Excellent Employment Prospects for Nurse Practitioners

djmatte, ADN, MSN, RN, NP · Mar 7, 2018

The big if in your statement is by 2024 "at current rates." A lot can happen by 2024. I don't think that underserved areas will go away by 2024 and surplus of NPs does not mean they will be appropriately distributed. In addition, I expect a lot more states will have full practice authority by 2024. Furthermore, we don't know what will happen to the supply of primary care MDs by 2024. By 2024, there could be a crackdown on subpar NP schools, or a change in the student loan system. All of these would have to be analyzed for a good prediction for 2024.
I do want to clarify that my intent in starting this thread was to focus on the short-term NP job market. For recent NP grads and those who are currently in NP school, job prospects are good if they are willing to go where the work is.
I also want to urge new grad NPs to work in under-served areas. There are a lot of these and they are not just rural areas. These sites may pay more and may be eligible for loan repayment and forgiveness programs. One to two years in such an area should not be a big deal and it may turn out the NP grows to like the location.
I've been clear that people should be willing to move when starting a new profession. Aspiring actors and actresses move to LA or NYC. High tech people move to Silicon Valley, Washington DC, Boston, etc. New grad lawyers go work for the firm that offered them a job. New doctors go where they are matched for internship and residency. Why would it be different for new NPs? Lack of mobility is a serious handicap for any professional career.

I won't commuter I someone thinking their own projections are somehow superior to federal government estimates. Quite frankly, DHHS probably had a lot more expertise in this department than you.

Outside that, doctors have luxuries few RNs who choose to go on to advance practice have. The vast majority are actively working and have homesteads well before advancing their careers. In many cases they are primary breadwinner in their households. So to suggest nurses should be willing to just uproot is massive at best and shows clear ignorance of the nursing profession as a whole. But as we've covered in the past, your goal was to be a provider and you have no concept of the nursing profession. You want to spread your rose colored glass view as if so long as you land the job, all other commitments, obligations, and personal preferences just don't exist or will just go away. Most people don't have the luxury of living I that fantasy land.

FullGlass, BSN, MSN, NP · Mar 7, 2018

I won't commuter I someone thinking their own projections are somehow superior to federal government estimates. Quite frankly, DHHS probably had a lot more expertise in this department than you.
Outside that, doctors have luxuries few RNs who choose to go on to advance practice have. The vast majority are actively working and have homesteads well before advancing their careers. In many cases they are primary breadwinner in their households. So to suggest nurses should be willing to just uproot is massive at best and shows clear ignorance of the nursing profession as a whole. But as we've covered in the past, your goal was to be a provider and you have no concept of the nursing profession. You want to spread your rose colored glass view as if so long as you land the job, all other commitments, obligations, and personal preferences just don't exist or will just go away. Most people don't have the luxury of living I that fantasy land.

You start your comment with"I won't commuter I someone thinking their own projections are somehow superior to federal government estimates." That statement makes no sense in English.

Your view of medicine is rose-colored. The average med student graduates with $200,000 in debt. They make basically nothing in internship, and not that much more in residency. So most of them opt for an income-based loan repayment plan, which means their interest accumulates until they get their first decent-paying job, so their student loan debt increases. I fail to see how a doctor in internship and residency can afford a decent home unless their spouse has a good job. Go talk to some new doctors if you don't believe me.

I don't know why you are so upset with me. I am an optimist, as you may have gathered from my screen name. I am sick of some people on this forum painting a gloomy picture of being a nurse practitioner.

You also resort to making a personal attack on me. How is this warranted? I merely stated I believe the short term job market is good for NPs and that new grad NPs should be prepared to relocate.

Nurse practitioners can make very good money. A new grad NP in California makes over $100K per year. Given that they only had to go to school for 1 to 2 years, that is very good money. And a lot of NP students have to move in order to attend a bricks and mortar nursing and nurse practitioner program. At least in my graduating class, most of the NPs were young and single and did not own homes. Most of them were also not from the same city as the school was located in. So, most of them moved upon graduation. I'm older, but I was more than willing to move to get the right first job, plus I had a public service obligation. In addition, in California a 1 hour commute is nothing extraordinary.

And a gentle reminder: when looking at research and reports, nurse practitioners are trained to evaluate the evidence. There is no "perfect" projection or estimate, at least not until it has come true. A good NP uses their critical thinking skills to evaluate and discuss research and reports. And we don't personally attack professionals with different opinions.

