Equal work for Equal Pay

[AAC.271]

What are your thoughts folks? As an sNP, I think if we do the exact same work we absolutely deserve the same high salary that physicians get.

Some of my peers in medical school say that education and qualifications deserve higher pay i.e. A college PH.D professor gets paid more than a masters trained high school teacher, even if they are both teaching AP biology/Intro to Biology 101.

I understand their Point of View, but I think it's unfair that just because we aren't learning as much material, but going to be dealing with many of the same cases and patients, that we do not deserve a physician's salary. Studies again and again show that NP's do an equal job if not better job than physicians at correctly diagnosing problems and treating patients. Some would argue that in a quality outcome based system, Nurse Practitioner's deserve even more pay because our results are better!!

[AAC.271]

In an earlier post i think he didn't get into medical school, he seems to be having some disgruntled feelings towards docs now. Not quite sure how it will help his future but to each their own I guess.

Here is his earlier post. There are several more like it in other sections.

That is irrelevant and I do not appreciate the slighted jab at me. I am not bitter at not becoming a physician. I am proud to become a future NP after I graduate from my program and happy to be treating all of the patients that come to me with the utmost quality and care. And even if I do not fully understand a complicated case, I can easily use evidenced based medicine websites like uptodate or do my own research to learn about a disease and its symptoms. This is something that even physicians use all the time because no matter how much education you have, you forget stuff! I am a strong proponent of the NP movement and I hope to be a leader for that movement because I firmly believe that the future of healthcare lies in the hands of nurse practitioners. We are here to tear down the glass ceiling of an outdated system that has hampered medicine's full potential in the modern world.

I'm not the only one taking a stand. Others believe in this movement for equality and recognition as well.

Melissa DeCapua, DNP (@melissadecapua) on Twitter

[TheOldGuy]

So.....

1. Many of the responses indicating MDs deserve more are not written by NPs.

2. If you are not familiar with how billing works then please don't pontificate.

3. If you are not an NP then please don't pontificate.

4. The issue is not pay as a function of number of years of schooling - consider PhDs vs MDs.

5. The issue is basic economics - supply vs demand. MDs have been working really hard at limiting the number of new docs. They keep the supply low while demand has surged. Consequently earnings have grown tremendously. Nursing in all its wisdom (NOT!) have exploded the number of nursing schools and NP programs. This will increase supply which in turn will decrease wages.

6. MD earnings in specialties eg plastic surgery, cardiac surgery, neurosurgery and orthopedic surgery are through the roof. That's ok - they have the specialized training and skills to justify it.

7. Many of the responses in favor of NPs earning less seem to indicate that the quality of the job done is somehow lower than that provided by MDs. The question asks about equal pay for equal work. If I am doing EXACTLY the same job, seeing EXACTLY the same patients, with equivalent or better productivity, providing care that is EQUAL TO or BETTER THAN that provided by my physician colleagues, then I should earn the same amount of pay. If I'm not doing the same work, then I don't deserve the same pay. In my field and practice setting, I do the same work, have better outcomes and the highest productivity in the facility.

8. Decades of research indicates that NP care is equal to or better than MD care. Malpractice claims are orders of magnitude lower for NPs compared to MDs - in states where full practice authority is present.

So...why are nurses here attacking nurses?

BTW, I am a big proponent of increasing the rigor of NP programs....but keep in mind that the NP model was originally based on the premise that you had experienced nurses who obtained advanced education and training to teach them what they needed to know in order to provide high quality care - diagnosing and treating. I know there are many NPs who do not have years of nursing experience who have "made it" but I know that because of my med surg, tele, ED and ICU nursing experience, I am a much stronger provider, and am considered to be equivalent to an MD in knowledge and ability by the medical director of our facility. When you add up years of experience and training in both undergraduate, employment and graduate level education, NPs are pretty darn close to MDs - who have 2 years of didactic in medical school and 2 years of clinicals before starting residency.

