FNP Oversaturation

[brinksta]

I am in school for FNP. I keep hearing that it will be hard to find a job because of how many people are doing FNP. This has got me thinking I should maybe switch specialites. Is this gonna be a real problem? I live in a rural area and don't mind working here.

[Jules A, MSN]

ksisemo said:

As it stands right now, with the current environment, where we will have the shortfall is with docs.

Maybe not so much. There are 22 new psych residencies in the making which is something I have never seen before.

https://apps.acgme.org/ads/Public/Reports/ReportRun?ReportId=8&CurrentYear=2018&SpecialtyId=&AcademicYearId=2017

[Polly Peptide, BSN, MSN, RN, APRN]

Jules A said:

Maybe not so much. There are 22 new psych residencies in the making which is something I have never seen before.

https://apps.acgme.org/ads/Public/Reports/ReportRun?ReportId=8&CurrentYear=2018&SpecialtyId=&AcademicYearId=2017

Perhaps there is a push in psych (as there should be). However my comment was specific to primary care physicians. It is projected there will be a shortfall of more than 20k. By 2025, 37 states are projected to have a deficit of primary care physicians, with 12 of them having a deficit of more than 1,000.

There is a current shortfall in some states, but the need is anticipated to grow far more than the demand. The supply of NPs and PAs is growing like wildfire, and yet, they can't replace the docs.

I know of some medical schools trying to set up incentives for students to go into primary care (as that is not the "sexiest" specialty). I am familiar with one in particular that is funneling students from an undergrad program directly into the med school by shortening the undergrad degree by a year...with a commitment from the student that they will go into primary care.

We've got piles of NPs/PAs (who have to be supervised or at least have a collaborating agreement) and will have few docs. It's a cluster.

[guest769224]

My friend is a PA and has told me he is weary about the future of the profession as well (meaning PA). He says more and more new grads are being pumped out and salaries are coming down, difficult to find jobs just like it is for NP's.

[KatieMI, BSN, MSN, RN]

ksisemo said:

Perhaps there is a push in psych (as there should be). However my comment was specific to primary care physicians. It is projected there will be a shortfall of more than 20k. By 2025, 37 states are projected to have a deficit of primary care physicians, with 12 of them having a deficit of more than 1,000.

There is a current shortfall in some states, but the need is anticipated to grow far more than the demand. The supply of NPs and PAs is growing like wildfire, and yet, they can't replace the docs.

I know of some medical schools trying to set up incentives for students to go into primary care (as that is not the "sexiest" specialty). I am familiar with one in particular that is funneling students from an undergrad program directly into the med school by shortening the undergrad degree by a year...with a commitment from the student that they will go into primary care.

We've got piles of NPs/PAs (who have to be supervised or at least have a collaborating agreement) and will have few docs. It's a cluster.

The problem is, the wast majority of those newly convinced psych/FP docs are not that much likely to stay there. They want (and easily can go) into lucrative areas like applied behavioral analysis, addictions and sports medicine, despite of excellencies of primary care being pushed down their throats. In addition, FP residencies now making en masse "genious" move by adding one full year to their 3 years "normal" term to squeeze even more Uncle Sam's $$$$$/trainee's head, which doesn't make tham any more attractive than they are now. In addition to this, the supply line of foreign medical grads who used to make up a substantial mass for primary care residencies seems to dry up thanks to current political and immigration climate.

In short, there will be no enough docs in the near future to provide enough primary care services for American public, and especially for its vulnerable serments such as institutionalized, poor, chronically ill and those living in medically underserved areas. Luckily for all of us here, in primary care there are (and they are not expected to appear in the near future) limits of how much NPs/PAs one physician can "supervise". Therefore, IMH(umble)O, around 2025 the basic "unit" of primary care will consist of doctors sitting in their offices few and far between them, each of them managing high numbers of PAs/NPs doing 95% of work for about 25% less money than right now. But at least there will be plenty of such jobs.

