Excellent Employment Prospects for Nurse Practitioners

[FullGlass]

According to the U.S. Department of Labor Bureau of Labor Statistics, as of January 18, 2018, the employment outlook for Nurse Practitioners is excellent. Expected job growth from 2016 to 2026 is 31%, much higher than average, with a projected 64,200 new job openings for this period.

The Bureau has a website with these projections nationally and also by state and area. Obviously, demand in some areas will be higher than others. Demand for new grad NPs will also vary by location and specialty.

The Bureau website also has links to other websites with additional information.

Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners : Occupational Outlook Handbook: : U.S. Bureau of Labor Statistics

[Riburn3, BSN, MSN, APRN, NP]

People complaining about oversupply are working in areas with too many NP's. It's very simple.

My slice of West Texas and New Mexico is in full blown desperation mode for good NP's. If you read that and thought to yourself "yeah but that means you have to live there", then don't complain, it's not our fault you would rather cry at a keyboard about your job market versus being adaptable. There is loads of opportunity out there if you are willing to seek it. Also, once you gain experience, it doesn't matter where you live, practices will pay for experience. If you're a new grad and struggling to land a job, it's time to expand your geographical search area. If that doesn't work, it's time to look inward and see what's wrong with you, your resume, or your interviewing skills.

[FullGlass, BSN, MSN, NP]

I am seeing the result of the massive number of NP's the colleges are grinding out. The schools have found a way to fill their coffers to pay for their sports department and are going big guns. The direct entry schools and online schools are absolutely trashing the profession. Every nurse that can fog a mirror wants to go to "NP" school. And if they have the loan or tuition fees, they will be accepted. I see the salaries dropping in this area. Experienced NPs seeking jobs for 6-9 months before finding something besides a pain clinic position. NPs being expected to see and complete pt visits in 10 min or less. Yes, the over supply is by location but eventually those areas will overlap and "saturation". I, myself, am considering taking a position as an RN simply to pay the bills. Have an RN friend working as a case manager for an insurance company making more than NPs in my section of the country. As time goes on, NPs will leave the profession because of the points made in many of the posts here. It is a simple equation, over supply= low pay, no jobs. Happens in any profession of too many applicants for available jobs.

You have a long list of grievances and I am sorry if you are having troubles. I will address your points:

1. I am not aware of NP programs that pay for sports departments. Online and for-profit schools do not have sports departments.

2. The direct entry and online schools are trashing the profession. Would you please provide evidence for this? There are many reputable DE and online schools such as Yale, Hopkins, U Penn, UCLA, Frontier, etc.

3. Every nurse that can fog a mirror wants to go to NP school. Can you please provide evidence of this?

4. If they have the loan and tuition fees, they will be accepted. Reputable schools are actually quite selective. I agree we need to advocate for higher quality NP programs.

5. You commented that you are considering leaving the NP profession in order to make more money. As more people make this decision, the oversupply of NPs in certain areas will self-correct.

6. There is nothing wrong with working in a reputable pain management clinic. These clinics are moving away from prescribing opioids.

7. 10 minute visits - this is indeed not good. In my experience, NP jobs generally allot 20 minutes for routine visits and up to 1 hour for new patients or complicated patients.

8. In the US, there is no guarantee that people will make money they want in the location they want. This is one of the disadvantages of encouraging home ownership. Most other developed countries do not do this, as a mobile workforce is important to efficiently address labor market conditions.

9. It would be helpful to share your general location, as this is good information for NPs in your area.

10. I don't think I've ever seen a guarantee that all NPs will make more money than all RNs. There are plenty of RNs who make very good money. Some have posted on this forum that they make up to $200K per year. People should not become NPs just to make more money. Not all lawyers make a lot of money, either.

[guest769224]

The direct entry schools and online schools are absolutely trashing the profession. Every nurse that can fog a mirror wants to go to "NP" school. And if they have the loan or tuition fees, they will be accepted

Yes! 100% agree. Barrier to entry is nearly non-existent. DE are a disservice.

[FullGlass, BSN, MSN, NP]

Yes! 100% agree. Barrier to entry is nearly non-existent. DE are a disservice.

