NP salary question

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futurepsych0

futurepsych0

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Hey everyone, this is not a how much does an NP make question but rather why do they make what they do. I was checking out this website http://www.midlevelu.com/blog/salary-comparison-np-vs-pa-vs-md, among others, and found that NPs tend to make about half of what MDs make. Now, this seems to hold true for family and peds but when it comes to other specialities it does not remain constant. Now on this website http://www.kevinmd.com/blog/2010/03/crna-salaries-surpass-primary-care-doctors.html we can see crnas making about half of what an MD makes in that speciality. So I was simply wondering if anyone could shed some light on how NPS are paid (especially in specialities) because I don't understand why there is such a difference. I remember reading a few people say insurance reimbursement for NPS is ~80% of what an MD gets reimbursed. Needless to say that just makes everything lack more sense. I appreciate any feedback and thank you in advance for educating my ignorance.
 
Any surgical specialty the MD will make significantly more than the PA or NP. They do the difficult parts of the procedure and hold all the risk therefore make the cabbage. As far as family practice and peds, most NP/PA make their money on the amount of patients they see. They have a base salary and then usually bonus out after seeing "x" amount of patients in a given time which can increase their salary. This is dependent upon the group they are with, it may not be true across the board. Its a classic notion that FP/Peds docs make garbage compared to specialties...not doing procedures hits them hard. As far as CRNA's making a lot of cash its because they can do everything (at least almost everything) a normal anesthesiologist can do. They will work for an SP but they can travel to areas that the doc doesn't want to go and be there to do all the procedures. There is a lot of money in anesthesia therefore they make more money than say a pain management NP/PA simply because pain management doesn't involve taking someone to a point where they would die without the MD/CRNA doing their job well. I'm sure there are NP/PAs out there making 200K a year, but this is rare. It simply comes down to what your scope of practice, how long you have been working, and the fact NP/PAs are not doctors. Just the way it is.
 
futurepsych0 said:
Hey everyone, this is not a how much does an NP make question but rather why do they make what they do. I was checking out this website http://www.midlevelu.com/blog/salary-comparison-np-vs-pa-vs-md, among others, and found that NPs tend to make about half of what MDs make. Now, this seems to hold true for family and peds but when it comes to other specialities it does not remain constant. Now on this website http://www.kevinmd.com/blog/2010/03/crna-salaries-surpass-primary-care-doctors.html we can see crnas making about half of what an MD makes in that speciality. So I was simply wondering if anyone could shed some light on how NPS are paid (especially in specialities) because I don't understand why there is such a difference. I remember reading a few people say insurance reimbursement for NPS is ~80% of what an MD gets reimbursed. Needless to say that just makes everything lack more sense. I appreciate any feedback and thank you in advance for educating my ignorance.
Click to expand...

NPs and PAs generally are employees of physicians or facilities, so the practice or facility reimbursed generally at 80-85 percent of what the NP or PA is doing. But you aren't comparing them straight up with physicians, because the physician isnt always pocketing 100 percent to take home with them... their practice is reimbursed at 100 percent of a rate. Out of the funds coming in from MD and NP/PA, a great deal of those funds go to support the overhead. So rent, staff, insurance, taxes, materials, charity care, a bajillion other things that needs to be paid for. So even saying a physician gets paid 100 percent of what comes in is deceiving yourself. Salaries are just a portion of where money goes out.

To sum up, you have all the money (100 percent of what an MD is reimbursed, and 85 percent what the non physician provider is reimbursed), going into the pot. From that pot all the practice expenses are paid. Generally, the physicians are the ones who own the practice, so it makes sense that since they hold all the risk, they get most of the reward. The "midlevels" are employees who expect to get paid regardless of how well things are going, so they get a wage. NPs that are out on thier own... practicing in psych for instance, would reap whatever they didnt have to pay out in overhead, but they would have to do it from reimbursements of 85 percent of a physician (but there are often things that they can be reimbursed at 100 percent, though). CRNAs also can be reimbursed at 100 percent for anesthesia services. MD anesthetists make bank often because they run the practice and hire 4 CRNAs to work anesthesia. As a nurse, the hospital bills for things that I do, and they do it at rates that are much higher than what they pay me. The meds I churn out at 30 dollars per tylenol doesnt get back to me.... the wage they pay me doesn't reflect on the true cost of whats going on. But then again, there are days that the hospital is making no money on a patient that Im taking care of, yet they still pay me because they pretty much have to.
 
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pamac said:
NPs and PAs generally are employees of physicians or facilities, so the practice or facility reimbursed generally at 80-85 percent of what the NP or PA is doing. But you aren't comparing them straight up with physicians, because the physician isnt always pocketing 100 percent to take home with them... their practice is reimbursed at 100 percent of a rate. Out of the funds coming in from MD and NP/PA, a great deal of those funds go to support the overhead. So rent, staff, insurance, taxes, materials, charity care, a bajillion other things that needs to be paid for. So even saying a physician gets paid 100 percent of what comes in is deceiving yourself. Salaries are just a portion of where money goes out.

To sum up, you have all the money (100 percent of what an MD is reimbursed, and 85 percent what the non physician provider is reimbursed), going into the pot. From that pot all the practice expenses are paid. Generally, the physicians are the ones who own the practice, so it makes sense that since they hold all the risk, they get most of the reward. The "midlevels" are employees who expect to get paid regardless of how well things are going, so they get a wage. NPs that are out on thier own... practicing in psych for instance, would reap whatever they didnt have to pay out in overhead, but they would have to do it from reimbursements of 85 percent of a physician (but there are often things that they can be reimbursed at 100 percent, though). CRNAs also can be reimbursed at 100 percent for anesthesia services. MD anesthetists make bank often because they run the practice and hire 4 CRNAs to work anesthesia. As a nurse, the hospital bills for things that I do, and they do it at rates that are much higher than what they pay me. The meds I churn out at 30 dollars per tylenol doesnt get back to me.... the wage they pay me doesn't reflect on the true cost of whats going on. But then again, there are days that the hospital is making no money on a patient that Im taking care of, yet they still pay me because they pretty much have to.
Click to expand...

