Fallout of Obamacare Question: Best Advanced Nursing Degree To Pursue?

Pachinko · Dec 16, 2012

I think that the original poster isn't asking about ACA-engendered changes in practice so much as changes in job prospects and overall roles of NPs within healthcare. I have a hard time believing that healthcare providers won't be impacted by millions of new patients obtaining health care coverage. My guess is that there will be an increase in most NP specialies, if only to accommodate the patient loads. I would also not be surprised if pay goes down uniformly as well, though the proponents of ACA say that it won't.

My sense is also that MDs will continue to gravitate toward specializing. The gov is giving incentives to MDs for staying in primary care, but they're not so good that they'll sway a majority of doctors. So, FNP, home care, preventative care...those are the fields that will probably expand most rapidly. But that doesn't mean that there won't be a lot of places for CRNAs, acute care NPs, etc. Just my dos centavos.

asiangal · Dec 18, 2012

Talked with a Director of Nursing today and she said that because physicians will be impacted negatively that Nurse Practitioners will be negatively impacted because [essentially] they play very similar roles. Now that I'm thinking about it....Family Physicians are going into many specialty type niches...and it maybe wise that Nurse Practitioners may want to follow-suit.

P.S. These are just some thoughts. Not saying it will happen. Just thinking out loud for those that want to read :)

Blessings all,

Asian Gal

InfirmiereJolie · Dec 18, 2012

Why do you call it "Obamacare"? Why not call it the Affordable Care Act? :***:

From what I've learned, it's only going to be BENEFICIAL! Those involved with primary care are going to get a 10% pay increase, the pay scale for medicaid is increasing, and QUALITY of care (not QUANTITY of care) is going to be rewarded slightly. There are also going to be more health community centers built (possibly hospitals?) due to the increase in demand and scholarships given for those interested in the health field (RNs, nurse practitioners, physicians, PA's, ect) to increase the number of professionals. They're also encouraging more professionals to provide care in undeserved areas.

It's all on the website timeline for the Affordable Care Act: Key Features of the Affordable Care Act, By Year | HealthCare.gov

Rebuilding the Primary Care Workforce. To strengthen the availability of primary care, there are new incentives in the law to expand the number of primary care doctors, nurses and physician assistants. These include funding for scholarships and loan repayments for primary care doctors and nurses working in underserved areas. Doctors and nurses receiving payments made under any state loan repayment or loan forgiveness program intended to increase the availability of health care services in underserved or health professional shortage areas will not have to pay taxes on those payments. Effective 2010 .

Increasing Payments for Rural Health Care Providers. Today, 68% of medically underserved communities across the nation are in rural areas. These communities often have trouble attracting and retaining medical professionals. The law provides increased payment to rural health care providers to help them continue to serve their communities. Effective 2010. Learn more about Rural Americans and the Affordable Care Act.

Strengthening Community Health Centers. The law includes new funding to support the construction of and expand services at community health centers, allowing these centers to serve some 20 million new patients across the country. Effective 2010.

Linking Payment to Quality Outcomes. The law establishes a hospital Value-Based Purchasing program (VBP) in Traditional Medicare. This program offers financial incentives to hospitals to improve the quality of care. Hospital performance is required to be publicly reported, beginning with measures relating to heart attacks, heart failure, pneumonia, surgical care, health-care associated infections, and patients' perception of care. Effective for payments for discharges occurring on or after October 1, 2012.

Encouraging Integrated Health Systems. The new law provides incentives for physicians to join together to form "Accountable Care Organizations." These groups allow doctors to better coordinate patient care and improve the quality, help prevent disease and illness and reduce unnecessary hospital admissions. If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save. Effective January 1, 2012. Fact Sheet: Improving Care Coordination for People with Medicare

Increasing Medicaid Payments for Primary Care Doctors. As Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government. Effective January 1, 2013. Learn how the law supports and strengthens primary care providers.

Paying Physicians Based on Value Not Volume. A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care. Effective January 1, 2015.

So, no I do not believe it is a "fallout" but more of a "benefit"

Pachinko · Dec 19, 2012

I don't really understand the logic behind "physicians will be negatively impacted, so nurse practitioners will as well." There are parallels between MD and NP roles, but there are also a lot of differences. The MD has a much larger scope of practice and also earns much more than the NP. MD schooling is also significantly longer than NP school. There may be some "meeting in the middle" on these issues rather than a uniformely negative impact.

MandaRN94 · Dec 21, 2012

The organization I work for is now hiring only FNP or PA as many clinics will be doing larger primary care services. We have hired WHNP and CNW for reproductive health services in the past but all open positions have now changed to FNP/PA as they can be cross trained to provide a larger scope of patient services.

Mijourney · Dec 24, 2012

IMO, do what you think you will enjoy and what will positively impact others who are in need of what you have to offer. I've been a nurse for a very long time and it concerns me that young people are only concerned about the external factors which may impact their practice versus the intrinsic factors which determines the type of care given and the effectiveness of that care. Obamacare or ACA should not be the major factor in determining what you want to do with your education or career. I would recommend that those of us that are concerned about Obamacare or ACA sit down and actually read what I believe is a 1500 page document and see what potential impact there is on health and medical care. In fact, those of us who haven't taken the time to review the ACA in its entirety, including me, need to sit down and take a close look. Oh, and make sure you review the document with an open mind.

