Oversupply of Nurse Practitioners

[guest416560]

I recently received a published form from the State of Florida showing that ARNPs increased 22% over the past two years. RNs only increased by 7.4% If you are a new grad wondering why you can't find a position here is your answer. Our NP mills have pumped out too many graduates for the demand of society. I don't have the data to back it up but if this is happening in Florida I would assume it is happening around the nation.

I'm licensed in Florida but moved to California years ago because I could see the tsunami of new graduates slowly starting to erode the wages of established NPs. It's now happening here in California and I have been directly affected. I can count at least another dozen of my NP colleagues around the nation who are complaining of wage deflation happening because new grads will accept a position at almost any wage. Starting wages are below those for RNs in some cases.

For those of you thinking of becoming a NP think and long and hard before you commit your money and your time. The job is enjoyable but the return on investment is declining year after the year with the flooding of the markets. Maybe one day the leaders of our nursing schools will open a book on economics and understand the relationship between supply and demand rather than stuff another useless nursing theory down our throats.

[ArmaniX, MSN, APRN]

Think it is safe to say every NP school is different. Some are better than others and some are terrible. Grouping all NP schools into one doesn't accomplish much.

[Ree01]

Yes but are the clinicals done in a setting that supports adequate training and supervision of students especially core physical assessment, diagnostic skills. Compare the training of a RN to that of a NP ( online) - RN training is heavily supervised and regulated by their educational institution- online training is not. Compare the clinical training of a medical student / Resident to that of an online NP - there is no comparison and in the end both NP and Medical Student/ Resident get to write prescriptions, see the same number of patients and make same diagnosis- how is that safe ?

[djmatte, ADN, MSN, RN, NP]

Ree01 said:

Yes but are the clinicals done in a setting that supports adequate training and supervision of students especially core physical assessment, diagnostic skills. Compare the training of a RN to that of a NP ( online) - RN training is heavily supervised and regulated by their educational institution- online training is not. Compare the clinical training of a medical student / Resident to that of an online NP - there is no comparison and in the end both NP and Medical Student/ Resident get to write prescriptions, see the same number of patients and make same diagnosis- how is that safe ?

What exactly are your credentials that are criticizing the backdrop of online NP education? Are you an NP? Have you ever gone through an NP clinical? Because I have worked in clinical rotations that had both online students and brick and mortar students present. No faculty from those schools were there unless they were there for a fly by to check in on the site. Both online and brick and mortar NP schools tend to treat the clinical experience very similarly. Especially in the primary care environment where sites are often far from a central hospital and more spread out. NP schools have curricular requirements they review with prospective sites and validate the learning opportunities in both scenarios whether it is directly affiliated within the school or an unaffiliated external entity.

To compare NP clinical (of any variety) to med school or nursing school...where herds of students are ushered into hospitals to assume tasks of jobs at the direct hand of associated nurses and MDs respectively is not how it works. Our clinical training is more akin to residency's where a provider agrees to take on an individual for an expected time frame and that person learns the ropes of that specialty to reinforce the didactic training. The specialty MDs that do this are considered "faculty" (much like NP clinical preceptors), but certainly are just operating in a similar fashion where they are evaluated and expected to keep up pre-established clinical goals/expectations.

[ToFNPandBeyond]

FullGlass said:

To the OP: You do not prove there is an oversupply of NPs. You just state that the supply has increased. So what? If my glass is half full, and I increase the contents by 22%, I still don't have a full glass. There is still an acute shortage and maldistribution of primary care providers and the vast majority of NPs work in primary care. EVERYONE in my graduating class of Dec 2017 had at least one job offer prior to graduation, and this is in a supposedly oversaturated market according to the self-proclaimed experts on this forum.

