Oversupply of Nurse Practitioners

Spadeforce · Sep 19, 2018

FNP2B1 said:

Yes I was a SRNA before switching over to FNP. I'm driving north today to explore the area where I have a job interviews lined up for next week. Every town wants a derm provider...I just have to find one that wants to pay $$$$ for it. ?

LOL did you tell administration they should take a payout before walking out?

I always used to snipe at admin when they got salty, at least the ones who had no idea what was going on.

Spadeforce · Sep 19, 2018

Jules A said:

I have appreciated physicians valid concerns both due to our lack of education and filling their positions but even more so now. I'm one of the high earning NPs, the last new hire was for $50,000 less than what I make and 1/2 the RN staff is in NP school. It won't be long.
OP glad you were financially intelligent and didn't live to the max of your means as I suspect many of the young-ins are doing.

living above means is overrated. only reason I was able to go back to med school bc I saved a bunch. besides 401K im out of money (excluding loans) now but at least it was enough to get thru a few years.

Long story short, employers want employees to live paycheck to paycheck since it limits the employees options. sounds like fNP2B1 has his or her stuff together and had the right idea.

Always nice enough to have enough money laying around to threaten to cut loose on the spot, new hires always cost employers more to get running than they expect LOL

Jules A, MSN · Sep 19, 2018

Spadeforce said:

Long story short, employers want employees to live paycheck to paycheck since it limits the employees options. sounds like fNP2B1 has his or her stuff together and had the right idea.

Agree. The reason I keep multiple jobs is to be able to walk whenever I want or wait out a low offer until the prospective employer gets that my requested rate is non-negotiable. Being in a jam leads to bad decisions and I'd rather not operate that way.

allnurses Guide · Sep 20, 2018

FNP2B1 said:

Thanks guys. Yes I am going to try to stay in California and still work in dermatology and/or family practice. My home is a yacht so it's fairly easy for me to unhook the lines and drive up or down the west coast to find a new position.

Sorry about the job loss, hope it all works out for the best.

I have to say in some ways I am jealous. I've been trying to persuade my wife that when we get a bit older to sell the house and live on a trawler and move as we see fit. I was fortunate to spend a month a year with my aunt and uncle every year growing up in the cruising community in the out-island Bahamas. They had a 38' Krogen and it was some of the best memories of my life. Recently we cruised by a Nordhaven 52 that was for sale and I started talking about doing the Great Loop and then moving on to other cruising and she looked at me like I had 10 heads. If I was single I would have done it yesterday.

I am fortunate to be a partner in a practice. I love my patients, and like my aging partner, I will have a hard time exiting practice when the time comes. Interestingly enough I have been talking recently with several successful independent NP derm practice in hopes that when my time comes (either age or reimbursements for PCPs hitting a no longer feasible number) I'd slide over into some cash derm/cosmetics business.

guest416560 · Sep 20, 2018

I didn't tell the administration anything when they told me take a salary cut to keep your job or lose your job. I just smiled, gathered my things and walked out. It's not worth my time to ***** and moan. It's theirr business and they will sink or swim. On the boat topic

I love living on my yacht, I'm a single guy...getting older..50 but love it. It's a 70 foot Hatteras, 3 bedrooms, 3 bathroom, 3 stories and more than enough room for entertaining all of my friends. I get horrible fuel economy of 0.8 mpg when going at the hull speed of 9 knots/mph. My family owned a boat business when I was a kid so being around boats is in my blood. I sometimes charter my boat when I'm in the mood to make a couple of thousand for the day but generally I don't like renting out my home.

After talking to recruiters today it looks like the best opportunities for work are around Sacramento/Stockton area for me. I do hybrid dermatology/family practice gigs. Locums jobs are paying around $95 an hour with no benefits but they are 40 to 80 miles east of Sacramento/Stockton in the San Joaquin Valley. Very rural. The jobs where I keep the boat now in Ventura are offering a flat rate max of $72 an hour, no benefits. 5 years ago I could of easily gotten $110 and up via a locums contract. Too much supply, too little demand.

FullGlass, BSN, MSN, NP · Sep 22, 2018

Spadeforce said:

of course if I was starting out again id do computer software engineering and development LOL

STEM is not for everyone. First, you have to like STEM and have an aptitude for it.

