (25.9)
  $90,000--$99,000       84 (8.1)    171 (15.6)
  $100,000--$119,000     45 (4.4)    113 (10.3)
  $120,000--129,000       9 (0.9)      20 (1.8)
  $130,000--$139,000      1 (0.1)      14 (1.3)
  $140,000 or higher      4 (0.4)      19 (1.7)
  Missing                19 (1.8)      18 (1.6)
Employed Part-Time      (n=249)       (n=279)
  < $40,000              90 (3.6)     30 (10.8)
  $40,000--$49,000      58 (23.3)     46 (16.5)
  $50,000--$59,000      39 (15.7)     36 (12.9)
  $60,000--$69,000       23 (9.2)     41 (14.7)
  $70,000--$79,000       16 (6.4)     28 (10.0)
  $80,000--$89,000        9 (3.6)      16 (5.7)
  $90,000 or higher       3 (1.2)      12 (4.3)
  Missing                11 (4.4)       6 (2.2)

Mean Salary
Employed               (n=1,033)     (n=1,098)
  Full-Time (a)
  Mean (SD)             $74,020       $82,233
                        (16,048)    (19,411) (b)
  Min, Max              $12,000,         NA
                        $200,000
  Missing                  19            18

Employed                (n=249)       (n=279)
  Part-Time (c)
  Mean (SD)             $44,335       $49,500
                        (19,526)    (24,577) (d)
  Min, Max              $1,000,          NA
                        $120,000
  Missing                  11            6

                         CNM/CM       CNM/CM
                        2010 (b)     2014 (b)
Nominal Salary (a)       n (%)        n (%)

Employed Full-Time      (n=795)     (n=1,333)
  < $60,000              18 (2.3)     25 (1.9)
  $60,000--$69,000       49 (6.2)     42 (3.2)
  $70,000--$79,000     137 (17.2)    113 (8.5)
  $80,000--$89,000     176 (22.1)   254 (19.1)
  $90,000--$99,000     180 (22.6)   319 (23.9)
  $100,000--$119,000   153 (19.2)   341 (25.6)
  $120,000--129,000      31 (3.9)     85 (6.4)
  $130,000--$139,000     11 (1.4)     45 (3.4)
  $140,000 or higher     29 (3.6)     84 (6.3)
  Missing                11 (1.4)     25 (1.9)
Employed Part-Time      (n=171)      (n=294)
  < $40,000             19 (11.1)     20 (6.8)
  $40,000--$49,000      26 (15.2)    34 (11.6)
  $50,000--$59,000      27 (15.8)    34 (11.6)
  $60,000--$69,000      32 (18.7)    41 (13.9)
  $70,000--$79,000       16 (9.4)    44 (15.0)
  $80,000--$89,000       17 (9.9)     28 (9.5)
  $90,000 or higher      17 (9.9)    26 (11.9)
  Missing                 5 (2.9)     16 (5.4)

Mean Salary
Employed                (n=794)     (n=1,331)
  Full-Time (a)
  Mean (SD)             $95,920      $103,771
                        (25,942)     (33,367)
  Min, Max              $18,000,     $20,000
                        $258,000     $516,169
  Missing                  72          178

Employed                (n=171)      (n=294)
  Part-Time (c)
  Mean (SD)             $63,561      $69,375
                        (30,054)     (32,728)
  Min, Max              $1,000,      $3,000,
                        $210,000     $238,000
  Missing                  26           59

(a) Nominal salary categories are annual gross, before taxes,
without bonuses and overtime.

(b) The recall period for salary was the year prior to the
survey.

(c) Nominal mean salaries (unadjusted) are total gross including
bonuses and overtime.

(d) 2007 survey collected salary in categories only; medians and
standard deviations calculated from grouped category data.

CM = certified midwife, CNM = certified nurse-midwife, NA = Data
not available for survey year

Table 4.
Annual Nominal and 2016 Inflation-Adjusted Salary and Relative
Changes Over Time 2004-2014 for Those Employed Full-Time

                               2016
                            Inflation-
                  Actual     Adjusted
Survey            Wages       Wages
Years      N       Mean        Mean

2004     1,033   $74,020     $96,551
2007     1,098   $82,233     $97,899
2010      794    $95,920     $107,308
2014     1,331   $103,771    $106,911

                    Relative Percentage Change
                    of Inflation-Adjusted Wages

Survey                      Years (a)
Years
         2003-2007   2007-2009   2009-2013   2003-2013

2004
2007        1.4         9.6        -0.37       10.73
2010
2014

(a) Previous year used in inflation calculation since surveys
asked about prior year's salary.

