Hello everybody! Welcome to another episode of The Truth About Travel Nursing Podcast. This is your host, Kyle Schmidt, and I want to thank you so much for joining me for episode 35 of the podcast. In this episode we’re going to have a highly detailed discussion about a question that every travel nurse and potential travel nurse will ask at one point or another, “How much money do travel nurses make?”
Let me tell you, if this were almost any other industry, the answer to the question would be clear-cut and straightforward. We wouldn’t even have much of a conversation to have; we’d just look at some simple numbers and be done with it. But determining how much money travel nurses make is actually a really convoluted task. So, we’ll take a look at all the factors at play and then provide some breakdowns of some sample travel nursing pay packages to illustrate. I really think that this will help travelers and those interested in travel develop proper expectations so that they can make better decisions when it comes to pay packages and ultimately achieve a better grasp of their own personal finances.
News From The Healthcare Staffing Industry
Healthcare Staffing Annual Revenue Projection Increase
Okay, so before we start, let’s take a quick look at some of the news from around the travel healthcare industry. For starters, in the beginning of October, 2015, which was a few weeks ago, Staffing Industry Analysts released a statement that they were revising their annual revenue estimates for the healthcare staffing industry. Now, the healthcare staffing industry includes everything from travel nursing, to locum tenens, to per diem nursing and everything else.
Anyway, they’re now saying that revenue is projected to grow by 17% in 2015 compared to 2014. And travel nursing is projected to lead the pack with 23% growth. And, just so you know, Staffing Industry Analysts estimated that the healthcare staffing industry generated about $10.5 billion to $11 billion in revenue in 2014. So, that would mean the industry would generate $12 billion to $13.5 billion in 2015. That’s a lot of revenue.
Cross Country Health Buys Mediscan
Alright, in other news, the mergers and acquisitions in the healthcare staffing space continue to add up. Cross Country Healthcare is purchasing a company called MediScan. They’re a company that’s involved in the traditional type of healthcare staffing that we’re all familiar with, which is staffing at the hospitals, but they’re also heavily involved with providing medical staff for public and charter schools. That’s a growing segment of the healthcare staffing industry and Cross Country is paying $33 million for MediScan, $28 million in cash and another $7 million worth of stock options. According to Cross Country, MediScan generates about $40 million in annual revenue.
Healthcare Staffing Stock Roller Coaster
Okay, so another interesting thing that happened last week was that the stocks of healthcare staffing companies had a real roller coaster ride. So, AMN was upgraded to a buy rating at Zacks. Of course, that spurs buying in the sector as a whole. But then, on Thursday, shares of AMN and the other healthcare staffing stocks plunged. AMN was down as much as 25% at one point.
Basically, what happened was that several hospitals, who are of course the customers of the healthcare staffing companies, all had some bad news surrounding them. Community Health Systems released revenue projections that were below estimates. Envision Healthcare Holdings released an earnings report that was below estimates. And Tenet Healthcare was downgraded by an analyst. So, investors got spooked thinking that negative news for all these hospital companies could lead to bad things down the road for the healthcare staffing agencies.
On-Demand Healthcare Staffing At North Shore University Health System
Now, the last piece of news I want to discuss doesn’t actually pertain to the healthcare staffing industry per se, but it does pertain to staffing. North Shore University Health System in the Chicago area has been using predictive analytics for on-demand healthcare staffing. So, basically, this system predicts the demand for staff 4 hours in advance. Of course, this has a huge impact on nurses who tend to be the ones most affected by this type of staffing. Essentially, you’re on-call with the hospital with 4 hours advance notice.
There was a quote in the article that I found a little amusing. Dr. Daniel Chertok, the senior data scientist for the hospital system, said, “Not all nurses are happy about on-demand scheduling.” I mean, are any nurses happy about on-demand scheduling? That sounds like an absolute nightmare to me. Anyway, these systems are of course designed to save money by helping the hospital staff at optimal levels at all times.
Okay, so as always, we’ll link to all of those stories in the show notes page if you’re interested in checking them out and doing additional research.
What Is The Annual Salary Of A Travel Nurse?
Alright, so let’s take a look at the question that’s on everyone’s mind at some point or another, “How much money do travel nurses make?” For starters, why is it that I contend that this is anything but a straightforward question. I mean, heck, I actually contend that this question is totally convoluted! Why is that?
