Equal pay for equal work?

zmansc, ASN, RN · Jan 8, 2014

For me it was a life choice. I have a family and not all paths could be done in my location. After careful review of my choices, what I found was:

MD - Nearest program 4+ hr away, 7 years away from family, kids would have graduated from HS and be on own (hopefully, somewhat) by time I was done.

PA - Nearest program 4+ hr away, 2 yr away from family, one kid would still be at home, the other would have graduated.

DO - Nearest program would require flights to commute to, same as MD.

NP - All schooling and clinicals can be done in my town, one kid still graduating before I'm practicing but I'm here to experience his high school years with him (not always sure he likes that, but that's a different story).

So, although money is important to me, living with my family is far more important. In fact if I couldn't do this from home, I probably would not be doing it at all. Family is just too important, and money won't buy you more time with your kids.

Agrippa · Jan 8, 2014

I think it all depends on what you want from your life, ei family, whether you're mobile, finances, etc.

In terms of finances - it depends on what specialty you want to go to. If you want to do primary care - MDs don't make enough for it would be worth it to go MD route vs NP route.

If you want to do surgery, radiology, dermatology, etc - then yes MD will be better route. Over the course of the next 30-40 years of your career, the money and time you spend on an MD education will be offset by the $200k+ you can make depending on specialty. Also as zmansc has said - what else do you have going on in your life? Are you willing to do the 1 or 2 extra years of pre-med classes, 4 years of med school, then at least 4 years of residency?

For me, I know what specialty I want to go into and the differences between what an MD and an NP make are not enough for me financially for me to go to medschool. But I do know some people who make the financially irrational decision to go to medschool to be a primary care md because they really...really want to be a "Doctor" - to each their own.

futureeastcoastNP · Jan 15, 2014

Money is always a consideration when pursuing extra school - school is an investment and no one would spend money without the hope of making a good return. Anyone who says otherwise is foolish.

Having said that, for me my decision to pursue NP over MD was a variety of things (starting school this Fall!). Yes, MDs make more money if they specialize, but the investment they put in is far greater. They spend HUGE sums of money, and many graduate (including the interest that accrues during residency) with $300,000+ in debt. This forces them to make decisions based on income, and perhaps not to practice the way they hoped to. Many physicians don't become "wealthy" until late 30s or 40s if they started med school at a young age.

NPs on the other hand don't have the same monetary or time investment (though some NP schools are charging outrageous tuition these days). It's possible to be an NP by age 24 if you go straight through (BSN age 22, MSN age 24) with very little debt if you had undergrad financial aid and tuition reimbursement from the hospital from the MSN. As an NP, it's unlikely to you'll ever get close to an MD starting salary, but you get to be "comfortable" early on without the fear or crushing debt and being unable to start a family until your 40s. You also get the chance to work in more underserved areas as the bottom line isn't quite as important. It's a trade-off.

I'm a huge proponent of NPs, but I honestly don't think they should receive the salary of an MD. Do many of the duties overlap? Of course, but the MD has (in most cases), made much bigger sacrifices and he or she deserves the bigger check. It is unfair for NPs to demand full recognition of their educational training while not giving the same courtesy to MDs. In order for these silly turf wars to end, NPs and MDs must recognize each other's strengths and limitations.

BlueDevil,DNP, DNP, RN · Jan 19, 2014

I've posted about htis before. My practice does believe in equal pay for equal work, and the salary ladder is the same for all providers, dependent upon years of experience. We start new NPs and MDs/DOs at the same base salary and we all have the same bonus potential. So pfffft to anyone who thinks it shouldn't be that way, lol. It is. Get used to it.

Camwill, ASN, BSN, MSN, DNP, LPN, APRN, NP · Jan 19, 2014

I was wondering what state or area you work in that DNP make equal to Mds. Also how much experience must I have before getting that kind of offer. I have been conditionally accepted to a np MSN program and I think I know where I plan to go for my DNP. But I wonder what else I need to do. Thanks for any advice

zmansc, ASN, RN · Jan 19, 2014

BlueDevil,

Do you think your experience is the norm? Is there anything can point to that you or others in your group did to come to this equal pay decision?

