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!
Those "creature" comforts might be worth 30K to 50K so if the difference is 100K vs even 150k I say you've got a point. But once you are North of 200K you can easily "purchase" all of those "creature comforts" yourself, and of equal or better quality. Let's break it down:
1. Employer portion of SSI and Medicare around 7%.
2. Employer paid portion of health insurance maybe 10K at best.
3. Employer paid part of a 401K maybe 10K if you max it out.
4. Paid time off. Maybe 5-10K each year. .
5. Educational benefits 2K
At best we are in the 35 to 50K value range here.
I recognize what you’re selling. But many clinicians aren’t going to take that deal. They prefer their stability and understanding their pay will stay the same regardless of random fluctuations in patient visits. That’s why many people choose salary positions. It’s an exchange for convenience. Same reason people sometimes stop at the convenience store vs the supermarket. They know they’re paying twice as much but it’s much closer and having to go through the hassle of going through the extra steps is their personal trade off.
I recognize what you’re selling. But many clinicians aren’t going to take that deal. They prefer their stability and understanding their pay will stay the same regardless of random fluctuations in patient visits. That’s why many people choose salary positions. It’s an exchange for convenience. Same reason people sometimes stop at the convenience store vs the supermarket. They know they’re paying twice as much but it’s much closer and having to go through the hassle of going through the extra steps is their personal trade off.
The difference is when I go to CVS or Walgreens it is a tiny fraction of my income. With my job it IS my income. As someone who is 51 with 200 k in combined credit card and student loan debt (and no 401k) and being a renter I would have zero chance of making headway by 70 ( or much). However, at 300k I’ve at least got a fighting chance. Still if my 19 year old son took your path he might retire secure at 65 (if he saves). However, with the higher pay approach he could reasonably retire by 40 with 3-4 million in the bank (or work part time). All security is largely an illusion just ask my engineering clients / workers at Boeing who made 200k and are now unemployed or the $50.00 per hour union employees at Chrysler who I knew as a kid in the 80’s who were laid off in the 90’s and left with almost nothing.
This is also one of the good things about the NP route vs MD. My son really could do my job by 25. However, if he went the MD/psychiatrist route he would be lucky to be working by 30. Not to mention that if someone did my job properly (1 hour rather than 90 min evals, charging no show fees, seeing patients monthly rather than working to get them to every three or six months, pursuing unpaid debts) they would earn closer to 500k shifting the argument even more. Not to mention that all of the lower paid jobs with salaries were also much harder with expectations of meetings to attend, supervisors to answer to and a 25 plus patient load each day. One job in Florida for 95k would have had me seeing 30 patients each day (double booked so cancels would still mean an appointment) and work 5 days per week with day five being doing TMS treatment and every other Sat I would had to run group therapy. Many of the NP’s I know by way of contrast where I work now earn over 200k working three 8 hour days per week. The difference is that the company is owned by social workers and counselors who value what they do rather than MD’s who see them as “an extender” to increase their income.
I’m not sure why you’re carrying on. Like I said, “I. Recognize. What. You’re. Selling.“ many aren’t going to buy it for the exact reasons I laid out. And on that I’m done discussing revenue.
Because I am arguing for "structural change" in the way NP's are treated nationwide. If I cannot convince even other NP's on this board how am I going to convince others. My approach which I believe would eventually increase average salaries could have several component (or different variations):
a. Percentage based pay where possible making expenses and revenues highly transparent. The goal would be to pay in the range of 60-80% of gross revenue depending upon the market, group and expenses.
b. Perhaps a "salary"/benefit option that would still be higher than what is standard for NP's.
c. This would be facilitate by groups that are primarily NP owned, and or owned in part by therapists Psychologists and MD's where necessary (to create incentives for MD's to act as supervisors in states that require this).