Does the 85% vs 100% difference make sense? Like, what is the rationalization behind paying 100% vs 85% for the same service, the only difference being the provider? Is there legislation in the works to change that?
 
NYCGuy86 said:
Does the 85% vs 100% difference make sense? Like, what is the rationalization behind paying 100% vs 85% for the same service, the only difference being the provider? Is there legislation in the works to change that?
Click to expand...

The rationalization is that NPs and PAs are generally dependent on either collaboration or supervision respectively from Drs. Doctors go through more training, and therefore have a deeper pool of knowlege to draw from, making them more valuable. Thier education is more expensive and they generally have greater scope available to them with which to treat. They have greater liability when they are supervising. Its not always the case that they are reimbursed at greater rates, but that is generally the case with many things. That standard is set by medicare/medicaid, and the insurance companies follow suit. I dont know about legislation in the works, but it seems like Ive heard of things like that occasionally. Its nothing to freak out about in my opinion though. When a doctor is in the mix, even though you might be getting the same treatment at that moment as a nonphysician provider would provide, the doctor is getting paid for his/her expertise and potential to troubleshoot. To me, that makes sense.
 
pamac said:
The rationalization is that NPs and PAs are generally dependent on either collaboration or supervision respectively from Drs. Doctors go through more training, and therefore have a deeper pool of knowlege to draw from, making them more valuable. Thier education is more expensive and they generally have greater scope available to them with which to treat. They have greater liability when they are supervising. Its not always the case that they are reimbursed at greater rates, but that is generally the case with many things. That standard is set by medicare/medicaid, and the insurance companies follow suit. I dont know about legislation in the works, but it seems like Ive heard of things like that occasionally. Its nothing to freak out about in my opinion though. When a doctor is in the mix, even though you might be getting the same treatment at that moment as a nonphysician provider would provide, the doctor is getting paid for his/her expertise and potential to troubleshoot. To me, that makes sense.
Click to expand...

Thanks, yes that does make sense.

What about for independent NPs, with no collaborative agreement with a physician? Is it the same? I guess the "education" reasoning would still apply in that situation though.
 
NYCGuy86 said:
Thanks, yes that does make sense.

What about for independent NPs, with no collaborative agreement with a physician? Is it the same? I guess the "education" reasoning would still apply in that situation though.
Click to expand...

Here's an interesting link for you:

http://blog.aarp.org/2013/03/29/nurse-practitioners-the-answer-to-the-doctor-shortage/

The healthcare law "obamacare" sounds like it provides equal pay for equal work, but Medicaid won't.

In most states an NP still needs a collaborative agreement to practice. I can't name one that doesn't.
 
AnnoyedByFreud said:
Really? Oregon, Washington, New Mexico, Arizona, DC, Idaho, Montana, Utah, Maine, New Hampshire, Vermont, Iowa etc...
Click to expand...
I was thinking the same thing...aren't there like 22 states with no md collaboration requirement, soon to be 30 if current bills pass?
 
Dynamo24 said:
Any surgical specialty the MD will make significantly more than the PA or NP. They do the difficult parts of the procedure and hold all the risk therefore make the cabbage. As far as family practice and peds, most NP/PA make their money on the amount of patients they see. They have a base salary and then usually bonus out after seeing "x" amount of patients in a given time which can increase their salary. This is dependent upon the group they are with, it may not be true across the board. Its a classic notion that FP/Peds docs make garbage compared to specialties...not doing procedures hits them hard. As far as CRNA's making a lot of cash its because they can do everything (at least almost everything) a normal anesthesiologist can do. They will work for an SP but they can travel to areas that the doc doesn't want to go and be there to do all the procedures. There is a lot of money in anesthesia therefore they make more money than say a pain management NP/PA simply because pain management doesn't involve taking someone to a point where they would die without the MD/CRNA doing their job well. I'm sure there are NP/PAs out there making 200K a year, but this is rare. It simply comes down to what your scope of practice, how long you have been working, and the fact NP/PAs are not doctors. Just the way it is.
Click to expand...

That makes perfect sense. I also assume that the more complicated (life threatening) procedures being done by the doctor will also call for a higher reimbursement thus making their higher salaries axiomatic. Since the NP/PA deal with the more "routine" their salaries tend to remain around the same range (80-105) regardless of whether they practice within a specific specialty or not. Thank you for your input.

pamac said:
NPs and PAs generally are employees of physicians or facilities, so the practice or facility reimbursed generally at 80-85 percent of what the NP or PA is doing. But you aren't comparing them straight up with physicians, because the physician isnt always pocketing 100 percent to take home with them... their practice is reimbursed at 100 percent of a rate. Out of the funds coming in from MD and NP/PA, a great deal of those funds go to support the overhead. So rent, staff, insurance, taxes, materials, charity care, a bajillion other things that needs to be paid for. So even saying a physician gets paid 100 percent of what comes in is deceiving yourself. Salaries are just a portion of where money goes out.

