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.

[Oldmahubbard]

Your perspective is valuable, no doubt.

I find it annoying that none of the savings of NPs doing the same job, and working for half of physician salaries- none of these savings are passed on to the public. Not at all. Not even a little. Someone is getting rich off of us.

IN FPA states, it is true we can have our own practice, but insurance companies make it very difficult by requiring a collaborator.

90% of the psychiatrists I have ever met have been so unimpressive as to be shameful, and why would I ever pay these morons for collaboration?

[FullGlass, BSN, MSN, NP]

Your perspective is valuable, no doubt.

I find it annoying that none of the savings of NPs doing the same job, and working for half of physician salaries- none of these savings are passed on to the public. Not at all. Not even a little. Someone is getting rich off of us.

IN FPA states, it is true we can have our own practice, but insurance companies make it very difficult by requiring a collaborator.

90% of the psychiatrists I have ever met have been so unimpressive as to be shameful, and why would I ever pay these morons for collaboration?

You have a very good point. At least in primary care, the MDs, PAs and NPs do identical work, so I also don't understand why there would be such a pay differential. In a practice where the MDs focus on more expensive services like procedures and the NPs do routine work, then yes the MDs should make more money.

Personally, I think NPs and PAs should take over primary care. The only needs for MDs in primary care is to handle more complex patients, but the MDs don't want to do that. In the business world, someone with a lot of training and expertise would be leveraged across multiple projects, so they could mentor the less senior people. Just having an MD practicing the same stuff as an NP in primary care makes no economic sense.

Our healthcare system is a mess in many ways and beyond the scope of this discussion. As for who is getting rich - it isn't the providers. It is the administrators and health insurance executives. I currently work at an FQHC and we really don't have a lot of money.

[TheAngryMan]

On 9/22/2018 at 11:32 AM, FullGlass said:

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 . . .

Truer words never spoken my friend. Worked at a major aerospace company as a spacecraft engineer. We literally had a big company wide meeting. I thought we got a new NASA contract....nope. The new announcement was literally "The Box...2.0".

[djmatte, ADN, MSN, RN, NP]

5 hours ago, TheAngryMan said:

Truer words never spoken my friend. Worked at a major aerospace company as a spacecraft engineer. We literally had a big company wide meeting. I thought we got a new NASA contract....nope. The new announcement was literally "The Box...2.0". 

I've already RSVP'd and given them a list of phony dietary restrictions just to cause a scene. I told them I was pesca-pescatarian. Which is one who eats solely fish who eat other fish. I think my absence would be noted.

[LilPeanut, MSN, RN, NP]

I'm an NNP and there's definitely a shortage of those, there aren't as many schools that offer that as a specialty.

When I started out, I made ~90k ish which was a big bump up from my RN salary and I could easily support my family on it.

I live in San Francisco now, with our famously high cost of living and I started at around 175-180k, now close to or over 200k (all of our salaries are published online because we're state employees) and whoever said 175k isn't enough in the bay area definitely has some different standards that me. I live downtown in a fancy brand new highrise apartment. I only rent, because buying doesn't make sense in SF. I don't need a car, I walk, use public transport, my bike or uber/lyft or a car share for transport. I never cook honestly, I only eat out because I can and I live by myself. (my monthly rent is ~4k) I don't spend frivolously but I also don't live paycheck to paycheck - I've been increasing my savings and index funds, I have a child in college that I help support, etc. My apartment may be small compared to a lot of the country, but I only need it to sleep and watch TV and hang out with my cat, because the weather is so nice I can always go outside.

I may not be getting rich any day soon or buying a fancy house next to Zuckerburg, but my life is good and I earn enough to enjoy it.

I do find there's a big mix in how schools prepare people, but there's also variation between students from the same school. At least for my specialty, some of the standardization for licensing I think has hurt our education, because they waste time in grad school teaching about big people things we don't need to know, which is time better spent on neo pathophys. While I happened to have pathophys across the lifespan at a graduate level, mainly because I was a graduate entry student so all my "nursing" classes were at the graduate level, it has *zero* to do with my ability to safely practice as an NNP. There are people I have met who have not had as much neo pathophys classes as I had because they had to take a lifespan class instead, which is a huge mistake.

NNPs though do have the same issue as other NPs - it is very likely that if you want to switch jobs, you may have to move, and move far away possibly. And if you live near a program that is churning out students, you'll need to be even more prepared to move. It's just how it goes.

[guest769224]

13 hours ago, LilPeanut said:

I never cook honestly, I only eat out because I can and I live by myself. (my monthly rent is ~4k)

That is just shy of $50,000/year being thrown at rental payments. Terrible

[Ximena2008, RN]

I am in my clinicals for my FNP here in Florida and the more I hear NP's the more discourage I get. I have many friends in Miami, FL that graduated a year ago and don't have a job. There is not only the RN becoming NPs but also the foreign MD becoming RN just to transition into NP.

Nevertheless, I am on the boat now and can't stop because I have spent countless nights, days, weekends on it as well as close to 30K per year. I also feel that I rather work as NP than RN even if I get pay the same.

[Ximena2008, RN]

Oh! I forgot to mention. We, as NPs should not strive to be paid as an MD. We have to recognized that regardles of our capacity, intellectual or for doing the same as a physician does, MDs have a lot more years of school as well as years of residency training in a hospital setting.

I do agree that higher education should be paid more, like a DNP should be paid more than a master's holder but not like an MD. It will be beautiful for us but not fair to MDs.

[NICUmiiki, DNP, NP]

5 minutes ago, Ximena2008 said:

Oh! I forgot to mention. We, as NPs should not strive to be paid as an MD. We have to recognized that regardles of our capacity, intellectual or for doing the same as a physician does, MDs have a lot more years of school as well as years of residency training in a hospital setting.

I do agree that higher education should be paid more, like a DNP should be paid more than a master's holder but not like an MD. It will be beautiful for us but not fair to MDs.

I don’t fully agree. If the work you do generates the same charge, you should be paid the same. If you collaborate or need help from a physician, then they should be compensated for that, and that will probably decrease your profitability. I do think that most of us agree that NP education doesn’t really prepare NPs to practice independently, but after 4-5 years, you should have enough practice hours to advocate for full pay.

[Ximena2008, RN]

17 minutes ago, NICUmiiki said:

I don’t fully agree. If the work you do generates the same charge, you should be paid the same. If you collaborate or need help from a physician, then they should be compensated for that, and that will probably decrease your profitability. I do think that most of us agree that NP education doesn’t really prepare NPs to practice independently, but after 4-5 years, you should have enough practice hours to advocate for full pay.

Most NP programs are 24 months of which only a certain amount of hours is hands-on with a preceptor, the rest is a self paced online desing for most universities were written assignments, discussion threats and a few quizzes and maybe a final exam takes place. MDs have to stay on site, days and nights for 3 years for Internal med and family practice after the 6 years of medical school. And no, the work does not generate the same for a practice, NPs bill 85%, meaning insurance companies pay 15% less to the practice where we do the work. Trust me, once I graduate I will love to be paid the same as an MD, but I know that won't happen so I am happy with the autonomy I get to practice even if less money.

[LilPeanut, MSN, RN, NP]

It's a little over 50k, after taxes, I can live very comfortably on that, if you've already taken my rent out of the picture. 4200 month to pay for food, cell phone, credit card, cat food, water, electricity, etc. That's a lot.

[LilPeanut, MSN, RN, NP]

Oh, and because I live in the city, I don't need a car, which saves a bunch! I'm not going to get rich, but I can go on vacations, and live my life without thinking about money really. I've never liked designer stuff.