[Polly Peptide, BSN, MSN, RN, APRN]

KatieMI said:

In short, there will be no enough docs in the near future to provide enough primary care services for American public, and especially for its vulnerable serments such as institutionalized, poor, chronically ill and those living in medically underserved areas. Luckily for all of us here, in primary care there are (and they are not expected to appear in the near future) limits of how much NPs/PAs one physician can "supervise". Therefore, IMH(umble)O, around 2025 the basic "unit" of primary care will consist of doctors sitting in their offices few and far between them, each of them managing high numbers of PAs/NPs doing 95% of work for about 25% less money than right now. But at least there will be plenty of such jobs.

Can you clarify?

You said there are limits to how many NPs/PAs a doc can supervise, which won't be changing anytime soon. But then you said the future will consist of docs supervising "high numbers" of NPs/PAs in each primary care "unit", which will give us "plenty of jobs."

I guess that seems contradictory, so I'm not sure I understand?

[djmatte, ADN, MSN, RN, NP]

ksisemo said:

Can you clarify?

You said there are limits to how many NPs/PAs a doc can supervise, which won't be changing anytime soon. But then you said the future will consist of docs supervising "high numbers" of NPs/PAs in each primary care "unit", which will give us "plenty of jobs."

I guess that seems contradictory, so I'm not sure I understand?

Most states with required collaboration have specific totals for "reasonable"collaboration. Meaning a stated limit in the total mid levels a doc could reasonably keep tabs on. In some cases there are added geographical requirements meaning must be at the same facility or with x miles of. Given these states are hard enough to sell on mid level autonomy, getting them to loosen the reigns in collaboration requirements is often a complicated and long road as well.

[Polly Peptide, BSN, MSN, RN, APRN]

djmatte said:

Most states with required collaboration have specific totals for "reasonable"collaboration. Meaning a stated limit in the total mid levels a doc could reasonably keep tabs on. In some cases there are added geographical requirements meaning must be at the same facility or with x miles of. Given these states are hard enough to sell on mid level autonomy, getting them to loosen the reigns in collaboration requirements is often a complicated and long road as well.

Thank you and I agree. I just didn't understand the "plenty of jobs" comment, considering there will be few docs limited to certain numbers of mid-levels.

[Dranger]

As I have said before, one key solution is to raise the barrier of entry into NP schools. As of now there is literally 0 barrier besides a BSN.

[KatieMI, BSN, MSN, RN]

ksisemo said:

Can you clarify?

You said there are limits to how many NPs/PAs a doc can supervise, which won't be changing anytime soon. But then you said the future will consist of docs supervising "high numbers" of NPs/PAs in each primary care "unit", which will give us "plenty of jobs."

I guess that seems contradictory, so I'm not sure I understand?

I wrote quite clearly that there are currently NO limits in number of PAs/NPs one physician can "supervise" IN PRIMARY CARE and it is not likely to change. Therefore, with relative paucity of primary care physicians, some oversupply of PAs/NPs and other causes (rapid increase of chronically sick baby boomers and "opioid generation" patients and institutionalized patients are just two of them), the logical practice model will possibly look like this: a physician who does mostly consulting/complicated cases, and many NPs/PAs who will do 95 or so % of the work these patients require. As the population becomes older, sicker and more demanding, the number of NP/PA jobs will increase accordingly, but wages stop follow.

If yuou have ever been in a SNF or ALF, you know what I am talking about.

[Oldmahubbard]

In my local SNF facilities, the pts are primarily managed by NPs and PAs. The NP or PA is there every day, and the physician about once a week. I think this is appropriate.

My speciality is psych, and I do not require or have a collaborator in my state, nor would it benefit the patients.

The problem I see is lack of communication between disciplines, not lack of education preparation.

Salary depends on the company one works for.

[Jules A, MSN]

ksisemo said:

Perhaps there is a push in psych (as there should be). However my comment was specific to primary care physicians. It is projected there will be a shortfall of more than 20k. By 2025, 37 states are projected to have a deficit of primary care physicians, with 12 of them having a deficit of more than 1,000.

Did you check out the link? My finger count is probably not 100% accurate but I counted #80 new residency programs listed for Family Medicine?

[Jules A, MSN]

KatieMI said:

I wrote quite clearly that there are currently NO limits in number of PAs/NPs one physician can "supervise" IN PRIMARY CARE and it is not likely to change. .

I'm confused not too because it is my understanding there are caps on the number of midlevels one physician can supervise in certain states.