The title says it all. Have you faced hates or disrespect from physicians (either attending or training) just because you are a NP? Because I did. Online.
As a RN and a NP student, I have seen many great attending physicians who work collaboratively and respectively with NPs. That rosy perception completely changed once I joined Reddit medical communities. There are massive posts showing hates against NP. The two main areas of criticism come down to: 1. Taking NP's malpractice cases or individual's anecdotal examples to basically question competency of all NPs in the states (although I am curious as to malpractice cases in comparison with MDs), 2. misunderstand and derogate the implication DNP (though it's an academic degree, not a clinical degree as MD, the physicians and trainee there seem to take it as NPs just trying to put a doctor title and lobbying to obtain an independent practice despite NP's allegedly inadequate competency.
I am not here to say NPs are equally trained as MDs because they are certainly not. Also, I also feel NP education has definitely rooms for improvement (another area of discussion).
Also, I acknowledge these people don't represent the majority medical societies so should take these views with a grain of salt. Nonetheless, I am unsure what to make out of the hates from these physicians (primarily in training) who will be our future coworkers other than trying to continuously learn and improve my competency and hopefully avoiding these toxic people in my future career if I have a choice.
I would appreciate any insightful advice from current NPs in the field. Thank you!
There is no reason that NP's cannot form together to create LLC's and open their own "primary" care clinics and instantly increase their pay by at least 50% while at the same time increasing their autonomy. Even in states that require MD supervision (most of these do not cap how many NP's can be overseen by a single MD) it is easy enough to find an MD to provider "supervision" for around a 10% fee. The umbrella company I work under is owned by Licensed Mental Health Counselor's and employs about 50 Psych NP's and maybe 250 therapists. The NP's all earn well over 200K (as do most of the therapists) and the owners are netting millions each month on their 30% (cut) and their $600 admin fee. It's a reasonable system for everyone involved. For example I saw 18 patients today and my 70% is about $140.00 per patient or around $2,500 before taxes and I still had time to get crucified on this board over my aversion to mandatory shutdowns and mandatory vaccinations.
Specializes in Former NP now Internal medicine PGY-3.
10 hours ago, djmatte said:
But that is the level that nurse practitioners generally are up against. The majority of nurse practitioners work in some form of primary or urgent care. Surgeons and specialists(docs at the top of their level) aren’t worried about NP autonomy. They know what they bring to the table. The only people who are seriously concerned are residents dismayed at the expense of their school and their mediocre resident pay compared with NPs their forced to report to who have in their view substandard education(literally statements I’ve seen on Reddit residency pages). Many of whom really have no interest in primary care short of a fall back.
Doctors who work in fields where NPs have made greater headway generally are more accepting of the trend. Partly because they see opportunities to save money while expanding their practice and because they recognize those newer md’s don’t give a damn about family medicine or primary care.
I am curious where you are seeing salaries increasing though in this field, because I don’t see it. Reimbursement is dropping all the time. Just looking at my own clinic system (four clinics) I often feel mid levels are floating those salaries. We have 6 total docs (two own the practice who don’t see full loads and often come and go as they please) and everyone’s schedule is equally slotted. 15 min office visits and 30 min physicals. None will see anyone outside those confines. And when they do their revenue reports, it’s clear their expenses are never met compared to lower paid staff who often exceed these measures. These docs are getting paid at least twice the salary. But given MD reimbursement, the difference should only be 15% more. These docs aren’t seeing more patients and they’re billing for the same complexity as everyone else.
MGMA and other groups and offers fellow residents have gotten show primary care salaries prior to the virus have gone up quite a bit in the past ten years or so. Same with hospitalist salaries. A lot of hospitals are restricting nps autonomy inpatient d/t silly consults (which isn’t just an NP thing buts it happens more often).
even if I was doing primary care the water is pretty good looking for doctors. I agree that NPs are great for the easier stuff but they’ll never replace physicians.