Second, I was in STEM prior to becoming an NP. I worked for THE best firms - Oracle Consulting, Accenture, PWC, and some very elite boutique consulting firms. It largely sucked and I am much happier as an NP.

Very few people in STEM make huge bucks. And the hours are brutal, with often very abusive work environments. And you may have to travel - A LOT. And there is NO job security - you can get laid off at the drop of a hat for no reason or b/c the job is being outsourced overseas to someone making $2 an hour, and to add insult to injury, you may have to train your replacement!

The grass is always greener . . .

FullGlass, BSN, MSN, NP · Sep 22, 2018

FNP2B1 said:

I could not agree more. There is a glut and those that disagree are in my mind naÃ¯ve. Those of us in the trenches see it. Just because you got one great job in the middle of nowhere USA doesn't mean jobs are plentiful and salaries are rising. In fact based on simply anecdotal evidence from over a dozen of my NP friends wages are decreasing and jobs are becoming more difficult to find for even the very experienced NPs. If I was considering being a NP for a career at this point I would seriously have second and third thoughts. It's just not a good time to be a NP if you are in it for $$$

I am so sick and tired of the negativity here. I got 9 job offers as a new grad NP w/o RN experience. Yes, it is absolutely true. I am also sick and tired of some people on this forum bashing rural areas and inner cities. Isn't part of the reason we are NPs to help people? These areas are in great need - it is heartbreaking. Personally, I find these patients much more interesting and easier to working with than upper middle class and wealthy patients.

Every day I get about a dozen emails, LinkedIn pings, etc. from headhunters. $140K for a job in a beautiful town in Oregon (probably Bend), $200K for a job in Alaska, $140K for a job in North San Diego County, jobs in Bakersfield, Fresno, Sacramento, Nevada, Oregon, Washington state, Arizona, New Mexico and on and on and on.

I work in a rural FQHC and make $124,000 per year as a new grad. I am renting a 2 BR 2 BA HOUSE for $750 in a good neighborhood and could easily have a roommate to decrease my rent. It's also walking distance to the clinic. People are very nice, love my patients, and the staff have been incredibly kind and supportive, including the other NPs and the MDs. The nearest city of 100,000 is 50 minutes away - one could commute from there quite easily. Living in a big city, commutes of one to 2 hours EACH way are very common, plus one has to suffer through traffic jams. I can be in Sacramento in 3 hours and the SF Bay Area in 5 to 6 hours driving - there are also flights from here. Reno is only 3 hours away, along with Lake Tahoe. I don't have to plan my life around traffic, unlike Los Angeles. We are always looking for NPs, PAs, MDs, and DOs, too.

I moved here from San Diego. There is a glut of all healthcare professionals in San Diego, b/c lots of people want to live there. The cost of living is skyrocketing and the pay is LESS than here. A home comparable to what I have here would be AT LEAST $2,000 a month and I would make $20K less a year! Consider cost of living when looking at salary. It's better to make $100K in an affordable area than $160K in Silicon Valley.

Also, I have power here. This clinic does not want to lose any providers. That is far different from living in San Diego, where there are tons of applicants for every job.

Looking for a job is a skill. It is not easy. One has to write a good resume and cover letter, know how to network effectively, and interview well. In addition, one has to know how to find job openings and be wiling to put in the work! I was driving 1500 miles A WEEK all over the western U.S. when looking for a job and all that effort paid off. Most people do not have good job search skills and a lot of people really don't put in that much effort or they are not flexible on location. Yet, could you do that in any other profession? Want to make big bucks in high tech? Well, then you have to live in or move to a tech hub city! Those high paid business executives? They usually have to move multiple times in their career in order to keep advancing.

Keep an open mind! There are plenty of lovely locations that are DESPERATE for NPs and that pay well and are affordable. At least consider interviewing there and looking around - you might be pleasantly surprised. Many of these locations are also within close distance of major cities. We have a clinic within a 20 minute drive of Klamath Falls, which is a lovely city that is very affordable with a big beautiful hospital. Yet, even the hospital there can't find providers! (Look at Sky Lakes if you're curious).

To those of you who are looking for a job or are in school - ignore the negativity here. This forum caused me so much unnecessary anxiety.