BlueDevil,DNP, DNP, RN · Jan 20, 2014

BlueDevil,
Do you think your experience is the norm? Is there anything can point to that you or others in your group did to come to this equal pay decision?

No, I'm sure it isn't the norm. There was no NP "movement" or demand, if that is what you are asking. The BOD came to that decision independently. I cannot say what led them to it other than to echo what they said at the time, which was that they felt it was the right step to take for the group.

If I had to hazard a guess, I'd venture that retention was one of the primary goals, as much as making the public statement of support for parity among all providers.

BlueDevil,DNP, DNP, RN · Jan 20, 2014

I was wondering what state or area you work in that DNP make equal to Mds. Also how much experience must I have before getting that kind of offer. I have been conditionally accepted to a np MSN program and I think I know where I plan to go for my DNP. But I wonder what else I need to do. Thanks for any advice

I don't identify where I live on the internet, except to say it is one of the independent practice states. AANP - State Practice Environment.

Not red or blue, but a "green" state, lol.

I was a new graduate NP when I came here. I did do a one year unpaid Family Practice NP Residency, but that was my choice and not formally part of my educational program. I was not yet a DNP, nor had I yet attained my orthopedic NP certification. Strictly a FNP with a strong CV.

We moved out of NC because I refused to work in a state with restricted or reduced practice. When choosing from the remaining states, the priority was where my partner could advance her career and where our children still in secondary school could enjoy the opportunities they were seeking. Once my partner found an opportunity in an otherwise acceptable locale, ,we just moved. I didn't even begin looking for work until I had been here another year. I spent a long time looking for a job that I really wanted, turning down several in the process. When I accepted this job, the pay was somewhat low, but I appreciated the support for my DNP goals and the respect with which the physicians treated their NP colleagues, and vice versa. Money was not a motivator to take the job, else wise I'd have taken one of the more lucrative offers. I'd been here a few years when the changes to the pay structure came about. I did nothing to affect them, they just happened.

So the only advice I have is take a job that you love and perform it passionately, and the rewards will be abundant. Do not take or stay in any position to which you don't desperately want to devote yourself. Do not allow peers to regard you as "less than." That is what we have always lived by, and what we tell our kids. I do't have any other secret approach to NP parity or happiness in this world.

Good luck.

zmansc, ASN, RN · Jan 20, 2014

Very well said BlueDevil!

Camwill, ASN, BSN, MSN, DNP, LPN, APRN, NP · Jan 20, 2014

Thank you!!! It is still a long journey I have but I feel like I have directions :)

nomadcrna, DNP, CRNA, NP · Jan 20, 2014

We do the EXACT same job. Why not receive the same pay?

you might feel different when you become a NP.

Money is always a consideration when pursuing extra school - school is an investment and no one would spend money without the hope of making a good return. Anyone who says otherwise is foolish.
Having said that, for me my decision to pursue NP over MD was a variety of things (starting school this Fall!). Yes, MDs make more money if they specialize, but the investment they put in is far greater. They spend HUGE sums of money, and many graduate (including the interest that accrues during residency) with $300,000+ in debt. This forces them to make decisions based on income, and perhaps not to practice the way they hoped to. Many physicians don't become "wealthy" until late 30s or 40s if they started med school at a young age.
NPs on the other hand don't have the same monetary or time investment (though some NP schools are charging outrageous tuition these days). It's possible to be an NP by age 24 if you go straight through (BSN age 22, MSN age 24) with very little debt if you had undergrad financial aid and tuition reimbursement from the hospital from the MSN. As an NP, it's unlikely to you'll ever get close to an MD starting salary, but you get to be "comfortable" early on without the fear or crushing debt and being unable to start a family until your 40s. You also get the chance to work in more underserved areas as the bottom line isn't quite as important. It's a trade-off.
I'm a huge proponent of NPs, but I honestly don't think they should receive the salary of an MD. Do many of the duties overlap? Of course, but the MD has (in most cases), made much bigger sacrifices and he or she deserves the bigger check. It is unfair for NPs to demand full recognition of their educational training while not giving the same courtesy to MDs. In order for these silly turf wars to end, NPs and MDs must recognize each other's strengths and limitations.