Equal rates for MD/DO & NP Bill Passed in Oregon

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Originally Posted by sarjasy

Again, I don't have strong feelings on this matter, and I could be convinced one way or another, but this still doesn't add up, especially in a world in which healthcare is funded by insurance.

I'll ask the two of you my question about the (real life) ENT who wrote a script for hypertension. How much reimbursement does he deserve vs. family physician or cardiologist?

How about the ENT writing the script vs. a cards NP who'd been practicing for 10 years? Who do you think possesses the more valuable, specialized knowledge in treating HTN?

There are a few things here:
First the ENT should not be writing a script for hypertension unless that medication was already prescribed by a primary care doctor, internist or someone in an internal medicine subspecialty. They just don't have much experience to chose the right medicine.

If we assume that you would get reimbursed for only the disease you are treating rather than lumping it into the visit- I would say that a cards NP should get paid more than an ENT for treating hypertension but less than a cardiologist. That said, an ENT really should not be treating hypertension except under very rare circumstances just like a PCP or cardiologist should not be treating something like vocal cord paresis.

...never heard of ENT rx antihypertensive..mostly likely the patient was already taking med.

Your continued referenced to the ENT writing for a beta blocker is irrelevant.
He came to the ENT for a consult, got his consult, was given an eval and sent home with an rx. He should get paid whatever an ENT clinic visit is customarily worth. It's not like he's going to take over the job of his PCP and schedule monthly bp checks. It doesn't matter what he was there for or what his diagnosis ultimately was. If the cards guy saw him he should be paid at the rate of a cardiologist not an FP or NP, because that's what he is, and that's what he customarily charges for an appointment. If it's a straight forward hypertension dx in a reasonably healthy patient, he should recommend followup with his PCM.
Here's a question, if the patients premium insurance allows him to schedule appointments with specialists directly, as mine does, should the cardiologist refuse to see this patient, who they now have a relationship with, for his followup care just because it's a straight forward disorder that could be competently managed by the quack at the free clinic? I would think not.

ENT in my neck of the woods wouldn't lay their hands on a patient with an uncontrolled HTN. They ship them back to PCP. Though, they lay their hands and pray if you're healthy (adequately/well controlled malignant hypertension). Is like an Orthopod telling a patient to loss wt, else They will not touch you/operate on them. That must be painful. Am so sorry!

IIDes
All this PCM =PCP=PMD. Can we all stick to one? I personally prefer PMD (not PDNP ok Sarjasy) because it has the MD tune to it.

Originally Posted by AndEE

... as utilization studies have shown that NP's in primary care order more radiographic and laboratory tests and consult to specialists more often than MD's and PA's. Given that this helps "drive healthcare costs through the roof," shouldn't we be paying the NP's less than they are getting now?

Always thought these studies were flawed, and a red herring.
Too many factors can go into why a particular 'provider' ordered a rad study,versus one that wasn't ordered (in the 'same' pt)

Worked with hundreds of physicians in several ERs over the last 20 years. Their practice style changes over time, depending on how the partners in the group practice, if he's been sued, bounce backs, etc.

Too many variables to produce reliability outside of the study.

In my experience, the docs that left academia, for example, to return to the ER, order some of the weirdest stuff I hadn't seen before or since, and spend a lot of the pt's (insurance's, state's, etc) money that baffles even their (physician) co workers...

Originally Posted by Denatured

Why would Sarjasy be able to answer a question you asked me?

Really, it's not relevant because how much we believe someone should be paid is opinion and because you are going to be distrustful of my opinion regardless of what I am. In fairness, I'm a PA and former Nurse. Like I said, I don't care about the bill specifically because I'm not affected by the issue and I'm not for NP independence with their current training. I do believe in same fee for same service.



Actually, residency programs receive federal monies. So I am paying plenty for that service.



I'm guessing since I am a PA my opinion doesn't count either.



If a FP did anesthesia for surgery, I would expect him to be paid the same. This won't happen (well it actually does rarely with older GPs who did anesthesia before credentialing and Board certification became so big) because no hospital would dare hire him to do such a thing and no insurance company would pay for it. So really it's not relevant.

What is relevant is that would should be paying for outcomes. If we could pay people based on how well they performed (and I'm talking in ratios, not paying based on one individual patient) then I'm sure it would balance out and those with more training and fewer poor outcomes would be paid more. I'm sure their are problems with this idea, such as it providing and incentive for providers to cherry pick patients, but with some tweaks I think it would be optimal.