To sum up, you have all the money (100 percent of what an MD is reimbursed, and 85 percent what the non physician provider is reimbursed), going into the pot. From that pot all the practice expenses are paid. Generally, the physicians are the ones who own the practice, so it makes sense that since they hold all the risk, they get most of the reward. The "midlevels" are employees who expect to get paid regardless of how well things are going, so they get a wage. NPs that are out on thier own... practicing in psych for instance, would reap whatever they didnt have to pay out in overhead, but they would have to do it from reimbursements of 85 percent of a physician (but there are often things that they can be reimbursed at 100 percent, though). CRNAs also can be reimbursed at 100 percent for anesthesia services. MD anesthetists make bank often because they run the practice and hire 4 CRNAs to work anesthesia. As a nurse, the hospital bills for things that I do, and they do it at rates that are much higher than what they pay me. The meds I churn out at 30 dollars per tylenol doesnt get back to me.... the wage they pay me doesn't reflect on the true cost of whats going on. But then again, there are days that the hospital is making no money on a patient that Im taking care of, yet they still pay me because they pretty much have to.
Click to expand...

I understand that if I work for let say a hospital, I would not be paid the amount of money i generate. A percentage always goes back into the pocket of whoever hired me for their overhead. However, this is what confuses me looking at it mathematically, if a doctor gets 100 dollars back for seeing a patient and an NP/PA gets back 80 (for the 80% reimbursement) and the employer takes 25% for overhead that would leave the doctor with $75 and the NP/PA with $60 (this is of course assuming that they take a percentage and not a solid figure). Looking at things this way would lead someone to assume that NPs/PAs salaries within specialties would rise and dwarf the salaries of NPs/PAs in fam/ped just how it does in the MD/DO world. I would also like to take this moment to clarify that I am in no way trying to insinuate that NPs/PAs should be making the same as their MD/DO counterparts. I highly respect the higher education and expertise of MDs and DOs and i would hate for this post or my comment to turn this into another doctor vs midlevel thread. But I guess since NPs/PAs do not perform the more life threatening procedures in specialties their reimbursement remains about the same while the MD/DO shoots up. Your post did help me understand a bit and I thank you for it. I currently do not work in a healthcare field so I lacked the understanding on how things worked in that realm.

NYCGuy86 said:
Does the 85% vs 100% difference make sense? Like, what is the rationalization behind paying 100% vs 85% for the same service, the only difference being the provider? Is there legislation in the works to change that?
Click to expand...

The only legislation in works for NPs (state by state) is to allow them to practice without the need of a SP or collaboration. Reimbursement is decided by insurance companies and they tend to enjoy spitting on providers. They will make as much cuts as possible. I was originally going to pursue a PhD in psych and was more interested in the clinical aspects of it. After doing some research, I do not think you will find a better example of how insurance companies can spit on a provider than a clinical psychologist (which is why, among other things, I am now going to go back and get another bachelors in nursing and eventually do NP). So, I personally do not think that they will start paying NPs/PAs more just because. If anything, they will try to further lower the reimbursement of both the MDs/DOs and NPs/PAs.
 
AnnoyedByFreud said:
Really? Oregon, Washington, New Mexico, Arizona, DC, Idaho, Montana, Utah, Maine, New Hampshire, Vermont, Iowa etc...
Click to expand...

emedpa said:
I was thinking the same thing...aren't there like 22 states with no md collaboration requirement, soon to be 30 if current bills pass?
Click to expand...


This actually leads me to another question. Would anyone happen to know if NPs that work in independent states make more, on average, than states that require stricter supervision/collaboration? I understand the desire to be autonomous (being able to do things on your own especially if there is not an MD/DO available to collaborate with) and the benefits it can potentially have for patients who live in areas with a very limited supply of MD/DO but is there also a financial benefit to the NP provider?
 
AnnoyedByFreud said:
Really? Oregon, Washington, New Mexico, Arizona, DC, Idaho, Montana, Utah, Maine, New Hampshire, Vermont, Iowa etc...
Click to expand...

I was under the impression that a collaboration plan of some nature needs to be on file, even in independent states. Even better.
 
pamac said:
I was under the impression that a collaboration plan of some nature needs to be on file, even in independent states. Even better.
Click to expand...
there are degrees of independence.
some states allow an np to own/run a practice independently but if they want to rx narcs they need a collaborating md. the number of truly independent( can run clinic AND rx narcs on their own) is lower than the numbers typically quoted as "independent states". don't remember what that # is, something like 12ish I think...
interesting factoid:
% of NP's who are practice owners? 4-5%
% of PAs who are practice owners? 4-5%
 
emedpa said:
there are degrees of independence.
some states allow an np to own/run a practice independently but if they want to rx narcs they need a collaborating md. the number of truly independent( can run clinic AND rx narcs on their own) is lower than the numbers typically quoted as "independent states". don't remember what that # is, something like 12ish I think...
interesting factoid:
% of NP's who are practice owners? 4-5%
% of PAs who are practice owners? 4-5%
Click to expand...

Thats probably a reflection of how hard it is to run a business (and be a provider). I can't see myself wanting to deal with the headaches associated with being a boss unless it was something like psyche with very little overhead. Being an employee suits me just fine.
 
pamac said:
Thats probably a reflection of how hard it is to run a business (and be a provider). I can't see myself wanting to deal with the headaches associated with being a boss unless it was something like psyche with very little overhead. Being an employee suits me just fine.
Click to expand...
yup, me too.
 
futurepsych0 said:
That makes perfect sense. I also assume that the more complicated (life threatening) procedures being done by the doctor will also call for a higher reimbursement thus making their higher salaries axiomatic. Since the NP/PA deal with the more "routine" their salaries tend to remain around the same range (80-105) regardless of whether they practice within a specific specialty or not. Thank you for your input.