[AAC.271]

So.....

1. Many of the responses indicating MDs deserve more are not written by NPs.

2. If you are not familiar with how billing works then please don't pontificate.

3. If you are not an NP then please don't pontificate.

4. The issue is not pay as a function of number of years of schooling - consider PhDs vs MDs.

5. The issue is basic economics - supply vs demand. MDs have been working really hard at limiting the number of new docs. They keep the supply low while demand has surged. Consequently earnings have grown tremendously. Nursing in all its wisdom (NOT!) have exploded the number of nursing schools and NP programs. This will increase supply which in turn will decrease wages.

6. MD earnings in specialties eg plastic surgery, cardiac surgery, neurosurgery and orthopedic surgery are through the roof. That's ok - they have the specialized training and skills to justify it.

7. Many of the responses in favor of NPs earning less seem to indicate that the quality of the job done is somehow lower than that provided by MDs. The question asks about equal pay for equal work. If I am doing EXACTLY the same job, seeing EXACTLY the same patients, with equivalent or better productivity, providing care that is EQUAL TO or BETTER THAN that provided by my physician colleagues, then I should earn the same amount of pay. If I'm not doing the same work, then I don't deserve the same pay. In my field and practice setting, I do the same work, have better outcomes and the highest productivity in the facility.

8. Decades of research indicates that NP care is equal to or better than MD care. Malpractice claims are orders of magnitude lower for NPs compared to MDs - in states where full practice authority is present.

So...why are nurses here attacking nurses?

BTW, I am a big proponent of increasing the rigor of NP programs....but keep in mind that the NP model was originally based on the premise that you had experienced nurses who obtained advanced education and training to teach them what they needed to know in order to provide high quality care - diagnosing and treating. I know there are many NPs who do not have years of nursing experience who have "made it" but I know that because of my med surg, tele, ED and ICU nursing experience, I am a much stronger provider, and am considered to be equivalent to an MD in knowledge and ability by the medical director of our facility. When you add up years of experience and training in both undergraduate, employment and graduate level education, NPs are pretty darn close to MDs - who have 2 years of didactic in medical school and 2 years of clinicals before starting residency.

Exactly! Thank you for your comments. This is exactly why I also believe physicians and physician education is outdated. They belong to an antiquated system built for the 20th century. This is the 21st century where we have education and knowledge right at our finger tips. The Data clearly shows that NP's are superior to MD's in diagnosing and treating problems. Clearly, the NP model of Education is superior in yielding efficient and good outcomes. NP's are the new face of healthcare and as we expand into more physician territory, we will become stronger, better, and more experienced. This is why the concept of physicians and MDs will become outdated as hospitals look for NP's as better practitioners.

[Jules A, MSN]

The Data clearly shows that NP's are superior to MD's in diagnosing and treating problems. Clearly, the NP model of Education is superior in yielding efficient and good outcomes. NP's are the new face of healthcare and as we expand into more physician territory, we will become stronger, better, and more experienced. This is why the concept of physicians and MDs will become outdated as hospitals look for NP's as better practitioners.

You can't be serious. Our education is superior? Have you been to NP school? Superior at diagnosing? Keep telling yourself this and you will miss opportunities to learn from skilled physician colleagues who are our allies not our enemies. This attitude will not serve you or fellow NPs well.

[pro-student]

Let me just point out that a major advantage attributed to APNs is precisely our cost-effectiveness. For example, in most situations roughly two NPs (or CNMs or CRNAs) can be hired for the same salary as one physician. Considering the economics of healthcare, this is one of the reasons APNs rose in popularity.

But, as some are suggesting, APNs and physicians are compensated equally, there is no longer any financial incentive to use APNs. In a situation in which costs are equal, most patients/payers/employers are going to go with the one with the higher level of education. In that scenario, APNs have just priced themselves out of tons of jobs.

