discussion regarding education of NP (DNP) and PA compared to MD/DO

Trauma Columnist · Feb 22, 2010

Keep up the spirited discussion but if you personalize it, will need to edit....thanks for your understanding.

springing · Feb 23, 2010

I never used that statement to justify paying physicians less. I used it to say that they should stop crying about their student loan debt and stop trying to use that to justify getting paid more. We don't hear students in other professions crying like little babies about their horrible student loan debts. We only hear that coming from medical students. It fully supports my point. You just need to think about it for a few minutes, I'm sure it will register, after all, medical students are smarter than anyone on earth aren't they? Doctors don't spend longer in training than anyone else, they just spend longer in formal training. It really isn't necessary to do that, it is just a choice by the profession to handle it that way. Since it is the choice of the profession, don't clamor with the public about it. Talk to the profession about it if you have a complaint. Tell them to shorten the amount of formal training. Don't cry to everybody else that this should make you eligible for higher compensation. Furthermore what do you mean it is more competitive to become a physician than other jobs that do not pay nearly as much? Give me some kind of an example of what you are talking about.

Are you kidding me? That's an absolute joke.

You tell me what other field has average indebtedness of 150,000 just in grad debt, not counting undergrad, and has to work for 40k for the next 4-7 years while interest accumulates on that debt. You don't imagine that interest magically goes away during residency, do you? Then again, maybe you do.

Say you have a burning desire to be a pediatric endocrinologist and help all those new juvenile diabetes cases. You graduate medical school with 150,000 in debt. You do a pediatric residency (3 years) and a pediatric endocrinology fellowship (3 years.) By the time you're making over 55k a year salary, your student loan debt has become 190k. You will make about 100k as a pediatric endocrinologist. Even if you were a regular old pediatrician, you wouldn't be making much more than 100k. After state and federal taxes, you will be making 75k a year, or 6250 a month. In order to pay off those loans in 10 years to avoid accumulating more interest, you'll be paying 2800 a month in student loans. Your take-home pay will be 3450 a month, AKA lower than many nurses' take-home pay.

Get it now? Or do I have to draw up more examples?

Demeaning the amount of time physicians train makes you look silly. No one seriously thinks that med students don't work DAMN hard to enter the profession (do you work 80 hours a week for 40,000 a year?), and no one with any sense believes that 150,000 in graduate loans is something to dismiss out of hand.

mbreaz1 · Feb 23, 2010

Are you kidding me? That's an absolute joke.
You tell me what other field has average indebtedness of 150,000 just in grad debt, not counting undergrad, and has to work for 40k for the next 4-7 years while interest accumulates on that debt. You don't imagine that interest magically goes away during residency, do you? Then again, maybe you do.
Say you have a burning desire to be a pediatric endocrinologist and help all those new juvenile diabetes cases. You graduate medical school with 150,000 in debt. You do a pediatric residency (3 years) and a pediatric endocrinology fellowship (3 years.) By the time you're making over 55k a year salary, your student loan debt has become 190k. You will make about 100k as a pediatric endocrinologist. Even if you were a regular old pediatrician, you wouldn't be making much more than 100k. After state and federal taxes, you will be making 75k a year, or 6250 a month. In order to pay off those loans in 10 years to avoid accumulating more interest, you'll be paying 2800 a month in student loans. Your take-home pay will be 3450 a month, AKA lower than many nurses' take-home pay.
Get it now? Or do I have to draw up more examples?
Demeaning the amount of time physicians train makes you look silly. No one seriously thinks that med students don't work DAMN hard to enter the profession (do you work 80 hours a week for 40,000 a year?), and no one with any sense believes that 150,000 in graduate loans is something to dismiss out of hand.

