FNP Oversaturation

Polly Peptide, BSN, MSN, RN, APRN · May 6, 2018

Jules A said:
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?

I didn't but will now; that is certainly good news, on the doc side at least. The HRSA projections have criteria of course, and limitations. Per their study:

"All projection models are sensitive to assumptions and the findings must be interpreted in light of those assumptions. An underlying model assumption in HWSM is that health care delivery in the future (projected until 2025) will not change substantially from the way care was delivered in the base year (2013); and current rates of workforce participation and retirement will continue similarly into the future. Changes in any of these factors may significantly impact both the supply and demand projections for all three types of primary care providers included in this report. Thus, it is important to note that the numbers presented here represent a planning tool for workforce development and should not be looked upon as exact numbers."

KatieMI, BSN, MSN, RN · May 6, 2018

Jules A said:
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.

I'd appreciate some evidence. I know there is limit in anesthesia, but nothing about primary care.

Polly Peptide, BSN, MSN, RN, APRN · May 6, 2018

KatieMI said:
I'd appreciate some evidence. I know there is limit in anesthesia, but nothing about primary care.

Right here.

https://www.ama-assn.org/sites/default/files/media-browser/specialty%20group/arc/ama-chart-np-practice-authority.pdf

Each state is different of course, because of the different levels of practice authority. But you will see in a variety of states that docs cannot supervise more than 3 FTE NPs (for example.

Dodongo, APRN, NP · May 6, 2018

In Pennsylvania it's a 1 physician : 4 NPs ratio.

Oldmahubbard · May 6, 2018

Dodongo said:
In PA it's a 1:4 ratio.

Same with NPs , however an experienced NP or PA is unlikely to contact the collaborator for "help" in a given week, or even a month.

KatieMI, BSN, MSN, RN · May 6, 2018

Right here.
https://www.ama-assn.org/sites/default/files/media-browser/specialty%20group/arc/ama-chart-np-practice-authority.pdf
Each state is different of course, because of the different levels of practice authority. But you will see in a variety of states that docs cannot supervise more than 3 FTE NPs (for example.

The document is what they wanna things to be and nothing more. AMA can "recommend" whatever but they cannot enforce it. There can be differences in states, and that's what matters, but I guess that there can be some well known and actively exploited loophole here and there.

Polly Peptide, BSN, MSN, RN, APRN · May 7, 2018

KatieMI said:
The document is what they wanna things to be and nothing more. AMA can "recommend" whatever but they cannot enforce it.

These numbers are not AMA recommendations. They are based on the individual states' collaborative practice agreements.

Polly Peptide, BSN, MSN, RN, APRN · May 7, 2018

KatieMI said:
The document is what they wanna things to be and nothing more. AMA can "recommend" whatever but they cannot enforce it. There can be differences in states, and that's what matters, but I guess that there can be some well known and actively exploited loophole here and there.

I am finding your comments confusing, so I'll quote your edit to reply again...otherwise I'll leave the topic alone so as not to threadjack.

The only attachment that this document has to the AMA is that I pulled it from their website.

All this is is a consolidation of the various practice authority acts (for advance practice nurses) by state. Which happens to be on the AMA site. Because it affects docs.

As it relates to this document and what it contains, the AMA is not deciding anything. This is all between the various governing bodies and the state BONs. The docs don't decide whether they are only allowed to "supervise" 3 FTEs because NPs have to have collaborative agreements in some states...by law. That has nothing to do with them.

Oldmahubbard · May 7, 2018

No doubt there are physicians who would love to supervise 10, 20, or more advanced practice clinicians, taking half the billing for doing very little work, but it is illegal.

The onus is on the NP or PA to make sure the collaborative rules and regs are being followed. I assure you they are not, in many cases. Hence "loopholes".