Table 5.
Annual Mean Salaries (Total Gross Including Bonuses and Overtime)
for Full-Time Midwifery Work 2014 by Selected Employer Types

                              Employer Type (a)

                    Self-
                  Employed
                    (own        Hospital/      Physician-
Characteristic    midwifery      Medical         Owned
                  practice       Centers        Practice
                  or birth
                 center) (b)

Number of            47            439            275
  Respondents
Mean (SD)         $126,463     $106,763 (c)   $102,608 (d)
                  (90,270)       (24,902)       (34,749)
Min, Max          $22,000,       $50,000,       $50,000,
                  $516,169       $207,000       $420,000

                     Employer Type (a)

                 Educational    Community
Characteristic   Institution     Health

                                 Center

Number of            91            32
  Respondents
Mean (SD)          $98,769     $96,516 (c)
                  (26,129)      (16,918)
Min, Max          $51,000,      $58,000,
                  $230,000      $135,000

                      Employer Type (a)

                  Federally
                  Qualified     Midwifery-
Characteristic     Health          Owned
                   Center        Practice

Number of            67             53
  Respondents
Mean (SD)        $93,933 (c)   $87,235 (c,d)
                  (18,822)       (26,797)
Min, Max          $52,000,       $48,000,
                  $145,200       $161,000

(a) Categories with small sample sizes not shown include business
other than a health center, federal government/military, Indian
Health Service.

(b) This category not included in the comparisons due to the large
variance.

(c) Salaries in hospital/medical center were statistically
different than community health center (p=0.039), Federally
Qualified Health Center (p=0.000), and midwifery-owned practice
(p=0.000) in pairwise comparisons using Dunnet T3.

(d) Salaries in physician-owned practice were statistically
different than midwifery-owned practice (p=0.007) in pairwise
comparisons using Dunnet T3.

Table 6.
Annual Mean Salaries (Total Gross including Bonuses and Overtime)
for Full-Time Midwifery Work 2014 by U.S. Census Division

                            Census Division (a)

                  Division 1     Division 2     Division 3
                     New           Middle       East North
Characteristic     England        Atlantic        Central

Number of            102            186             174
  Respondents
Mean             $109,837 (c)   $106,511 (d)   $98,977 (c,e)
(SD)               (28,410)       (38,207)       (22,950)
Min                $65,000        $59,000         $45,000
Max                $203,000       $423,000       $270,000

                           Census Division (a)

                 Division 4    Division 5       Division 6
                 West North       South         East South
Characteristic    Central       Atlantic          Central

Number of            87            241              36
  Respondents
Mean              $104,493    $98,616 (c,e)   $88,239 (c,d,e)
(SD)              (28,007)      (26,713)         (24,830)
Min               $52,000        $20,000          $48,000
Max               $207,000      $289,500         $175,000

                   Census Division (a)

                 Division 7
                 West South   Division 8
Characteristic    Central      Mountain

Number of            50          100
  Respondents
Mean              $109,848     $104,383
(SD)              (66,117)     (38,658)
Min               $22,000      $51,000
Max               $516,169     $420,000

                  Census Division (a)

                  Division 9     Other
Characteristic     Pacific        (b)

Number of            147           12
  Respondents
Mean             $109,945 (e)   $106,542
(SD)               (32,105)     (47,684)
Min                $30,000      $50,000
Max                $220,000     $200,000

Division 1: CT, ME, MA, NH, Rl, VT; Division 2: NJ, NY, PA;
Division 3: IN, IL, Ml, OH, Wl; Division 4: IA, KA, MN, MO, NE,
ND, SD; Division 5: DE, DC, FL, GA, MD, NC, SC, VA, WV; Division
6: AL, KY, MS, TN; Division 7: AR, LA, OK, TX; Division 8: AZ,
CO, ID, NM, MT, UT, NV, WY; Division 9: AK, WA, HI, OR, CA

(a) Missing not included (n=20)

(b) Includes Puerto Rico

(c) Salaries in Division 1 were statistically different than
Division 3 (p=0.043), Division 5 (p=0.029), and Division 6
(p=0.002), in pairwise comparisons using Dunnet T3.

(d) Salaries in Division 2 were statistically different than
Division 6 (p=0.017) in pairwise comparisons using Dunnet T3.

e) Salaries in Division 9 were statistically different than
Division 3 (p=0.022), Division 5 (p=0.014), and Division 6
(p=0.001), in pairwise comparisons using Dunnet T3.