While pretty much everyone agrees we need to crack down on poor quality NP schools, that is a separate issue from DE programs. This is also not relevant to the discussion at hand. However, I will yet again address this issue. I'm not sure why repeating the same things over and over is helpful to this discussion, but here we go:

With regard to direct entry, every reputable NP school requires RN work experience for acute care NPs. In addition, certain NP specialties such as oncology, also require RN work experience to get hired.

For primary care, direct entry NP programs are now offered by all reputable schools such as U Penn, Yale, Hopkins, UCLA, etc. That is because the evidence indicates DE NPs perform just as well in primary care NP roles. I agree there should be more research on this topic.

You have complained about DE NPs many times, but have yet to provide a shred of evidence, other than anecdotal, to back up your complaints. In addition, it appears you work in an ICU, so I fail to see how you can evaluate NP performance in a primary care setting, whether or not the NP is DE or not. You would likely work with acute care NPs, but acute care NPs are generally required to have RN work experience. Do you have an issue with the acute care NPs you work with?

I have yet to see an NP who advertised their RN experience, or lack thereof. During my clinical rotations and on my new job, no patient has ever asked if I worked as an RN. In addition, NP experience trumps RN experience. For DE NPs with one or two years experience, their lack of RN experience is no longer relevant.

Of course, you could start a crusade against all DE programs. Why don't you write to the DONs of Yale, Hopkins, U Penn, UCLA, UCSF, Univ of Washington, Univ of Maryland, Columbia, Duke, etc., denouncing their DE programs, demanding their cessation, and share their responses with us?

[Jules A, MSN]

Also, once you gain experience, it doesn't matter where you live, practices will pay for experience.

I am now living in an area with too many NPs however I'd disagree with the above. Practices, and particularly hospitals where I work, have little interest in paying for quality. The last two NPs hired at my job started at $30,000 and $40,000 less than what I make.

Although I am well known and I feel I am respected I have no delusions that should I ever want to change jobs I will not find another local position in my current salary range. This could have been avoided if the credentialing organizations didn't approve any school that applies and if NP schools actually had admission standards and taught their students the bare minimum about business and negotiations. Bottom line is this is about supply and demand. For now and the foreseeable future employers are in the drivers seat.

[Riburn3, BSN, MSN, APRN, NP]

I get where you are coming from Jules but you're also probably in the top 1% of earners in our field. Pretty much anyone in any field that is at the top of their game is going to take a cut if they try and go elsewhere. I'm in the same boat as you in my region, but I know firsthand that if I try and head elsewhere, I will be offered a rate still higher than the market average based on my experience.

My point is more that if you have a few years of experience, a practice is going to pay you more than they would a new grad, and jobs are easier to come by because many require experience before they will look at you.

[djmatte, ADN, MSN, RN, NP]

Calling me snobbish for saying the job market is good is unwarranted and demonstrates a lack of vocabulary. By encouraging people to enter the nurse practitioner profession, I am being the opposite of snobbish. I have also apologized for losing my temper in previous threads. Some of you evidently feel a compulsion to personally attack me no matter what I say. I think I could say "the sun rises in the east and sets in the west" and someone would attack me. Disagreement does not mean free rein to launch personal attacks.

In most cases, you're misinterpreting disagreeing with attacks. As was pointed out, you all too commonly do this. My initial response to your OP was exactly that...a disagreement knowing that the expectations are nothing like your OP presents in the near future. Which you as expected retaliated by suggesting I was somehow "promulgating negativity" when I was being realistic.

While I did come off as brash as you graciously float out your views that *all* a nurse has to do is be willing to uproot and go wherever they want as if its someone using the argument "don't like the laws of your state, just move". The reality is you had no time spent as an RN...so when some of us who know the climate of many RNs see someone pontificating about how *easy* it is to get a job and never spent a second in the profession, you are going to see some annoyed reactions.

In any case, I'm thinking that if there is a problem where it seems the majority of people are constantly "attacking" you....maybe the problem isn't necessarily them.

[FullGlass, BSN, MSN, NP]

Do you know what the growth of NP programs and number of new grads yearly from NP schools is projected to be?

Actually I dug these up but would like to see what others have found if contradictory.