The story with CNMs is a little different because, while their reimbursement is equivalent to physicians for the same service, OBs still make more because they can provider higher level services like CS, more infertility treatments, higher risk women, and surgeries all of which are reimbursed handsomely. So even though they get the same reimbursement for a routine visit, PAP, or lady partsl delivery, they are still an economically advantageous addition to practices/facilities.

I know there is tons more to be said on the topic particularly r/t quality and outcomes but I'd contend that the unintended consequences of "equal pay for equal work" could be disastrous for APNs.

[Aromatic]

Exactly! Thank you for your comments. This is exactly why I also believe physicians and physician education is outdated. They belong to an antiquated system built for the 20th century. This is the 21st century where we have education and knowledge right at our finger tips. The Data clearly shows that NP's are superior to MD's in diagnosing and treating problems. Clearly, the NP model of Education is superior in yielding efficient and good outcomes. NP's are the new face of healthcare and as we expand into more physician territory, we will become stronger, better, and more experienced. This is why the concept of physicians and MDs will become outdated as hospitals look for NP's as better practitioners.

Why do you keep telling yourself this stuff? In what way is NP education better, and where are these studies showing that we do a better job the the docs? I think you are fairly delusional, I mean, your not even an NP yet so how do you know the education is superior?

Describe how the physician education is outdated... because you can't just say it is because you feel like it is. These are pretty much just personal opinions and not what is really happening.

You make it sound like nurse practitioner school puts some magic sauce in its education and in like 1/6th the time pops out a better provider. This is untrue, and you will hurt the nurse practitioner population by thinking this way.

[TheOldGuy]

Thank you for your support of my comments but I've got to disagree with you on a couple of items:

1. I do not feel that the NP model is superior. I do believe that NP programs need more rigor. I believe that NPs who also have years of nursing experience are able to effectively leverage that experience with additional education and training to provide high quality care with outcomes equivalent to or better than our physician colleagues in some areas - not all.

2. I do not believe physicians will become outdated by any stretch....I do believe that there will be increased focus on specialty areas eg surgery, neurology, etc where NPs have essentially no training.

Please do not turn this into an anti-physician blog - the OP was asking views about equal pay for equal work. My comments were directed specifically at this question. The key here is the "equal work" part!

[TheOldGuy]

Nothing to worry about here Pro. The only unintended consequences will affect our physician colleagues who want to hire NPs for $55 per hour, bill at $200 per hour and pocket the difference. Its a business model that practice management consultants are selling heavily.....

The reality is that there is a staggering level of demand for health care provider services that the medical community is trying to maintain a monopoly on. As the NP role matures and scope of practice laws expand, compensation and opportunities for NPs will rise - unless we fail to limit the explosive growth of marginal quality NP programs that are mass producing poorly educated and trained NPs with virtually no nursing experience....

My 2 cents.....

[Corey Narry, MSN, RN, NP]

The "equal pay for equal work" movement is still in its infancy but slowly but surely, I think it will gain a following...

NP Payment Parity Bill Signed into Law - Oregon Nurses Association

[PG2018]

Once again, I come here to reply to the same thread. Some things will be caps because I don't know how ot make my words bold while typing from a tablet. I'm not screaming at anyone which is important to point out on AN.

Overall, should a NP, PA, MD/DO bill a 99213 and receive X then the NP and PA billing 99213 should receive the same reimbursement? YES.

Do many NPs sit on their hinds talking ad nauseum to patients? YES.

Does talking ad nauseum, i.e. seeing less patients and billing less patients reduce productivity? YES.

Can a NP make more money by moving quickly? YES. (That's how I do it.)

Should a MD/DO make more on a 99213 or any other code if the same work is replicated by a PA or NP? Absolutely NOT.

Are our outcomes "as good" or "better" than physicians? NO. I disagree with what limited research I've seen. Here's why. Most midlevels cannot deal with the patient volume physicians do. As a whole, the limited training of midlevels prevents rapid decision making particularly in the first years of practice. That said, midlevels spend more time thus reducing productivity and order more tests thus increasing cost burden.