Anesthesiologist receives stipends from hospitals to be able to acquire their current level of income, therefore they cost more healthcare dollars.

And I'm sure if peds liver transplants were done at places that weren't huge academic centers with anesthesiology residencies and residents given first dibs, I'm sure there would be CRNAs doing them. I've seen claims that CRNAs don't independently do CABGs and TEE, but I've seen that too.

Anyway, this is not about independence. So that's the last I have to say on that matter. This is about pay. It's not about private insurance either, as you allude to. While CRNAs can bill 100% of medicaid/medicare, they often cannot with private insurance companies.

You obviously aren't reading very closely. I am very cognizant that residents are paid by Medicare; what I wrote was you would not be very happy if you had to pay for residents being paid the same or more than a midlevel since based on your logic we perform the same care with residents providing more care and more complex care usually.

You seem to think that if a NP and MD see a patient for the same reason, the bill should be the same. You're certainly not looking at the time and expense that goes into training for the MD or the increased amount of knoweldge and skill the MD possesses over the NP. This is why their should be a disparity in compensation. You get what you pay for and with an MD/DO you are getting a far more comprehensive understanding and thought process than with an NP for the most part.

Originally Posted by IlDestriero

Your continued referenced to the ENT writing for a beta blocker is irrelevant.

It's completely relevant, and gets to the heart of the matter. If the patient got the same dx, rx and clinical advice/recommendations from the ENT as he would have from the FP, why should the ENT get more or less money for it. What if a family practice physician had a PhD in molecular biology? Arguably, he has "better" training than the average, but should an insurance company pay him more for it?

Originally Posted by IlDestriero

He came to the ENT for a consult, got his consult, was given an eval and sent home with an rx. He should get paid whatever an ENT clinic visit is customarily worth.

Agreed, in this case at least, because the patient was there for an ENT visit, not for HTN. And I understand your point that a specialists time, in general, is worth more than primary care providers time, but not if they are doing work that does not rely on their specialty.

Originally Posted by IlDestriero

Here's a question, if the patients premium insurance allows him to schedule appointments with specialists directly, as mine does, should the cardiologist refuse to see this patient, who they now have a relationship with, for his followup care just because it's a straight forward disorder that could be competently managed by the quack at the free clinic? I would think not.

The cardiologist should be free to refuse to see anyone he/she doesn't want to see for starters. Futhermore, if the cardiologist were paid for a simple HTN follow up in an otherwise health patient at the same rate of a family practice physician (as he should), he just might refuse.

Originally Posted by sarjasy

Agreed, in this case at least, because the patient was there for an ENT visit, not for HTN. And I understand your point that a specialists time, in general, is worth more than primary care providers time, but not if they are doing work that does not rely on their specialty.

This is where the concept of "opportunity cost" comes in. The ENT surgeon's time costs more than the FM doc's time because the ENT surgeon has more specialized training and can typically bill more per unit time. By occupying the ENT's time with anything (including a HTN visit), you are preventing them from using their specialized training on an ENT-specific problem. So even "if they are doing work that does not rely on their specialty" in an office visit, that office visit is still worth whatever an ENT usually charges for an office visit.

If I insist that the senior partner at a law firm read over a contract before I sign, do you think he should bill me what one of his first year associates bills for doing the same thing (let's say $100/hour) or should he bill at whatever he usually bills his time out at (let's say $400/hour)? If you agree he should bill me at his usual rate (which most reasonable people would), then why is his expertise worth four times as much as the associate's for the same work? It's because: 1. He has greater experience and might catch something the associate wouldn't; and 2. Because he could bill for doing something else at the $400 rate. If I want to purchase an hour of his time/expertise, I need to pay him what he would bill for doing something "in his specialty."

Originally Posted by Instatewaiter

If we assume that you would get reimbursed for only the disease you are treating rather than lumping it into the visit- I would say that a cards NP should get paid more than an ENT for treating hypertension but less than a cardiologist.

I don't think the NP should get paid more, but at least you are consistent in your thinking.

Originally Posted by Instatewaiter

That said, an ENT really should not be treating hypertension except under very rare circumstances just like a PCP or cardiologist should not be treating something like vocal cord paresis.

It was an indigent patient and he did the right thing, though I could tell he was a little uncomfortable doing it.