I LOVE my job and my patients.

guest769224 · Sep 23, 2018

FullGlass said:

To those of you who are looking for a job or are in school - ignore the negativity here.

To ignore the real world experiences of practicing clinicians here on this site would be foolish. It's not negativity, it's someone's reality.

Ree01 · Sep 23, 2018

I feel as if I am the one that contributed to the whole "negativity " thread here. Therefore my response today. It is sad that as educated responsible professionals, we are not able to experience the reality of other professionals. Each person has his or own version of reality which is based on their experiences. None of the " negativity" described by some of the NPs's here are based on fiction writing for entertainment and pleasure or to hopefully make the big screen movie scene or a Lifetime movie. It's real stuff that we are living through, and experiencing. The job of an NP has changed; the role has changed, the expectations, job market has all changed from 20 years ago. This is life. Nothing stays the same. I think we experienced NP's where hoping with change it would get better but no ; it is not and that is reality. In the last two months at my hospital, we had two new inpatient grads get fired and two outpatient grads get fired due to incompetence. We have about 6 new NP grad RNs still doing bedside nursing cos no one wants to hire them. Almost 3/5 Floor RNs are in NP school- with a projected school loan debt of $30000.00 - $ 80000.00 at end of completion. This is the truth. I'm not making it up.

I have met RNs who claim they will never go to NP school coz they see what is going on. These RNs are choosing Academia and Education instead. I just trained a new Nephrology Grad this week. He did his undergrad in the Phillipines. He moved to US in 2013. In 2015 he started online NP program. He told me how back in the Philippines, a lot of students applying to Nursing Programs there in hope of getting RN then coming to US to become NP's. So even internationallly, RNs are graduating in hopes of being recruited to US to become NPs. A lot of RNs that are from India told me the same thing - they left India to become NPs in US. They had no chance of going to Med School in their countries but coming to US gives them a chance to be like a " doctor"

The international supply of RNs, together with the ever increasing number of online NP programs,and easy admission process are only going to increase the oversupply of NPs.

Am I lying ?? No - this is the reality. I'm happy for those that find good NP jobs that they are happy in but to incoming and prospective NP students , I will stick to the fact that this is not the norm.

injured1 · Sep 25, 2018

Really? My situation...Only 2 classes from going into P.A school, only 2 classes from Pharmacy school, and only 2 classes away from Direct entry into Occupational Therapy, My undergrad is like a pre-everything. However, I went nursing because I only need 8 classes to get R.N and then hop into N.P school. However, I do not want to do family practice ( I know this coming in ). I opted NOT to go into OT because their tuition is around 75k for just 2-3 years of grad school. Plus everyone wants to become OT. I think there was only 10,000 OTs National wide, now 30,000. In my nursing program an OTA( occupational therapy assitant ) is in the class. I asked why....why not go OTA to an OT bridge program? Like how RNs to N.P? She replied with the same thing I didn't go direct entry into grad school with OT, the cost. Ots make about $35 an hr where I live, which where I live it is 10% below the national average in income ( not for OT but just in general ). So OTs do well for the cost of living. However, if you add undergrad and grad debt to be an OT, it would be around 130k to make $35 an hr. So, I said, welp.....Nursing then N.P it is. I got accepted into every nursing program I applied ( should have applied to more ). However, my whole focus is N.P. Nursing is eh....we spend 15 minutes on a wash cloth fold and 1 minute on shock. Is this normal? I mean for infection control.......I studied the labs, Basophils, Moncytes etc for infection...if they elevate or drop etc. I also thought there would be scenerio based questions on this with these labs and science? You know what we were tested on....Bed linens..on infection control? I was pizzed. I studied the book, the study guide, the power points in red and all what I studied was not on test, but bed linens....The prof I guess uses not her power points, the assigned book and the assigned study guide, but outside sources. Anyone have this?