d. Providing the best "operational shell" around day to day work endeavors so that NP's can focus on seeing clients. Thus at my company I do not have to book appointments, take payments (although I sometimes do for clients that pay by cash), worry about credentialing, billing insurance or getting paid in a timely manner. In fact the group I work under is so efficient at billing insurance that many of our companies pay within two weeks considerable less than the market average (I know because a part time job where I worked was taking 6-8 weeks to receive payment). They also facilitate business licenses, CE's for my professional licenses, and keep me updated with reminders when my various certifications and professional organization memberships are coming due. However, I decide how much to charge, how long to see clients, what clients I see and so forth. Also I decide when I work.
e. Another aspect would be that if we "flood" the market with this approach we will drive average NP compensation up while also driving MD salaries down. This will increase the tendencies for MD's to flock to specialties like surgery where we cannot compete. This will make us even less popular and I don't care. I would rather see better pay, and treatment for NP's while providing continued excellent care to patients. In short I would rather win.
I’m not sure why you’re carrying on. Like I said, “I. Recognize. What. You’re. Selling.“ many aren’t going to buy it for the exact reasons I laid out. And on that I’m done discussing revenue.
Also, I engage in continual "point counter point" even with myself as my SO will attest. Perhaps, I need less Battlefield 4 and at least a friend or relative to talk to more than once or twice per year.
Because I am arguing for "structural change" in the way NP's are treated nationwide.
Simply put...no. It’s because your model isn’t everyone else’s preference and your advocation and proselytizing are borderline absurd. People will choose a payment situation that suits them and for what ever their employer is willing to agree to. Period. I’m sure multiple post responses are absolutely selling your views as you continue to derail this thread. Nobody came here to discuss models of payment, but on you continue to rant.
I’m not the op, but I do recommend you start your own thread if you feel so strongly about such sentiments and let people respond there as they are inclined.
Simply put...no. It’s because your model isn’t everyone else’s preference and your advocation and proselytizing are borderline absurd. People will choose a payment situation that suits them and for what ever their employer is willing to agree to. Period. I’m sure multiple post responses are absolutely selling your views as you continue to derail this thread. Nobody came here to discuss models of payment, but on you continue to rant.
I’m not the op, but I do recommend you start your own thread if you feel so strongly about such sentiments and let people respond there as they are inclined.
Cheers!
My response is responsive. The OP concerns MD's feeling and speaking poorly about NP's. My response is "who cares" we are winning. Not only that I want to take steps that go far beyond payment models that would exponentially increase the very MD hate they are concerned about. I literally want to "take the war" to them and drive as many FNP's out as possible (or as a consequence of the actions I propose) as possible. I would submit it could hardly be more responsive to the OP's point.
I have witnessed it first hand: The NP that owns the practice I am joining tried interviewing NPs and couldn't find one since everyone stopped as soon as they realized she required them to start a PLLC. I think this point is clearly reflected in the average salaries you see if you search in Google as well; It is plain obvious most NPs take salaried positions and are employees, otherwise, average income would be somewhat higher. The 85% thing that is common/law reimbursement means that a primary care NP theoretically make at least 160-190k if you compare it to the MD salaries. So there is quite a gap so where is that $ going...? ?
To firstly even believe you can get to 200K+ as an NP you really have to understand and look into billing and coding, again which most NPs don't care to do. My teachers, colleagues, friends I have that are NPs have no idea their actual $ worth.
I have witnessed it first hand: The NP that owns the practice I am joining tried interviewing NPs and couldn't find one since everyone stopped as soon as they realized she required them to start a PLLC. I think this point is clearly reflected in the average salaries you see if you search in Google as well; It is plain obvious most NPs take salaried positions and are employees, otherwise, average income would be somewhat higher. The 85% thing that is common/law reimbursement means that a primary care NP theoretically make at least 160-190k if you compare it to the MD salaries. So there is quite a gap so where is that $ going...? ?
