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.
Specializes in Psychiatric and Mental Health NP (PMHNP).
On 6/19/2019 at 1:08 PM, myoglobin said:
I disagree that becoming an NP "does not require standardized testing of "any" kind:
a. Most nurses took the ACT or SAT to get into their primary programs. Many also took the TEAS test.
b. All RN's must also take the NCLEX, all NP's must also pass the board exams.
c. Many NP programs do require the GRE, and many do not.
d. Almost all RN programs involve extensive dosage calculation quizzes in the program.
The reason top schools are dropping the GRE requirement is that the GRE:
1. is not a reliable predictor of future academic success
2. discriminates against the poor and minorities
3. it does not test things that are important for an NP
4. the GRE just tests the ability to take the GRE
The best predictor of future academic performance is past academic performance. Even someone who went to a crappy school, but worked hard, will have a good GPA. Crappy students have crappy grades, period. And for those of you, like me, who made some mistakes in their initial undergrad studies, there are ways to make up for that. In my case, nursing is my second career, and I had substantial professional experience that demonstrated the ability to succeed in an intellectually demanding profession. I took my nursing school prereqs and made almost straight As in those. I took some other relevant courses prior to applying to nursing school and earned a 4.0 in all of those. Since those were the most recent examples of my ability to perform well academically, the nursing schools put the most weight on those.
The GRE is expensive. In order to take it, one must pay for the test, at least pay for some study materials, or take a GRE prep course. Poor people can't afford this.
I took the GRE and did not find it relevant. I don't use geometry or perform complicated math. I am able to read and understand relevant medical information. I have no plans to become a PhD researcher and to write a bunch of professional papers. I can write well enough that my charts notes are comprehensible and provide the necessary information.
Looking at an NP applicants grades, experience, essays, and at least one interview should be adequate for making admissions decisions for NP programs.
Specializes in Psychiatric and Mental Health NP (PMHNP).
On 6/17/2019 at 1:17 PM, ThePTNurseGuy said:
I like many of the points you made; however, I think it’s BOTH an oversupply AND a distribution problem. At the rate we’re headed, regardless of the demands that are present in certain areas, we’re going well beyond the normal healthy growth rate of a booming profession. Assuming we keep a steady growth rate with no increase in numbers each year (a big assumption to say the least), were looking at half a million NPs by 2025, at the latest. First it was 10,000 graduates. Now it’s 20,000, and according to the data, 30,000 every year. It’s a short term fix with glaring flaws down the road. These schools don’t care about the profession: they care about the $$$. Let’s be proactive and not let our profession becoming a laughingstock among our colleagues.
We can't assume that the supply of new NP grads will continue to increase ad infinitum.
Not all new grad NPs can get a job and some of them return to nursing because they don't like being an NP, judging from numerous posts on this forum.
There is a shortage of primary care MDs and I think this will only get worse. Primary care just doesn't pay enough to justify the cost of medical education, and med students are certainly smart enough to understand this. Personally, I think primary care will be taken over by NPs and PAs, with a few MDs sprinkled in for oversight/guidance, etc. More about this below.
Again, I am very familiar with NP recruiting and there are many areas of the country desperate for providers, of any type.
So, if there is an oversupply of NPs in Florida, for example, and an undersupply in most of the Western US, what will happen? Some NPs in Florida will not be able to get an NP job and they will either move or take a non-NP job.
I believe in a free market economy. If I have 10 applicants for one NP job, then I will pick the one I think is the best, that I can afford. That's it. So, an excellent NP or NP new grad should not worry. That's how it works in the rest of the economy. Pay in the STEM fields is not plummeting, despite the flood of people entering those fields. The only thing holding down STEM pay is off-shoring to cheaper countries like India, Eastern Europe, etc., along with cheap(er) migrant labor from the H-1B visa program (don't get me started on how this is abused by Silicon Valley).
The future of primary care is to move to non-MD providers. Look, about 80% of my patients present with very routine problems that an excellent RN or "Dr Mom" could resolve: various upper respiratory infections (most treatments are available OTC along with rest and hydration), incision and drainage (which many people do at home), etc. An NP is needed to write prescriptions. The NP also needs to recognize when a patient needs to go to an ER or requires specialist referral - not rocket science IMHO.
As for the more complicated cases such as people with multiple chronic comorbidities, I do see a role for MDs here, but internists already exist and perhaps they should be used more widely. An experienced NP or PA can also handle most of these cases, especially when the patient is also seeing specialists. While there is a need for MDs in primary care, the vast majority of primary care can be performed by NPs and PAs, even RNs. Given that, the hard economic truth is that MDs don't make economic sense for most of primary care, unless we really change our healthcare system.
I do agree with raising some standards for NP schools. We also need NP residencies. In addition, I would like to see it mandated that NP schools provide accurate information about NP job prospects, both locally and nationally.