Originally Posted by sarjasy

It's completely relevant, and gets to the heart of the matter. If the patient got the same dx, rx and clinical advice/recommendations from the ENT as he would have from the FP, why should the ENT get more or less money for it. What if a family practice physician had a PhD in molecular biology? Arguably, he has "better" training than the average, but should an insurance company pay him more for it?

Agreed, in this case at least, because the patient was there for an ENT visit, not for HTN. And I understand your point that a specialists time, in general, is worth more than primary care providers time, but not if they are doing work that does not rely on their specialty.

There are 2 problems with your logic here.

First, you can't diagnose hypertension based on 1 BP reading or even multiple readings in the same clinic appointment.

Second, I can almost guarantee you that the ENT did not do what I, as a family doctor, would have done. Did he get a CMP? As most common BP meds mess with electrolytes, that can be important. Its also a decent screening tool for some of the causes of secondary hypertension. What about a lipid panel? High BP and high cholesterol tend to go together these days. Perhaps an A1c was indicated, especially if the patient was overweight. Was there a f/u to go over said labs and recheck BP? Did he evaluate for possible complications of this supposed hypertension (heart failure, kidney disease, hypertensive retinopathy)? Did he counsel on low salt diet or exercise? What about weight loss?

So no, I doubt very much that this surgeon did what I would have done.

Originally Posted by VA Hopeful Dr

There are 2 problems with your logic here.

First, you can't diagnose hypertension based on 1 BP reading or even multiple readings in the same clinic appointment.

Second, I can almost guarantee you that the ENT did not do what I, as a family doctor, would have done. Did he get a CMP? As most common BP meds mess with electrolytes, that can be important. Its also a decent screening tool for some of the causes of secondary hypertension. What about a lipid panel? High BP and high cholesterol tend to go together these days. Perhaps an A1c was indicated, especially if the patient was overweight. Was there a f/u to go over said labs and recheck BP? Did he evaluate for possible complications of this supposed hypertension (heart failure, kidney disease, hypertensive retinopathy)? Did he counsel on low salt diet or exercise? What about weight loss?

So no, I doubt very much that this surgeon did what I would have done.

The Boss just walked in! Where the heck have you been all this long? I almost die!

Sarjasy aka "diagnose this" doesn't worth the time. Am saving my energy. Repleting with the newly branded energy drink. Folks, I have plenty to pass around. Hit me up.

The nurses are dreaming if they think that they are all of a sudden going to get a pay increase to the level of MDs.

The insurance companies will cut MDs to the NP rates; not raise the NPs up. They're in for a rude awakening if this thing actually goes thru.

Originally Posted by Socrates25

The nurses are dreaming if they think that they are all of a sudden going to get a pay increase to the level of MDs.

The insurance companies will cut MDs to the NP rates; not raise the NPs up. They're in for a rude awakening if this thing actually goes thru.

The bill is dead! Buried!! We're currently celebrating her life. Come on over and join the celebration.

Originally Posted by VA Hopeful Dr

There are 2 problems with your logic here.

First, you can't diagnose hypertension based on 1 BP reading or even multiple readings in the same clinic appointment.

Second, I can almost guarantee you that the ENT did not do what I, as a family doctor, would have done. Did he get a CMP? As most common BP meds mess with electrolytes, that can be important. Its also a decent screening tool for some of the causes of secondary hypertension. What about a lipid panel? High BP and high cholesterol tend to go together these days. Perhaps an A1c was indicated, especially if the patient was overweight. Was there a f/u to go over said labs and recheck BP? Did he evaluate for possible complications of this supposed hypertension (heart failure, kidney disease, hypertensive retinopathy)? Did he counsel on low salt diet or exercise? What about weight loss?

So no, I doubt very much that this surgeon did what I would have done.

I am just pre/med as well as finishing my BSN and I agree would suggest everything you just said. For primary HTN isn't the first line treatment temporary calcium channel blockers if diet, exercise etc aren't fixing the problem on its own (medically uncomplicated patient/A1c neg). Save the BB and diuretics for later? Unrelated to the thread I know.