I have yet to see one shred of evidence from all the Eeyores on this forum that proves, or even strongly supports, that there is an oversupply of NPs or that compensation is decreasing for NPs. Yes, there may be regional variation, but it is on the prospective NP to do their research on job opportunities and pay in their desired location. My NP school was very accurate in describing the job market and NP pay in their region. It doesn't take a genius to ferret out job opportunities and compensation in specific locations. Someone who can't figure out how to do that probably isn't smart enough to be an NP. There are crappy NP schools out there, unfortunately, but if people want to go to those schools, it is a free country. Going to a good school is an advantage for a new grad NP, and anyone who denies that is fooling themselves. That is true of any profession. Who do you think will have an easier time finding their first job - a new Harvard MBA or someone who went to an MBA diploma mill? Someone who is willing to relocate or someone who has decided they can't move? I don't know about the rest of you, but if I decided I wanted to be an actress, I'd move to LA or NYC. If I wanted a career in high finance, I'd move to NYC. If I wanted a career with the federal government, I'd move to DC. When I worked in high tech, I lived and worked in major tech centers like Silicon Valley, DC, L.A.

I have provided evidence that there is still high demand for primary care providers, and that includes NPs. In addition, as more states provide NPs with full practice authority, the demand for primary care NPs will continue to increase. Primary care is becoming less and less attractive to MDs due the high cost of medical school and higher compensation in specialties.

RNs can make excellent money and many RNs truly want to be RNs their whole career. We need good RNs. Anyone who is an experienced RN, then goes to school and looks for their first job as an NP is going to take an initial pay cut. People who can't afford that shouldn't go to NP school. In addition, one should become an NP because that is the job they want to perform, not just to make more money. There have been many posts on this forum by former RNs who just didn't like being an NP, regardless of pay.

I'm sick of all the negativity here because it scared the crap out of me when I was a student. After reading the falsehoods that certain people love to post here for some weird idiosyncratic psychological needs, I was terrified that I wouldn't be able to get a job as a new grad NP, much less a good job. Well, I got 9 excellent job offers. I love my job, the clinic management and patients are happy with me, and I am quite satisfied with my pay. I also live in a beautiful area. We have clinics in our system that can't find any NPs, PAs, or MDs, even when they are in beautiful, desirable, low cost of living areas that are very close to good-sized cities and we are paying top dollar! We have recently recruited some NPs from "oversaturated" markets and they are very happy they made the move.

When evaluating compensation, one must consider the local cost of living. $175,000K in the Bay Area is actually crappy pay given the high cost of living there. Someone making $80K a year in an affordable area is way better off.

People CAN move. You're not moving to a 3rd world country, for goodness' sake. The economy is good. A house can be sold. The kids will adjust to a new school. The spouse can find a new job. I'm an Army brat and attended 12 schools in 12 years. I loved it!

For those are interested, look for my other posts on how to get a good job as a new grad NP.

And, yet again, here is some actual evidence:

According to the Medical Group Management Association (MGMA), primary care compensation has been increasing substantially, based on data from over 136,000 providers in over 5,800 organizations. "Nurse practitioners saw the largest increase over this period [past 5 years] with almost 30% growth in total compensation. Physician assistants saw the second-largest median rise in total compensation with a 25% increase." This is from an article about primary care MD compensation:

"Compensation Data Underscores Primary Care Doc Shortage," Health Leaders Media, May 21, 2018,

Compensation Data Underscores Primary Care Doc Shortage | HealthLeaders Media

In a 2017 report, recruiting firm Merritt Hawkins reported that NPs and PAs were 3rd on their most requested recruiting assignments (after doctors), up from number 5 in the previous year. Page 9 of this report shows average pay for NP recruiting assignments since 2012, and it has been steadily increasing, from an average of 105, 000 in 2012 to $123,000 in 2017. You can find that report on this page:

Thought Leadership

2017 Survey of Physician and Advanced Practitioner Recruiting Incentives

Thought Leadership

And finally, the hubris of many on this forum astonishes me. I have great respect for my RN and NP instructors, many of whom are national and international leaders in their fields. All of my clinical NP professors had at least 20 years practice experience prior to becoming NP professors and they all continued to practice at least 8 hours per week; many worked more. I will always appreciate their excellent instruction and kindness to me.

The only reason I even bother to post here anymore is that I don't want current students to be freaked out like I was. There are plenty of good NP jobs out there!