I understand that if I work for let say a hospital, I would not be paid the amount of money i generate. A percentage always goes back into the pocket of whoever hired me for their overhead. However, this is what confuses me looking at it mathematically, if a doctor gets 100 dollars back for seeing a patient and an NP/PA gets back 80 (for the 80% reimbursement) and the employer takes 25% for overhead that would leave the doctor with $75 and the NP/PA with $60 (this is of course assuming that they take a percentage and not a solid figure). Looking at things this way would lead someone to assume that NPs/PAs salaries within specialties would rise and dwarf the salaries of NPs/PAs in fam/ped just how it does in the MD/DO world. I would also like to take this moment to clarify that I am in no way trying to insinuate that NPs/PAs should be making the same as their MD/DO counterparts. I highly respect the higher education and expertise of MDs and DOs and i would hate for this post or my comment to turn this into another doctor vs midlevel thread. But I guess since NPs/PAs do not perform the more life threatening procedures in specialties their reimbursement remains about the same while the MD/DO shoots up. Your post did help me understand a bit and I thank you for it. I currently do not work in a healthcare field so I lacked the understanding on how things worked in that realm.



The only legislation in works for NPs (state by state) is to allow them to practice without the need of a SP or collaboration. Reimbursement is decided by insurance companies and they tend to enjoy spitting on providers. They will make as much cuts as possible. I was originally going to pursue a PhD in psych and was more interested in the clinical aspects of it. After doing some research, I do not think you will find a better example of how insurance companies can spit on a provider than a clinical psychologist (which is why, among other things, I am now going to go back and get another bachelors in nursing and eventually do NP). So, I personally do not think that they will start paying NPs/PAs more just because. If anything, they will try to further lower the reimbursement of both the MDs/DOs and NPs/PAs.
Click to expand...

I think you are right on the money about lowering reimbursement.

One thing you seem to be missing out on is the fact that in most cases, an NPP is given an offer or negotiates with an employer. There could be a divying up of spoils as part of the arrangement, but its usually presented differently. Its not usually so much a "you have this much of a stake in the practice" as much as a "the captain of the pirate ship counts the money, and unless you have specific arrangements made for a percentage of the booty, he will pay you a wage, and the rest goes where he wants it". Its the difference between being an employee and a partner. Generally, the NPP is an employee, and this is reinforced when someone has supervision, or structured collaboration over you. It makes all the difference in the world where the money goes before it gets to you. You dont have a ton of skin in the game... 100 percent of what you generate goes to the boss who sends it back at you in whatever portions you guys agreed to.
 
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emedpa said:
there are degrees of independence.
some states allow an np to own/run a practice independently but if they want to rx narcs they need a collaborating md. the number of truly independent( can run clinic AND rx narcs on their own) is lower than the numbers typically quoted as "independent states". don't remember what that # is, something like 12ish I think...
interesting factoid:
% of NP's who are practice owners? 4-5%
% of PAs who are practice owners? 4-5%
Click to expand...

Here is a current map indicating the status of the 50 states. See attached.
 

Attachments

pamac said:
I think you are right on the money about lowering reimbursement.

One thing you seem to be missing out on is the fact that in most cases, an NPP is given an offer or negotiates with an employer. There could be a divying up of spoils as part of the arrangement, but its usually presented differently. Its not usually so much a "you have this much of a stake in the practice" as much as a "the captain of the pirate ship counts the money, and unless you have specific arrangements made for a percentage of the booty, he will pay you a wage, and the rest goes where he wants it". Its the difference between being an employee and a partner. Generally, the NPP is an employee, and this is reinforced when someone has supervision, or structured collaboration over you. It makes all the difference in the world where the money goes before it gets to you. You dont have a ton of skin in the game... 100 percent of what you generate goes to the boss who sends it back at you in whatever portions you guys agreed to.
Click to expand...

So I guess the trick is to find an MD to make you a partner rather than an employee or open up your own practice (in states that allow it). I just read, in another post, that a board certified GP was complaining because her husband (a psychiatrist) hired a psych NP and this NP was making more than her. So I guess being a partner or owning a practice is more of a factor than anything else. I can see why I didn't understand salaries because there are so many damn factors that can make all the difference in the world. Thank you.


Now I know this is derailing my own thread but I was wondering if anyone knows if healthcare experience plays a big part in getting accepted to an accelerated BSN program (stony brooks in particular). I am finishing up two classes for pre reqs and have a 3.9 GPA for my bachelors degree, I have TAed for two years, and have one semester of volunteering in a psychiatric hospital. I was thinking of maybe applying to become a volunteer EMT but it would really drain me since I work full time and go to school. I did look at their programs requirements for applying and it does not mention healthcare experience, but I just want to be safe.

Also, is there any preferred individuals to get letters of recommendations from? The program requires three and I was thinking of using a family friend who is an NP, the professor who oversaw my TA and tutoring, and someone who I know from work who is on the board of trustees of a hospital. I thought that would give me the best mix of personal, academic, and work related recommendations, but I don't know if that is what schools want. Any advice would be appreciated.
 
futurepsych0 said:
So I guess the trick is to find an MD to make you a partner rather than an employee or open up your own practice (in states that allow it). I just read, in another post, that a board certified GP was complaining because her husband (a psychiatrist) hired a psych NP and this NP was making more than her. So I guess being a partner or owning a practice is more of a factor than anything else. I can see why I didn't understand salaries because there are so many damn factors that can make all the difference in the world. Thank you.


Now I know this is derailing my own thread but I was wondering if anyone knows if healthcare experience plays a big part in getting accepted to an accelerated BSN program (stony brooks in particular). I am finishing up two classes for pre reqs and have a 3.9 GPA for my bachelors degree, I have TAed for two years, and have one semester of volunteering in a psychiatric hospital. I was thinking of maybe applying to become a volunteer EMT but it would really drain me since I work full time and go to school. I did look at their programs requirements for applying and it does not mention healthcare experience, but I just want to be safe.

Also, is there any preferred individuals to get letters of recommendations from? The program requires three and I was thinking of using a family friend who is an NP, the professor who oversaw my TA and tutoring, and someone who I know from work who is on the board of trustees of a hospital. I thought that would give me the best mix of personal, academic, and work related recommendations, but I don't know if that is what schools want. Any advice would be appreciated.
Click to expand...

