Equal pay for Equal Work NP

[VA Hopeful Dr]

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I am okay with them reforming their own education. But, I would rather physicians be involved to ensure standards are met.

My state medical board requires 20 hours of CME per year for physicians to remain licensed. Board certification requires 150 every 3 years, but you do not need certification to practice - only licensure.

This is not to say that APNs should not be required to do more - perhaps they should. I also think the physicians in my state should be require to do more. I am just saying that the minimum requirements for APNs and physicians are not that different.

They are 30 for 2 years, so we have have them beat somewhat although interestingly they can renew licenses if they are board certified and skirt the state-required CME that way.

Something that occurred to me earlier: you've previously said you're a surgeon, correct? I've found that specialists tend to utilize midlevels differently than us primary care folks do. Ortho from what I've seen uses them as post-op rounders and in-office fracture care - both fairly easy and narrow in scope. OB/GYN as primarily pap smear monkeys, cardiology/GI/hospitalists/Pulm as first-line inpatient consult (getting all the history together for when the MD shows up to speed things along). Compare that to primary care where we have a tendency to just let them do their own thing most of the time. Might explain why you and I have different thoughts about the issue

 

[zeppelinpage4]

I once had a doc explain to me his argument for the NP/MD stuff. He argued that the big problem is that NPs want the same pay for the same work because they are actually doing the same work and they shouldn't be, and that is the fault of the FPs. He was a family practice doc that was arguing that we physicians have been operating below our level because of the system and the NPs should be doing the well adult checks and the ear infections, while the physicians should be doing the more complicated patients that the NPs don't feel comfortable taking. The system isn't set up this way, but he argued that it should shift so instead of FPs and NPs operating at 5/10 difficulty all the time, the NPs operate at a 5 all of the time and the FPs operate at an 8. Then we wouldn't be worried about encroachment.

I haven't really delved more into the issue, but it always seemed like an interesting take on it to me.

I heard this today as well. I don't know how true it is, but I was told nurses are doing a lot of the doctors jobs because it's getting forced on to them, even if it's outside their scope of practice. They're getting this along with the long hours.

 

[Mjolner]

If they are doing the same work, then there's no good argument against equal pay.

If it wasn't for NPs and PAs, people would be dying because they wouldn't get to see their doctor on time. The medical training system is too elitist and ineffective to provide affordable care to 300 million people.

That's like paying Mike Trout the same money as a rookie straight out of the minors.
They may be doing exactly the same work, but one is probably a whole hell of a lot better at it and deserves to have some more money in his paycheck.


Sent from my iPhone using SDN mobile

 

[Mace1370]

It's not equal work. They don't have comparable training and to claim their work is equal to that of their superior is a false equivalency.

It never ceases to amaze me at the lies people tell themselves to justify their desire to take from others. If you want to earn more, then go to medical school and become a physician. Lobbying congress to be paid the same for less training is disgusting, imo.

 

[WingedOx]

yes, but the NPs see your fancy graphics, and raise you this...

 

[TwinsFan]

yes, but the NPs see your fancy graphics, and raise you this...

The "Not extenders or mid-levels" part is sort of debatable depending on perspective or semantics (even though the only reason they exist in the first place was to perform that very role)...

But the "not non-physicians" is absolutely incorrect. Everyone who isn't a physician is by definition... a NON-PHYSICIAN. lol

 

[giantswing]

Equal pay for equal education!

...oh wait...

 

[WingedOx]

The "Not extenders or mid-levels" part is sort of debatable depending on perspective or semantics (even though the only reason they exist in the first place was to perform that very role)...

But the "not non-physicians" is absolutely incorrect. Everyone who isn't a physician is by definition... a NON-PHYSICIAN. lol

sorry, it's on a graphic. It must be true. I saw it on twitter.

 

[Señor S]

yes, but the NPs see your fancy graphics, and raise you this...

At least she's fulfilling a public need by practicing in the underserved Seattle metro area.

 

[dr zaius]

I use the mid levels to enhance the efficiency of the practice. However, I still work longer hours, make bigger decisions, take more liability, and bring in more revenue. Therefore, I get paid more. Would you suggest that a CEO make the same money as a VP or department manager? Isn't the CEO simple making money off the backs of his employees?

As I read these forums, particularly with regard to mid-levels, I see most of the arguments against them are made from one of several questionable angles:
1) APNs go to school less so must be worse. Truth is that many APNs go to school only to learn primary care - not surgery, labor and delivery, intensive care, oncology, all the other things physicians need exposure to. Therefore, less school is not necessarily inappropriate.

The rest of the stuff you posted is fine, but I have an issue with this one. Primary care "providers" see post surgical, postpartum and pregnant, post ICU stay, and cancer patients all the time. By no means are they supposed to be an expert on each of these fields, but they should have enough exposure to pick up on the important outcomes/complications/side effects when these patients come to the clinic. That's what makes an excellent primary care "provider."

 

[ProfMD]

The rest of the stuff you posted is fine, but I have an issue with this one. Primary care "providers" see post surgical, postpartum and pregnant, post ICU stay, and cancer patients all the time. By no means are they supposed to be an expert on each of these fields, but they should have enough exposure to pick up on the important outcomes/complications/side effects when these patients come to the clinic. That's what makes an excellent primary care "provider."

I completely agree with you. I certainly would not ask you to read everything I have written, but I would advocate APNs in 2 roles: (1) directly supervised by a physician in speciality and primary care and (2) serving underserved areas if they are first trained by a physician.

I certainly do not want to rehash all the arguments for and against, but suffice to say, I do not see APNs as equivalent to physicians in every way, by I do see that they can provide meaningful health care that is better than no health care.

 

[DrMaccoman]

https://www.linkedin.com/in/melissadecapua

That militants nurse you quoted went direct from bsn to np school. No rn experience before whatsoever. The notion that most nurse practitioners are seasoned nurses before is a lie. The tide is turning and you have a bunch of new nursing grads taking this joke of an online degree right after college.

 

[Psai]

I heard this today as well. I don't know how true it is, but I was told nurses are doing a lot of the doctors jobs because it's getting forced on to them, even if it's outside their scope of practice. They're getting this along with the long hours.

Yeah 40 hours a week is long when you're used to doing 3 12s with mandatory breaktime