A landmark decision in my workplace

[BlueDevil,DNP, DNP, RN]

We found out on Friday that our corporate pay schedule is being completely revamped and NPs and MDs/DOs in any given specialty will be paid the same, weighted according to experience, not educational path. MSN/DNP prepared NPs will earn the same as MDs/DOs with the same amount of time in practice. Post graduate residency does count toward years of experience, as do fellowships. My "residency" was part and parcel of my graduate program, i.e. pre-graduation, and would not count. They way it was explained to me is that the corporation sees no effective difference between the physician in his/her first year of practice after a 3 year family practice residency and the NP with 3 years experience.

Salary varies widely according to specialty. I am in family practice and we are at the bottom of the salary tiers, but I am about to get a 28K a year raise, effective July 1st. Some of the specialties do not have NPs, so it doesn't apply-surgery for instance.

Bonuses will be paid on productivity and billing/collections, and be completely unrelated to level or type of education. They also threw out the patient satisfaction component. All that matters now is how much revenue one generates for the (for-profit) company. This is a very large corporation spanning two states, with 9,000 employees. It was approved by the board of directors that is almost entirely (11 physicians and 1 NP) made of up physicians- and it will be interesting to see how many of our competitors follow suit in the next few years. If this is the future, one would have to be absolutely crazy to go to medical school and then enter a low paying specialty like family practice/pediatrics, etc.

I think NPs might also have to be crazy to stay in backward states that do not allow for NP independence. I will be earning twice what my Duke classmates who stayed in NC earn, and have complete autonomy while I think the North Carolina NP practice act still calls for "supervision."

I suspect the dominos will start falling soon. States that restrict practice and income will not have any providers at all, and with health care reform coming to fruition around the corner, no one can afford to be in that position.

Unfortunately, the organization sees PAs differently and they are not included in the restructuring. There is one CNS (in diabetes) and she was not included either and I heard she resigned in protest at the end of the day Friday. Both of the states that this organization has offices in have independent provider status for NPs. I assume PAs and the CNS were left out because they cannot be independent providers. This is a real shame, and I hope it will be rectified very soon.

[zenman]

Interesting. What do the physicians think about this? Do you also have PMHNPs there?

[BlueDevil,DNP, DNP, RN]

It only came to light on Friday, so I don't really know what the physicians think company wide. In my office, the docs were all for it because they feel we are doing the same job and should be paid equivalently. They aren't making any less money, we are being brought up. If their salary was being cut, I'm sure they would not be so supportive!

I imagine the people with the biggest beef (and rightfully so) will be the PAs. We don't have many at all. NPs outnumber PAs about 20:1 in the company. Surgery has a few PAs, one in the hand clinic and one in the ortho clinic that I know of, but I haven't encountered any in the other areas. They may be there, I don't pretend to know the credentials of all 9,000 employees. I do know that NPs are preferred by this company, not because we are better in any way, but because we require no oversight of any kind there is no additional responsibility for the physicians. They seem to prefer it that way. They don't like being liable (on paper) for anyone else's work I guess. Simpler for them to just work alongside other MDs/DOs and NPs for whom they have no legal responsibility or liability.

I do know that they are over the moon that the patient satisfaction criteria has been dropped from the bonus structure!! That seemed to be the thing that held back the docs in my office from qualifying for the larger bonuses. I've never come close to qualifying based on productivity; I see 1/4 to 1/3 fewer patients than they do because I'm a chatty Cathy and I don't do 15 minute visits. My shortest is 20 minutes now. I see an average of 18-20 a day lately, and my physician roomie sees 35-40. He double books people in 15 minute slots all day and averages about 6 minutes a patient, so he deserves to earn a big bonus as he is brining in a lot more money than I am! It isn't their fault if the patient doesn't like the person who answers the phone (or more often, doesn't answer, lol) or doesn't think they got enough time, coddling, or vicodin! They are thrilled they will no longer be losing money based on judgements of people not qualified to evaluate them professionally!

No, we don't have any PMHNPs or psychiatrists in the group.

[Baubo516, RN]

What state do you work in?

[libran1984, ASN, RN]

YAY!!! That makes me so happy to hear they're throwing away the patient satisfaction component. While pt satisfaction sounds great in theory, it is abused like the 1-10 pain scale rating and does not directly reflect the quality of care received.

[traumaRUs, MSN, APRN]

Hmm...as a CNS (certified in two speciaties) employed by a specialty practice where the PAs, NPs and I do the same exact job and bill the same way...I would be ticked too.

[studentdrtobe]

They're basing the pay on "years" of experience rather than number of clinical hours of experience? Does that mean that physicians who trained for 80 hrs/week for 3 years of residency are getting paid the same as someone who practiced for 40 hrs/week for 3 years? I'm kind of speechless if that's the case; it completely devalues medical education and gives another reason for medical students not to pursue primary care. Also, how does complexity of patients factor into the pay? Just curious.

Please don't take this as an attack. I hope you understand where I'm coming from (re: decreasing med students' motivation to go into primary care since it would require 7 years of investment, with the rigors associated with med school and residency, instead of a few years through the NP/PA programs). This is the first I'm hearing of something like this happening.

[BlueDevil,DNP, DNP, RN]

I don't blame you trauma. I don't think it is fair, but I don't think CNS's in this state (which for privacy reasons I am not going to name) have an independent scope of practice so she found herself in the same boat as the PAs. She runs the diabetes education classes, and I have no idea how profitable those are. I don't think she manages patients independently. This company is all about how many dollars you are billing/collecting. They decided to run it like the large law firms: billables billables, billables. Everyone is created equal and the only hierarchy is that demonstrated by P&L statements.

They may come around on that issue eventually. In the meantime, I just think it is momentous that we are now officially recognized as fully equal peers to our physician colleagues in every way.

[BCgradnurse, MSN, RN, NP]

Very interesting. I'm happy for you and your NP colleagues.

[myelin]

Wow! That's amazing. I will be going to school in a non-independent practice state (CA), but plan on practicing in either OR or WA. I plan on advocating for myself very strongly. Anyone have any advice on negotiating or books to check out? I am early in my career, but I want to be prepared and not get taken advantage of.

[PetsToPeople]

Awesome!

[RxOnly]

Congrats on the raise!

Question though- not to hijack the post, but it has me thinking about where I may want to practice in the future. What states allow for an NP to practice independently, or where can I find that information? I live in MA and I don't believe we are one of those states (correct me if I'm wrong) ...Thanks, and congrats again to the OP :)