I fail to understand why some people on this forum get so angry with optimism. Those of you who want to be gloomy are free to do so. Those of us who want to be more optimistic have a right to express our views without being personally attacked.

djmatte, ADN, MSN, RN, NP · Mar 7, 2018

You start your comment with"I won't commuter I someone thinking their own projections are somehow superior to federal government estimates." That statement makes no sense in English.

There's this feature on smartphones called autocorrect that doesn't always correct appropriately. And here I thought you had a background in IT....

FullGlass, BSN, MSN, NP · Mar 7, 2018

There's this feature on smartphones called autocorrect that doesn't always correct appropriately. And here I thought you had a background in IT....

Whether or not you used autocorrect, the statement did not make sense in English.

I do not understand why you feel compelled to attack me. You recently obtained your NP and got a good job. I, along with many others, sincerely congratulated you. I would think that you would be happy about your recent successes and excited about your new career as an NP. You are now in a position to mentor and encourage other good people who wish to become RNs and NPs. It is sad that you are not interested in doing so, but choose to use this online forum to mount personal attacks on, and snarky comments to, a fellow NP who has some different opinions and a different background than you.

If you want to discuss this topic with me, I am happy to do so, but I will no longer engage with you if you continue to make snarky comments to me.

guest769224 · Mar 7, 2018

@ FullGlass

People can disagree as much as they please on this forum. It isn't attacking you.

Ironically, you yourself have posted personal attacks in prior threads.

RJamesMed · Mar 7, 2018

@FullGlass

This is my first comment, but I'm a long time reader. I might get banned for asking this, but are you a some type of college recruiter? I only ask this, because many of your posts are about how the jobs are plentiful, everyone should be an NP, you don't have to be a nurse to become an NP, and how being an NP is the greatest thing since sliced bread (everybody join the party). It's almost like the "come to America, where the streets are paved with gold" slogan, America used to recruit Europeans. And like one pointed out: It's always you and ShibaOwner (Name?) with the same posts. The thing is that it really isn't like that. Here in NYC, there are employers asking PMHNP's to work for $90,000, though the cost of living is ridiculous. Hospitals who survive mostly on Medicaid pay $110,000 - $120,000, the NP's in NY are reimbursed 100%. Seems like everyone is in NP school. NP videos on YT are becoming very popular. There has to be higher standards or this profession will never be great. A friend of mine opened his/her own practice in NYC (charging cash), because she wants to make as much money as she can before all the PMHNP students flood the market in 2-4 years. Heck, I almost feel bad for psychiatrists. Almost anyone can get into these schools (pass the easy classes) and it shouldn't be that way. I hate to comment on anything, but I feel the truth has to get out there. 3rd year RN's are making almost $100,000 a year (without overtime) in the "good" NYC hospitals, but their NP's make around $114,000.

Oldmahubbard · Mar 7, 2018

I can appreciate optimism about the NP career, and mine eventually went very well, although it took quite awhile. However, I know people who are still drowning in debt, and working 60 hours a week, 15 years later. Getting regular phone calls from collections.

I feel for all the unemployed NPs that we will eventually see if and when the market is truly glutted. Which seems inevitable if the low quality, low standard schools remain in operation.

The same thing happened in law and education.

In education, anybody could get a teaching certificate, and anybody did.

And yes, the cream of the crop will probably still do OK, but the fact that there are so many unemployed NPs will directly depress wages.

And wages are already quite low. I can't believe how many people are still working for 100k or less.

I didn't do it for the money, but if I were still paying off loans, it would be disheartening.

In my case, I happened to be in the right place at the right time. There was a big luck factor involved.

I went to a respected brick and mortar program, but I wouldn't call it academically rigorous.

I am almost entirely self taught, with good and bad mentors, as I have previously said.

And the salary I am currently getting is based on the limited availability of PMHNPs.

My pay would literally drop by 40k a year if there were a bunch of others willing and able to do what I do.

I can't imagine how people are getting clinical placements. That might be the saving grace.

Being an NP has never been about making money, but when I went to speak to a group of undergrads, that was their main question.

Some were also astounded that I diagnose people with schizophrenia without the help of a physician.

Rant over.