To firstly even believe you can get to 200K+ as an NP you really have to understand and look into billing and coding, again which most NPs don't care to do. My teachers, colleagues, friends I have that are NPs have no idea their actual $ worth.
I'm not arguing that our worth isn't much higher than it is. Similarly, an MD's worth can be much higher than their salaries dictate often if they feel inclined to go it alone without the safety net of a salary. My "simply put...no" statement was toward the absurd assertion that I was talking him down just because he was proselytizing for structural change. While many don't really know their true worth, many are comfortable with making what they understand as a norm for their region, profession, and level of comfort given the work they are doing. Particularly based on their own understanding of the economics of their job. There is value to some to be getting paid the same when sometimes they walk in and half their patients no-show. Those buffers are why salaries are beneficial to some people.
Within our practice, Epic gives us a dashboard for what we bill, what was paid, and what was written off (mostly insurance agreements that can't be recouped). In 2020, I billed for over $550,000 and that was spending half the year at one of our less busy clinics. Of that, I recouped over $291,000. According to my employer, with my base salary, benefits, operational costs, MA cost, etc, my individual overhead to $284,000. They factor these in by taking all providers and dividing the cost of the buildings/utilities, then adding specific needs to the individual provider (MA, Scribe, Etc). I am also certain they have a minimal level of profit they factor into that whole algorithm as well. No two people in our clinics have the same overhead here. They try to sweeten it by paying a percentage bonus over meeting the base metrics as well to encourage seeing more patients. I recognize I could make more for less by doing my own thing. But again, not everyone WANTS that level of risk financially/professionally.
Specializes in Psychiatric and Mental Health NP (PMHNP).
1 hour ago, djmatte said:
I'm not arguing that our worth isn't much higher than it is. Similarly, an MD's worth can be much higher than their salaries dictate often if they feel inclined to go it alone without the safety net of a salary. My "simply put...no" statement was toward the absurd assertion that I was talking him down just because he was proselytizing for structural change. While many don't really know their true worth, many are comfortable with making what they understand as a norm for their region, profession, and level of comfort given the work they are doing. Particularly based on their own understanding of the economics of their job. There is value to some to be getting paid the same when sometimes they walk in and half their patients no-show. Those buffers are why salaries are beneficial to some people.
Within our practice, Epic gives us a dashboard for what we bill, what was paid, and what was written off (mostly insurance agreements that can't be recouped). In 2020, I billed for over $550,000 and that was spending half the year at one of our less busy clinics. Of that, I recouped over $291,000. According to my employer, with my base salary, benefits, operational costs, MA cost, etc, my individual overhead to $284,000. They factor these in by taking all providers and dividing the cost of the buildings/utilities, then adding specific needs to the individual provider (MA, Scribe, Etc). I am also certain they have a minimal level of profit they factor into that whole algorithm as well. No two people in our clinics have the same overhead here. They try to sweeten it by paying a percentage bonus over meeting the base metrics as well to encourage seeing more patients. I recognize I could make more for less by doing my own thing. But again, not everyone WANTS that level of risk financially/professionally.
You make good points. I wanted to clarify a couple of items.
1. In the business world, one expects to make more $ for more risk. So, an indepedent practitioner is incurring more risk, so they should make more $. An employee incurs less risk, therefore should expect to make less $.
2. Mental health is generally high risk for an independent practitioner because there is usually a high no-show rate. However, with telehealth the no-show rate goes way down. I am in mental health and now, with telehealth, on most days I have NO cancellations at all.
djmatte, ADN, MSN, RN, NP
1,248 Posts
I recognize what you’re selling. But many clinicians aren’t going to take that deal. They prefer their stability and understanding their pay will stay the same regardless of random fluctuations in patient visits. That’s why many people choose salary positions. It’s an exchange for convenience. Same reason people sometimes stop at the convenience store vs the supermarket. They know they’re paying twice as much but it’s much closer and having to go through the hassle of going through the extra steps is their personal trade off.