I just realized your signature Socrates. I disagreed! PA are your friends. Initially, my position were similar to yours. But, recently, after much reading/research/PA friend/Review of their curriculum and applicable state law etc etc, I have decided to be more PA friendly. I'd hire a PA (not DNP) and maybe NPs those with a straight mind. MLP (PA) when use effectively makes significant difference in respect to one's bottom-line. A friend hired (not fired) 2-PAs and makes good profit off of them. Both were experience prior to jumping on board. He takes more vacations now and devote more free time to wife and kids than he's ever before. Though, he's an internist. Not sure if same will applies in other specialty.

Originally Posted by Dranger

I am just pre/med as well as finishing my BSN and I agree would suggest everything you just said. For primary HTN isn't the first line treatment temporary calcium channel blockers if diet, exercise etc aren't fixing the problem on its own (medically uncomplicated patient/A1c neg). Save the BB and diuretics for later? Unrelated to the thread I know.

..when treating hypertension, the patient's phmx must be consider prior to jumping the gun in choosing anti-hypertensive meds. In an healthy pt (no prior mi, diabetes, renal issues, etc etc), I believe JNC guidelines recommended thiazide diuretic (could be wrong, sh!t who cares). where the heck is my coffee?

Originally Posted by Socrates25

The nurses are dreaming if they think that they are all of a sudden going to get a pay increase to the level of MDs.

The insurance companies will cut MDs to the NP rates; not raise the NPs up. They're in for a rude awakening if this thing actually goes thru.

I just realized your signature Socrates. I disagreed! PA are your friends. Initially, my position were similar to yours. But, recently, after much reading/research/PA friend/Review of their curriculum and applicable state law etc etc, I have decided to be more PA friendly. I'd hire a PA (not DNP) and maybe NPs those with straight mind ( not talking about sexual preference ok). MLP (PAs) when use effectively makes significant difference in respect to one's bottom-line. A friend hired (not fired) 2-PAs and makes good profit off of them. Both were experience prior to jumping on board. He takes more vacations now and devote more free time to wife and kids than he's ever before. Though, he's an internist. Not sure if same will applies in other specialty.

I'll tell you what, some of the posts in this thread have really opened my eyes. Next time I have to stay in a hotel, I'll demand to be moved to a vacant deluxe suite but only be billed for hole-in-the-wall standard room. After all, the website says they have the same kind of bed, so I'm going to get the same quick sleep either way. I'm not going to take advantage of the hot tub or petting zoo so I should really be charged at the basic rate.

Originally Posted by Dranger

I am just pre/med as well as finishing my BSN and I agree would suggest everything you just said. For primary HTN isn't the first line treatment temporary calcium channel blockers if diet, exercise etc aren't fixing the problem on its own (medically uncomplicated patient/A1c neg). Save the BB and diuretics for later? Unrelated to the thread I know.

Nope, actually the JNC-7 recommends thiazides as your first pharmacologic option for most cases though there's a note saying that ace/arb/bb/ccb can also be used.

http://www.nhlbi.nih.gov/guidelines/...on/express.pdf

Originally Posted by VA Hopeful Dr

There are 2 problems with your logic here.

First, you can't diagnose hypertension based on 1 BP reading or even multiple readings in the same clinic appointment.

Second, I can almost guarantee you that the ENT did not do what I, as a family doctor, would have done. Did he get a CMP? As most common BP meds mess with electrolytes, that can be important. Its also a decent screening tool for some of the causes of secondary hypertension. What about a lipid panel? High BP and high cholesterol tend to go together these days. Perhaps an A1c was indicated, especially if the patient was overweight. Was there a f/u to go over said labs and recheck BP? Did he evaluate for possible complications of this supposed hypertension (heart failure, kidney disease, hypertensive retinopathy)? Did he counsel on low salt diet or exercise? What about weight loss?

So no, I doubt very much that this surgeon did what I would have done.

Your post does not refute my logic, only the example I gave. I have no idea what the ENT's workup was - I only know that he treated a patient for HTN. The point is, assuming an equivalent workup for the sake of conversation, does the ENT deserve less than an FP physcian, more, or the same?

Originally Posted by sarjasy

Your post does not refute my logic, only the example I gave. I have no idea what the ENT's workup was - I only know that he treated a patient for HTN. The point is, assuming an equivalent workup for the sake of conversation, does the ENT deserve less than an FP physcian, more, or the same?

It doesn't refute your point, it makes your question invalid. I bet there's not 1 ENT in 5,000 who would approach primary care issues in the same comprehensive way that I do.

That said, if all the ENT did was address the hypertension then no, he shouldn't get paid what I would.