FullGlass, BSN, MSN, NP · Mar 7, 2018

@ FullGlass
People can disagree as much as they please on this forum. It isn't attacking you.
Ironically, you yourself have posted personal attacks in prior threads.

Calling me snobbish for saying the job market is good is unwarranted and demonstrates a lack of vocabulary. By encouraging people to enter the nurse practitioner profession, I am being the opposite of snobbish. I have also apologized for losing my temper in previous threads. Some of you evidently feel a compulsion to personally attack me no matter what I say. I think I could say "the sun rises in the east and sets in the west" and someone would attack me. Disagreement does not mean free rein to launch personal attacks.

FullGlass, BSN, MSN, NP · Mar 7, 2018

@FullGlass
This is my first comment, but I'm a long time reader. I might get banned for asking this, but are you a some type of college recruiter? I only ask this, because many of your posts are about how the jobs are plentiful, everyone should be an NP, you don't have to be a nurse to become an NP, and how being an NP is the greatest thing since sliced bread (everybody join the party). It's almost like the "come to America, where the streets are paved with gold" slogan, America used to recruit Europeans. And like one pointed out: It's always you and ShibaOwner (Name?) with the same posts. The thing is that it really isn't like that. Here in NYC, there are employers asking PMHNP's to work for $90,000, though the cost of living is ridiculous. Hospitals who survive mostly on Medicaid pay $110,000 - $120,000, the NP's in NY are reimbursed 100%. Seems like everyone is in NP school. NP videos on YT are becoming very popular. There has to be higher standards or this profession will never be great. A friend of mine opened his/her own practice in NYC (charging cash), because she wants to make as much money as she can before all the PMHNP students flood the market in 2-4 years. Heck, I almost feel bad for psychiatrists. Almost anyone can get into these schools (pass the easy classes) and it shouldn't be that way. I hate to comment on anything, but I feel the truth has to get out there. 3rd year RN's are making almost $100,000 a year (without overtime) in the "good" NYC hospitals, but their NP's make around $114,000.

I am not a recruiter. I have been clear that NP job markets vary by location. In many previous posts, I have urged new grads to look outside the highly competitive job markets such as NYC, SF, LA, etc., for more opportunities with better pay. When I wrote an article about new grad NP job search, I was clear that my article was based on the Western U.S.

My experience is very different because I only looked for work in Underserved areas. In underserved areas, which do include some large cities, there is, by definition, a shortage of primary care and mental health care providers.

In addition, I have confined my comments to primary care NPs. I don't discuss acute care NPs or PMHNPs because I have no knowledge of these job markets. (Although I know there is an acute shortage of PMHNPs in California).

So, let me state this as clearly as possible: The short term job market for primary care NPs is excellent in some locations. Be prepared to move in order to get the best job. If you won't, or can't, relocate, then your job prospects and pay may be more limited.

twozer0, NP · Mar 7, 2018

Respectfully, I disagree. If we are concerned about the quality of NPs, then we do not want to limit the supply of NPs. By limiting supply, that sets up a situation where all NPs get hired, regardless of quality. That is not good for patients. We want a situation where only the best NPs get hired, which should increase the overall quality of NPs that are hired. We live in a capitalist economy where market forces drive supply and demand in the job market.
There is concern over the proliferation of subpar NP schools and I share that concern. That is an issue that should be addressed. Simply stating that there are too many NPs and the NP job market is bad is not addressing that issue. It's also not true - the NP job market varies by location. There will always be a demand for NPs in underserved areas, by definition. In addition, the top NP grads will get jobs.
If the NP profession does not regulate itself and adopt higher standards for admission to NP programs, then the job market will perform this function. The low quality NPs will not get hired and that will result in the closure of the low quality NP schools. That is how job markets work in a capitalist economy.
With regard to medical schools, there has been a lot of criticism that the US needs more medical schools and that there is an attempt by medical organizations to deliberately keep the supply of MDs too low, in order to prop up MD compensation. This is not good for patients.
America should get rid of oppressive job licensing - Licence to kill competition
Occupational licensing blunts competition and boosts inequality - How to rig an economy

The argument was not about the quality of NP's, the argument was about the job market and oversaturation. Sure there will be jobs, but you'll have hundreds lining up for the availability. If you think for a second that a business wouldn't pit you against each other, you are sadly mistaken. It's not about quality, its about the bottom line. It always has been. This happens in EVERY industry. Why do you think Unions exist?