Anyway to the point, if N.P is going to be Like O.T.....then man. My Profs already know I am not in it for nursing itself. I actually was breaking down chemistry with one of the profs who has it for grad school for Doctorate Degree they are taking. I took Pharm and took that with an M.D and also my Patho was taught by an M.D, along with my AP2 class. So, I learned how the drugs work at the chemical level. I didn't use a drug handbook in Pharm because I just memorized generics and knew how each class worked. If you know how they work, then you can kind of predict why they would take how long and possible sides and tie that into patho and abnormal psychology( which I took as well ). Although trade names, I am screwed lol. However, this thinking does not seem to be any relevance for nursing, but who knows my first semester.

djmatte, ADN, MSN, RN, NP · Sep 25, 2018

Really? My situation...Only 2 classes from going into P.A school, only 2 classes from Pharmacy school, and only 2 classes away from Direct entry into Occupational Therapy, My undergrad is like a pre-everything. However, I went nursing because I only need 8 classes to get R.N and then hop into N.P school. However, I do not want to do family practice ( I know this coming in ). I opted NOT to go into OT because their tuition is around 75k for just 2-3 years of grad school. Plus everyone wants to become OT. I think there was only 10,000 OTs National wide, now 30,000. In my nursing program an OTA( occupational therapy assitant ) is in the class. I asked why....why not go OTA to an OT bridge program? Like how RNs to N.P? She replied with the same thing I didn't go direct entry into grad school with OT, the cost. Ots make about $35 an hr where I live, which where I live it is 10% below the national average in income ( not for OT but just in general ). So OTs do well for the cost of living. However, if you add undergrad and grad debt to be an OT, it would be around 130k to make $35 an hr. So, I said, welp.....Nursing then N.P it is. I got accepted into every nursing program I applied ( should have applied to more ). However, my whole focus is N.P. Nursing is eh....we spend 15 minutes on a wash cloth fold and 1 minute on shock. Is this normal? I mean for infection control.......I studied the labs, Basophils, Moncytes etc for infection...if they elevate or drop etc. I also thought there would be scenerio based questions on this with these labs and science? You know what we were tested on....Bed linens..on infection control? I was pizzed. I studied the book, the study guide, the power points in red and all what I studied was not on test, but bed linens....The prof I guess uses not her power points, the assigned book and the assigned study guide, but outside sources. Anyone have this?
Anyway to the point, if N.P is going to be Like O.T.....then man. My Profs already know I am not in it for nursing itself. I actually was breaking down chemistry with one of the profs who has it for grad school for Doctorate Degree they are taking. I took Pharm and took that with an M.D and also my Patho was taught by an M.D, along with my AP2 class. So, I learned how the drugs work at the chemical level. I didn't use a drug handbook in Pharm because I just memorized generics and knew how each class worked. If you know how they work, then you can kind of predict why they would take how long and possible sides and tie that into patho and abnormal psychology( which I took as well ). Although trade names, I am screwed lol. However, this thinking does not seem to be any relevance for nursing, but who knows my first semester.

Some of what you note is the concern I have with people who run into the nursing profession to get to work as a mid-level clinician. While nursing is a more advance level compared to an MA or CNA who are simply changing beds and doing vitals/I's and O's, it is the incorporation of multiple levels of patient care in order to improve patient outcomes. It's the recognition of the very things that lead to poor outcomes and the attempt to minimize that from happening. These include everything from safety, infection prevention, on down to knowing the pharmacokinetics of numerous insulins. I think of it from a military perspective, you aren't expected to be in charge of a multi-million dollar aircraft if you don't know the difference between specific wrenches and why they are used on specific parts. Nurses are expected focus on technique be it hand washing, IV starting, medication administration, etc because patient's lives are at stake. While RNs are expected to understand some pharmacology at the administration level, their school shouldn't be considered "less than" or looked down on when they prefer to use formulas over longer scientific conversion. The whole point of advance practice was to capitalize on the nursing experience and to add the advance training that you crave such as pharmacology and advance human assessment/A&P knowledge to that prior knowledge to improve access to healthcare and also add a different layer of perspective to healthcare.

And the concern I have is many (like yourself) don't care about the semantics of how you change a bed because you want that deeper knowledge. But the experienced RN recognizes that how that bed is made may be the difference between a bed sore or a patient that is awake and hitting the call bell all night. This knowledge also helps the advance clinician identify other situations that could be causing an outcome that they are trying to correct. It may seem menial to some, but they are the very reasons nurses have been asked from early on to advance their practice and incorporate their base knowledge. And is one of the very reasons I am against APRN programs that don't require some prior nursing experience.

