Friend MD Made Me a 50/50 Offer

[sonnyluv]

Hey all-

Good friend of mine is an anesthesiologist who runs a busy pain management clinic. He is also a certified Family Medicine Doc. He wants to start up urgent care/ basic family care clinics with NP's as business partners. His idea: NP invests 50% start up cost, owns half of business. We split billings 50/50. My understanding is he wants to start multpiple clinics and said he would also want someone to oversee facility management. Could lead to a managerial role for me. This is in California.　

But I am hesitant to finish pursuing my NP license. The more practicing NP's I meet the more discouraged and worried I get about the rewards. Coming from a corporate/professional background I see NP's as a largely unsavy business group. Poorly promoted as practioners and certainly poorly received. Worst of all, the NP's I have shadowed in a multitude of specialties, including masters degree trained CNS (I know different job) have absolutely been clinically proficient and clearly an asset to the groups they worked for. They truly are talented at what they do.

Unfortunately, many of these professionals bristle at the talk of compensation or negotiation. I felt as if the pervasive attitude was "We are lucky for what we get and it beats working on the floor." I also noticed obvious condescension from MD peers. Some of the NP's I shadowed (11 total, I research hard) still seem to have the R.N. instinctual fear of M.D. authority and like less professional R.N.'s talked with cattiness about fellow staff. No talk of negotiation, some talk of bonus, NO PROFIT SHARING! WHAAAT? Several simply said (generalizing) "I didn't like being on the floor" implying to me that they didn't see themselves as a new professional entity but merely doing something different then working as a staff R.N.

I see salary starts for NP's barely more than non-advanced practice nurses. I find many NP's justify the inequities of their treatment with again , "It beats being on the floor." What!?

In my opinion, as a male RN, NP's are absolute proof of sexism and glass ceilings. Why is it that PA`s start in upper 70's to low 90's, while NP are lucky to start at 40/hr and often get pigeon-holed into salary postions in the low 70's where they work like dogs. I have a friend who just graduated from UCLA with a NP/CNS (dual certification) specialty in cardiology. She met with a group of cardiologists for a position, they ask her what is she looking for most of all. She says "respect". The president of the group says point blank, "No. You will not get it here." She is offered 72K, 50 hour work week minimum. She will be on call 3 weeks out of the month FIELDING NIGHTT PAGES FOR THE MD MEMBERS OF THE TEAM TO DECIDE IF THEY SHOULD BE DISTURBED FROM THEIR PRINCELY SLEEP. The same cardiology group not only utilizes PA's but it also has TO TRAIN THEIR PA'S in cardiology but starts them in the mid 80's. PA'S have one week on call. She tells them to take a hike. No other better offers presented. Now she is back working with me in critical care, 50K+ in debt, exhausted and furious.

My MD friend is not impressed with PA`s professionally and has had good experiences with NP's (Of course!). The bottom line is there are simply not enough MD'S going into or existing in primary medicine yet the AMA still attacks advanced nursing every chance it gets. I don't want to get into this fight for a living but at first glance my friend is offering me a genuinely great opportunity.

Sad to say, while I may be business savvy, if my peers are not, and are working for a few thousand more than non-advanced practice nurses while passing rigourous didatic, clinical training and then passing challenging licensing tests all for little promotion and recognition it's going to be a long slog that will put a strain on my family in many ways- trying to move ahead while everyone stays back. Just doesn't seem worth it.

So: Am I wanted as a business savvy negotiator among NP peers? Or will it be much of the same as it is in critical care: Institutionalized mal-treatment. Professional insecurities, petty infighting, the patient lost in the shuffle. I`m inclined to go CRNA for business reasons but my passion lies with working with families and giving excellent primary care.

I just keep asking myself- why is there such a difference between CRNA and NP? Perhaps there was a time when NP'S were not adequately trained for the positions they attemped to take on? Why is no one effectively promoting the advanced nurse as cost saving effecient and competent professionals that they are?

Thanks all, long post-my apologies. It's just that I take this commitment seriously and if I plan to move ahead, I`m moving ahead. I do not mean to offend anyone I am just being frank. No doubt, people who have different opinions than me will inform me and I encourage the discussion. Looking for some light at the end of the tunnel here!

Sonny

[traumaRUs, MSN, APRN]

You bring up some very valid points about APNs in general (I'm actually a CNS).

The urgent clinics in my area (IL) have the area already saturated: MinuteClinic, Take Care and now some MD/PA combo have two more. However, we are in a recession and these places only deal in cash/credit card and they do not bill your insurance - that's the pt's responsibility. So....it hasn't worked well here and several have closed their doors.

[elkpark]

I would be extremely cautious, in any discipline/occupation, about going into business with a friend -- lots of potential boundary/loyalty issues.

[drfitness]

I really enjoyed reading your post. I have some more questions for you. Can you please send me a pm since I cant send you one. Thanks

[TX RN]

Some individuals place a higher value on professional development and education than they do on money.

Don't get me wrong, I would love to finish up and land a great paying job. I'm finishing up an ACNP program this December.

My suggestion to you is this:

Decide what will make you happiest.

a. CRNA type salary

b. Primary care type profession

Good luck.