Well, for starters, when someone asks the question, “How much money do travel nurses make?” their frame of reference for asking the question is permanent employment. In other words, when we ask this question, we’re looking to get a straightforward answer that we can then compare to something else. And that something else is invariably a permanent job.
For example, a nurse who’s interested in travel nursing might ask how much travel nurses make. And a recruiter or some healthcare staffing agency website might give them an answer like $75,000 a year 0r $100,000 a year. And the understandable tendency here is for the nurse to say, “Wow! That’s way more than I make at my permanent job!! Travel Nursing is awesome!!”
But in reality, travel nursing and travel healthcare in general, are so much different than permanent nursing. And many of these differences have a significant impact on the value of the travel nursing compensation package. And that’s a big part of what we’re going to discuss in this episode. What are these differences and how can we accurately determine how much these pay packages are actually worth relative to the permanent pay packages we’re all used to.
What Do Travel Nursing Companies And Lead Generators Say About The Annual Salary Of Travel Nurses?
Okay, so before we go down that path, I want to take a quick look at some of the answers you’ll find across the internet to the question of how much travel nurses make. I think it’s important to look at these things because I want to make sure that you’re getting all the information available. But more importantly, I think that taking a look at these answers will help us discover how to interpret these things when they come up for us.
Alright, so the most common way for people to do research these days is to simply go to Google and search for what they’re looking for. So, if you were to go to Google and search for the term “travel nursing pay”, the first thing you’d see in the organic search results, below the ads, would be what Google calls a “Quick Answer Box” from the website TravelNursing.org.
So, just so that you know, a Quick Answer Box is when Google presents a snippet of information from a website that Google believes will provide an answer to the question you are asking. In this particular case, the answer is as follows. And this is the answer that Google is currently presenting as of October 2015, when we’re doing this podcast. Google’s search results may change, but it’s been like this for a well over a year now, so here it is:
“Regardless of location and specialty, you can often expect to make a travel nurse salary of about $75,000 a year, based on a 48 hour work year and average $40 an hour. And, of course, a travel nurse salary can even go up from there depending on location, specialty, and overtime pay.”
Now, again, this answer comes from TraveNursing.org. The website is a lead generator for the healthcare staffing industry. Remember, lead generators are in the business of getting people to enter their contact information so that it can be sold to third parties. Of course, this company has an incentive to make things sound totally wonderful and amazing…because they want you to enter your contact information. Now, Google obviously hasn’t figured that out yet, but they probably will eventually.
That said, we can’t conclude that the information is inaccurate just because the source has an agenda. And like I said, we’re going to take a detailed look at those inaccuracies in a bit. But for now, I just want to point out that the numbers in this statement don’t actually add up.
The annual salary is quoted at $75,000. But then they go on to say that it’s based on a 48 hour work year. I have no idea what a 48 hour work year is. But it also says that the average pay is $40 per hour. I cannot get these numbers add up any way I crunch them.
I mean, my assumption is that they meant a 48 week work year. And 48 weeks at 40 hours per week and $40 per hour comes out to $76,800. But it’s so rare for Registered Nurses to ever work 40 hour work weeks. You’re either working 48 or 36.
Anyway, another thing to note about this answer is that it makes it sound as though this is the absolute minimum you could expect to make. It says, “of course a travel nurse salary can even go up from there.” I mean, there is so much that isn’t being taken into consideration here. We’ll discuss what that is in a second. First, I want to take a quick look at some of the other answers.
So, Simply Hired says the average salary for travel nurse jobs is $55,000. Buzzle, which is a website that’s kind-of like about.com, says that new nurses can make $40,000 to $50,000 a year as travelers while experienced nurses can earn more than $90,000. 50 States Staffing, which is a subsidiary of Nightengale Nursing, says, “Traveling RN’s earn outstanding wages — far surpassing the *$64,000 median annual income in 2010 for nurses overall. Factor in the top salaries, 401(k), insurance, bonuses, free housing, travel allowance, free CEUs— and travel RN’s can make up to $100,000 annually.” And the last one I want to point out is from NurseChoice. They’re a subsidiary of American Mobile. They have an infographic on their site that says at an average of 48 hours per week for 48 weeks at $43 per hour, you’ll make $99,840 for the year.
