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!!
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
Just FYI, I wasn't really referring to volume or quality but rather time and cost. I think for most NPs they are slower and more costly. I mean I'm fast and cheap, but j think in comparing social and economic ramifications of healthcare. Truth be told, I have no idea how we measure quality.
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.)
Your statement completely disregards the large numbers of NPs who are coming out of direct entry MSN programs with 2-3 years of nursing education, often with no prior healthcare background whatsoever.
You can call physician residencies "on the job training," but I have worked in academic medical centers with residents for years, and I can tell you that the time they put in, although they are receiving a minimal stipend, is definitely education. They are being observed and supervised by their senior residents and attendings, and are still attending classes and seminars. They are not yet considered "full-fledged," independent physicians. And I can tell you where a figure of 14,000 hours comes from -- working 60 hrs/week x 50 wks/yr x 4 yrs = 12,000 hours. Doing that for 5 years = 15,000 hours. That's an entirely reasonable and realistic scenario for a resident (it certainly is for the residents with whom I work). It doesn't take residents until they're 50 yrs old to accomplish that because they work a whole lot more, and harder, than nursing students do.
No, not equal pay, but also no attitude if I refer a more complex patient to the MD. I've gotten push back about it sometimes. Put your schooling to good use and earn your higher pay, mkay?
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.
I wouldn't consider 4 years of BSN to be all medical education. Usually at least 1.5 of that is pre nursing coursework. Plus many of the nursing classes would not directly help much in a provider role.
We also need to look at the density of coursework taken, which, in almost all aspects pre-med is a much harder major than nursing. It takes much more effort to complete med school pre-reqs than it does a BSN (I've done both).
Pre-med classes do not really provide any medical information, but what they do provide is a basement membrane which makes learning medically related information much easier than just taking chem 101 and anatomy and physiology. It also teaches you how to study more effectively, and I would bet most medical students are able to absorb information at a higher rate than most nursing students due to this previous coursework. Undergrad nursing stuff, at least the science and clinical bites, do help out in the MSN though too.
All else aside, training in a provider role, basically FNPs get around 700-1000 of clinical and maybe 1500-3000 of class time/study time. (less at some of the shady for-profit schools).
Medical school is pretty much at least 4000 hours of class time/study time for each of the first two years and then another 3000-4000 in the clinical setting each year for the next two years (not counting studying for board exams)
Then comes another 3000-4000 per year for 3-7 years in residency.
So I think they add up pretty well, and depending on speciality, I may have shorted the docs a little bit.
Counting RN experience, which I do have to admit does help with communication skills, time management, getting the flow of the hospital, and limited decision making is worthwhile, but it is still not being set into the role of a provider.
I'm a nurse for 13 years and now a NP student. Physicians should always receive a higher salary. NP education and clinical requirements is no where near what physicians receive. Nursing lacks support and we are still struggling with making BSN entry level for RN. We have online programs that make you teach yourself. So until we raise our standards, then it will be exactly what is now. I will never regret my career decisions, but I have always admired the structure of MD training.
MD training is amazing. Why can't NP's get paid residencies so they don't have to scrounge for preceptors? I've heard residents get 50k per year- half paid by hospital and half by federal government. And teaching hospitals have so many patients to learn from..and 1:1mentoring from attendings and senior residents. And didactics all tailored for their learning. We have a lot to catch up on. But our outcomes seeing patients one at a time are similiar and this is what a lot of jobs are.
MD training is amazing. Why can't NP's get paid residencies so they don't have to scrounge for preceptors? I've heard residents get 50k per year- half paid by hospital and half by federal government. And teaching hospitals have so many patients to learn from..and 1:1mentoring from attendings and senior residents. And didactics all tailored for their learning. We have a lot to catch up on. But our outcomes seeing patients one at a time are similiar and this is what a lot of jobs are.
I agree 100% about requiring fellowships and/or a minimum of time working as a RN prior to getting on the NP fasttrack.
The whole outcome thing trips me up. How is that actually determined with any accuracy? For example say an inexperienced primary care NP sees 500 patients with complaints of ear pain, diagnoses otitis media in all of them and prescribes antibiotics. It is likely some have been misdiagnosed and treated inappropriately however a majority of them would recover without complications anyway and a year later would still be alive so does that mean the provider was a good clinician? No. In psychiatry I've seen horrific inappropriate prescribing but is there any way to accurately measure outcomes? Number of relapses as compared to peers with the same diagnosis? There are too many variables regardless of the prescriber's skill.
In my opinion as both a garden variety physician or NP its fairly easy to suck and fly under the radar. Thankfully it is rather difficult and rare to kill someone especially in a primary care setting.
Of course we should be paid the same for the same work. Reimbursement used to be based on CPT, not license. General physicians used to argue that they should be paid the same for the same work as their specialist counterparts, and eventually won that argument. This argument is exactly the same. If pay was based on degrees, DOs would be paid different than MDs and perhaps CNS different than NPs. 40 years of research shows NPs provide the same or better high level care that a physician provides. The only reason most states have not embraced equal pay for equal work (although Oregon has!) is for two reasons.
The first reason is insurance companies like to make money, so they will cut corners wherever they can. The second reason is not economics, but political - the AMA is very powerful and they have crafted a careful, almost price fixing environment where they artificially inflate how difficult it is to get into medical school so that the supply of physicians remains small, demand remains high, and therefore reimbursement is high.
With NPs, however, that demand is no longer as high, state by state, as NPs are recognized as independent. It is only a matter of time before NPs are paid equitably as physicians.
The outcomes have been determined through rigorous studies, including ones which test as many as 20 outcomes, such as managing HTN, diabetes, CAD, psychiatric disorders, etc, as well as patient satisfaction with time spent with appointments. I can go through and find some of this research if you'd like - we just went over a lot of it in one of my doctoral courses.
I have read some posts about physicians and education and I just want to say that time is relative to the individual. For example, Columbia and other colleges have started
an accelerated md program that is 3 years rather than 4 years. I am currently in a DNP program at NYU and when I am complete I will have almost 11 years of education.
2 years ADN, 2.5 years BSN, 2 years MSN, 2 years postmasters, 2.5 years DNP. Of course the experiential learning from working in a hospital for 14 years.
I am currently in a DNP program at NYU and when I am complete I will have almost 11 years of education.
2 years ADN, 2.5 years BSN, 2 years MSN, 2 years postmasters, 2.5 years DNP. Of course the experiential learning from working in a hospital for 14 years.
And out of that probably 4 years of nursing fluff-theory, leadership, populations...Not even remotely comparable to physicians education.
PG2018
1,413 Posts
Just FYI, I wasn't really referring to volume or quality but rather time and cost. I think for most NPs they are slower and more costly. I mean I'm fast and cheap, but j think in comparing social and economic ramifications of healthcare. Truth be told, I have no idea how we measure quality.