Specializes in Psychiatric and Mental Health NP (PMHNP).
On 6/17/2019 at 8:17 PM, ThePTNurseGuy said:
@FullGlass: I appreciated the points you made. There were was a lot to dissect in your post, but I'd like to clarify the following:
1. I am not suggesting that we add more classes on TOP of the curriculum. I am proposing an updated curriculum that meets the demands of being a provider.
3. While I agree with your 'survival of the fittest' mentality, I don't think it changes the fact that opening more mediocre schools is healthy for the profession or beneficial for the population that we serve.
We do agree on the most important issues.
With regard to classes, the reason for those fluff classes is that the accreditation bodies require those. So, that is where the change needs to be made. Students can also choose schools without a lot of fluff. Hopkins folded Nursing Theory and Ethics into one class for that reason. They'd like to reduce it further, but can't because of the accreditation. Nursing Theory was the only fluff in my curriculum. Ethics should be taught, but could be folded into another class or made into a 1 unit class, IMHO.
Philosophically, I am opposed to a centrally planned economy. As long as schools adhere to proper standards, then they should be allowed to open an operate. It is the standards that are the problem and I agree our profession needs to address this.
I've done a lot of recruiting prior to becoming an NP, and since becoming an NP have been active in recruiting NPs and PAs. Reputable organizations don't just grab the cheapest candidate. They want the best candidate they can reasonably afford. If the organization is shoddy, that's a different issue.
As for Florida, I don't understand what is going on there. Florida has a shortage of primary care MDs, so that should be beneficial to NPs. There is a system issue in that state which is separate from the number of NPs.
Specializes in Psychiatric and Mental Health NP (PMHNP).
On 6/17/2019 at 7:48 PM, FPMHNP2019 said:
Most of NP schools don't find preceptors for students. Thise very few schools that do are super expensive. Tuition ranges from 1500-1800$/credit...v.s. those that charge 400-800/credits but not place students.
Sorry, but this is not true.
Schools that provide preceptors and cost per unit:
Johns Hopkins FNP DNPs $1721
Johns Hopkins Post Master's PMHNP $1631
UCLA $17,232 for California residents
Cal State LA for California residents $8066 per year (2 years to complete, assuming 2 semesters per year)
Specializes in Psychiatric and Mental Health NP (PMHNP).
On 6/19/2019 at 4:04 PM, Oldmahubbard said:
As of 2019, with some 40 years of practice under our belts, we have saved the public not one nickel.
You are largely correct. Personally, I think this is an issue and is tied to the general lack of price transparency in health care. What NPs have done is provide greater access to healthcare by increasing the number of providers and also staffing urgent care centers. NPs are also more likely to work in underserved areas, at least for awhile.
You are largely correct. Personally, I think this is an issue and is tied to the general lack of price transparency in health care. What NPs have done is provide greater access to healthcare by increasing the number of providers and also staffing urgent care centers. NPs are also more likely to work in underserved areas, at least for awhile.
I was exaggerating a bit to say we haven't saved the public a nickel. We just haven't saved the public anywhere near what you would expect, given our salaries have been 40%, and sometimes less, of physician salaries.
When Medicare reimburses us 85%, in almost no setting do we get the 85%. Someone else gets a large chunk.
Schools that provide preceptors and cost per unit:
Johns Hopkins FNP DNPs $1721
Johns Hopkins Post Master's PMHNP $1631
UCLA $17,232 for California residents
Cal State LA for California residents $8066 per year (2 years to complete, assuming 2 semesters per year)
Most of the schools you list above are quite expensive relative to the $350 per credit hour that USI charges even for out of state applicants. Also, even if I went to Johns Hopkins just how would they find me clinical sites here in central Florida? The five or six psych clinics within a two hour drive are so busy that patients have a challenging time getting the phone answered (I hear them complain daily about this). The only way I found a spot was multiple calls/visits and letters, and I got lucky. If it were necessary I would have written every clinic in North America and moved to remote Alaska to find a clinical site. However, having the flexibility to find my own spot was a blessing and benefits many distant education and working students who are older and who have families.
Specializes in Psychiatric and Mental Health NP (PMHNP).
1 hour ago, Oldmahubbard said:
I was exaggerating a bit to say we haven't saved the public a nickel. We just haven't saved the public anywhere near what you would expect, given our salaries have been 40%, and sometimes less, of physician salaries.
When Medicare reimburses us 85%, in almost no setting do we get the 85%. Someone else gets a large chunk.
Yes, I agree. I think patients should be charged less to see an NP. It is the clinics that are pocketing the "profit" in staffing NPs.
If patients paid less to see an NP, demand for NPs would go up.
Specializes in Psychiatric and Mental Health NP (PMHNP).