Originally Posted by Kj615

I'm not sure if this has been discussed. I did a search and found nothing. Nothing against NP/DNP, but reimbursing NP's at the same rate as MD/DO for the same procedures?

http://oregoncapitolnews.com/blog/20...practitioners/

then theres no reason to see an NP right?

Who would eat at mcdonalds if it cost the same as a fancy restaurant

Originally Posted by zenman

If someone with a doctorate painted the front of your house and someone with a lessor degree painted the back but the paint job was of equal quality what would you have to say?

I'd say come to the real world my child. Ever see what the pay between a union worker is and a non-union worker say for the longshoremen? Convention workers? Teamsters? Maybe that's why the whole American enterprise is upended by lower wage workers overseas. What? They do the same job so let's pay them less here, why not. Why don't we just recognize every medical school in the world too while we are at it. Why go to MD/DO school then, everyone just go to NP school. It's so much easier.

Why pay for a Mercedes when the Hyundai Genesis is the same luxury car? Why pay for a BMW M3 when you got the Tiburon for pennies?

Originally Posted by sarjasy

Your post does not refute my logic, only the example I gave. I have no idea what the ENT's workup was - I only know that he treated a patient for HTN. The point is, assuming an equivalent workup for the sake of conversation, does the ENT deserve less than an FP physcian, more, or the same?

Less. Much, much less. As in zero dollars and zero cents.

In other words, he or she should make just as much as a colorectal surgeon should be getting for a tympanomastoidectomy, a pediatrician for a thyroidectomy, or a pathologist for ear tubes.

Originally Posted by chimichanga

Always thought these studies were flawed, and a red herring.
Too many factors can go into why a particular 'provider' ordered a rad study,versus one that wasn't ordered (in the 'same' pt)

Well, no doubt these studies are flawed, but IMO it's far more objective than the "evidence" that the pro-NP crowd uses to justify their claim that NP's are as cost-effective (if not more so) than MD's.

Nobody gets paid based on ICD-9 codes (e.g. 401.1 for "hypertension" or whatever). We get paid based on E&M and CPT codes. ICD-9 codes are recorded to document and support the care provided, but are not directly reimbursable. E&M (evaluation and management) codes are based on history, physical examination, and medical decision making, and one's documentation thereof. CPT codes are procedures.

Presently, most specialists are reimbursed at a higher rate than primary care physicians for equivalent E&M and CPT codes, Medicare being an exception. What that means is that yes, if an ENT treats an established patient's hypertension and bills a 99213, they're probably going to get paid more than a primary care physician who did the same thing and also billed a 99213.

I'm not suggesting that it should be that way, but that's the current reality.

Originally Posted by RDlv

We're cost effective.

Say that to yourself 500 times.

"NPs are a cost-effective solution to the health care crisis, providing equal if not better care than physicians."

^^^This is a quote out of my own mind, from having the sentiment drilled OVER and OVER and OVER into my ear over the last two years. I'm very curious what the google results would be for googling the whole phrase? Am I making this up?

EDIT: From the IOM report:

"Since nurse practitioners' education is supported by federal and state funding, we are underutilizing a valuable government investment. Moreover, nurse practitioner training is the fastest and least expensive way to address the primary care shortage. Between 3 and 12 nurse practitioners can be educated for the price of educating 1 physician, and more quickly."

http://www.nejm.org/doi/full/10.1056...=&sort=oldest&

Great, I'm better because I'm a welfare recipient. I'm a cheap date. Great way to boost pride in the profession, folks. Do I also start to look better after you have a six-pack in you?

You are correct, actually, that when NPs see patients, the prognosis is equal or better than when a physician sees them. Some of that data may be skewed, in my opinion, by the fact that physicians generally are overwhelmed with patient caseloads, and NPs may not be at this time, and have more time to spend giving care.

The New England Journal of Medicine quotes research which found that:
"Some physicians’ organizations
argue that physicians’ longer,
more intensive training means
that nurse practitioners cannot
deliver primary care services that
are as high-quality or safe as
those of physicians. But physicians’
additional training has not
been shown to result in a measurable
difference from that of
nurse practitioners in the quality
of basic primary care services." (New England Journal of Medicine, January, 2011, p. 193)

I think NPs should get equal reimbursement for doing the same work, particularly when there's no research whatsoever which shows physician care to be superior in primary care. Obviously, there are no NP surgeons as the training simply does not exist, so I would never advocate for NPs to replace MDs. The two professions work well together, particularly in this age of primary care shortage.

