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Fallout of Obamacare Question: Best Advanced Nursing Degree To Pursue?


I'm an RN of 32 years old with 6 years of experience. I'm motivated and looking to further my education and marketability as a nurse. As I'm pondering my decision, obviously one must look at the fallout of Obamacare will have on the future of an advanced nursing degree.

That as a foundation, my questions are as follows:

1) Which advanced nursing degree would be wise to pursue knowing the Obamacare is just around the corner? I know you should choose a career path that best caters to your passion and strength.....but I'm just just seriously curious overall on what everyone's opinions are!!!

2) CRNA versus Nurse Practitioner - Which Nursing Professional (in your opinion) will benefit more (and get a greater Return on Investment) with their advanced degree? I know these 2 positions vastly differ in many ways...but my sense is one would be in more demand than the other. Based on my research, this is what I'm sensing:

1) Nurse Practitioners will be in greater demand because of the many doctors may getting out of the profession...causing a greater demand for Nurse Practitioners. More demand...equals more job security and pay.

2) CRNA's will be in less demand (and maybe get less of a Return on Investment) with this advanced degree than an Nurse Practitioner. The medical field seems to be going to the more "home health care" and the extreme causes related to Hospitals may force hospitals to have less budget to pay for CRNA's. Yes...I know that there will always people needing surgeries ect. But with many people going for CRNA's....the market could be much more saturated then the Nurse Practitioner

3) Masters in Science in Nursing (MSN) - Not sure how Obamacare will effect this but would appreciate anybodies input if a MSN is a better degree to pursue than an NP or CRNA. To me, common sense tells you, that getting a NP or CRNA would be better.

In closing, thanks for letting me share all this as I'm a person that thinks as I type. In terms of a potential decision, I've learned that some of the best choices you make are the ones you didn't make. After thinking things through a little bit more, perhaps (just perhaps) Obamacare will lesson the salaries of these Advanced Nursing Degrees and people won't get a good return on investment with their degrees. That said....perhaps its best to just be content where I'm at :)


Edited by asiangal

BlueDevil,DNP, DNP, RN

Specializes in FNP, ONP. Has 25 years experience.

I don't think the ACA is going to have a significant impact on advanced nursing practice for the foreseeable future. You should pursue which ever path interest you more, as they are vastly different and have virtually nothing in common.

I understand the I should pursue my interests...THAT ASIDE....which one will have more of an affect on Obamacare?

BlueDevil,DNP, DNP, RN

Specializes in FNP, ONP. Has 25 years experience.

As I said, I don't think either will be deeply impacted.

And it's not Obamacare-It's the Affordable Care Act. Obama actually ran on the one payer system like Medicare but caved in when he knew he would never get it passed. The Affordable Care Act is actually based on what Romney got passed in Massachusetts when he was governor.

Any other thoughts out there?

roser13, ASN, RN

Specializes in Med/Surg, Ortho, ASC. Has 17 years experience.

I don't understand what the ACA has to do with anyone's career choices?

Follow your interests. Do what you love.

Always the best advice.


Specializes in FNP. Has 8 years experience.

When I was going for my NP I thought about this, I was originally going for Acute Care NP and then switched to Family, I dont see anything "in writing" but it seems like most physicians are going into specialities and my world domination plan is that NPs will be primary care and physicians can specialize.

Froggg123 for president in 2016


Specializes in ER. Has 5 years experience.

I don't think the ACA will have an impact on the various and sundry roles of providers. Personally, I think the MDs are just whining. They will have to stay on board whether they like it or not. Ha ha.

I think in general, midlevels will continue to see an increase in demand for their skills. This would include the CRNAs.

So, under ACA, how do you think the role of the CRNA will change? And the FNP? Obviously, I've given my opinion....but I'm not saying I'm right. Would love to hear yours.

Hospitals are what they are - they want to make and keep money (this is bad for nurses). Insurance companies are what they are - would rather people not be patients in hospital because they don't want to pay out $$$$$ benefits.

If there was no Obamacare, everything would still point to less healthcare benefit, and more out of pocket for patients. This as well as attempts to keep patients out of hospitals. Nobody wants to pay for inpatient care. You will pay more, and get less no matter what/who. The best way to do that is keep you away from the hospital.

Sooooo. Outpatient is probably the way to go.

BlueDevil,DNP, DNP, RN

Specializes in FNP, ONP. Has 25 years experience.

What we are telling you is that no one thinks either of the roles is likely to change much, if at all. What is possible, is that your state practice act may change. You should check with your state BON and state professional AP org and find out what kind of legislation might be pending, or is being discussed. The ACA isn't going to have much impact, but APNs in your state may be vying for change completely independent of it. We are telling you to look at the big picture. The ACA should not be significant to your decision.

Good luck.