In regards to your comment about medical school. Medical school is not the dictator of the supply of physicians en route to practice, residency is. There are more applicants to match than available and some never get matched. Residency is what dictates who enters practice, which is primarily backed by CMS. There are some private slots created by grants, private funds, or university center funding but the majority are CMS. This means there are a finite amount of docs entering the workforce every year based on residency. Its not the medical schools limiting the supply, its the residency. So I'm not sure where you are getting your information from.

momofm1998 · Mar 7, 2018

I am seeing the result of the massive number of NP's the colleges are grinding out. The schools have found a way to fill their coffers to pay for their sports department and are going big guns. The direct entry schools and online schools are absolutely trashing the profession. Every nurse that can fog a mirror wants to go to "NP" school. And if they have the loan or tuition fees, they will be accepted. I see the salaries dropping in this area. Experienced NPs seeking jobs for 6-9 months before finding something besides a pain clinic position. NPs being expected to see and complete pt visits in 10 min or less. Yes, the over supply is by location but eventually those areas will overlap and "saturation". I, myself, am considering taking a position as an RN simply to pay the bills. Have an RN friend working as a case manager for an insurance company making more than NPs in my section of the country. As time goes on, NPs will leave the profession because of the points made in many of the posts here. It is a simple equation, over supply= low pay, no jobs. Happens in any profession of too many applicants for available jobs.

FullGlass, BSN, MSN, NP · Mar 7, 2018

The argument was not about the quality of NP's, the argument was about the job market and oversaturation. Sure there will be jobs, but you'll have hundreds lining up for the availability. If you think for a second that a business wouldn't pit you against each other, you are sadly mistaken. It's not about quality, its about the bottom line. It always has been. This happens in EVERY industry. Why do you think Unions exist?
In regards to your comment about medical school. Medical school is not the dictator of the supply of physicians en route to practice, residency is. There are more applicants to match than available and some never get matched. Residency is what dictates who enters practice, which is primarily backed by CMS. There are some private slots created by grants, private funds, or university center funding but the majority are CMS. This means there are a finite amount of docs entering the workforce every year based on residency. Its not the medical schools limiting the supply, its the residency. So I'm not sure where you are getting your information from.

With regard to doctors, there is a projected shortfall of 100,000 doctors by 2030. Addressing this requires:

1) More medical schools slots

2) More residencies

3) Greater use of NPs and PAs

So you do have a valid point about residences and doctor supply, but that is not the only issue in doctor supply.

The above doctor shortage will likely increase demand for NPs and is not figured into most estimates and predictions for the NP job market.

I fundamentally believe in a free market and competition. I am against efforts to limit the supply of professionals in any field, simply to artificially inflate salaries. Given the rising costs of healthcare, such efforts are ultimately harmful to patients and distort the economy. It appears we have a philosophical difference on this.

I am fine with unions. As Henry Ford said, "Any company that gets a union deserves one." Smart employers treat their employees well so they don't form a union. However, I'm in primary care, and most primary care is delivered in small clinics, maybe with just one NP. Therefore, unions really don't make sense for primary care NPs.

Personally, I always strive to be among the best at what I do. I expect to compete for good jobs. In my opinion, in the long run, eliminating competition for jobs will result in poor quality job candidates. Without competition, where is the incentive to strive for greatness?

Let's take a look at STEM and high tech. There is no effort to decrease the number of STEM graduates. Yet, Silicon Valley is screaming they need more and more of these folks and even need to import them. Salaries are extremely high for skilled tech people. And even in a recession, the best tech people have jobs.

Efforts to artificially limit the number of healthcare practitioners will ultimately backfire. First, there will be a move to import more practitioners. Second, this would give even greater impetus to automation efforts. Even doctors are not exempt from this. Japan already has robot nurses.

In my opinion, our profession would be best served by advocating for stricter admissions and credentialing for NP programs, along with educating prospective NPs on job prospects. Simply trying to discourage all prospective NPs is not helpful, because we will always need good candidates. Painting a blanket picture of doom and gloom for the NP profession will also discourage the good candidates, which is not good for our profession.

A Doctor Shortage? Let’s Take a Closer Look - The New York Times

Research Shows Shortage of More than 1