Originally Posted by fab4fan

Sorry, I don't think mid-levels should bill at the same rate as a physician.

NPs are not mid-levels. PAs are mid-levels, as they are below physicians. For your edification:

In October 2004, the American Association of Colleges of Nursing (AACN) published a position paper focusing on the issue of converting the terminal degree for advanced practice nursing from the Master's to the Doctor of Nursing Practice (DNP) by the year 2015.

[...]

The American Academy of Nurse Practitioners (AANP) opposes use of terms such as “mid-level provider” and “physician extender” in reference to nurse practitioners (NPs) individually or to an aggregate inclusive of NPs. NPs are licensed independent practitioners. AANP encourages employers, policy-makers, healthcare professionals, and other parties to refer to NPs by their title. When referring to groups that include NPs, examples of appropriate terms include: independently licensed providers, primary care providers, healthcare professionals, and clinicians.

Terms such as “midlevel provider” and “physician extender” are inappropriate references to NPs. These terms originated in bureaucracies and/or medical organizations; they are not interchangeable with use of the NP title. They call into question the legitimacy of NPs to function as independently licensed practitioners, according to their established scopes of practice. These terms further confuse the healthcare consumers and the general public, as they are vague and are inaccurately used to refer to a wide range of professions. The term “midlevel provider” (mid-level provider, mid level provider, MLP) implies that the care rendered by NPs is “less than” some other (unstated) higher standard. In fact, the standard of care for patients treated by an NP is the same as that provided by a physician or other healthcare provider, in the same type of setting. NPs are independently licensed practitioners who provide high quality and cost-effective care equivalent to that of physicians.1,2

The role was not developed and has not been demonstrated to provide only “mid-level” care. The term “physician extender” (physician-extender) originated in medicine and implies that the NP role evolved to serve an extension of physicians’ care. Instead, the NP role evolved in the mid- 1960’s in response to the recognition that nurses with advanced education and training were fully capable of providing primary care and significantly enhancing access to high quality and costeffective health care. While primary care remains the main focus of NP practice, the role has evolved over almost 45 years to include specialty and acute-care NP functions. NPs are independently licensed and their scope of practice is not designed to be dependent on or an extension of care rendered by a physician. In addition to the terms cited above, other terms that should be avoided in reference to NPs include "limited license providers", "non-physician providers", and "allied health providers". These terms are all vague and are not descriptive of NPs. The term "limited license provider" lacks meaning, in that all independently licensed providers practice within the scope of practice defined by their regulatory bodies. "Non physician provider" is a term that lacks any specificity by aggregately including all healthcare providers who are not licensed as an MD or DO; this term could refer to nursing assistants, physical therapy aides, and any member of the healthcare team other than a physician. The term "allied health provider" refers to a category that excludes both medicine and nursing and, therefore, is not relevant to the NP role. 1. AANP (2007). Nurse practitioner cost-effectiveness. Austin, TX: AANP. 2. AANP (2007). Quality of nurse practitioner practice. Austin, TX: AANP. For more information, visit www.aanp.org Use of Terms Such as Mid-Level Provider and Physician Extender © American Academy of Nurse Practitioners, 2009 Revised 2010

Originally Posted by madglee

You are correct, actually, that when NPs see patients, the prognosis is equal or better than when a physician sees them. Some of that data may be skewed, in my opinion, by the fact that physicians generally are overwhelmed with patient caseloads, and NPs may not be at this time, and have more time to spend giving care.

.

NP on another forum said his company just started paying NPs and MDs the same...based on years of experience only. Should be interesting.

Just wait for ObamaCare.....we are all going to get screwed.

Originally Posted by zenman

NP on another forum said his company just started paying NPs and MDs the same...based on years of experience only. Should be interesting.

They're either overpaying the NPs or underpaying the physicians. If the former, it's their loss, if the latter, good luck hiring.
Anesthesia benefits from CRNAs getting equal pay with supervision. Bill $300k, pay $150. Winning.
Of course the AMCs are now doing it to both. Winning more.

madglee is just mad because he wasted a small fortune on a worthless cracker jack box psych NP program and now he's pissed because he doesnt get the same $$$ as a REAL doctor, a psychiatrist.