TBH I wouldn’t want to be in a residency that answered to nps either...we don’t in mine that’s for sure. I don’t think most beyond six months in intern would have much to learn from an NP or pa unless it’s in a super niche field
TBH I wouldn’t want to be in a residency that answered to nps either...we don’t in mine that’s for sure. I don’t think most beyond six months in intern would have much to learn from an NP or pa unless it’s in a super niche field
Of course that part might indicate the real evaluation of their residency program and might validate these Reddit residents are the very bottom feeder docs who may not mount too much in their insecurity.
thankfully I learned from working in hospitals that I don’t really like working in them. I prefer the primary care environment. But I would say while there things I will occasionally chat with my docs about, after 3 years of practice I have gained a pretty good understanding of what I can handle and significantly reduced the number of referrals I make.
I don’t know if this could be obtained on one year of residency, but maybe it endorses a slower structured approach of entry rather than the typical drop in and expect a full load out of school. I also had a luxury of a really light load 14ppd) because one of our clinics couldn’t get the right traffic. So I more or less has the time to ease in and find my groove.
Specializes in Former NP now Internal medicine PGY-3.
45 minutes ago, djmatte said:
Of course that part might indicate the real evaluation of their residency program and might validate these Reddit residents are the very bottom feeder docs who may not mount too much in their insecurity.
thankfully I learned from working in hospitals that I don’t really like working in them. I prefer the primary care environment. But I would say while there things I will occasionally chat with my docs about, after 3 years of practice I have gained a pretty good understanding of what I can handle and significantly reduced the number of referrals I make.
I don’t know if this could be obtained on one year of residency, but maybe it endorses a slower structured approach of entry rather than the typical drop in and expect a full load out of school. I also had a luxury of a really light load 14ppd) because one of our clinics couldn’t get the right traffic. So I more or less has the time to ease in and find my groove.
I think yeah it’s like that for most people. As you see things you get more comfortable. For primary care they entertained the idea of letting people graduate a year early which wouldn’t be a bad idea to get more people interested in it especially in rural areas.
Where I am there are tons of pcp jobs (small city) not considered a saturated “cool” city by any means. Might even do it IDK it’s temping.
though I think FNP and fm both are really to broad to get a good grasp on their population (everyone) 500-1000 hours def isn’t enough and for how many different environments FM docs train in IDK how they can properly manage kids from. A week or whatever to 90 year plus olds
The bottom line is that without regard to MD opinion NP autonomy continues to grow with Mass. joining the ranks most recently. It is always better to win than be popular.
Specializes in Former NP now Internal medicine PGY-3.
Doesn’t seem to be much difference in most situations in states with or without IP. Hospitals still require credentialing as do insurances. I used to work in kentucky and IP there after a few years of practice changed nothing really. Y’all can have it. Won’t hurt our coffers
Doesn’t seem to be much difference in most situations in states with or without IP. Hospitals still require credentialing as do insurances. I used to work in kentucky and IP there after a few years of practice changed nothing really. Y’all can have it. Won’t hurt our coffers
My point is that "percentage based pay" is what NP's should be focused upon whether it is an IP or non IP state. If you are getting a fixed percentage of gross revenues then you are typically going to earn far more as an NP. In many non IP states (for example Florida before the IP law passed) it was difficult to find many of these jobs. Thus, most offers I had were in the 100K-120K range. Thus, I looked in other states like Washington that offered anywhere between a 65-70% split and the income is more like 250K plus (granted 1099 and no benefits). Thus, I conclude that in states that are not "IP" that NP's should join together to split expenses and pay themselves a reasonable split. Where MD's are required for supervision they will still make more and should have relatively little trouble finding supervisory MD's (who may or may not even see patients at the practice) for a fee in the range of around 10% and perhaps a share of the ownership (of the LLC or C Corp group practice).
Whether people like me or not is almost not even relevant. Then again I'm "on the spectrum" and barely even care if my own wife and son like me so long as they don't annoy me too much and I get to enjoy my morning workout and play my Battlefield 4 every day.