"Primary Care Nurse Practitioners (NPs) The primary care NP supply is projected to outpace demand at the national level if NPs are utilized in the same way in the future. • Approximately 57,330 primary care NPs were active in the U.S. workforce in 2013. Assuming continuation of current training levels and workforce participation patterns, the supply of NPs is expected to grow by 53,210 FTEs – from 57,330 FTEs in 2013 to 110,540 FTEs in 2025 – a 93 percent increase. • The national demand for primary care NPs is projected to grow by 10,710 FTEs – from 57,330 FTEs in 2013 to 68,040 FTEs in 2025 – a 19 percent increase. Projected changes in supply and demand for primary care NPs vary by region. • Distributional imbalances in primary care NP supply and demand are projected at the regional level. • While primary care NP supply is expected to exceed demand in all U.S. Census Bureau regions, the 2025 oversupply is expected to be greatest in the South region (18,070 FTEs)."

https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-national-projections2013-2025.pdf

"An estimated 23,000 new NPs completed their academic programs in 2015-2016"

From: AANP - NP Fact Sheet

I'm going to respond to your post in more detail. The source you cited is National and Regional Projections of Supply and Demand for Primary Care Practitioners: 2013-2025, HHS HRSA, 2016 ("HRSA," for short in this post). This report covers MDs, DOs, NPs, and PAs.

To quote from HRSA: "The national demand for primary care physicians is projected to increase by 38,320 FTEs - from 224,780 FTEs in 2013 to 263,100 FTEs in 2025 - a 17 percent increase. With delivery system changes and full utilization of NP and PA services the projected shortage of 23,640 FTEs can be effectively mitigated." (p. 5) However, a newer projection by AAMC in 2017 projects a shortage of 100,000 MDs by 2030, with a shortfall of up to 43,100 primary care MDs.

From HRSA: "The primary care NP supply is projected to outpace demand at the national level IF [emphasis added] NPs are utilized in the same way in the future. That's big "if," given that the trend is to move toward full practice authority in all states. The VA also added full practice authority after this report was written.

On page 18 of HRSA, limitations of the analysis are provided. Basically, the limitations are that this is based on 2013 baselines, which may or may not be accurate; and that "current patterns of provider utilization will continue." It is also based on 2013 patterns of healthcare delivery remaining the same. Those are very big assumptions that have already changed, given the increase in states and organizations that provide NPs with full practice authority, along with rapid technology advances such as telemedicine. The discussion of limitations continues that depending on the accuracy of the 2013 baseline, ". . . the projected NP and PA supplies may be closer in equilibrium wiht projected demands." (p. 19) And the limitations discussion concludes that "An overall limitation of these projections is that data gaps and uncertainties exist regarding how health care use and delivery patterns will evolve over time." (p. 19)

HRSA concludes that the projected oversupply of NPs and PAs could alleviate the projected shortfall of primary care doctors, depending on scope of practice laws and regulations. The report also concludes that advances in technology, such as telemedicine, may increase demand for care.

An analysis of the HRSA estimates by Streeter et al (2017) discusses the limitations of the HRSA projections. "The HWSM projections reflect baseline assumptions regarding supply, demand, new entrants into each profession, retirement patterns, and provider‐utilization ratios. Projected shortages and surpluses must be considered in the context of those assumptions. For example, if the national baseline shortage of primary care physicians is greater than the assumed 8,200 physicians needed to de‐designate the HPSAs, then the 2025 shortages may be greater than estimated by the HWSM. Similarly, if 2013 primary care NP and PA demands are greater than baseline supplies, then the 2025 demands may be higher than projected, which could reduce projected surpluses of NPs and exacerbate projected shortages of PAs." Streeter et al also point out that the HRSA report provides point estimates, not ranges. Projections typically provide ranges and margin of error. This analysis concludes that regional shortages must be addressed and that expanding scope of practice for NPs and PAs, improved care delivery models, and improved technologies can alleviate the impact of doctor shortages.

Furthermore, not all primary care NPs will go into primary care and stay there. Evidently, some are working in acute care environments like EDs. Some NPs move into specialities, academia, and administration. Judging from this forum, some NPs don't like their jobs and go back to being RNs or leave healthcare altogether. That will also bring down the number of NPs who are practicing in primary care. So, just as a rough estimate, let's say 85% of NP graduates actually stay in primary care for significant time.