Dear God, is Self Pity 101 the first course they teach in medical schools these days? There are tons of other fields that students start out with higher student loan debt balances in proportion to their starting salaries. That is common these days with the cost of education soaring, just like the cost of healthcare is. So let's say you do have that high interest rate that makes your loan balance go up to 190k by the time you finish your residencies. At least you get paid a good salary and don't have to make the payments while you do it. Some students finish with over 40k in loans and struggle to get a job making much more that $30,000. Consider yourself lucky. You need to check your amortization schedule on the loan there. The payment is more like $1900 per month given the balance, term, and current rate for consolidation loans. If you can't figure out that your banker screwed you over because you aren't smart enough to understand a loan amortization, don't complain to everyone else. You have only yourself to blame for that. Also, I'm not sure what part of the earth you live in where starting pediatric endocrinologists make 100k per year and starting nurses make 60k per year, but it doesn't happen in this country. Average starting pay for a pediatric endocrinologist in this country is around 180k per year and a starting nurse is more like 40k per year. Don't make up numbers and try to argue with a numbers guy. The information is readily available for anyone to find. So now that we have the true numbers, no I don't feel sorry for you making 180k per year with a 190k student loan debt. I think you are far better off than the nurse who graduates with 50k in student loan debt and only makes 40k per year. Tell me how much bring home pay that nurse gets with your little calculator. Please bring me some more examples from your magical mystical little medical school world. Go ahead and set them up on a tee for me like that one and I will be pleased to knock them out of the park for you. Phyisicans like to make up myths and somehow convince themselves to believe them. Seems to be a recurring theme in healthcare these days.

I never was demeaning about the time that physicians spent in training, but there are many other professions where people work 80 hours a week for 40k per year. So like I said, quit crying about it. I also didn't dimiss out of hand the amount of student loans. I just said it was proportional to starting salaries for many other professions, and I am sick of hearing medical students and physicians cry about it. You are far better off than most other people and you should count your blessings. Crying about it makes you look silly, but if you can't take the heat get out of the kitchen.

I won't accuse you of making this argument, but I also love to hear physicians say that they won't do their jobs anymore if they have to take a cut in pay. I always wonder what in the world they think they would do to make half of what they make as a physician. Maybe you could tell me, what job would a neurologist who makes over half a million per year be able to find that woud even pay him 100k per year if he left his post because he had to take a pay cut? I can't wait to hear this, I'm sure it will be good.

springing · Feb 23, 2010

Dear God, is Self Pity 101 the first course they teach in medical schools these days? There are tons of other fields that students start out with higher student loan debt balances in proportion to their starting salaries. That is common these days with the cost of education soaring, just like the cost of healthcare is. So let's say you do have that high interest rate that makes your loan balance go up to 190k by the time you finish your residencies.

6.8%, same as all federal loans. You call yourself a "numbers guy" and have no idea what the interest on Stafford loans are?

At least you get paid a good salary and don't have to make the payments while you do it. Some students finish with over 40k in loans and struggle to get a job making much more that $30,000.

Which is still better than a physician making 100k with 180k loans.

Also, I'm not sure what part of the earth you live in where starting pediatric endocrinologists make 100k per year and starting nurses make 60k per year, but it doesn't happen in this country. Average starting pay for a pediatric endocrinologist in this country is around 180k per year and a starting nurse is more like 40k per year. Don't make up numbers and try to argue with a numbers guy.

You're not correct. Pediatric specialties are for the most part VERY low as is general pediatrics.

http://www.jobs-salary.com/pediatric-endocrinologist-job-salaries.htm

The information is readily available for anyone to find. So now that we have the true numbers, no I don't feel sorry for you making 180k per year with a 190k student loan debt. I think you are far better off than the nurse who graduates with 50k in student loan debt and only makes 40k per year.

Of course there are nurses who graduate with 50k debt. There are also physicians who graduate with 300k debt. But the AVERAGE debt for physicians is 150,000 in grad school alone - that doesn't include undergrad. If you can find me anything that says average nurse debt is 50,000, that would be great. Until then YOU are making up numbers and trying to make the EXCEPTION prove the RULE.

Tell me how much bring home pay that nurse gets with your little calculator. Please bring me some more examples from your magical mystical little medical school world. Go ahead and set them up on a tee for me like that one and I will be pleased to knock them out of the park for you. Phyisicans like to make up myths and somehow convince themselves to believe them. Seems to be a recurring theme in healthcare these days.

I'm not in medical school. I'm just not a moron.

I never was demeaning about the time that physicians spent in training, but there are many other professions where people work 80 hours a week for 40k per year.

Name some. With proof. Facts, statistics, SOMETHING. Indulge yourself in evidence-based posting.

By the way, a nurse working 80 hours a week for a mere $25 an hour would be making $96,000 a year.

By the way, 20% cuts in medicare are coming, so physician salaries will only continue to lower. If half your patients are on medicare, that's a 10% salary cut for you. Would you still work at your hospital if they called you into your office and told you they were slicing your salary by 10%?

bajasauce07 · Feb 23, 2010

Springing, there's no use arguing with self righteous windbags. Society has villianized doctors and the healthcare profession in general. The average person goes to the doctor but resents his high bills. Most wouldn't hesitate to sue you for the slightest mistake. People demand perfection in their healthcare providers, but want it at the price of mediocrity.