Specializes in Former NP now Internal medicine PGY-3.
seems like battlefield 4 is >5 from everyone I have talked to. A lot of what you are saying seems to be psych specific.. Sort of like anesthesia, one of the two fields where you probably just don't need a physician most of the time (minus heads and hearts)
seems like battlefield 4 is >5 from everyone I have talked to. A lot of what you are saying seems to be psych specific.. Sort of like anesthesia, one of the two fields where you probably just don't need a physician most of the time (minus heads and hearts)
Psych helps because of combo coding and less equipment expense. However, the basic principle still applies. If you have a group of FNP's billing even two 30min appointments per hour say four days per week they should still be able to earn 200k on a 70% split with no great issues even with Medicaid in the mix let alone with most insurance or private pay rates.
One of the MD's I trained with during my six month "medical rotation" before entering the psych part of the program told me that if I would switch to FNP he could pretty much guarantee me 200k on a 70% split if I was willing to work four days with nine hours of patient contact (and that's in central Florida). Obviously, I didn't, but he was willing to make that offer.
Specializes in Psychiatric and Mental Health NP (PMHNP).
On 1/4/2021 at 3:24 PM, Tegridy said:
The younger generation of docs seem to be more normal to me. And yes most fam med docs aren’t that great most people who go into fam med were at the bottom of everyone’s med school class. We had a few strong people go into it but not so much. Sounds like the docs you worked with are meh or you have a chip on your shoulder.
I do not have a chip on my shoulder. I simply said what needed to be said and it got a good discussion going, which was my goal.
I am sick and tired of all the online hate directed against NPs by MDs and quacks like Dr. Rebekah Bernard. This type of behavior is not becoming to the image of MDs. Some of these bozos even attack DOs.
I read KevinMD regularly, and when I wait for that page to come up, my thought is always "What are they whining about today?" Most of the doctor/bloggers on that site are incredibly whiny and entitled.
In my previous profession, as a management consultant, I worked for the world's best firms, like Accenture, PWC, etc. We had to be team players also be able to engage in very direct, pointed discussions, something MDs are not capable of, as one has to dance around their oh-so-big and fragile egos. It makes me laugh to read on sites like KevinMD that so many MDs think they should leave medicine and pursue other careers like business. LOL. They couldn't take it.
As for socializing, I am talking of MDs of all ages. Interestingly, the MDs I like and enjoy socializing with have told me they avoid other MDs! LOL
In real life, I have yet to meet one of these keyboard warrior MDs in person. My experience has been that MDs and NPs work well together, not surprising since it is usually an MD that hires NPs. However, I have seen some crappy MDs, just like I have seen some crappy NPs.
seems like battlefield 4 is >5 from everyone I have talked to. A lot of what you are saying seems to be psych specific.. Sort of like anesthesia, one of the two fields where you probably just don't need a physician most of the time (minus heads and hearts)
Also Battlefield 4 is amazing. I only play the Hardcore mode (which allows team kills) and then only Golmud Desert with my favorite multiplayer map being "Havocs Falling on Your Head." I like it because it has strategic elements that rival Go or chess, but also requires a great amount of reflexes, skill, and ability to do many different roles. If God came to me and said "Myoglobin" I offer you the chance to sit at my right hand side and live until the heat death of the multiverse I would still have to ask the question "But will I be able to play Battlefield 4?"
myoglobin, ASN, BSN, MSN
1,453 Posts
There is no reason that NP's cannot form together to create LLC's and open their own "primary" care clinics and instantly increase their pay by at least 50% while at the same time increasing their autonomy. Even in states that require MD supervision (most of these do not cap how many NP's can be overseen by a single MD) it is easy enough to find an MD to provider "supervision" for around a 10% fee. The umbrella company I work under is owned by Licensed Mental Health Counselor's and employs about 50 Psych NP's and maybe 250 therapists. The NP's all earn well over 200K (as do most of the therapists) and the owners are netting millions each month on their 30% (cut) and their $600 admin fee. It's a reasonable system for everyone involved. For example I saw 18 patients today and my 70% is about $140.00 per patient or around $2,500 before taxes and I still had time to get crucified on this board over my aversion to mandatory shutdowns and mandatory vaccinations.