Find a good job is a skill that must be learned and practiced. There is plenty of information available on how to find a job. My school also put a lot of effort into teaching us how to find our first NP job.

Love this post. Thank you for continuing to use your voice (words rather) to address the alternative thought!

[Ree01]

I am a NP certified in Adult, Acute Care.I graduated from my program at a prestigious university 21 years ago. It was a very competitive program, where you had to take GRE. I was 26 when graduated and am now 47 years old. I worked for ten years in Cardiology in open heart unit, then Cardiac ICU. I then worked one year in hospitalist program before transferring to Renal Transplant/ Nephrology division. I work at 450 bedded hospital that supports the training of NP and PA students from local universities. In the last few years I have worked with NPs and RNs that have graduated from Universities that are so unfamiliar.

When I started as a NP , there were few jobs but but they were easily available. NP's were sometimes even considered better than some doctors. Patients back then preferred a NP to a MD. They felt NPs spent more time and were more thorough . But now in recent years that has changed. NP's do not have as good a reputation. They are not so popular amongst physician groups and patients. Part of the problem is that most NPs are overworked and can not provide same level of care that they used to with patients. Another part is educational standards. In the last few months I have witnessed some of the following mistakes by new NP's:

1. Prescribing Torsemide and Furosemide for same patient

2. Prescrbing Aldactone for patient with elevated potassium.

3. Missing a diagnosis of Pulmonary Embolus on a patient admitted with pleuritic chest pain, cough and apprehension.

4. Prescribing Glucophage on a patient with significant renal impairment.

I also find that new NP's today order a lot more expensive unnecessary imaging studies on patients and send out a lot more unnecessary consults than before. TTherefore I question the training .

Remember it was not long ago that Obama administration went after for profit universities that over promised vulnerable students degrees that did not result in gainful employment . Students get suckered into taking huge federal loans that leave them in debt. I believe the same thing may be happening with RN to NP programs. The more information prospective students have, the better. It would be good if we could have physicians write on this forum.

[JellyDonut]

Ree01 said:

I also find that new NP's today order a lot more expensive unnecessary imaging studies on patients and send out a lot more unnecessary consults than before. .

I had to chuckle at this one...No one on Earth orders more useless testing than do residents. The hear hoofbeats and immediately think Zebra or unicorns.

[algae1492]

Ree01 said:

Yes but are the clinicals done in a setting that supports adequate training and supervision of students especially core physical assessment, diagnostic skills. Compare the training of a RN to that of a NP ( online) - RN training is heavily supervised and regulated by their educational institution- online training is not. Compare the clinical training of a medical student / Resident to that of an online NP - there is no comparison and in the end both NP and Medical Student/ Resident get to write prescriptions, see the same number of patients and make same diagnosis- how is that safe ?

We have physical examination testing by faculty, and diagnostics skills testing.

[algae1492]

Ree01 said:

I am a NP certified in Adult, Acute Care.I graduated from my program at a prestigious university 21 years ago. It was a very competitive program, where you had to take GRE. I was 26 when graduated and am now 47 years old. I worked for ten years in Cardiology in open heart unit, then Cardiac ICU. I then worked one year in hospitalist program before transferring to Renal Transplant/ Nephrology division. I work at 450 bedded hospital that supports the training of NP and PA students from local universities. In the last few years I have worked with NPs and RNs that have graduated from Universities that are so unfamiliar.

When I started as a NP , there were few jobs but but they were easily available. NP's were sometimes even considered better than some doctors. Patients back then preferred a NP to a MD. They felt NPs spent more time and were more thorough . But now in recent years that has changed. NP's do not have as good a reputation. They are not so popular amongst physician groups and patients. Part of the problem is that most NPs are overworked and can not provide same level of care that they used to with patients. Another part is educational standards. In the last few months I have witnessed some of the following mistakes by new NP's:

1. Prescribing Torsemide and Furosemide for same patient

2. Prescrbing Aldactone for patient with elevated potassium.

3. Missing a diagnosis of Pulmonary Embolus on a patient admitted with pleuritic chest pain, cough and apprehension.

4. Prescribing Glucophage on a patient with significant renal impairment.

I also find that new NP's today order a lot more expensive unnecessary imaging studies on patients and send out a lot more unnecessary consults than before. TTherefore I question the training .