You see, the national NP organizations all give the same BS spiel about how "we're independent, we're just as good as a doc, we dont need supervision" etc but when these NPs get out in the real world it all comes crashing down on them when they realize that they will NEVER be real doctors, regardless of the letters behind the name.

Originally Posted by zenman

NP on another forum said his company just started paying NPs and MDs the same...based on years of experience only. Should be interesting.

Could be the same person

Originally Posted by zenman

NP on another forum said his company just started paying NPs and MDs the same...based on years of experience only. Should be interesting.

I saw that as well on the other forum. Interesting, since it was apparently a group of physicians who decided to give NPs equal pay.

I think there is probably going to continue to be a narrowing of the gap in family practice over the next few years, even if we never get to the same starting point where I work. Our bonus structure is exactly the same, as are all of the benefits. The only thing that is different is that the MDs make about 10-15% more than we do. I know for a fact that the surgical PAs make more than the MDs in family practice. I think the whole healthcare situation is untenable and there are going to be lots of changes in the next 20 years.

[QUOTE=ChillyRN;12396330] I know for a fact that the surgical PAs make more than the MDs in family practice. /QUOTE]
I used to work for a major hmo where the senior em, surgical, ortho, and gi pa's made more than the entry level fp docs by around 10k/yr.

I think the discrepancy is even greater here. The 3 FT docs in my FP clinic lost all of their bonus and still had to pay the clinic back to make up for the $50K the clinic lost, mostly due to the expenses involved in hiring two providers who didn't stay more than 6 months. As in, those three guys had to write the company checks to bring the balance sheet to zero. The onsite medical director told me he ended up netting just a few thousand more than I do. He said the difference in our actual take home pay was "not enough to buy a used car." I feel really bad for him, he is an awesome person. He is a great boss, great mentor, great provider! He is universally loved and respected by colleagues and patients. He already lost all of his retirement trying to take a stab at private practice, and lost his house in a bitter divorce. He is now in his mid 60s and starting over, living in a crappy apartment, driving a 1980 Bonneville, and by his own report, not making much more than an new grad NP. My husband and I feel so bad for him that we have him to dinner at least once a week! My kids call him Uncle Mike. If he is bitter he doesn't show it, but it had to kill him to see a PA get the "Provider of the Year" award last year that comes with a 10K bonus when that kid (I say kid, but he is probably 30) already earns more than Mike does. The kid PA earned it though, I'm not trying to take anything away from him: he billed out over 1.5 million and had outstanding satisfaction scores.

In the end, it is all about the money. Kid brings in money to the company, Mike will be lucky if he breaks even and doesn't die at his desk.

[QUOTE=emedpa;12396776]

Originally Posted by ChillyRN

I know for a fact that the surgical PAs make more than the MDs in family practice. /QUOTE]
I used to work for a major hmo where the senior em, surgical, ortho, and gi pa's made more than the entry level fp docs by around 10k/yr.

Which is why I laugh every time I hear PAs and NPs are going to "take over" primary care.

Only a foolish PA/NP would do primary care when they can make DOUBLE the money doing subspecialty work with ZERO extra training.

The PAs and NPs are running even faster from primary care than the MDs are. At least the MDs have to train for at least 3 years longer to make bigger money as a subspecialist.

P.S. CRNAs make double what a subspecialty PA makes

Originally Posted by madglee

NPs are not mid-levels. PAs are mid-levels, as they are below physicians.

And yet an NP's training is inferior to that of a PA's. Most NP programs require 700 hours or less of clinical training vs. 2000 for a PA. Many NP programs can be done online whereas not one PA program like med school can be done online.

Words from a nursing organization mean nothing. NP or DNP are midlevels. Period.

In my book, I would hire a PA way before I would even think about hiring an NP. In fact, I'll look into getting rid of any NP's at whatever place hires me and replace them with PA's.

[QUOTE=Socrates25;12397319]

Originally Posted by emedpa

Which is why I laugh every time I hear PAs and NPs are going to "take over" primary care.

Only a foolish PA/NP would do primary care when they can make DOUBLE the money doing subspecialty work with ZERO extra training.

The PAs and NPs are running even faster from primary care than the MDs are. At least the MDs have to train for at least 3 years longer to make bigger money as a subspecialist.

P.S. CRNAs make double what a subspecialty PA makes

I guess I'm foolish but I love my job, but then I don't care about money.