There isn't a person alive who would knowingly subject themselves to a career in medicine without the compensation that a physician deserves. Let this guy believe what he wants. I just hope we all have the balls to strike and leave them to the consequences when legislation finally cuts salaries to the breaking point.

bajasauce07 · Feb 23, 2010

PRARIENP

My nursing education provided a strong foundation in communication and health promotion (for many naysayers "fluff").

It is fluff, not for many, it is fluff for anyone. Seriously, can you be taught to communicate? I take quite a lot of time explaining my patients conditions to them and making sure they understand all possible treatment outcomes and options, but I didn't need 2 years of "communication and health promotion" classes to do it. If your training focuses on differential diagnosis and treatment that will come naturally unless you don't care about what the average person knows. and if you think the majority of your patients have the slightest idea what they need you are either sorely mistaken or work with a very select group of educated patients. I can tell you after nearly 3 years of working I've never had a patient population greater than 50% that ever truly understood everything I would have liked them to, although I did usually get them to understand enough, they really never grasped the full understanding of their disease. That's why we get paid. don't kid yourself.

That is also why patient satisfaction is retarded. it's based completely on subjective criteria. I've known TERRIBLE doctors, whose patients absolutely adored him. Why is it used? only by practitioners trying to prove something that isn't true.

wowza · Feb 23, 2010

So let's say you do have that high interest rate that makes your loan balance go up to 190k by the time you finish your residencies. At least you get paid a good salary and don't have to make the payments while you do it.

First, please stop talking about things you know nothing about. It makes you look like an idiot. You do have to pay your loans during residency. They took out deferment during residency years ago.

Good salary? The $42,000 they pay the residents for 80 hours a week works out to be $10/hr at my hospital. That is less than the janitor makes. I made more per hour as a junior in high school working at Costco. Hardly a great salary.

I never was demeaning about the time that physicians spent in training, but there are many other professions where people work 80 hours a week for 40k per year.

Name a single profession where they work anywhere near 80 hours a week consistently and make $40K. And this time provide a source.

mbreaz1 · Feb 23, 2010

First, please stop talking about things you know nothing about. It makes you look like an idiot. You do have to pay your loans during residency. They took out deferment during residency years ago.
Good salary? The $42,000 they pay the residents for 80 hours a week works out to be $10/hr at my hospital. That is less than the janitor makes. I made more per hour as a junior in high school working at Costco. Hardly a great salary.
Name a single profession where they work anywhere near 80 hours a week consistently and make $40K. And this time provide a source.

Who cares if you have to pay them back during residency? When was that ever the point? NOBODY CARES! GET IT? NOBODY CARES if you conisder it to be a GOOD salary or not. DEAL WITH IT. If someone chooses a profession then they have to deal with the good and the bad that goes along with it. So you mean to tell me that you made over $42,000 per year working at Costco in juinor high? LIAR! Show me the evidence of that. I would love to see that pay stub. You are arguing apples and oranges again and I think you have a magical little calculator like your friends do.

I have never seen your or your little friends provide a source that shows me that residents consistently work 80 hours a week. Please provide me with that. There are plenty of accountants and attorneys who work far more than 80 hours a week for less money than a resident makes and on a consistent basis. Contrary to the popular belief here, other people besides doctors in America do work hard.

wowza · Feb 23, 2010

1) First of all, I think your study here is a little dated. If you check more recent figures, physician salaries are growing again. Don't bring out a study that is seven years old and try to call it current.
2) You are obviously not telling the truth about being a finance major, or you studied at flunkee community college because they surely didn't train you very well.
3) The real point of the opinion article is not just the opinion, but whose opinion it is. Could you please state for the record the profession of the author?

1) This is the most recent study I could find. How about you find me a more current one- you know one that is a study and not an article, and based on data not surveys or opinions.

2) Where I went to school is of no consequence to this discussion. If you really want to make it about that I will post it. It is very well known university.

Did you even take college econ? Did you even go to college?

3) Sure he's a doctor. It is the OPINION of a doctor. I don't think anyone is saying it is not a doctor. Yet still, it is only an opinion, not fact and not supported by any evidence he provides. Opinion is just that, one person's take on an issue. Similarly I could provide 3 different econnomists who blame the economy on Clinton, Bush and Obama.

wowza · Feb 23, 2010

Who cares if you have to pay them back during residency? When was that ever the point? NOBODY CARES! GET IT? NOBODY CARES if you conisder it to be a GOOD salary or not. DEAL WITH IT.