Goldenfox · Sep 25, 2018

I am so sick and tired of the negativity here. I got 9 job offers as a new grad NP w/o RN experience. Yes, it is absolutely true. I am also sick and tired of some people on this forum bashing rural areas and inner cities. Isn't part of the reason we are NPs to help people? These areas are in great need - it is heartbreaking. Personally, I find these patients much more interesting and easier to working with than upper middle class and wealthy patients.
Every day I get about a dozen emails, LinkedIn pings, etc. from headhunters. $140K for a job in a beautiful town in Oregon (probably Bend), $200K for a job in Alaska, $140K for a job in North San Diego County, jobs in Bakersfield, Fresno, Sacramento, Nevada, Oregon, Washington state, Arizona, New Mexico and on and on and on.
I work in a rural FQHC and make $124,000 per year as a new grad. I am renting a 2 BR 2 BA HOUSE for $750 in a good neighborhood and could easily have a roommate to decrease my rent. It's also walking distance to the clinic. People are very nice, love my patients, and the staff have been incredibly kind and supportive, including the other NPs and the MDs. The nearest city of 100,000 is 50 minutes away - one could commute from there quite easily. Living in a big city, commutes of one to 2 hours EACH way are very common, plus one has to suffer through traffic jams. I can be in Sacramento in 3 hours and the SF Bay Area in 5 to 6 hours driving - there are also flights from here. Reno is only 3 hours away, along with Lake Tahoe. I don't have to plan my life around traffic, unlike Los Angeles. We are always looking for NPs, PAs, MDs, and DOs, too.
I moved here from San Diego. There is a glut of all healthcare professionals in San Diego, b/c lots of people want to live there. The cost of living is skyrocketing and the pay is LESS than here. A home comparable to what I have here would be AT LEAST $2,000 a month and I would make $20K less a year!!! Consider cost of living when looking at salary. It's better to make $100K in an affordable area than $160K in Silicon Valley.
Also, I have power here. This clinic does not want to lose any providers. That is far different from living in San Diego, where there are tons of applicants for every job.
Looking for a job is a skill. It is not easy. One has to write a good resume and cover letter, know how to network effectively, and interview well. In addition, one has to know how to find job openings and be wiling to put in the work! I was driving 1500 miles A WEEK all over the western U.S. when looking for a job and all that effort paid off. Most people do not have good job search skills and a lot of people really don't put in that much effort or they are not flexible on location. Yet, could you do that in any other profession? Want to make big bucks in high tech? Well, then you have to live in or move to a tech hub city!!! Those high paid business executives? They usually have to move multiple times in their career in order to keep advancing.
Keep an open mind! There are plenty of lovely locations that are DESPERATE for NPs and that pay well and are affordable. At least consider interviewing there and looking around - you might be pleasantly surprised. Many of these locations are also within close distance of major cities. We have a clinic within a 20 minute drive of Klamath Falls, which is a lovely city that is very affordable with a big beautiful hospital. Yet, even the hospital there can't find providers! (Look at Sky Lakes if you're curious).
To those of you who are looking for a job or are in school - ignore the negativity here. This forum caused me so much unnecessary anxiety.
I LOVE my job and my patients.

Re-read your post and make a note of how many times you used the words "I", "me", and "my". Your view of the situation is myopic. You see everything only from the point of view that fits your individual situation. Consider for a moment that not everyone who is or who will become a nurse practitioner is like you or has circumstances exactly like yours. For example, not everyone can just move. And moving is not always a solution either. Everyone's life, finances, and family situation is unique to them.

What is "lovely?" What is "affordable?" What is "good?" What is "bad?" Do you not see that experience is subjective, and that most of these descriptors are frequently nothing more than a point of view? What you have written is YOUR point of view and a description of your own situation. Many other NPs have had very different experiences. When others tell about their experiences and observations its not just a matter of 'negativity' as you choose to view it, its another perspective of reality. And when the majority of these perspectives tell a very different story than yours then maybe that is of significance?

Circumstances can change. Not every new grad NP stays in the big coastal cities. Some ARE relocating for job opportunities. I am happy for you that you are successful but you need to understand that your utopia can change too. Others have posted here about how that happened to them.