Hce doesn't play much of a role at all for accelerated bsn programs... Grades do. You are probably in really good shape. The pace is busy and they want to know how well you can handle the academics. I see more folks in accelerated programs that have no HCE than have it.

And yes... Psyche NPs can make bank.

One thing to remember about independence is that you only can practice as freely as what you can be reimbursed for, or whatever the facilities you work in will allow. So you may be "independent" but hospitals won't let you work without cosigning with a doc, or an insurance won't reimburse NPs for certain work. That's separate entirely from what the state says about you being able to practice on your own (another wrinkle in the topic). Psyche is great I that regard because its procedures are more straightforward to being reimbursed, and there is less overhead for other ancillary items. You often sit back, listen, prescribe, and maintain. So there's less for an insurance company to sit there and say "why was an NP doing this when a physician or specialist would have been more appropriate to evaluate this patient and decide if this was neccessary?"

So the landscape has wrinkles that add to the complexity of practice. The new heathcare law, according to things I've read, insists that insurance companies reimburse equally NPs vs PAs based on procedure... So if it's a procedure or activity that NPs can do, and they do it, it pays the same as a physician would. Obviously, physicians are going to be the ones doing the more expensive and specialized stuff, but that bodes ok for many of the things NPs do already.
 
pamac said:
...So the landscape has wrinkles that add to the complexity of practice. The new heathcare law, according to things I've read, insists that insurance companies reimburse equally NPs vs PAs based on procedure... So if it's a procedure or activity that NPs can do, and they do it, it pays the same as a physician would. Obviously, physicians are going to be the ones doing the more expensive and specialized stuff, but that bodes ok for many of the things NPs do already.
Click to expand...

I'm not sure what you mean. Do you mean reimburse NPs and PAs the same, or NPs preferentially better?
 
I dont know about whether PAs are in on that deal or not.
 
PAMAC, are you an NP now? If so, what field do you work in?
 
pamac said:
One thing to remember about independence is that you only can practice as freely as what you can be reimbursed for, or whatever the facilities you work in will allow..
Click to expand...
very true. I work in a state that does not require chart review but the hospital requires 100% chart review so that trumps state law.
we have an np in our group who is according to the state "independent" but not by our group which only lets her work in urgent care and requires 100% of her charts cosigned.
PAs in our group work in the e.d. and obs unit as well as urgent care. I work for a group with lots of former military docs and they are all familiar with PAs but not with NPs from their time in the military.
 
HenryH said:
PAMAC, are you an NP now? If so, what field do you work in?
Click to expand...

I'm in medical lab science and nursing. Right now in nursing full time at my home facility where I was a lab scientist for the last few years (and who paid for my nursing school), and I picked up a part time gig at another hospital in their lab on my time off when I'm not doing my 3/12s a my "home hospital". Because of overtime, I can't really dip into lab and nursing at one single facility and not go over, and I really need to spend 3 full shifts focusing on nursing since I'm new to it. At some point in the future when I'm ready to hack it, I may switch over to nursing at facility 2 instead of working their lab, but I want to get more time under my belt before I try to do that. Interesting enough, as a lab scientist at hospital 2 I make more than I did as a lab scientist at hospital 1, but nursing at hospital 2 would pay less than nursing at hospital 1. But it's a pretty awesome ER there at hospital 2 that I'd like to work in, and close to home. Great for prn work.
 
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I guesse maybe I wasn't clear... I'm an RN when I'm a nurse. Now working on my bachelors completion program. Currently have an associates, but will have the bachelors done by this time next year.... Taking it slow because of all the stuff going on right now with certifications and training for my department. Slow means one class at a time.
 
I will again derail my own thread because I didn't feel like starting a new one. Here is an interesting video on NPs. I was impressed when the NP kept her cool after an obgyn said NPs are dumber than dog doo and I was surprised to hear her malpractice insurance is only 1200 a year. This video also helps clarify some questions on Independence that were brought up on this thread. I hope this information is informative to someone out there!
http://www.midlevelu.com/blog/nurse-practitioners-and-call-independence (the link to the video is found in this article)
 
np malpractice is subsidized/underwritten by the nursing organizations which is why it is so low.
for a pa and an np to do the same thing at the same place the pa pays something like 5x the malpractice because they are not subsidized.
np em policy around 1500/yr
pa em policy 6000-7000/yr
md/do em policy 25-35k/yr

interesting that most nonphysician provider jobs in em still go to PAs in the vast majority of places(aside from where pamac lives apparently which must be some np stronghold like ohio, indiana, or illinois where pa laws are still pretty backwards).
I see 10 em pa job listings for every one for an np. PAs are recognized by the american college of emergency physicians as the " non-physician provider of choice" in emergency medicine.
 
emedpa said:
np malpractice is subsidized/underwritten by the nursing organizations which is why it is so low.
for a pa and an np to do the same thing at the same place the pa pays something like 5x the malpractice because they are not subsidized.
np em policy around 1500/yr
pa em policy 6000-7000/yr
md/do em policy 25-35k/yr

interesting that most nonphysician provider jobs in em still go to PAs in the vast majority of places(aside from where pamac lives apparently which must be some np stronghold like ohio, indiana, or illinois where pa laws are still pretty backwards).
I see 10 em pa job listings for every one for an np. PAs are recognized by the american college of emergency physicians as the " non-physician provider of choice" in emergency medicine.
Click to expand...

Very interesting, I was wondering why it would be so low. I always thought it would be on par of what an MD/DO pays. I guess that is a benefit. 10 to 1? I hope you aren't in NY otherwise I'll have a hard time finding a job at a hospital with those odds :-/. I appreciate the input and information.