Okay, so as you can see, there is a ton of disparity in these numbers. Now, the disparity is actually a good thing because there actually is quite a bit of disparity. It’s just not really for the reasons that are indicated. And more importantly, there are tons of factors that make travel nursing different than permanent nursing when it comes to determining how much travel nurses make. So, let’s take a detailed look at what’s going on here.
Factoring Costs Into The Travel Nursing Salary Estimate
Okay, so, the first to consider when discussing how much travel nurses make is that travel nurses typically incur costs that permanent employees do not incur. Let’s take a look at some of these costs.
Tax Home Expenses for Travel Nurses
Perhaps the biggest cost that travel nurses will incur is the cost of their tax home. As we discussed in great detail in episode 18 of the podcast, one of the main way to qualify for the tax-free stipends that travel nursing companies pay is to incur fair market value costs associated with your declared tax home. Specifically, this means paying your mortgage or rent back at your tax-home. If you don’t do this, then it can be really difficult to maintain your status to qualify for the tax-free reimbursements offered by the agencies.
And of course, if you’re doing this, then it typically goes beyond just your mortgage or rent. There will be various bills you’ll need to pay, the water bill, perhaps the electricity bill and so on. You may also need to pay for landscaping and upkeep on the property.
Travel Expenses and Travel Nursing Pay
So, the next cost associated with travel nursing contracts is the cost of traveling itself. You’re going to travel from one location to the next and you may even travel home any number of times during the course of a year. Whether you travel by plane, train or automobile, there will be costs involved. And the more times you travel the more the costs will rack up.
Paid Vacation And Paid Sick Leave For Travel Nurses
Another difference to consider between travel nursing and permanent pay packages is that most travel nursing jobs do not offer any paid time off or paid sick leave while most permanent jobs do. And this is actually really important when it comes to travel nursing because travelers often find themselves off of work for a week or two in between new assignments. Now, there are some cases when paid sick leave and/or paid time off are offered to travelers. In fact, paid sick leave is now required in the state of California. But, this is still something to be aware of, especially as it pertains to paid vacation which is really rare for travelers to receive.
The Cost of Medical Benefits For Travel Nurses
Okay, so another potential cost to consider as a traveler is medical benefits. Many travelers opt to get their own medical benefits. This is because you could potentially change agencies pretty often in order to land the assignments you really want to work. Each time you change agencies, you’ll change medical insurance, so it could be pretty difficult to maintain continuity of care. And, in many cases, if you don’t take the medical benefits offered by the agency, then they might give you more money instead.
The Cost Of Licenses, Certifications And Clinical Records For Travel Nurses
Okay, so another cost to consider is the cost of licenses, certifications, and clinical records like titers or physical exams. Most permanent employers cover the cost of these items. However, many travelers end up paying for these things out of their own pockets. And even if the agency pays for them, they almost always deduct the cost from the compensation package when they’re working out the pay package for the assignment.
The Cost Of Low Taxable Wages
Okay, so the last cost difference between permanent and travel nursing jobs that I want to point out is the cost that’s involved with the lower taxable wages that travel nursing pay packages typically offer. We’ve discussed this in detail before, but basically, the taxable hourly rate that you’re paid is what your social security payments and unemployment benefits are based off of when or if you need to use them. So, lower taxable wages means that less money is being paid into those coffers, which means less money will be paid out when the time comes. And, you know that’s not going to come out of your pocket right now; you’re not going to see that immediately. But I think it’s only fair to point it out because it can indeed end up being a cost you incur down the road.
But Travel Nursing Agencies Provide These For Free!
Now, I can already hear the recruiters and agencies saying that they provide most of these things for free. And, you know, as I’ve discussed many times on the podcast, nothing is really free. If they’ll give you housing or money instead, then it’s not really free. More importantly, the cost of everything comes out of the bill rate for the assignment. But more importantly, the point here is that you really can’t add in the value of these things when someone is asking how much travel nurses make.
Again, that’s because the frame of reference that people are using when they ask that question is the pay package for a permanent job. And when you have a permanent, you’re not paying for two separate houses; you know…you get paid time off; the 401 k benefits are in addition to the salary you’re quoted, right?
