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.
I generally look at places like San Francisco from a different perspective. Most of the time the pay reflects cost of living. It's only * hard* for people in service industries. Professional jobs tend to hold up better. You can get by in those cities with no car and probably technically afford a house in the right situation. Comparing what you get in the Midwest compared to major cities is where people get tripped up. But I remember living in Stuttgart Germany. 1600 euros a month for housing, but a train stop two blocks away and impeccable bus system and I didn't own a car for two years. Only had my Harley. Wife and I could easily live in San Fran or NYC comfortably.
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.
I pretty specifically listed the qualifiers for my opinion. If you generate the same charge, you should be paid the same. Medicare pays 85%, but not all insurers do. There are plenty of cases where NPs and MDs generate the same charges, but I also mentioned that if collaboration/supervision is involved then the physician should be reimbursed for that which will lower NP profit. I understand that physician spends a lot more time training, but at the end of the day if an NP and an MD see the same patient, do the same exam, order the same treatment, and bill the same, then they should be paid the same for that. There are a lot of convoluted if/ands/buts in there, but I think that's where it should start.
NP pay is going to be based on market factors, end of story. Still it rankles me that when the NP is paid 40% of the MD rate for similar work in primary care, that margin is siphoned off into somebody's pocket. Usually the MD who "supervises", or "collaborates". The low pay or savings, depending on how you look at it, are not passed on to the public or the health care system at large. Not at all. Not even a little.
This thread worries me, but yet in the hospital I'm at (a trauma 1 , teaching hospital) I continue to see more and more NPs hired in all specialties, because they work for less than MDs.
I agree 100% NP schools are too easy to get into. Most just require a 2.7 or 3.0 min GPA to get in without taking the GRE. If 2.6 or under, they require the GRE but still can accept you. I don't think NP schools should raise the bar to MD schools entrance requirements, because we already are nurses continuing our education, but maybe at least make the academic requirements higher.
I actually think if programs just increased clinical hours and classes, you'd have less people desiring to take them on to get their FNP.
Food for thought....MDs have years of residency training? What about the full time working nurse at the bedside that helps train these residents going back to school to become a NP. While this is not viewed as formal education and we are being paid, does the experience not count? Of course it should and in many ways the experienced RN at the bedside going back to be a NP is much more capable than a 1st year resident. I have worked with both. The only thing an experienced nurse graduating from a reputable DNP program is missing that a MD has is perhaps a few more hard earned academic classes, depending on specialty of course. That is my opinion anyway. What I don't agree with is a brand new graduate nurse applying for NP school and they haven't even gained a year of working experience. I think is very dangerous and most don't even know what they are getting into, they just know that the bedside is hard work.
Food for thought....MDs have years of residency training? What about the full time working nurse at the bedside that helps train these residents going back to school to become a NP. While this is not viewed as formal education and we are being paid, does the experience not count? Of course it should and in many ways the experienced RN at the bedside going back to be a NP is much more capable than a 1st year resident. I have worked with both. The only thing an experienced nurse graduating from a reputable DNP program is missing that a MD has is perhaps a few more hard earned academic classes, depending on specialty of course. That is my opinion anyway. What I don't agree with is a brand new graduate nurse applying for NP school and they haven't even gained a year of working experience. I think is very dangerous and most don't even know what they are getting into, they just know that the bedside is hard work.
I have 2 good friends in 2 different medical schools right now. One has been there for 2 years, the other just started this January.
It is not just some more academic classes. I followed my January friends journey closely, and in the first few weeks I was thinking "Wow I learned all this in nursing school/bio classes!" but that didn't last beyond the first few weeks, pretty soon I was saying instead "holy moly.." because it is definitely more than what they taught us and what they teach in NP schools. The first 2 years of medical schools are hard core sciences.
I agree with you though that medical residents sometimes don't know more than the nurses due to the nurses' bedside experience. But we as nurses are taught that experience is not enough. We need evidence based research, not just "this has worked for me so that's why I know how to do it". I am hoping that NP schools will start shaping their programs to fit the demand for new nurses who want to go right into NP, because seems like us millennials are doing that in droves.
I agree, but it is stronger and more academics. In reality I think if we could marry the two educational systems you would end up with an outstanding practitioner. This would be why a lot of academic centers are trying to bring together medical students and nurses in projects at critical points in their education. We can't marry the two systems, but we can do better at working together rather than arguing over who is smarter. One is about rubber meeting the road. The other is about understanding the vehicle and the road to a much greater extent before even leaving the garage. I do think we need to let go of the concept that one is more than or the other is less than. They are unequal parts that should not be compared that way, rather complement each other and understood each meets a critical need for patient and family.