You work in a hospital right? I know it would be anecdotal but in your experience would you say the job market for CRNAs is saturated? That is another path I am considering post BSN. I just remember reading that in a forum and would like to hear from someone who is in a hospital setting having first hand experience. Again, I appreciate any input.
 
futurepsych0 said:
Very interesting, I was wondering why it would be so low. I always thought it would be on par of what an MD/DO pays. I guess that is a benefit. 10 to 1? I hope you aren't in NY otherwise I'll have a hard time finding a job at a hospital with those odds :-/. I appreciate the input and information.

You work in a hospital right? I know it would be anecdotal but in your experience would you say the job market for CRNAs is saturated? That is another path I am considering post BSN. I just remember reading that in a forum and would like to hear from someone who is in a hospital setting having first hand experience. Again, I appreciate any input.
Click to expand...
lots of em pa jobs in new york state. most of the good ones are not in nyc but upstate. lots of small rural facilities with solo pa coverage 24/7.
crna jobs are still very plentiful and will likely continue to be. lots of great single coverage crna gigs at rural facilities. my new rural job has a crna on call 24/7/365 for emergent procedures.
 
I know quite a few ACNPs... they're not exactly starving for work around here.
 
emedpa said:
np malpractice is subsidized/underwritten by the nursing organizations which is why it is so low.
for a pa and an np to do the same thing at the same place the pa pays something like 5x the malpractice because they are not subsidized.
np em policy around 1500/yr
pa em policy 6000-7000/yr
md/do em policy 25-35k/yr

interesting that most nonphysician provider jobs in em still go to PAs in the vast majority of places(aside from where pamac lives apparently which must be some np stronghold like ohio, indiana, or illinois where pa laws are still pretty backwards).
I see 10 em pa job listings for every one for an np. PAs are recognized by the american college of emergency physicians as the " non-physician provider of choice" in emergency medicine.
Click to expand...

I don't live any of those places, but my state is about as friendly to PAs as it can get. But the PAs in ERs is a marketing issue more than anything else. You don't brag about your patients seeing a non physician provider... Unless you want to basically send the message to patients that in a potential crises that there is a chance they won't see a doctor. Rural ERs are the exception because they need coverage and have trouble getting providers. Most other places they put you on triage or doing minute clinic duties, and in those roles you would be hard pressed to have a facility want anyone but a physician doing something rough for fear of lawsuit. So in that capacity it makes the NP or PA an assistant in a true sense.

It doesn't surprise me that physicians orgs that traditionaly oppose nurse independance are fine with promoting dependent PAs as a political statement, so their endorsement of PAs should be looked at with that in mind. Pas have to deal directly with physicians according to their pleasure... What's not for them to like.

The malpractice issue is another canary in the coal mine for PAs.... Who is looking out for them to help lower their rates? The physicians? If they are, what good is it doing... It's still however many times greater than NPs. Shows a great deal of weakness that nobody is going to bat for them there. This isn't weakness regarding training or ability(PAs haste well trained), but that their national org is weak and excited about their role as a dependent provider... And fearful of offending physicians in the slightest. Incedentally, that aspect of being dependent also is one of the reasons PAs insurance is higher... They are connected to physicians, and lawyers want a crack at their moneybags when they sue... And another reason emergency groups hire independent providers oftentimes.... It insulates them from harm because the litigant has to prove that if a mistake is made, that the practice had some idea of the provider having a known history of problems. With a PA they jut have to show that their physician didn't pay as muh attention to what was going on and only signs charts once a month, if even that. It's the difference between driving your own car drunk, or someone else letting you drive their car when they know you are drunk. PA rates are higher in large part because of their dependent status, not just because nursing groups subsidize insurance. That helps, but there's more to it. But often practices cover insurance for non physician providers.

So yeah, I don't look at the job boards, even though I do get emails every week that offer jobs to NPPs due to my old associate membership to the AAPA when I was a Pre PA. Mostly they say "seeking PA/NP". The only career guaranteed to dominate emergency medicine is that of physicians and RN. And like emedpa says, much of the time in "midlevel" roles it matters what you did in a previous career.... If you werent an ER nurse prior to NP or PA training, you are at a disadvantage. So they are picky. New grads can pull it off, but they scare the heck out of everyone unless they are in fasttrack doing minute clinic.
 
One of the things that came to mind when I was deciding between NP and PA (among many things I considered), was the strength of their position in medicine. AAPA isn't ever going to be stronger. One problem is that PA schools are churning out younger and younger grads... folks who will get their first career level job when they become a PA. They have little understanding of the value they can potentially bring to an employer, and dont have much experience dealing with employers and HR about wages. Theres not a lot for them to compare to. That doesn't make for rabid advocates for the profession. Say what you want about them, but I'll throw my lot in with the crazy cat lady's running nursing, because at least they know what they want (everything), and how to get it (by being a pain in the butt). When you get wind of how over half the room at an AAPA convention starts freaking out over some common sense items that would improve the image of PAs considerably, you start to figure out which profession is going to advance faster (or advance at all).

A mental excercise that illustrates this is to pretend there is a magic wand that would exchange PA's with NP's in thier regulated roles to see which group would be pleased with thier level of independence, and which would feel ripped off. The PAs would love to be offered parity with NPs, and the NPs would be upset at functioning as a dependant provider. That tells you which organization carries more weight. This is sad, because PAs are extremely well schooled, and probably should have the kind of representation nurses do.
 
emedpa said:
np malpractice is subsidized/underwritten by the nursing organizations which is why it is so low.
for a pa and an np to do the same thing at the same place the pa pays something like 5x the malpractice because they are not subsidized.
np em policy around 1500/yr
pa em policy 6000-7000/yr
md/do em policy 25-35k/yr

.
Click to expand...