If we rerun the numbers in light of my analysis:

2025 supply of NPs = 110,540 * 85% = 93,959

20251 demand NPs = 68,040

Projected surplus = 25,919

However, there is expected to be a primary care doctor shortfall of 23,640. HRSA concludes that NPs can perform 80 to 90% of what a primary care doc does, so just as a very rough estimate, let's say 80% of 23,640 = 18,912 primary care doc jobs NPs could fill. That would bring the projected NP surplus down to 7,007, based on my analysis above. However, more recent projections of MD supply make the projected shortfall of primary care MDs significantly greater, which would mean that there would be no surplus of NPs, or even a slight deficit. That is why HRSA and the Streeter et al analysis indicate that supply and demand of NPs could very well be in equilibrium by 2025.

A couple of final thoughts:

1. If there is an oversupply of NPs, the market will correct itself. Not all the NPs will get jobs and they will do other things. This will also reduce the number of people looking to become NPs. This will also result in the best NPs getting hired.

2. According to Say's Law, supply can also create its own demand. This has been seen with specialist MDs. One can argue that there is still a lot of unmet demand for healthcare services that is not accounted for in current projections, and more providers can meet the currently unknown demand.

3. The discussion above only pertains to primary care NPs. Not all NPs go into primary care and I have not seen a discussion of whether or not there is a shortage or surplus in acute care, mental health care, specialties, etc.

Streeter et al

Perspectives: Using Results from HRSA's Health Workforce Simulation Model to Examine the Geography of Primary Care

NPs can reduce disparities

The Untapped Potential of the Nurse Practitioner Workforce in Reducing Health Disparities. - PubMed - NCBI

State level projections (as opposed to national projections)

https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-state-projections2013-2025.pdf

Shortfall of primary care clinicians in California by 2030, which is different from HRSA projection

California Demand for Primary Care Providers to Exceed Supply by 2

[FullGlass, BSN, MSN, NP]

In most cases, you're misinterpreting disagreeing with attacks. As was pointed out, you all too commonly do this. My initial response to your OP was exactly that...a disagreement knowing that the expectations are nothing like your OP presents in the near future. Which you as expected retaliated by suggesting I was somehow "promulgating negativity" when I was being realistic.

While I did come off as brash as you graciously float out your views that *all* a nurse has to do is be willing to uproot and go wherever they want as if its someone using the argument "don't like the laws of your state, just move". The reality is you had no time spent as an RN...so when some of us who know the climate of many RNs see someone pontificating about how *easy* it is to get a job and never spent a second in the profession, you are going to see some annoyed reactions.

In any case, I'm thinking that if there is a problem where it seems the majority of people are constantly "attacking" you....maybe the problem isn't necessarily them.

You attacked me because I am a DE NP. Yes, I am and so what? There is nothing wrong with knowing from the outset that one wants to become an NP. In addition, I did nothing unethical or illegal. Judging from comments on this forum, there are many RNs who just want to become NPs to make more money or because they mistakenly think it is easier and then are sorely disappointed. At least a DE NP knows what they want.

The RN and NP roles are not the same, so knowing the "climate of many RNs" is irrelevant to finding an NP job in primary care. Few RNs work in primary care. (And before all the protests, I am clearly saying PRIMARY CARE). Whether or not I spent time as an RN, I did have success in finding an NP job, so my job search tips are quite relevant.

I never suggested that all an NP has to do is relocate - I have provided many action steps to getting a good job. In any profession and in any job search, people who are willing to relocate have a better chance of finding a good job. Someone who will only look for work, especially as a new grad NP, within a 30 minute commute of their home is severely limiting their opportunities. New grad MDs have to go where they are matched. Thems the shakes. That is also why most developed countries do not encourage home ownership to the extent the US does, because it creates an inefficient labor market.

In addition, most NP students still go to brick and mortar schools and many of them have to relocate to go to school. So they don't expect the stay in the same city as where they went to school. The majority of students in these schools are young, single, and don't own a home.