The point is that you are talking about things that you know nothing about. Your extensive knowledge about the system is belied by your comments.

I have never seen your or your little friends provide a source that shows me that residents consistently work 80 hours a week. Please provide me with that.

Do you even work as a nurse or are there just not residents where you work?

There are plenty of accountants and attorneys who work far more than 80 hours a week for less money than a resident makes and on a consistent basis. Contrary to the popular belief here, other people besides doctors in America do work hard.

What lawyers or CPAs are workign more than 80h and make less than a resident? How about some proof for your ridiculous claims.

Oh and re-read my post. I said I made more per hour as a high school student 10 years ago than a resident currently does.

mbreaz1 · Feb 23, 2010

The point is that you are talking about things that you know nothing about. Your extensive knowledge about the system is belied by your comments.
Do you even work as a nurse or are there just not residents where you work?
What lawyers or CPAs are workign more than 80h and make less than a resident? How about some proof for your ridiculous claims.
Oh and re-read my post. I said I made more per hour as a high school student 10 years ago than a resident currently does.

Nobody was discussing an hourly rate. We were talking about professional salaries. So your point is completely invalid about what you made in high school. There are tons of lawyers and CPAs who work more than 80 hours a week and make less than a resident and I have plenty of proof to show you as soon as you submit one shred of evidence to support your claims.

I know plenty about the healthcare system and all of it's woes, and I don't have to be a nurse or a physician to understand it. In fact I have a better vantage point than both of them do. Please explain how my extensive knowledge about the system is belied by my comments?? You are just mad because you know them to be true, but they hurt.

mbreaz1 · Feb 23, 2010

6.8%, same as all federal loans. You call yourself a "numbers guy" and have no idea what the interest on Stafford loans are?

I have a perfectly clear picture of what the rates are and have posted the link for you below. Sorry, 6.8% ain't the number either. Take a look for yourself and be enlightened.

http://www.salliemae.com/get_student_loan/apply_student_loan/interest_rates_fees/#consolidation

Which is still better than a physician making 100k with 180k loans.

You're not correct. Pediatric specialties are for the most part VERY low as is general pediatrics.

http://www.jobs-salary.com/pediatric-endocrinologist-job-salaries.htm

Yes I am correct. This link is hardly proof of anything. This shows a "base salary" around $100,000. That is hardly the total compensation that a physician will work for. Try this link to see some real numbers on true physician compensation.

http://www.mommd.com/pediatric-salary.shtml

Of course there are nurses who graduate with 50k debt. There are also physicians who graduate with 300k debt. But the AVERAGE debt for physicians is 150,000 in grad school alone - that doesn't include undergrad. If you can find me anything that says average nurse debt is 50,000, that would be great. Until then YOU are making up numbers and trying to make the EXCEPTION prove the RULE.

You haven't shown me anything that says that average debt for physicians is 150,000 in grad school alone. Why would I need to dig up any figures for you? I am throwing out hypotheticals just like you are, so don't go asking me for evidence just because I am able to poke holes in your weak examples.

I'm not in medical school. I'm just not a moron.

Sounds like you should apply to go to medical school. I hear they are lining up the morons down there everyday and handing out magical calculators. I think your's has a rusty battery and you may need a new one.

Name some. With proof. Facts, statistics, SOMETHING. Indulge yourself in evidence-based posting.

By the way, a nurse working 80 hours a week for a mere $25 an hour would be making $96,000 a year.

Huh?? What the hell does that prove?

By the way, 20% cuts in medicare are coming, so physician salaries will only continue to lower. If half your patients are on medicare, that's a 10% salary cut for you. Would you still work at your hospital if they called you into your office and told you they were slicing your salary by 10%?

I am very happy to hear that these cuts might finally make it through without Congress heading them off again. They should have happened years ago. So I say bring them on. I think a 10% cut is a great start. If you were in business and someone came to you and said you have a competitor opening up down the street who can do this for 10% less than you can, you would figure out how to cut your costs. That is what I would do. Why is it that you think physicians are entitled to be paid a certain amount for their services? Physicians aren't entitled to a set amount. They need to figure out how to make it by being innovative instead of expecting someone to drop it in their lap.