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!
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.
Using the "dynamic" at the company I work with you would have been paid $291,000 - 30% or (87,300)- $680X12 or 8,170 (office fee/service fee)= Thus your gross would have been $195,530. The problem with your scenario is that your employer may or may not reflect accurate and fair accounting of expenses. With the approach of my company it is up to them to be profitable from the 30% of my gross revenues they take plus the monthly service fee (their expenses are their business). They do this successfully with over 50 NP's and over 500 therapists and are doing quite well. I would submit that any business run "by NP's and therapists" for "NP's and therapists" would tend to pay much better even if they offered a guaranteed salaried option or a pure "percent" option. By paying standard percentages of gross receipts there is less stress over "funny" accounting.
A PMHNP, who is an actual employee, with benefits, can make $180 to $200K in California.
Yes, but I was replying to a particular individual who may or may not be in California. In all likelihood one of the jobs that you reference that pays 200K with benefits in California would generate 300K plus on a 70% split such as I outline. Again my "theme" isn't so much "work for a percentage" (although that certainly is one of my main points) as it is "NP's need to take control of practices" so that more are owned by and for the benefit of the employees with a larger percentage of the revenues going toward the NP owners/practitioners.
Yes, but I was replying to a particular individual who may or may not be in California. In all likelihood one of the jobs that you reference that pays 200K with benefits in California would generate 300K plus on a 70% split such as I outline. Again my "theme" isn't so much "work for a percentage" (although that certainly is one of my main points) as it is "NP's need to take control of practices" so that more are owned by and for the benefit of the employees with a larger percentage of the revenues going toward the NP owners/practitioners.
Also a "typical" Florida based scenario would be Dr. C (where I did clinical for about a year). There I was offered around 100K with benefits. I would have been expected to see from 25-32 patients per day and she would have "grossed" on average around $150 per patent. Thus we get $150.00 X 25 X 5 X 48 (week per year) or around $900,000. Even assuming my figures are a bit optimistic (My company grosses about $190.00 per patient visit) you can see that the percentage at 100k is at best around 20% even with every benefit (and they were modest) that can be imagined.
A PMHNP, who is an actual employee, with benefits, can make $180 to $200K in California.
I chuckle to myself whenever I see people reference anecdotes about certain states and pay. I mean, come on guys dollars are important, but what about everything else?
I have relatives that live in Cali and DC. They can barely afford the rent/mortgage... I know if you live outside the cities, that costs aren't so bad, but what about the income taxes for high earners? A 200k Cali salary is probably a lot less in reality depending on where you live. And then when you go to the desirable locations, you are dealing with homeless camps? I tend to like the DC area, but when I was out by myself in some parts, I felt really out of place. Not to mention the Winter's are brutal and can't feel my face when outdoors. Then traffic, etc...
I chuckle to myself whenever I see people reference anecdotes about certain states and pay. I mean, come on guys dollars are important, but what about everything else?
I have relatives that live in Cali and DC. They can barely afford the rent/mortgage... I know if you live outside the cities, that costs aren't so bad, but what about the income taxes for high earners? A 200k Cali salary is probably a lot less in reality depending on where you live. And then when you go to the desirable locations, you are dealing with homeless camps? I tend to like the DC area, but when I was out by myself in some parts, I felt really out of place. Not to mention the Winter's are brutal and can't feel my face when outdoors. Then traffic, etc...
Yes, but with tele health you don't necessarily have to live where you work. Thus, my clients are in Washington state and my house in Florida. Thus, I have the advantage of my 28K per month in earnings integrated with the cost of living of Florida. There is no reason that "NP" owned businesses could not propagate this dynamic and offer partners the option of 1099, PLLC, or W-2 (obviously at different percentage levels to reflect the differences in cost/benefits, and taxes paid by the company). However, with such a company the emphasis would be on maximizing the pay/benefits of the workers rather than enriching the owner. Thus, at "Dr. C's" in Florida (the place that offered me 100K with benefits) she lives in a 10 Million dollar home in Florida and has other homes in Puerto Rico and elsewhere. Indeed, at her practice even the MD psychiatrists still only earned about 160-180K (still alot more than the NP's) and were expected to see about 25-30 patients per day. My approach would even pay many MD's more than they earn in typical Florida (and other states in the South) MD owned practices.
Specializes in Psychiatric and Mental Health NP (PMHNP).
On 1/23/2021 at 7:51 AM, DrCOVID said:
I chuckle to myself whenever I see people reference anecdotes about certain states and pay. I mean, come on guys dollars are important, but what about everything else?
I have relatives that live in Cali and DC. They can barely afford the rent/mortgage... I know if you live outside the cities, that costs aren't so bad, but what about the income taxes for high earners? A 200k Cali salary is probably a lot less in reality depending on where you live. And then when you go to the desirable locations, you are dealing with homeless camps? I tend to like the DC area, but when I was out by myself in some parts, I felt really out of place. Not to mention the Winter's are brutal and can't feel my face when outdoors. Then traffic, etc...
California housing prices vary greatly depending on location. I just moved to Bakersfield and paid cash for a beautiful 2600 sq ft one-story home on 2/10 of an acre in a great neighborhood. California property taxes are pretty reasonable and the top marginal tax rate is currently about 10%. Our sales and gas taxes are high, yes. However, the higher Calif pay I receive more than makes up for that. Bakersfield has done a great job of almost eliminating homelessness.
People who don't live here like to bash California, so go right ahead. Calif has the best public university and college system, at the most affordable prices, of any state. We also provide a lot of social benefits. While I don't know if I will live here forever, Calif is my home and I love this state. Where else can you go to the beach in the morning, go skiing in the afternoon, then be in the desert by evening?
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!
I’m in the mental health field so I’m not sure if it is the same as in other specialties because we are our own breed (haha), but I have found the psychiatrists very supportive of NPs. The ones I work with make comments about how we need more psych NPs to meet the growing mental health and addiction needs in our area. Granted these psychiatrists also serve as preceptors and love teaching the next generation of providers.
I think it ultimately comes down to experience. Just like a patient may think all NPs are incompetent after 1 bad experience with an NP, doctors may feel the same. In the same way if you’ve had a wonderful experience with an NP you would be more open to seeing an NP in the future.
Yes, but telehealth is not limited to Psych NP's. One can also do aspects of FNP on a tele basis. Also, my central thesis is for "NP owned/managed practices" whether they be tele or in person. I believe they will on average pass on a greater percentage of profits to providers and employees.
myoglobin, ASN, BSN, MSN
1,453 Posts
Using the "dynamic" at the company I work with you would have been paid $291,000 - 30% or (87,300)- $680X12 or 8,170 (office fee/service fee)= Thus your gross would have been $195,530. The problem with your scenario is that your employer may or may not reflect accurate and fair accounting of expenses. With the approach of my company it is up to them to be profitable from the 30% of my gross revenues they take plus the monthly service fee (their expenses are their business). They do this successfully with over 50 NP's and over 500 therapists and are doing quite well. I would submit that any business run "by NP's and therapists" for "NP's and therapists" would tend to pay much better even if they offered a guaranteed salaried option or a pure "percent" option. By paying standard percentages of gross receipts there is less stress over "funny" accounting.