Table 7.
Benefits for CNMs/CMs Employed Full-Time Provided by
Employers, 2004-2014

                               Proportion of CNMs/CMs
                               Who Reported Receiving
                                   this Benefit

                                 2004         2007
                               N=1,033      N=1,098
Benefit                         n (%)        n (%)

Do Not Receive Any Type        34 (3.3)     26 (2.4)
  Benefit
Self-Employed and Pay Own         NA           NA
Benefits
Insurance (health and life)
  Health                      872 (84.4)   940 (85.6)
  Dental                      651 (63.0)   709 (64.6)
  Vision                      443 (42.9)   525 (47.8)
  Prescription drug           716 (69.3)   758 (69.0)
    reimbursement or
    co-pay
  Short-term disability       459 (44.4)   510 (46.4)
  Long-term disability        475 (46.0)   480 (43.7)
  Life                        622 (60.2)   671 (61.1)
Insurance (professional)
  Professional liability      895 (86.6)   966 (88.0)
    insurance
Professional Development
  Paid time off to attend
    continuing education      878 (85.0)   923 (84.1)
    conferences
  Professional                677 (65.5)   726 (66.1)
    organization dues
  Tuition reimbursement       382 (37.0)   433 (39.4)
Paid Leave
  Vacation                    924 (89.4)   996 (90.7)
  Sick leave                  769 (74.4)   833 (75.9)
  Paid personal days off      566 (54.8)   641 (58.4)
  Funeral leave               559 (54.1)   568 (51.7)
Post-Employment Income
and Miscellaneous
Retirement plan               666 (64.5)   729 (66.4)
Other                          79 (7.6)    102 (9.3)

                               Proportion of CNMs/CMs
                               Who Reported Receiving
                                   this Benefit

                                 2010          2014
                                N=795        N=1,333
Benefit                         n (%)         n (%)

Do Not Receive Any Type        14 (1.8)       62 (4.7)
  Benefit
Self-Employed and Pay Own      30 (3.8)       26 (2.0)
Benefits
Insurance (health and life)
  Health                      661 (83.1)   1,119 (83.9)
  Dental                      536 (67.4)    962 (72.2)
  Vision                      402 (50.6)    778 (58.4)
  Prescription drug           514 (64.7)    830 (62.3)
    reimbursement or
    co-pay
  Short-term disability       384 (48.3)    722 (54.2)
  Long-term disability        352 (44.3)    639 (47.9)
  Life                        491 (61.8)    877 (65.8)
Insurance (professional)
  Professional liability      680 (85.5)   1,102 (82.7)
    insurance
Professional Development
  Paid time off to attend
    continuing education      664 (83.5)   1,045 (78.4)
    conferences
  Professional                527 (66.3)    879 (65.9)
    organization dues
  Tuition reimbursement       287 (36.1)    444 (33.3)
Paid Leave
  Vacation                    699 (87.9)   1,133 (85.0)
  Sick leave                  570 (71.7)    874 (65.6)
  Paid personal days off      441 (55.5)    656 (49.2)
  Funeral leave               400 (50.3)    626 (47.0)
Post-Employment Income
and Miscellaneous
Retirement plan               477 (60.0)    835 (62.6)
Other                          52 (6.5)      109 (8.2)
                                               (a)

(a) Includes answering service, car allowance, car payment, cell
phone, company car, continuing education costs, DEA license fee,
dry cleaning for lab coats, FMLA, gas card, gym discount, health
insurance premiums, health savings account, holiday bonus, hospital
medical staff dues, housing and cost of living, purchase or supply
of lab coats, long-term care insurance, maternity leave, medical
savings account, membership in a local service organization,
mileage reimbursement, no-cost health care by hospital medical
staff, overtime for holidays, pager, parking, passport and visa
fees, personal laptop, professional license fee, professional
magazine subscriptions, profit sharing, prescriptive authority
expense, purchase or supply of sign-on bonus, some meals, student
loan pay-off assistance, supplies, tax-deferred plan, textbooks,
travel clinic and immunizations, travel medex insurance, YMCA
membership

NA: Data not available for survey year.
COPYRIGHT 2019 Jannetti Publications, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2019 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Author:Schuiling, Kerri D.; Sipe, Therese Ann; Fullerton, Judith T.
Publication:Nursing Economics
Date:May 1, 2019
Words:7857
Previous Article:Developing a Business Case for the Care Coordination and Transition Management Model: Need, Methods, and Measures.
Next Article:Creating Partnerships that Reflect the Collective Will of Healthcare Professionals: An Interview with Megan Ranney.
Topics:

Terms of use | Privacy policy | Copyright © 2022 Farlex, Inc. | Feedback | For webmasters |