Nurse_Ratched_1952
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- Feb 19, 2019
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I am retiring in two weeks, after nearly 40 years in healthcare, starting as an RN, and finishing my last 12 years as a FNP. I enjoy reading this forum, and wanted to finally make a post, as I enter retirement. I am not trolling here, but trying to give you my honest thoughts on what you, as an MD can expect in today's modern healthcare world.
I started my career at a time when the MD was omnipotent in the healthcare field; a time when he (very few she's back then) entered the nurse's station, you as the nurse gave him your seat, if he had no place to sit, so he could write his orders. No EMR's back then. Everything revolved around the MD, and he was a "God-like figure".
Back then, and through the 90's, there were very few prior authorizations, and the medical field was not controlled by the insurance companies. Today, everything is cost based. You will come to hate prior authorizations, as they are so time consuming, and you will also come to see that everything is based on productivity, and what "will save the most money".
Don't get me wrong, the medical field is still a great place to work, but you must be aware of how things not only have changed, but drastically. I find most MD's I work with are still happy with their career choice, yet many strongly encourage their children to find another vocation. NP's don't have to spend months preparing for Step I and Step 2 exams. Gunners don't exist in the NP world. NP's don't have to worry about some strict State Board of Medicine coming down on them, as patients today can file grievances on-line. State nursing lobbies are very powerful (and very liberal), as politicians realize (and want to please) their strength in numbers.
I recently finished a locums job where the unit I worked on had one IM MD hospitalist, and three NP's. 15 years ago, rounds would have been done by the family GP, but rarely does the family doc even venture into the hospital.
NP's who started as floor nurse like me, and who worked 20 years in various settings before becoming NP's, are far superior (IMHO) to those NPs who become RN's/BSN's and quickly work to get their NP credentials on-line, and by the age of 24 are writing orders. Soon the NP field will be saturated, just like the pharmacy field. Salaries will drop. Salaries for MD's are stagnant and dropping in metro areas. Why would a clinic want to pay $150 per hour to an MD when they can get essentially the same services, from an NP or PA for $85 per hour? You don't need 8 years of medical training to manage somebody's HTN or DMII.
I leave making a decent $145,000 per year w/ great benefits. 24 states now let NPs work completely independent of MD's. Clinics and other facilities that were 100% MD 15 years ago are now probably 50-50 between MDs and NP's/PA's. PA's are often very good, but the "beef" I have with them is that most of them have no, or very little prior hospital experience, like most older NPs who worked as staff RN's, before entering the world of writing prescriptions and orders labs and tests.
When I went through NP training (MSN), I went to a real university, had to get up early and drive through rush hour traffic for long lectures and labs, while today, everything but NP clinical practicums is done on-line. I have preceptored five NP students, and frankly, NO STATE should allow any NP to prescribe until he or she has five years of experience! Some are just plain ignorant and even dangerous, especially those with less than a few years of hospital, regular RN experience.
Finally, be concerned with outsourcing. Many of my dictated reports are sent to transcriptionists in India via the internet. I have seen MRI's get sent to Israel and Australia for cheaper readings, so I am not sure radiology is the "cush job" it once was. A pathology MD friend told me that AI is slowly but surely taking over the interpretation of biopsy slides. Surgery is probably the only area where there is a longterm "safe harbor" for those of you who put in so many years to make it to the promised land.
I hope that my thoughts, which are as honest and direct as I could possibly have written, give you accurate and helpful insight into what you can expect. Good luck to all.
I started my career at a time when the MD was omnipotent in the healthcare field; a time when he (very few she's back then) entered the nurse's station, you as the nurse gave him your seat, if he had no place to sit, so he could write his orders. No EMR's back then. Everything revolved around the MD, and he was a "God-like figure".
Back then, and through the 90's, there were very few prior authorizations, and the medical field was not controlled by the insurance companies. Today, everything is cost based. You will come to hate prior authorizations, as they are so time consuming, and you will also come to see that everything is based on productivity, and what "will save the most money".
Don't get me wrong, the medical field is still a great place to work, but you must be aware of how things not only have changed, but drastically. I find most MD's I work with are still happy with their career choice, yet many strongly encourage their children to find another vocation. NP's don't have to spend months preparing for Step I and Step 2 exams. Gunners don't exist in the NP world. NP's don't have to worry about some strict State Board of Medicine coming down on them, as patients today can file grievances on-line. State nursing lobbies are very powerful (and very liberal), as politicians realize (and want to please) their strength in numbers.
I recently finished a locums job where the unit I worked on had one IM MD hospitalist, and three NP's. 15 years ago, rounds would have been done by the family GP, but rarely does the family doc even venture into the hospital.
NP's who started as floor nurse like me, and who worked 20 years in various settings before becoming NP's, are far superior (IMHO) to those NPs who become RN's/BSN's and quickly work to get their NP credentials on-line, and by the age of 24 are writing orders. Soon the NP field will be saturated, just like the pharmacy field. Salaries will drop. Salaries for MD's are stagnant and dropping in metro areas. Why would a clinic want to pay $150 per hour to an MD when they can get essentially the same services, from an NP or PA for $85 per hour? You don't need 8 years of medical training to manage somebody's HTN or DMII.
I leave making a decent $145,000 per year w/ great benefits. 24 states now let NPs work completely independent of MD's. Clinics and other facilities that were 100% MD 15 years ago are now probably 50-50 between MDs and NP's/PA's. PA's are often very good, but the "beef" I have with them is that most of them have no, or very little prior hospital experience, like most older NPs who worked as staff RN's, before entering the world of writing prescriptions and orders labs and tests.
When I went through NP training (MSN), I went to a real university, had to get up early and drive through rush hour traffic for long lectures and labs, while today, everything but NP clinical practicums is done on-line. I have preceptored five NP students, and frankly, NO STATE should allow any NP to prescribe until he or she has five years of experience! Some are just plain ignorant and even dangerous, especially those with less than a few years of hospital, regular RN experience.
Finally, be concerned with outsourcing. Many of my dictated reports are sent to transcriptionists in India via the internet. I have seen MRI's get sent to Israel and Australia for cheaper readings, so I am not sure radiology is the "cush job" it once was. A pathology MD friend told me that AI is slowly but surely taking over the interpretation of biopsy slides. Surgery is probably the only area where there is a longterm "safe harbor" for those of you who put in so many years to make it to the promised land.
I hope that my thoughts, which are as honest and direct as I could possibly have written, give you accurate and helpful insight into what you can expect. Good luck to all.
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