Since you had success in landing a job as a new grad NP, why don't you share your experiences and job search tips? That would be a far more productive and positive use of your time and energy, as opposed to running me down.

This thread was started to discuss the current job market for NPs, which is open to debate and discussion. My intent was to provide some much-needed encouragement to good NP candidates and new grad NPs, as well as to initiate discussion of local NP job markets. My posts have been nothing but professional on this thread. So why does that annoy you? It appears you just find me and anything I have to say as annoying, but annoying you still does not justify attacking me on a personal level as opposed to discussing the issue at hand. I did not attack you or mention you in any way in my original post on this thread.

You have a pattern of trying to personally attack me instead of discussing the actual issue. Even after I offered heartfelt congratulations on your new job, you still have an irresistible urge to attack me. I suggest you take a closer look at yourself. You seem incapable of admitting you are wrong and apologizing. I am willing to admit when I am wrong and apologize. So, I suggest you engage in some self-reflection and determine why you are unable to do the same. In your professional practice, you may need to apologize. Studies have shown that apologies also reduce malpractice claims when a mistake is made (Peter Pronovost, MD).

[FullGlass, BSN, MSN, NP]

I won't commuter I someone thinking their own projections are somehow superior to federal government estimates. Quite frankly, DHHS probably had a lot more expertise in this department than you.

Outside that, doctors have luxuries few RNs who choose to go on to advance practice have. The vast majority are actively working and have homesteads well before advancing their careers. In many cases they are primary breadwinner in their households. So to suggest nurses should be willing to just uproot is massive at best and shows clear ignorance of the nursing profession as a whole. But as we've covered in the past, your goal was to be a provider and you have no concept of the nursing profession. You want to spread your rose colored glass view as if so long as you land the job, all other commitments, obligations, and personal preferences just don't exist or will just go away. Most people don't have the luxury of living I that fantasy land.

I did not provide my own projections. I quoted The Department of Labor.

[FullGlass, BSN, MSN, NP]

@FullGlass

This is my first comment, but I'm a long time reader. I might get banned for asking this, but are you a some type of college recruiter? I only ask this, because many of your posts are about how the jobs are plentiful, everyone should be an NP, you don't have to be a nurse to become an NP, and how being an NP is the greatest thing since sliced bread (everybody join the party). It's almost like the "come to America, where the streets are paved with gold" slogan, America used to recruit Europeans. And like one pointed out: It's always you and ShibaOwner (Name?) with the same posts. The thing is that it really isn't like that. Here in NYC, there are employers asking PMHNP's to work for $90,000, though the cost of living is ridiculous. Hospitals who survive mostly on Medicaid pay $110,000 - $120,000, the NP's in NY are reimbursed 100%. Seems like everyone is in NP school. NP videos on YT are becoming very popular. There has to be higher standards or this profession will never be great. A friend of mine opened his/her own practice in NYC (charging cash), because she wants to make as much money as she can before all the PMHNP students flood the market in 2-4 years. Heck, I almost feel bad for psychiatrists. Almost anyone can get into these schools (pass the easy classes) and it shouldn't be that way. I hate to comment on anything, but I feel the truth has to get out there. 3rd year RN's are making almost $100,000 a year (without overtime) in the "good" NYC hospitals, but their NP's make around $114,000.

I did not address PMHNPs in my post. However, there is an acute shortage of mental health professionals and this has been in the news a lot. There is an acute shortage of psychiatrists and PMHNPs can help alleviate this shortage, especially with full practice authority.

Perhaps there is a surplus of PMHNPs in NYC, but that is not the case everywhere. We have an acute shortage of PMHNPs in California and they are paid very well - up to $190K or more in low cost of living areas (yes, we have those in California).

In addition, if there is a projected surplus of PMHNPs overall, it would be great to see your evidence.

https://www.thenationalcouncil.org/wp-content/uploads/2017/03/Psychiatric-Shortage_National-Council-.pdf

[FullGlass, BSN, MSN, NP]

@ FullGlass

People can disagree as much as they please on this forum. It isn't attacking you.

Ironically, you yourself have posted personal attacks in prior threads.

You are not disagreeing. You are attacking me personally. When I have made a mistake, I apologized. I have also strived to be more polite and professional.