Should NPs have more education required? YES, of course. What idiot on here thinks otherwise.

Are physicians sued more frequently? YES, but let's put that into context. In an unclear setting, a midlevel will likely consult on a physician. A physician may consult on another, but I would perceive that, as a whole, they consult less frequently than midlevels. They are also vastly more procedural than midlevels opening themsevles up for more liability.

That said, midlevels, in my opinion, do less "critical" tasks than the physician population thus opening themselves up for more liablity. BUT MORE IMPORTANTLY, I believe midlevels are sued less because of the time and testing used by midlevels which patients perceive as empathy and concern. People are MORE for personal infractions than malpractice. The malpractice is generally a vessel for "that doctor that did me wrong."

As salaried persons, being paid a salary, physicians have value added qualities making them more costly and in many respects more useful so in that spectrum they would necessitate greater pay. Taking productivity into account, as others have said, there is no reason my 30 patients should put less food on the table than a collaborator's 30 patients.

[TheOldGuy]

Don't mean to argue PsychGuy but I do have to disagree with a few points.

When I mentioned lower claims, I was referring to states where NPs have full practice authority. The data is clear - lots of studies. NP provided care is as good as or better than MD provided care in primary care settings. You can disagree and that's fine but outcomes refers to quality not number of patients seen. One of the reasons that MD care is not rated as high, is that they don't take the time to listen to patients - which means they don't pick up on symptoms - which means they may misdiagnose and consequently improperly treat.

That said, I have the highest productivity in my clinic which is mostly staffed by MDs. We all see the same sorts of patients - no difference in severity of symptoms/treatment etc. I don't do anything "less critical" than my physician colleagues do. However, I do order more lab tests than they do. The most common reason I hear from them as to why they don't order more labs is that they don't want the liability associated with reviewing labs and possibly missing something or improperly treating. I use every tool I can because I want to provide the highest quality care that I can. On the other hand, many of my MD colleagues don't use all the tools available and just as they don't always do a good job listening and consequently miss symptoms, they may miss more objective indicators. I recently got a new patient with a hx of schizoaffective DO and IVDA who was recently seen by an MD psychiatrist. The MD increased his antipsychotic to address confusion, paranoia and agitation. I ordered labs including NH3. NH3 was significantly elevated and I started him on lactulose - guess what - symptoms improved......

NPs do tend to consult more - our MD colleagues tend to consult less - which I have seen results in more missed diagnoses. Unfortunately, egos sometimes get in the way of practicing good medicine.

Finally, new providers whether MD or NP are not as efficient - no big revelation there. Over time, we all get better, and faster - the key is not to get sloppy and not take the time needed to provide high quality health care.

Peace

[Lisa.fnp]

and I cannot say that the 14000 or so hours of additional training that the docs receive is completely worthless. . .

Where does this 14,000 thousand hours of additional training coming from? And are your comparing it to 'over' what an NP's training is which is claimed to be only700 to 1,000 hours?

These numbers are full of inadequacy and does not add up. At minimum, an NP has a total of 6 years of education in medical. A holistic bedside education of care for 4 years (BSN) and continues into primary care training with attainIng a Master's Degree (2 years.) To claim that a physician has 14 times of the amount of training then NP (14,000 hours vs. 1,000 hours) of training wouldn't they still be going to school to about age 50 comparatively speaking?

When a physician gets paid $50,000.00 plus a year (half come from the Federal Government half coming from the institution the new Physician is working at for each of their 3 year Residency, if going that route for some are just one to two years long. I call it on the job training. Thinking back if where to count my multiple bachelor degrees and Masters, along with the 18 years of working in medical before becoming a FNP. I would have over 40,000 hours of so-called training. One would would never claim such a thing so why should any physician. Let's measure by results of care and not some made up numbers that once said it must be true.