56 minutes ago, myoglobin said:
Most of the schools you list above are quite expensive relative to the $350 per credit hour that USI charges even for out of state applicants. Also, even if I went to Johns Hopkins just how would they find me clinical sites here in central Florida? The five or six psych clinics within a two hour drive are so busy that patients have a challenging time getting the phone answered (I hear them complain daily about this). The only way I found a spot was multiple calls/visits and letters, and I got lucky. If it were necessary I would have written every clinic in North America and moved to remote Alaska to find a clinical site. However, having the flexibility to find my own spot was a blessing and benefits many distant education and working students who are older and who have families.
Hopkins will find clinical placements for their students, no matter the location. Of course, they appreciate any help the student can provide. The Hopkins name opens a lot of doors.
It is hard to find preceptors because being a preceptor requires some effort. Preceptors don't want morons, to be blunt. They are more likely to consider precepting a student from a good school or from an alma mater.
Perhaps this isn't an issue where you live, but in a city like Baltimore, with a lot of NP students from schools like Hopkins and Univ of Maryland, it is very hard for NP students from crap schools to get a preceptor. The same is true of most other major cities with good NP schools.
Specializes in Psychiatric and Mental Health NP (PMHNP).
2 minutes ago, Oldmahubbard said:
But if it didn't come directly out of their pocket, probably not.
True, but I think our current healthcare system needs major reform. I'd like to see price transparency and more use made of cash payment. I think a lot of patients would benefit from having some skin in the game, as well as being able to do some comparison shopping.
In addition, if insurance companies could pay less when patients see an NP, the insurance companies would put big pressure on the powers that be to grant full practice authority to NPs, especially in primary care.
Mental health is one of the areas where there are a lot of cash-only practices.
What annoys me about healthcare is that the industry does not use leverage. Other professions are highly leveraged. Other professions have a pyramid structure so the most skilled individuals are focusing on highly complex issues and also guiding less skilled staff.
In high tech, a tech architect is the creme de la creme on the technical side. Tech archs work on multiple projects and also oversee and mentor more junior staff. This actually results in greater billing and revenue for the organization. It also provides a means to grow the organization by developing more and more highly skilled professionals. In order to make this work in healthcare, how work is done and billed for would have to be rethought, but I think it is possible.
Hopkins will find clinical placements for their students, no matter the location. Of course, they appreciate any help the student can provide. The Hopkins name opens a lot of doors.
It is hard to find preceptors because being a preceptor requires some effort. Preceptors don't want morons, to be blunt. They are more likely to consider precepting a student from a good school or from an alma mater.
Perhaps this isn't an issue where you live, but in a city like Baltimore, with a lot of NP students from schools like Hopkins and Univ of Maryland, it is very hard for NP students from crap schools to get a preceptor. The same is true of most other major cities with good NP schools.
Hopkins by definition probably represents the top 10% of applicants. Good for them, but most of us are "by definition" within a standard deviation of the 50th percentile (as applicants) and we need places to go to school as well. Again, just because someone scores higher (or gets better grades) doesn't mean they will be a superior NP (to someone who scores less) it is of course one factor, but there are many.
FullGlass, BSN, MSN, NP
2 Articles; 1,962 Posts
The reason top schools are dropping the GRE requirement is that the GRE:
1. is not a reliable predictor of future academic success
2. discriminates against the poor and minorities
3. it does not test things that are important for an NP
4. the GRE just tests the ability to take the GRE
The best predictor of future academic performance is past academic performance. Even someone who went to a crappy school, but worked hard, will have a good GPA. Crappy students have crappy grades, period. And for those of you, like me, who made some mistakes in their initial undergrad studies, there are ways to make up for that. In my case, nursing is my second career, and I had substantial professional experience that demonstrated the ability to succeed in an intellectually demanding profession. I took my nursing school prereqs and made almost straight As in those. I took some other relevant courses prior to applying to nursing school and earned a 4.0 in all of those. Since those were the most recent examples of my ability to perform well academically, the nursing schools put the most weight on those.
The GRE is expensive. In order to take it, one must pay for the test, at least pay for some study materials, or take a GRE prep course. Poor people can't afford this.
I took the GRE and did not find it relevant. I don't use geometry or perform complicated math. I am able to read and understand relevant medical information. I have no plans to become a PhD researcher and to write a bunch of professional papers. I can write well enough that my charts notes are comprehensible and provide the necessary information.
Looking at an NP applicants grades, experience, essays, and at least one interview should be adequate for making admissions decisions for NP programs.
https://dailybruin.com/2018/10/15/gre-wastes-applicants-time-fails-to-indicate-future-student-success/
https://www.insidehighered.com/admissions/article/2019/03/18/cornell-and-harvard-english-departments-drop-gre-requirement
https://whyy.org/segments/graduate-schools-are-opting-out-of-the-gre/