SPower82 · Feb 3, 2013

check this out:

Health Care Future Bright for Nurses, Stinks for Doctors - Forbes

may not be accurate but essentially whats going to happen is there will be a big group of medicaid patients coming online in 2014. NPs stand to make more, physicians stand to loose. most CRNAs i think deal with elective surgeries which are mostly covered by private insurance and medicare anyway so probably no difference???

pro-student · Feb 8, 2013

And it's not Obamacare-It's the Affordable Care Act. Obama actually ran on the one payer system like Medicare but caved in when he knew he would never get it passed. The Affordable Care Act is actually based on what Romney got passed in Massachusetts when he was governor.

This!But to answer the OPs question, all segments of healthcare are likely to see a significant increase with more patients being insured, more will be able to afford and will seek care. This includes surgery, hospitalizations, primary care, mental health. There's a push to increase primary care since effective primary care reduces overall cost both fiscally and in health indicators. Since fee-for-service is more lucrative for specialists, physicians have heavily tended towards these fields (and APNs as well). One of the big ideas of healthcare reform is to re-incentivize primary care. Many leading healthcare experts believe that primary care NPs will be fundamental in meeting the increasing demands for PCPs. All that being said, it really truly boils down to what interest you (or anyone) as a healthcare provider. If you like primary care, you will be likely facing an improving environment to practice in. However, is you wanted to be a CRNA, more insured patients (and more people seeing a PCP) will invariably mean more surgeries and more demand for services. The same is true with any other specialty (CNMs, ACNPs, psych providers, etc...).

Solarcableguy · Feb 15, 2013

I'm an RN of 32 years old with 6 years of experience. I'm motivated and looking to further my education and marketability as a nurse. As I'm pondering my decision, obviously one must look at the fallout of Obamacare will have on the future of an advanced nursing degree.
That as a foundation, my questions are as follows:
1) Which advanced nursing degree would be wise to pursue knowing the Obamacare is just around the corner? I know you should choose a career path that best caters to your passion and strength.....but I'm just just seriously curious overall on what everyone's opinions are!!!
2) CRNA versus Nurse Practitioner - Which Nursing Professional (in your opinion) will benefit more (and get a greater Return on Investment) with their advanced degree? I know these 2 positions vastly differ in many ways...but my sense is one would be in more demand than the other. Based on my research, this is what I'm sensing:
1) Nurse Practitioners will be in greater demand because of the many doctors may getting out of the profession...causing a greater demand for Nurse Practitioners. More demand...equals more job security and pay.
2) CRNA's will be in less demand (and maybe get less of a Return on Investment) with this advanced degree than an Nurse Practitioner. The medical field seems to be going to the more "home health care" and the extreme causes related to Hospitals may force hospitals to have less budget to pay for CRNA's. Yes...I know that there will always people needing surgeries ect. But with many people going for CRNA's....the market could be much more saturated then the Nurse Practitioner
3) Masters in Science in Nursing (MSN) - Not sure how Obamacare will effect this but would appreciate anybodies input if a MSN is a better degree to pursue than an NP or CRNA. To me, common sense tells you, that getting a NP or CRNA would be better.
In closing, thanks for letting me share all this as I'm a person that thinks as I type. In terms of a potential decision, I've learned that some of the best choices you make are the ones you didn't make. After thinking things through a little bit more, perhaps (just perhaps) Obamacare will lesson the salaries of these Advanced Nursing Degrees and people won't get a good return on investment with their degrees. That said....perhaps its best to just be content where I'm at :)
Thoughts/Opinions?

As for the CRNAs having a lower demand that is not true based on the demographics and the numbers expected for surgical procedures over the next 10 years.

There is a predicted increase in surgical procedures requiring OR suites of 40% over the next ten years.

The average age of all nurses is 45 years of age. 27% of Anesthesiologists and CRNAs are over the age of 55. The baby boomers are retiring and will be around for at least 10-20 years after the youngest of them retires. This all adds up to a huge demand right around the corner for these services. Current, immediate demand is not as high, but this is only due to the economy and the fact that many of the baby boomers just started retiring in the last two years. The so called glut that many people on these boards are referring to is nothing more than a blip on the screen.

BCRNA · Feb 20, 2013

Go with what you love. Though I think that even if CRNA's get pay cuts, they will still make the same, if not more than NP's. If Obamacare doesn't get funded then everyone is going to suffer. Even if every has the same health care, if there is no one paying the bill then services will not be rendered. Medicare was already going bankrupt. Currently, most primary care providers I know are starting to refuse to take medicare patients because they don't pay well and take over a year to re-imburse. Though I think all nurse will see an increase in their scope of practice, just because they can do a physicians job cheaper (at least basic health care). I think NP's will be the gatekeepers and provide most of the care, and pass the complicated cases to physicians.

CRNAs don't generally like being called midlevel providers by the way, they can practice completely independently and provide the same care. They aren't physician extenders if they can replace them completely. CRNAs are not required to have a physician sponsor (or collaborater, not sure of the technical name since I am not an NP).

Pick whatever makes you happy, in the end that is all that matters. My personal opinion is that healthcare is going to collapse in on itself and be unable to pay the providers. Everyones pay is going to be cut, and our workload is going way up. The only thing that can prevent that is if they actually finance the new healthcare. You can't constantly provide a service that doesn't have an income.