Remember it was not long ago that Obama administration went after for profit universities that over promised vulnerable students degrees that did not result in gainful employment . Students get suckered into taking huge federal loans that leave them in debt. I believe the same thing may be happening with RN to NP programs. The more information prospective students have, the better. It would be good if we could have physicians write on this forum.

I do not stand anywhere near your experience, as I am a student in a FNP program. However, I will say the first day of clinical as a student RN I encountered a resident medication error. I cannot attest to anything else you've written. If you want to highlight who is making more serious and frequent errors, then it requires data to support the claim.

[Ree01]

Please note that my intentions are not to discourage future RNs from pursuing a NP program or their career goals; neither is it to emphasize how incompetent new NPs are in comparison to Med students or residents. I really wrote this to caution prospective students to be cautious when choosing a NP school. I have shared the same sentiments with RNs in the hospital and they have been so grateful for my honesty. For example one RN that worked for 18 years as a clinical manager in Pre Op. She was about to do this online FNP program. She waited a couple of years before she could get in to University of Miami Psych DNP program . She graduates next May and has a job lined out for her making a very substantial salary. Also her clinicals were done with rotating Psych residents and Psychiatrists, NPs etc.

[Ree01]

I am sorry if I offended you or any other NP. That was not my intention.

[djmatte, ADN, MSN, RN, NP]

Ree01 said:

Please note that my intentions are not to discourage future RNs from pursuing a NP Program or their career goals; neither is it to emphasize how incompetent new NPs are in comparison to Med students or residents. I really wrote this to caution prospective students to be cautious when choosing a NP school. I have shared the same sentiments with RNs in the hospital and they have been so grateful for my honesty. For example one RN that worked for 18 years as a clinical manager in Pre Op. She was about to do this online FNP program. She waited a couple of years before she could get in to University of Miami Psych DNP program . She graduates next May and has a job lined out for her making a very substantial salary. Also her clinicals were done with rotating Psych residents and Psychiatrists, NPs etc.

While I appreciate your experience and perspective, I did disagree with some of your anecdote and comparisons. You do work in acute care and probably do see a slew of NPs from a range of colleges and experience levels. But that experience and clinical training is vastly different from the primary care environment. As someone else noted, the amount of tests and rabbit holes traversed, new NPs can easily be similar to new medical residents who both respectively don't have a significant wealth of experience to make better choices. This isn't a fault of going to online vs brick and mortar... It's a simple lack of experience. I recall a study pointing this problem or with new nurse practitioners... But it had nothing to do with * where* they went to school. While yes some of these schools can be classified as "diploma mills", there's a difference that separates them from true diploma mills. We all have a barrier of entry and in most states must pass a certification exam. Maybe that barrier needs to be boosted because frankly this education method isn't going away and for many working nurses, it's the only option they have.

[Oldmahubbard]

Almost all of the content of an NP program can be delivered online. Why not? For most of that content, there is no discernible benefit to sitting in a classroom vs watching a recorded or live lecture, or using other study materials.

But, if students are only online and there are never any proctored exams or other in person evaluations, I do question the validity.

I attended school just before the start of online classes. I had to drive 2 hours each way, it was extremely annoying to be forced to do that, and then sit through a poor quality or meaningless lecture. This happened many times.

Although I attended a well known brick and mortar school, we had to find our own preceptors, and it was a literal nightmare.

Thankfully, I finally found someone. She told me she was hesitant because she had to fail others in the past. They were completely unprepared.

The quality overall of the program was poor. Our department head had her degree, and literally no other experience. She believed in Freud.

Summary : A lot of improvements need to be made in NP education, most of them costing more money.

Things have changed and NPs are not just writing refills for people who have already been evaluated by doctors. That went out decades ago.

The boards for the Psych NP unfortunately were ridiculously easy, and wouldn't protect the public from quacks.