Originally Posted by ChillyRN

[I guess I'm foolish but I love my job, but then I don't care about money.

The above quote wasn't me in #89.

Originally Posted by AnnoyedByFreud

I saw that as well on the other forum. Interesting, since it was apparently a group of physicians who decided to give NPs equal pay.

Was it the physicians or the corporate guys? If I remember correctly, PAs were not included in the new pay structure. Bet that makes Taurus a little nervous!

Originally Posted by zenman

Was it the physicians or the corporate guys? If I remember correctly, PAs were not included in the new pay structure. Bet that makes Taurus a little nervous!

Why work for such a group when there is soo much money to be made doing other things but oh well......also groups like this won't last I foresee some lawsuits popping up if these crop up more commonly......(at least in the states where NP's don't have indenpendence) that whole equal work equal pay thing.....

Originally Posted by zenman

Was it the physicians or the corporate guys? If I remember correctly, PAs were not included in the new pay structure. Bet that makes Taurus a little nervous!

Don't know. If I remember correctly, it was stated that the board that voted to approve the new pay scale was made up almost completely of physicians and that they're really happy with their NPs and are trying to attract more with the better pay. Yes, CNSs and PAs were not included in the pay raise, which seems ridiculous to me.

Originally Posted by Taurus

Many NP programs can be done online whereas not one PA program...can be done online.

http://www.med.und.edu/physicianassi...urriculum.html

FWIW this program until very recently only accepted nurses...essentially an np program that was funded as a pa program. not a big fan of this program for a variety of reasons....but yes, it is a pa program with a distance component. I do not recommend this program to anyone.
from their website:
Beginning in 1972, the Program turned to experienced registered nurses for its applicant pool. The Program’s goal was to expand and extend the role of RNs in community-oriented primary care practice settings. From then until January, 2004, a Physician Assistant Certificate was given to all who successfully completed the 12 month Program. And from 1972 to 1992, those who qualified received dual certification as a Physician Assistant and a Family Nurse Practitioner.
In August, 2006, a three class pilot program began when the Program accepted not only registered nurses, but experienced clinical health care professionals from other disciplines.

Originally Posted by emedpa

FWIW this program until very recently only accepted nurses...essentially an np program that was funded as a pa program. not a big fan of this program for a variety of reasons....but yes, it is a pa program with a distance component. I do not recommend this program to anyone.
from their website:
Beginning in 1972, the Program turned to experienced registered nurses for its applicant pool. The Program’s goal was to expand and extend the role of RNs in community-oriented primary care practice settings. From then until January, 2004, a Physician Assistant Certificate was given to all who successfully completed the 12 month Program. And from 1972 to 1992, those who qualified received dual certification as a Physician Assistant and a Family Nurse Practitioner.
In August, 2006, a three class pilot program began when the Program accepted not only registered nurses, but experienced clinical health care professionals from other disciplines.

Maybe I missed it but I didn't even see a requirement for a MCAT or GRE. I guess if I fail outta school, UND here I come! ha.

Originally Posted by emedpa

FWIW this program until very recently only accepted nurses...essentially an np program that was funded as a pa program. not a big fan of this program for a variety of reasons....but yes, it is a pa program with a distance component. I do not recommend this program to anyone.
from their website:
Beginning in 1972, the Program turned to experienced registered nurses for its applicant pool. The Program’s goal was to expand and extend the role of RNs in community-oriented primary care practice settings. From then until January, 2004, a Physician Assistant Certificate was given to all who successfully completed the 12 month Program. And from 1972 to 1992, those who qualified received dual certification as a Physician Assistant and a Family Nurse Practitioner.
In August, 2006, a three class pilot program began when the Program accepted not only registered nurses, but experienced clinical health care professionals from other disciplines.

The PA accreditation should be pulled from this program. Let it be just another online NP program. That is one of the important distinguishing features of PA programs compared to NP programs - PA programs are of higher standards, rigor, and quality.

no standardized test requirement? Yikes. Sounds like one of those really crappy online NP programs, except it's a PA program. How programs like these are even allowed to exist is beyond me.

I just got so depressed/angry reading this thread. How have we come to this? We, as physicians, need to stand up against this?

Put a stop to what? NPs? Independent practice? You're several decades too late. If you mean professional schools, degree mills, and for profit universities, then yeah, I'm with you.