And the point here is that this is what a lot of agencies and marketers do. I mean, go back to the statement from 50 states staffing earlier, they literally say:
“Factor in the top salaries, 401(k), insurance, bonuses, free housing, travel allowance, free CEUs— and travel RN’s can make up to $100,000 annually.”
Again, there are really two things going on here. First, we wouldn’t typically add the value of insurance and 401ks and stuff like that to permanent pay packages when we were quoting them. And second, some of these things like housing and travel allowances are actually additional costs, so it’s not really fair to add them to the value of the salary, or call them a part of what you stand to make as a travel nurse.
Now, all of that said, it’s certainly possible for travel nurses to make $100,000, or even more, in a year even after all of these costs have been factored in. But, this level of annual income is indeed the exception, not the rule for travel nurses. And there are a whole slew of other variables that go into whether or not this is possible. So, let’s take a look at those variables now.
The Travel Nursing Job Market
Okay, so I think the biggest factor to consider when it comes to the annual pay potential of travelers is the state of the travel nursing job market. If the job market is really hot, like it is right now in 2015, then there are going to be many more assignments with crisis rates or rapid response rates. These are increased rates that hospitals are willing to pay because they’re in dire need of travelers. Hospitals are also going to be more prone to increasing their normal bill rates for a while too. And they’ll offer more assignments with completion bonuses.
And all of these things will increase the pay significantly. To give you an idea, according to one source I found on American Mobile’s website, the average bill rate for a travel nurse is $65 per hour. And that sounds about right to me given all the bill rates that I’ve seen in my day. But crisis rates and rapid response rates tend to be anywhere from $75 to $85 per hour and sometimes they can get to be over $100 per hour. Heck, I’ve seen some assignments advertised recently with blended pay rates of $94 per hour. I’m guessing the bill rate for that is at least $130 per hour.
Obviously, that has a huge impact on pay rates. But again, even in a hot job market, not every job is like this, there are just more of them. So, you can’t necessarily bank on these jobs for an entire year. It’s more reasonable to anticipate that you’ll get 3 to 6 months out of the year on these rates.
Travel Nursing Specialties And Pay Rates
Okay, so the next thing to be aware of is that different specialties have different bill rates. We discussed this in episode 17 when we discussed bill rates, so we won’t go into great detail here. But the bottom line is that specialties like Med Surg, Psych, PostPartum, and Peds, tend to have lower bill rates, not by much, maybe $2 to $5 less per hour, but they’re lower nonetheless.
More importantly, some specialties tend to have more of the higher paying rapid response and crisis rate assignments. Specialties like L&D, NICU, and PICU tend to lead the way with ICU, ER and OR doing pretty well too. And it’s important to note that this is as a percentage of all the jobs for the specialty in question. So, for example, there might be more rapid response jobs for ICU than L&D total, but a higher percentage of L&D jobs might be rapid response.
Cost Of Living And Travel Nursing Pay
Okay, so the next variable that affects how much travel nurses make is the location of the assignment. And this is kind-of a big one. Many nurses from places like Mississippi or Arkansas will see the standard pay rates out in California and think they can make a killing out there. But the cost of living is astronomical in most of California compared to the south. So, at the end of the day, this could ultimately be a wash and in some cases I had nurses tell me they saved more at home in Mississippi than they did on a travel assignment in California. So, that’s definitely something to watch out for, especially given the fact that a significant percentage of travel nursing jobs are in places like California, Washington State, New York and the Northeast.
How Many Weeks Do You Work In A Year As A Travel Nurse?
Okay, so the last thing I want to touch on is that the number of work weeks you work in a year will greatly impact how much you make for the year. And this is really important for travel nurses because there is a really good chance that you’ll be switching jobs and or locations multiple times throughout the year. Each time, there may be travel involved that keeps you off of work for a week. Or your next assignment might not start for a week or two after the last assignment ends. So, you’re not getting paid those weeks.
You know, I worked with many travelers who had difficulty working for 48 weeks out of the year each year. And that’s understandable. You definitely want to have your planned vacations. And then there would be these gaps for travel from one assignment location to the next or because the new job had a later start date or even got pushed back. I mean, missing just 2 weeks like this could result in $3000 to $4000 less on an annual basis.