Food for thought....MDs have years of residency training? What about the full time working nurse at the bedside that helps train these residents going back to school to become a NP. While this is not viewed as formal education and we are being paid, does the experience not count? Of course it should and in many ways the experienced RN at the bedside going back to be a NP is much more capable than a 1st year resident. I have worked with both. The only thing an experienced nurse graduating from a reputable DNP program is missing that a MD has is perhaps a few more hard earned academic classes, depending on specialty of course. That is my opinion anyway. What I don't agree with is a brand new graduate nurse applying for NP school and they haven't even gained a year of working experience. I think is very dangerous and most don't even know what they are getting into, they just know that the bedside is hard work.
Nurses teach residents some stuff but most of it is superficial how to use equipment or which PRN order is best for this basic issue. A vast majority of resident teaching comes from attending, other residents, what they learn in med school.
I would say at the 6 month mark most residents on an internal medicine service would outperform most NPs. They have such a more extensive education than nurses ever get. The nurses fallacy is that they see a new intern on their first iCU rotation and compare their 10 years of nursing experience up against the intern and expect the intern to know everything day one. Yet the internal has had several outpatient rotations, medicine rotations psych, etc and if the nurse was put into any of those rotations they would be just as clueless since they only know ICU.
I was an NP in my last year of med school and can say the two degrees are vastly different an nP school is mostly a joke
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.
You mean to tell me that you make nearly $200K and you've decided to live in the most expensive parts of the country RENTING! You are literally handing over $4k a month to make someone else rich. How about using that money and investing! If not for yourself, then your child!
You mean to tell me that you make nearly $200K and you've decided to live in the most expensive parts of the country RENTING! You are literally handing over $4k a month to make someone else rich. How about using that money and investing! If not for yourself, then your child!
Only in America...
I invest, but not in real estate here, which is a poor investment for your money, especially with the risk of earthquake. If you read more about the benefits vs costs of renting vs owning, owning does not always make sense.
I pay my rent, I get a well-maintained building that gets all my packages for me, has a workout facility, spa with hottub, rooftop grills and gathering places, a concierge, no maintenance, the ability to move immediately if I so desire, no property taxes and basically nothing else I have to worry about. If I were to buy, I would need to have over 100k to put as a down payment, and then my payments would still be more than my rent, especially when you include property taxes and I would not be able to live downtown as I do now, thereby not needing a car.
Instead of buying a home I do not want, I invest in index funds and have a good amount of growth with that.
ETA: I do find it amusing you say "only in america" - because in europe, home ownership is very much not as stressed as it is here and people will rent their whole lives. It's far more common in large cities with high costs of living.
I invest, but not in real estate here, which is a poor investment for your money, especially with the risk of earthquake. If you read more about the benefits vs costs of renting vs owning, owning does not always make sense.
I pay my rent, I get a well-maintained building that gets all my packages for me, has a workout facility, spa with hottub, rooftop grills and gathering places, a concierge, no maintenance, the ability to move immediately if I so desire, no property taxes and basically nothing else I have to worry about. If I were to buy, I would need to have over 100k to put as a down payment, and then my payments would still be more than my rent, especially when you include property taxes and I would not be able to live downtown as I do now, thereby not needing a car.
Instead of buying a home I do not want, I invest in index funds and have a good amount of growth with that.
All of the amenities you've mentioned you don't own. With the amount of money your throwing away in rent, you could put down $100K in just under 4 years if you were paying a reasonable amt in rent. I lived in SF. All one would need to do is purchase insurance in case of an earthquake which is very affordable. Listen, if you're happy with what you're doing, great. But for any other new grad reading this who is concerned about making their money grow, it's not a smart investment in my humble opinion. Anyone who invests knows that there are only 2 options that makes sense, stocks and real estate. I had to move out of the bay to not get trapped in the rat race.
djmatte, ADN, MSN, RN, NP
1,248 Posts
I generally look at places like San Francisco from a different perspective. Most of the time the pay reflects cost of living. It's only * hard* for people in service industries. Professional jobs tend to hold up better. You can get by in those cities with no car and probably technically afford a house in the right situation. Comparing what you get in the Midwest compared to major cities is where people get tripped up. But I remember living in Stuttgart Germany. 1600 euros a month for housing, but a train stop two blocks away and impeccable bus system and I didn't own a car for two years. Only had my Harley. Wife and I could easily live in San Fran or NYC comfortably.