AHNP v. FNP

ANPFNPGNP · Jul 25, 2009

Background, I am enrolled in a FNP program and will begin my first clinical classes this fall. Our school is offering a new adult health nurse practitioner program with added geri focus. My first question is for any adult health nurse practitioners (not acute care!), have you more difficulty finding employment versus your FNP counterparts? Where do you work? My second question is to those that are FNPs (not specializing), do you see many kids? My background is adult oncology/med-surg and I am not interested in working in a critical care area and my feelings re: treating children are neutral. Any advice/suggestions appreciated. Thanks.

I graduated from a dual ANP/GNP program and loved it. HOWEVER, I started working in urgent care and absolutely loved that too! Unfortunately, even though we rarely see kids at our clinics (there are urgent care clinics strictly for kids), sometimes we do and I needed to be able to see kids under the age of twelve. Well, I had to GO BACK to school. Fortunately, the program I attended offered a post-Master's certification as a FNP and they combined the Maternal/Child class, so that's the only class I had to take. Unfortunately, the Texas Board of Nursing wouldn't let me duplicate clinical hours and I had to REPEAT clinical hours in adult/geri...of course, the hours don't count if you get paid for them or complete them at your place of employment. You can only imagine how excited my internal medicine preceptor was, since I was required to work for FREE and he could legally bill for my services!

MarylouNP · Jul 25, 2009

I think the answer re difficulty finding a job as an ANP vs FNP depends on where you want to work...I am an ANP, I have worked for an internist, a group cardiology practice and now a large teaching hospital. An ANP can see pts over age 18, and pts younger than that "with an adult condition." I think I have seen less than 5 pts younger than 18 in my 10 years as an ANP, but that is probably based on my choice of employers and specialty.

sandnnw, BSN, MSN, EMT-B, APRN · Jul 25, 2009

I agree w/MaryLou. It depends, if you wish to work at Walgreens, Kroger, CVS etc. or a family practice (hence the F in FNP). And yes, you can't just walk into a job as an ANP. However, if you have no desire to work with kids (as I do) you don't have much of a choice, other than A/GNP or ACNP. I did not want to take the ACNP jump, so I chose ANP. So, no I can't work in the minute clinics, but can still work in Internal Med, Endo, Geriatrics and even in the hospital.

If you can stand the kids, go for FNP. You'll get a job quicker.

core0 · Jul 25, 2009

I graduated from a dual ANP/GNP program and loved it. HOWEVER, I started working in urgent care and absolutely loved that too! Unfortunately, even though we rarely see kids at our clinics (there are urgent care clinics strictly for kids), sometimes we do and I needed to be able to see kids under the age of twelve. Well, I had to GO BACK to school. Fortunately, the program I attended offered a post-Master's certification as a FNP and they combined the Maternal/Child class, so that's the only class I had to take. Unfortunately, the Texas Board of Nursing wouldn't let me duplicate clinical hours and I had to REPEAT clinical hours in adult/geri...of course, the hours don't count if you get paid for them or complete them at your place of employment. You can only imagine how excited my internal medicine preceptor was, since I was required to work for FREE and he could legally bill for my services!

Thats called fraud. Medicare is very clear on this. The applicable statue:

Medicare's rule on reassignment requires that Medicare pay only the NP, the NP's employer, a facility that has contracted with the NP, an organized healthcare delivery system if there is a contractual arrangement between the organization and the NP, a physician under a locum tenens arrangement, a government agency, or a billing service working under contract with an NP. A medical practice, which has an independent contractor relationship with an NP, may be paid under the provision for an organized healthcare delivery system.

From here:

http://www.medscape.com/viewarticle/422935_5

Medicare has prosecuted a couple of physicians for this. Unless they are paying you or have a contract with you then they can't bill for you.

David Carpenter, PA-C

ANPFNPGNP · Jul 25, 2009

Thats called fraud. Medicare is very clear on this. The applicable statue:
Medicare's rule on reassignment requires that Medicare pay only the NP, the NP's employer, a facility that has contracted with the NP, an organized healthcare delivery system if there is a contractual arrangement between the organization and the NP, a physician under a locum tenens arrangement, a government agency, or a billing service working under contract with an NP. A medical practice, which has an independent contractor relationship with an NP, may be paid under the provision for an organized healthcare delivery system.
From here:
http://www.medscape.com/viewarticle/422935_5
Medicare has prosecuted a couple of physicians for this. Unless they are paying you or have a contract with you then they can't bill for you.
David Carpenter, PA-C

Very interesting. I can assure you there is all kinds of fraud issues in the healthcare system today. In fact, just the other day I ordered a Xopenex nebulizer treatment on a patient and I noticed the packaging it was in...A SAMPLE FROM THE PHARMACEUTICAL COMPANY! So, they're billing $50 for each of these treatments, yet they are using free samples!

From what I've seen, nothing surprises me any more.