To answer your question regarding CRNA pay and why CRNA's seem to earn more money than NP's do:

It's because CRNA's successfully lobbied their profession way back in the day. They established their practice early on, before anesthesiology was even offered as a specialty to physicians. Nurses were the anesthesia providers. In fact, much of the early use of anesthesia was practiced and taught by nurses. Anesthesia as a physician specialty didn't come about until the 1960's. With such a rich history of successful practice, CRNA's successfully lobbyied for scope of practice and more importantly - REIMBURSEMENT.

[nursetim, NP]

Maybe you just found your niche. How about a professional negotiator for NP's? Maybe then we will be valued for what we bring to the table.

Technically speaking, there is very little that an MD can do that I can't, theoretically speaking at least. Yet they are making much more than I am. Were I as well trained as I would have liked to be, there would be no difference. Billing is not an issue, we do not bill medicare/medicaid or any other insurance.

[AbeFrohman, BSN, RN]

CRNAs make more because they generate more. This is simply a fact of the specialty. It's like asking why doesn't the cardiologist make as much as an anesthesiologist. Anesthesia does more procedures, has lower overhead, and HIGH liability.

As far as PAs making more, this is not true. If you look up the average salaries for NP and PA, there is almost no difference. Your story about your friend seems to be hyperbolic. Your friend may have misinformed about the PA salary/work schedule or that particular group just prefers PAs, or maybe those PAs are getting some OR time which adds income. I know a PA in a neurology practice that does the exact same thing as the NPs, but make more because she also goes to the OR on certain days. I also doubt they would need much more training in cardiology than your friend considering their clinical hours/rotations/curriculum.

If the case was they preferred PAs, there are just as many groups that prefer NPs and will treat them better than a PA.

Sausage King of Chicago, RN

[nursetim, NP]

CRNAs make more because they generate more. This is simply a fact of the specialty. It's like asking why doesn't the cardiologist make as much as an anesthesiologist. Anesthesia does more procedures, has lower overhead, and HIGH liability.

As far as PAs making more, this is not true. If you look up the average salaries for NP and PA, there is almost no difference. Your story about your friend seems to be hyperbolic. Your friend may have misinformed about the PA salary/work schedule or that particular group just prefers PAs, or maybe those PAs are getting some OR time which adds income. I know a PA in a neurology practice that does the exact same thing as the NPs, but make more because she also goes to the OR on certain days. I also doubt they would need much more training in cardiology than your friend considering their clinical hours/rotations/curriculum.

If the case was they preferred PAs, there are just as many groups that prefer NPs and will treat them better than a PA.

Sausage King of Chicago, RN

I have to respectfully disagree. I have seen ads for mid levels that ADVERTISED PA's being offered 20K more than NP's. So please do not say that it is hyperbole. Is it common, maybe not, but it is out there and I have not seen the reverse.

[AbeFrohman, BSN, RN]

I'm sorry, but it seems hyperbolic to think that ANYONE (MD, PA, NP) would offer a job with call for three weeks and expect someone to take it. Lots of people get low balled on their offer, PAs and CRNAs included. The post reeks of a poorly organized pity party. SEXISM? REALLY?

Sex: Females accounted for 64 percent of the respondents to this year’s census

Source: AAPA

So there are actually more female PAs than there are males.

NPs are just as well respected as any other profession. Some would say more respect since PAs are often left out of national health care discussions. President Obama has specifically mentioned nurse practitioners in his speeches, but not PAs.

I'm not trying to turn this into a PA vs NP vs CRNA kind of thread. However, I cannot abide misinformation, especially "poor pitiful me" kind of information. I'm a nurse through and through, so if anything I have a bias towards anything nursing.

PA 20K over NP? I would like to see that job posting, but I doubt very seriously it is for an identical position (same specialty, same locale, same duties). And the reverse is happening. According to the research, NPs are actually making more on average in some areas. This says ALOT because it should be higher for PAs since they vastly outnumber NPs in CV surgery which is one of the highest paid specialties.

"The mean base salary for full-time NPs from their main practice

setting was $84,250, with an average total income of $92,110."

Source: AANP

"The median total annual income from primary employer for respondents who work at least 32 hours per week for their primary employer and who are not self-employed is $85,710; the mean is $89,897."

Source: AAPA

Average Indiana NP salary: $85,116

Source: Economic Research Institute

Average Indiana PA salary: $80,468

Source: AAPA

Edit: The information is correct but the second link keeps going to the 2007 report data, so do some digging and you'll find the info. Look for the 2008 report.

[psychonaut]

The PA forum has a sub-forum for discussions of Contracts and Negotiations. I have found it very educational, as that sort of thing seems to be discussed with less frequency on these boards. The PA posts have given me a great deal of insight as to what I will be looking for when I get my NP

Throughout my NP education (just starting out now), I will be actively seeking out education in these matters. I realize that this position will require a drastically different mindset as to compensation than I have now as a "staff" nurse. I also realize that this subject is only minimally covered in NP school.

Our allnurses PA guru (posting as "core0") has mentioned a PA conference on contract negotiation. I don't know if such a thing exists for NPs, but it would be worthwhile to look around.

Regarding salaries, Advance magazine has some good data for both PAs and NPs available on-line.

I'm with you, contact and compensation are very important aspects of a professional career, and they are aspects that should be given more emphasis in the training of neophyte NPs.

I have great respect for the PA profession. If they are succeeding in the area of compenstation/negotiation, I'd be inclined to look at both what they are diong right and what we (as nurses) are doing wrong.