Just FYI my psych NP policy in an indenpendent state and not connected with any nursing organization was $800 yr.
 
pamac said:
One of the things that came to mind when I was deciding between NP and PA (among many things I considered), was the strength of their position in medicine. AAPA isn't ever going to be stronger. One problem is that PA schools are churning out younger and younger grads... folks who will get their first career level job when they become a PA. They have little understanding of the value they can potentially bring to an employer, and dont have much experience dealing with employers and HR about wages. Theres not a lot for them to compare to. That doesn't make for rabid advocates for the profession. Say what you want about them, but I'll throw my lot in with the crazy cat lady's running nursing, because at least they know what they want (everything), and how to get it (by being a pain in the butt). When you get wind of how over half the room at an AAPA convention starts freaking out over some common sense items that would improve the image of PAs considerably, you start to figure out which profession is going to advance faster (or advance at all).

A mental excercise that illustrates this is to pretend there is a magic wand that would exchange PA's with NP's in thier regulated roles to see which group would be pleased with thier level of independence, and which would feel ripped off. The PAs would love to be offered parity with NPs, and the NPs would be upset at functioning as a dependant provider. That tells you which organization carries more weight. This is sad, because PAs are extremely well schooled, and probably should have the kind of representation nurses do.
Click to expand...
totally agree. if I could have the training and job opportunities of a pa and the practice rights of an np I would be much happier indeed.
 
pamac said:
One of the things that came to mind when I was deciding between NP and PA (among many things I considered), was the strength of their position in medicine. AAPA isn't ever going to be stronger. One problem is that PA schools are churning out younger and younger grads... folks who will get their first career level job when they become a PA. They have little understanding of the value they can potentially bring to an employer, and dont have much experience dealing with employers and HR about wages. Theres not a lot for them to compare to. That doesn't make for rabid advocates for the profession. Say what you want about them, but I'll throw my lot in with the crazy cat lady's running nursing, because at least they know what they want (everything), and how to get it (by being a pain in the butt).
Click to expand...

:laugh: It's funny because it's true. And you're right, the fact that nursing actually knows how to get shi* done (despite its many flaws), was a huge reason why I decided on this route.
 
emedpa said:
totally agree. if I could have the training and job opportunities of a pa and the practice rights of an np I would be much happier indeed.
Click to expand...

I'm not sure that the job opportunities aren't there for NPs. I see them all over. Obviously, jumping between soecialties is easier for PAs, but if you are a nurse, and want to commit to a path, you can do equivalent things.... ie RN first assist if you want to do surgery. But these days, even jumping around as a PA among different specialties is getting more complicated. As far as salary and NPs clustering around certain areas.... 96 percent of NPs are female. Many NPs started out as floor nurses working tough schedules. Once they finish their NP, they are ready to get out of the grind and sacrifice the high wages and pressure of specialties and working for demanding physicians. Why not just relax in a primary care clinic 9-5? A motivated NP has a lot of options, and I never compare my prospects to general trends. I compare myself to the other male NPs, whose salaries match PAs, and function outside of the norms that you see represented for most NPs as far as what fields they prectice in.
 
pamac said:
I'm not sure that the job opportunities aren't there for NPs. I see them all over. .
Click to expand...
very location dependent.
I see LOTS of outpt jobs for NPs in psych, fp, peds, women's health, pain clinic, etc but it is very rare to see an inpt np position posted at least around here
 
emedpa said:
very location dependent.
I see LOTS of outpt jobs for NPs in psych, fp, peds, women's health, pain clinic, etc but it is very rare to see an inpt np position posted at least around here
Click to expand...

The last 2 PAs I saw in an inpatient setting rounded... in the evenings... when I'm assuming doctors didn't want to be there. PA forums are littered with stories of PAs getting lowball offers to work aweful shifts on the floor. Inpatient work is a tough sell. Besides, if I wanted to do that, I'd look into acute care NP.

So the university of washington acute care nurse practitioner program isn't prducing NPs that can gain any traction there? Someone better tell them theres no market for them.
 
pamac said:
The last 2 PAs I saw in an inpatient setting rounded... in the evenings... when I'm assuming doctors didn't want to be there. PA forums are littered with stories of PAs getting lowball offers to work aweful shifts on the floor. Inpatient work is a tough sell. Besides, if I wanted to do that, I'd look into acute care NP.

So the university of washington acute care nurse practitioner program isn't prducing NPs that can gain any traction there? Someone better tell them theres no market for them.
Click to expand...
I know a few grads of the uw np program. they all work urgent care.
yes, there are some crappy inpt pa jobs out there. the central truth of being a pa is that docs hire us to do the work they don't want to do at the times and placs they don't want to do it.
this is nights/weekends/holidays/inner city/rural/ early am rounds/ hospital and er consults, admissions, and discharges/hep c and pain management clinics, etc
lucky for me I like working all nights and rural.
 
looks like U of W doesn't even have an acute care np program. They only have Adult NP, Family NP, Neonatal NP, Nurse Midwife, Pediatric NP, and Psych NP.

Also, looks like at UW Med Center, they've got jobs for NP/PA in Wound/Ostomy (the hospital I work at has a consult wound care NP that works with the gen surg service), NP/PA for CT-ICU, and ER NP (and a CRNA position). Wasn't able to find any additional PA jobs there outside of the above two.

I've done searches for NP jobs (yes, I know it says "pre-pharm" to the left, but I'm strongly considering just sticking to my roots and going the nursing route with a second degree (no, not direct entry)), and I've seen many jobs for inpatient NPs. I've seen postings looking for hospitalist NPs, critical care NPs, ob/gyn NPs, cardiology NPs, interventional cardiology NPs, CV surgery NPs, neurosurgery NPs, GI NPs and heme/onc NPs. I live in NYC, and it looks like NYU, NYP, and Beth Israel have job listings for NPs in those areas. My hospital has an inpatient NP cardiology service as well (NYP has an NP/PA MICU, and various other area hospitals have NP/PA run services, very interesting). I've also looked at hospitals in California, Arizona, and Florida, and have found similar offerings. The only thing I would say is that PAs have more opportunities in surgical areas, especially when they're looking for someone for the intraoperative phase, since PAs have surgical clinical rotations, as well as surgical skills training. But FWIW, I don't think NPs have any difficulty finding inpatient jobs.
 