FullGlass, BSN, MSN, NP · May 7, 2018

ksisemo said:
Increasing NP pay will increase their SUPPLY...not their demand. Unfortunately.
I am kind of with you, though, on ambivalence about increasing pay (significantly, at least). While I think the current pay is too low, I also think if we increase it too much, we defeat one of the reasons we can advocate for NPs' ongoing position as healthcare providers. If we are paid as much (or close to) doctors, why do they need us? Beyond the fact that med schools aren't pumping out docs fast enough.
I believe in an appropriate balance. Pay that reflects the responsibility and work, but that doesn't price us out of the market. There are a LOT of factors. I do think that we are flooding the market with far too much supply, thus destroying our (using "our" loosely...I am not an NP, yet) ability to negotiate. That and generally we have a "comparison" problem - basing NP pay on former RN pay, which frankly, should be irrelevant. As others have said, it shouldn't be viewed a "raise" based on "progression."
I'd like to interject some important stats into this conversation.
Based upon the HRSA Health Workforce primary care provider supply/demand study done in November 16, as of 2013, there were notable shortages of NPs/PAs in California, New Jersey, Illinois, Ohio, and Michigan (with California having a shortage of more than 2,000).
In 2013, TN had an oversupply of more than 1,000 NPs. By 2025, NO state is anticipated to have a shortage of NPs. NONE.
Fortunately...there will still be a few with PA shortages. As well, there will still be a PCP shortage, unless the med schools do something (and they are). Of course, legislation will have to change to allow NPs/PAs to fill in the blanks.
Point is...this is not just a "feeling" or gloom and doom on a website. It is happening, unfortunately. Whether "everyone" will realize it and it will self-correct...who knows?
https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-state-projections2013-2025.pdf

I've discussed this on another thread. There are flaws in the 2013 projections. California, according to their own projections, will have a PCP shortage at least until 2030. My clinic is actively recruiting NPs, PAs, and MDs. Good pay, low cost of living.

djmatte, ADN, MSN, RN, NP · May 8, 2018

FullGlass said:
I've discussed this on another thread. There are flaws in the 2013 projections. California, according to their own projections, will have a PCP shortage at least until 2030. My clinic is actively recruiting NPs, PAs, and MDs. Good pay, low cost of living.

Where are there flaws in their estimates? Even here people are already seeing saturation in their markets. The only flaw imo is the suggestion that it will make up the difference in rural needed locations which I don't think it will. But there will still be a surplus in every state regardless of where they specifically choose to work.

FullGlass, BSN, MSN, NP · May 9, 2018

djmatte said:
Where are there flaws in their estimates? Even here people are already seeing saturation in their markets. The only flaw imo is the suggestion that it will make up the difference in rural needed locations which I don't think it will. But there will still be a surplus in every state regardless of where they specifically choose to work.

I did a very detailed analysis of this in a previous thread, so I'm not going to repeat it here. I see NO saturation of too many NPs, PAs, or primary care docs. It is very hard to project beyond 5 years, because conditions change. We don't have a supply problem, we have a distribution problem. What I find amazing is that with all the hand wringing going on here, when I post that our clinic is actively recruiting, not a single person tried to reach out to me about a job.

People need to go where the jobs are. End of story. Personally, I have no sympathy for people who whine and complain about low pay and/or lack of jobs, but are unwilling to move. If a person can't or won't move for a better opportunity, that is no one's fault but their own.

Pay does vary by location. Evaluating compensation requires looking at the cost of living. $125 K for a new grad NP might sound like a lot, but it doesn't go very far in San Francisco. A new grad accepting an NP job for $80K a year in a low cost of living area is probably better off when looking at standard of living.

This is a free country. People have a right to pursue whatever career they wish. If more people apply to NP school, that increases competition, which means only the best will get in. Harvard and Yale don't necessarily have the best academic programs, but with thousands of candidates for every spot, they can pick the best. We live in a free market economy, not a planned one. If there are too many NPs, only the best will get jobs. The market will thus correct any supply issues.

Personally, I have yet to see anyone on this forum produce a shred of actual evidence that NP pay is decreasing. If anyone does have such evidence (and I don't mean anecdotal) I'd love to see it.

There are very few professions where job openings are greater than the number of candidates. Dedicated professionals are not daunted by this. Competition is vital in a free market economy. Confident dedicated professionals plan for success and do what it takes to be at the top of their profession and they aren't afraid of competition. The cream of the crop will always command top dollar, too.