I think that the original poster isn't asking about ACA-engendered changes in practice so much as changes in job prospects and overall roles of NPs within healthcare. I have a hard time believing that healthcare providers won't be impacted by millions of new patients obtaining health care coverage. My guess is that there will be an increase in most NP specialies, if only to accommodate the patient loads. I would also not be surprised if pay goes down uniformly as well, though the proponents of ACA say that it won't.

My sense is also that MDs will continue to gravitate toward specializing. The gov is giving incentives to MDs for staying in primary care, but they're not so good that they'll sway a majority of doctors. So, FNP, home care, preventative care...those are the fields that will probably expand most rapidly. But that doesn't mean that there won't be a lot of places for CRNAs, acute care NPs, etc. Just my dos centavos.

Talked with a Director of Nursing today and she said that because physicians will be impacted negatively that Nurse Practitioners will be negatively impacted because [essentially] they play very similar roles. Now that I'm thinking about it....Family Physicians are going into many specialty type niches...and it maybe wise that Nurse Practitioners may want to follow-suit.

P.S. These are just some thoughts. Not saying it will happen. Just thinking out loud for those that want to read :)

Blessings all,

Asian Gal


Has 5 years experience.

Why do you call it "Obamacare"? Why not call it the Affordable Care Act? :p:***:

From what I've learned, it's only going to be BENEFICIAL! Those involved with primary care are going to get a 10% pay increase, the pay scale for medicaid is increasing, and QUALITY of care (not QUANTITY of care) is going to be rewarded slightly. There are also going to be more health community centers built (possibly hospitals?) due to the increase in demand and scholarships given for those interested in the health field (RNs, nurse practitioners, physicians, PA's, ect) to increase the number of professionals. They're also encouraging more professionals to provide care in undeserved areas.

It's all on the website timeline for the Affordable Care Act: Key Features of the Affordable Care Act, By Year | HealthCare.gov

  • Rebuilding the Primary Care Workforce. To strengthen the availability of primary care, there are new incentives in the law to expand the number of primary care doctors, nurses and physician assistants. These include funding for scholarships and loan repayments for primary care doctors and nurses working in underserved areas. Doctors and nurses receiving payments made under any state loan repayment or loan forgiveness program intended to increase the availability of health care services in underserved or health professional shortage areas will not have to pay taxes on those payments. Effective 2010 .

Increasing Payments for Rural Health Care Providers. Today, 68% of medically underserved communities across the nation are in rural areas. These communities often have trouble attracting and retaining medical professionals. The law provides increased payment to rural health care providers to help them continue to serve their communities. Effective 2010. Learn more about Rural Americans and the Affordable Care Act.

  • Linking Payment to Quality Outcomes. The law establishes a hospital Value-Based Purchasing program (VBP) in Traditional Medicare. This program offers financial incentives to hospitals to improve the quality of care. Hospital performance is required to be publicly reported, beginning with measures relating to heart attacks, heart failure, pneumonia, surgical care, health-care associated infections, and patients' perception of care. Effective for payments for discharges occurring on or after October 1, 2012.

Encouraging Integrated Health Systems. The new law provides incentives for physicians to join together to form "Accountable Care Organizations." These groups allow doctors to better coordinate patient care and improve the quality, help prevent disease and illness and reduce unnecessary hospital admissions. If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save. Effective January 1, 2012. Fact Sheet: Improving Care Coordination for People with Medicare

Increasing Medicaid Payments for Primary Care Doctors. As Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government. Effective January 1, 2013. Learn how the law supports and strengthens primary care providers.

  • Paying Physicians Based on Value Not Volume. A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care. Effective January 1, 2015.

So, no I do not believe it is a "fallout" but more of a "benefit"

I don't really understand the logic behind "physicians will be negatively impacted, so nurse practitioners will as well." There are parallels between MD and NP roles, but there are also a lot of differences. The MD has a much larger scope of practice and also earns much more than the NP. MD schooling is also significantly longer than NP school. There may be some "meeting in the middle" on these issues rather than a uniformely negative impact.


Specializes in OB/GYN,PHN, Family Planning. Has 20 years experience.

The organization I work for is now hiring only FNP or PA as many clinics will be doing larger primary care services. We have hired WHNP and CNW for reproductive health services in the past but all open positions have now changed to FNP/PA as they can be cross trained to provide a larger scope of patient services.

IMO, do what you think you will enjoy and what will positively impact others who are in need of what you have to offer. I've been a nurse for a very long time and it concerns me that young people are only concerned about the external factors which may impact their practice versus the intrinsic factors which determines the type of care given and the effectiveness of that care. Obamacare or ACA should not be the major factor in determining what you want to do with your education or career. I would recommend that those of us that are concerned about Obamacare or ACA sit down and actually read what I believe is a 1500 page document and see what potential impact there is on health and medical care. In fact, those of us who haven't taken the time to review the ACA in its entirety, including me, need to sit down and take a close look. Oh, and make sure you review the document with an open mind.