Examples Of Annual Salaries For Travel Nurses
Okay, so with all of that in mind, let’s take a look at some numbers to get an idea of how much travel nurses make. The first set of numbers we’re going to look at comes straight from American Mobile. They have a web page where they’re marketing to potential client hospitals. On this page, they break down the cost of a permanent employee versus the cost of a travel nurse.
And they even provide the pay of they’re going to give to the travel nurse based on a bill rate of $65 per hour. They quote a pay rate of $35 per hour. Plus, they say they’re going to give the traveler health, dental and life benefits, housing 401k matching, and tuition reimbursement. They also say that they’re factoring in social security, workers comp, and unemployment costs as well as liability insurance, recruitment costs and other administrative costs. All of these items total $30 per hour.
Okay, so the main figure we have is $35 per hour. Now, for all the examples we discuss on this podcast, I’m going to assume that you’re able to work 48 weeks in the year. I wrote a blog post in which I assumed a 46 week year because I think that’s more realistic for most travelers. I’ll link to that blog post in the show notes and you can review it there if you’d like. But here, I’m going to use 48 weeks which is what all the marketers and agencies seem to prefer.
So, $35 per hour for 36 hours per week for 48 weeks is $60, 480. Now, it’s fair to say that a portion of that $35 pay rate is going to be the M&IE stipend. My experience is that AMN usually goes with $250 per week for M&IE. So, assuming that it’s a contract for 36 hours per week it is to $6.94 per hour. I’m pointing this out because we want to make an apples to apples comparison with permanent jobs and permanent jobs don’t give you tax free money. $250 per week for 48 weeks is $12,000. So, you’re not going to pay taxes on $12,000 of that income. If we assume a 25% tax bracket, that saves you $3,000 in taxes. Therefore, this would be like a permanent job that paid $63,480.
Okay, so remember that you’d need to pay for the expenses at your tax home and anything else. And of course, there is the rare instance in which you may not be paying taxes at a tax home year round, but instead only for a portion of the year. If that’s the case, then you can add the value of the housing to your annual pay. But my experience indicates that the vast majority of travelers are either paying for a tax home or they’re unfortunately not playing by the rules. I’m going to proceed as if you’re playing by the rules and that’s what all the agencies and marketers should be doing to.
In any case, you can see that the figure we’ve come to is much less than some of the figures that were advertised to travel nurses on various websites. I mean, even if we assumed that you were going to work 48 hours per week for 48 weeks, it would come to $80,640, which is about $19,000 less than advertised to travelers on nursechoice.com which is AMN’s subsidiary.
Okay, so that’s an example straight from AMN’s website. And while I’m sure it’s correct, my experience indicates that they’re being a little overly optimistic with the amount of the pay package they’re quoting. So, I’m going to breakdown a pay package based on a bill rate of $65 per hour that I think is more realistic. We’re going to work these numbers out for a standard contract of 36 hours per week for 13 weeks.
For starters, let’s take out the agency’s gross profit margin. As I’ve mentioned previously, these usually run between 20% and 25%. So, let’s use 20%. 20% of $65 is $13 per hour. So, right off the bat, we’re left with $52 per hour to work with.
Okay, next, I’m going to use a total cost of $4.95 per hour for some of the standard burdens and payroll costs. And here we’re talking about things like the non-billable orientation hours, liability insurance, licensing and credentialing costs, FICA payroll costs, and state disability, unemployment and worker’s compensation costs. Now, we discussed how to calculate these figures in episode 14 and we also have a detailed blog post about these costs that I’ll link to in the show notes. But for now, we’re just going to use this number for all our calculations. It can be off by a dollar or two per hour, but I think $4.95 is a pretty standard number to use for these costs.
Okay, so now we’re down to $47.05 per hour.
Next, let’s assume a travel stipend of $700. That’s $1.50 per hour, so we’re down to $45.55 left out of the $65 we started with.
Next, let’s factor in the cost of medical benefits. I’m going to use a fairly common cost for this variable of $350 per month. So, that’s $1050 for the entire 3 month contract which comes out to $2.24 per hour worked. That brings us down to $43.30 per hour.