Someone mentioned pain medicine... out of curiosity, how much do pain NP's make on average? I couldn't find a statistic via Google. I was just wondering if they did really well since pain physicians sure do.
 
an rn first assist has no role outside of the OR.
A surgical PA or NP can also take first call to the ER, do hospital admits and discharges, take call to the floor, run the surgical clinic, write RXs, etc.
if all you want is to be in the o.r. then surgical tech and rn first assist are both good options. if you want more you need to be at the level of a PA or NP.
there are > 20 PA residencies in surgery(many around > 30 years), many in general surg but some specific to CT, burns, trauma, urology, neuro, derm, etc
see www.appap.org for links to most pa residencies.
 
The reality is that there are plenty of options for working in the OR, ER, ICU as a NP. Is the PA route for these roles more straight forward? Maybe. Are there more opportunities for PAs? Depends on location. But I see NPs working in these areas all the time. I also agree that nursing is an almost ridiculously viable field for anyone with the slightest business acumen. 50% of RNs have only an ADN degree, so coming into the field with a graduate degree already puts you well ahead. Male nurses especially have an easier time moving up. People who come into nursing well educated and with a plan for getting to the top seem to be very successful, from what I've seen around here (my experience is pretty limited to the bay area, so keep that in mind).
 
AnnoyedByFreud said:
The reality is that there are plenty of options for working in the OR, ER, ICU as a NP. Is the PA route for these roles more straight forward? Maybe. Are there more opportunities for PAs? Depends on location. But I see NPs working in these areas all the time. I also agree that nursing is an almost ridiculously viable field for anyone with the slightest business acumen. 50% of RNs have only an ADN degree, so coming into the field with a graduate degree already puts you well ahead. Male nurses especially have an easier time moving up. People who come into nursing well educated and with a plan for getting to the top seem to be very successful, from what I've seen around here (my experience is pretty limited to the bay area, so keep that in mind).
Click to expand...

I don't know that there is anything inately biased involved in males moving up quickly (when it happens). When I see females making thier way into upper levels, its because they share a lot of the same qualities that many of the successful males posess. It takes a certain degree of agressiveness (or maybe better termed as determination) to catch the eye of management. A lot of the folks who feel overlooked are actually in denial about thier unwillingness to modify thier approach to suit the wants of the bosses. If the Romans want a polished, diplomatic, management supporting go-getter, then do as the Romans do and refine yourself. It can be hard for a lot of folks, and especially many females, to balance responsibilities to thier families, manage to stay late, take on additional responsibilites at work, and fill in for folks who are absent. Those are things that get you noticed, and are things that clash with being a guilt free mom, wife (or live-in girlfriend), and all around home-making bad A. I also think males are a little more bold with thier approach to networking as well. When it came to the job search after RN school finished, I had been talking to the folks in charge about my goals for 2 YEARS, so it was no surprise when I showed up to the unit I wanted to be on months ahead of time asking for a job. Every clinical, at every facility I rotated through, I went to any manager I could track down and introduced myself and told them who had been training me that day (pretty transparent that I was trying to promote myself, but it meant that I at least stood out... and led to job offers). I even stepped into an open office door that I walked by of a nursing department on a unit I didn't even train on and said "Hi, I'm PAMAC, and I've been training on 5th floor with Toby... and I just want to compliment you on the nurses on the units here... this has been a great day for me". Its bold, and is basically a sales cold call, but it works to get you ahead (theres a way to do it and not creep people out too). And you never know who is going to come through for you. The seasoned CNA that you treated with respect and supported at every opportunity just might have the ear of the lady who you want to be your boss. Success isnt an action, its an attitude. You hear people talking about how they filled out 40 applications and have no takers. I don't fill out an application until I walk in and basically have a job lined up, or else have someone in the organization say "lets get your application in and see what we can do about getting you on". This is how my wife has been rolling for the last year or so as well, and it means that we get work... and we get it where we want to with minor compromise.

So in a nutshell, if I want something that is feasable and realistic to even a slight degree, I plan to obtain it. I'm not average. Its not that I'm awesome (I'm certainly not), but I am good at recognizing my weaknesses, and that is what gives me an edge. When my grades sucked, or I was painfully shy, or I didn't have any decent contacts in the medical field, I stepped out of denial, faced some inconvenient truths, and fixed it. Women in nursing can do this too, but many don't. If it seems like guys are busting into leadership roles, it might be because guys got into that mindset in the first place and thats how they got into nursing. The males who didn't have enough of the right stuff (or were too insecure) to take a leap into a female dominated realm self selected themselves out.

It takes finesse to get along in a minefield like nursing, especially if you are a guy. I also think that as a male, I'm a bit more guarded, and therefore less exposed than many of the females around me... and that helps mold someone who is a bit more appealing as managerial material. Think about it... being male and married, I'm pretty much programmed by default to avoid some of the pitfalls that come with socializing/fraternizing with the female staff. That leaves me out of the loop in some ways, but also tamps down the familiarization that can subtlely scuttle career plans. I think the majority of my peers show up to work as professionals, but because many males walk a bit more of a tightrope to avoid being seen as flirty (or worse), it provides a bit of distance from conversations about drama. This has the effect of insulating you from being involved in it even by association from merely hearing about it. And that makes it easier to stay above the fray... even if it really only seems that you are. But in reality, all of my supervisors are female, so if there is a gender bias towards males, I've yet to harness the benefit. I look at other units and see some of the same elements that I mentioned, though.
 
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