Now, I’m going to stop here. In American Mobile’s example, they said they were paying the nurse $35 per hour. We’re at $43.30 already, so the difference is $8.30 per hour. Essentially, this is the amount that we have left to provide housing. So, $8.30 per hour at 468 total hours comes out to $3884 for the entire contract which is $1294 per month.
My experience is that housing is much more expensive than that. In fact, it’s pretty common for companies like American Mobile to offer at least $1500 for a housing stipend. And my experience is that it’s going to cost at least $2000 per month to secure a fully furnished 1 bedroom apartment that’s worth of a travel healthcare professional.
And that comes out to $12.82 per hour for housing. So, if we subtract that from the $43.30 we had, then we’re left with $30.47 per hour for the travel nurse’s pay. Now, I think that most travel nurses would say that this is a much more common offer that they here out there. That’s $30 to $31 per hour, plus company hosing or a $2000 monthly lodging stipend, plus a $700 travel stipend, plus medical benefits. And it doesn’t even include some of things that AMN included in their example, like 401k matching and tuition reimbursement.
In any case, at $31 per hour, we’re looking at annual pay of $53,568 if you worked 36 hours per week for 48 weeks. Again, this may be less or more depending on your situation with your expenses at your tax home.
Now, I’m going to run through the next examples much more quickly. Essentially, I’m going to keep all the same costs. $4.95 per for burdens and payroll costs, $1.50 per hour for the travel stipend, $2.24 per hour for medical benefits and $12.82 per hour for housing comes to $21.51 for those costs.
With that in mind, let’s look at a low end bill rate of $58 per hour. While this is low, it’s a pretty common rate in much of the country. Again, the first thing we’re going to do is subtract the agency’s gross profit margin. So, 20% of 58 is $11.60 per hour and we’re left with $46.40. Then, we subtract the $21.51 and we’re left with $24.89. Now, I’m sure that there are travel nurses out there who have been offered a rate of $24 to $25 per hour plus housing. This is how that happens, a bill rate of $58 per hour.
Now, to be fair, these bill rates are often in states that have cheaper housing costs. So the housing in these states might actually only cost around $1500 per month. That saves $500 that can be added to the pay rate which would bring the pay rate up by $3.20 per hour. So, we’re looking at $28.09 per hour if that’s the case.
So, in this example, the annual pay would be about $43,000 to $48,500.
Okay, so now let’s take a look at an assignment with a rapid response rate of $85 per hour. Again, we’re going to start by taking out the 20% gross profit margin. That’s $17 per hour, so we’re left with $68 per hour. Then, we subtract the cost $21.51 we’re using for our example and we’re left with $46.49 per hour for the pay package.
So, in this example, the annual pay would be $80,334 per hour.
Alright, so what does all this mean? Well, I think it’s fair to say that we really have to do some finagling with the numbers to arrive at some of the higher figures that are on found in the top search results served up by google and found elsewhere on the internet.
Now, it’s also possible that you can avoid the costs associated with maintaining duplicate expenses. Again though, that’s really difficult to do and I don’t think we should be advertising to folks who are the exception to the rule. It’s also possible that you’re able to save a bunch on housing by finding your own housing and pocketing the difference. But here again, that’s not necessarily what these marketers advertise, right? So, the whole point here is that the numbers that are widely cited are grossly oversimplified. Each person’s circumstances will be unique. But hopefully, this episode gives you an idea of how to approach the issue to that you’re not caught off guard.
Okay, so that’s a good place for us to wrap up this episode. As always, we’ll have the transcript of this episode up on the show notes page along with useful links to some of the stuff we discussed today. The show notes page will be found at blog.bluepipes.com/episode35.
While you’re there, be sure to join BluePipes and take advantage of all he amazing tools designed to help you manage your healthcare careers more effectively and efficiently. And for recruiters, remember, you can join for free to. BluePipes is a professional networking site like LinkedIn, so we don’t sell candidate contact information to recruiters or other third parties, but it’s a great way to build a professional network in the travel healthcare industry and the healthcare industry in general.
Of course, we always welcome your questions and comments about this topic on the show notes page as well. So please let us know if you think there is something we missed or if there are any questions you have by posting in the comments section at the bottom of the show notes page.
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Okay, until next time, have a safe and prosperous travel healthcare adventure.