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.

[Kooky Korky, BSN, RN]

On 7/29/2019 at 10:36 PM, irvine123 said:

Socializing medicine would save a whole lotta money but then all the salaries would go down and big pharma/insurance would lose out on a lot of dough which is why it won't happen because its all about "me" in the US of A.

I agree that the insurance and big pharma industries need to go.  They have a stranglehold on our health care.  Absolutely sinful.  Alternative medicine, nutrition, etc. need to be freely allowed and paid for same as Western medicine is.  And I think we do need so-called socialized medicine in America.  It is high time to come into the modern era in this regard.

Where is it not about ME?  Everyone is fallible and selfish in some way and degree, all the world over.

Also, the doors here are not locked.  You can leave America any time you wish.  

[umbdude, MSN, APRN]

17 minutes ago, Kooky Korky said:

For example, if you want to see Ortho, you must instead see the PA or NP, who will determine if you get to see the MD. 

I had to see my primary care doctor to get a referral to see ortho. My PCP does his assessment and figure out whether I need a referral, more diagnostics, or just RICE. That's how HMOs work. I can't just walk into an Ortho office because it would be a waste of their time if you don't need interventions that involve ortho specialist.

[Kooky Korky, BSN, RN]

19 hours ago, umbdude said:

I had to see my primary care doctor to get a referral to see ortho. My PCP does his assessment and figure out whether I need a referral, more diagnostics, or just RICE. That's how HMOs work. I can't just walk into an Ortho office because it would be a waste of their time if you don't need interventions that involve ortho specialist.

Agreed and not necessarily bad. 

Personally, I hate the concept of a gatekeeper telling me who I may and may not see.  I am a nurse and I know who I need and want to see.  And I know when I don't need a doc at all.

I was talking, though, about Medicare.  M does not require referrals, nor does my secondary insurer.  I am free to choose to see a specialist when I want to.  And I love that aspect of my insurance.  (Notice how we are suddenly talking about insurance, not about NP's?)

But back to NP's.  They were meant to be physician extenders.  They were to be able to evaluate patients and determine a course of action, including referring to an MD/DO if needed.

A doctor would supervise in person upon setting up collaborative practice initially and at a certain interval.  The doctor would review a certain number of charts at a set interval.  The doctor had to be within a certain distance from where the NP was working geographically and had to be readily available by phone. And there were limits on the NP being able to prescribe.

Thus the NP's role was to extend the doctor's ability to "see" more patients in underserved areas, such as rural and inner city. 

Then doctors figured out that their NP's could take call, thereby relieving them of many off-hours calls.  The NP could reach the doctor if need be, but the patient had to first talk to the NP.  Likely most often the NP could handle after hours calls.  But she could reach the MD for consultation if needed, just like during normal business hours.

The latter is what I was referring to when I said that a person has to see an NP before being allowed to see the MD in, for example, the Ortho office.

[djmatte, ADN, MSN, RN, NP]

A lot of what an NP was “meant” to do comes down to whatever politics or spin the individual is more likely to embrace. If you’re off the medical model belief,  then yes the NP was made to extend the reach of the physician.  On the other hand, many view the NP as an expansion of a role that nurses in underserved communities are doing already.  Specifically in the public health as well as severely underserved arenas.  
 

My school Frontier for instance started as the Frontier Nursing Service, providing midwifery and family care through the Kentucky mountains. There was one doctor across multiple FNS locations across multiple towns. But it was those nurses delivering babies, doing in home well baby/child checks, and treating whole families as they did their work. 
 

The truth of what is/was meant is probably somewhere in the middle and influenced by decades of politics and ideologues.

[Guest1168644]

On 6/27/2018 at 9:56 PM, FullGlass said:

 

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. 

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:

Thank you for this data! 

[Guest1168644]

On 2/20/2021 at 1:36 AM, MentalKlarity said:

Nothing "easy" is worth having for long.

These poorly prepared graduates oversupply the market and bring down everyone's wages...

It’s comical to me that the only place I can find this mythical oversupply theory is on this nursing forum. 

[Guest1168644]

On 8/25/2019 at 3:48 AM, phil1968 said:

As programs shift to DNP this high bar will hopefully stem the tide of grad mills..

If anything, this is what feeds the “grad mills”.

[myoglobin, ASN, BSN, MSN]

I went to the University of Southern Indiana and had to find my own preceptor.  He was willing to work around my hours in such a way that I could continue to work part time in the ICU. The cost per hour was around $300.00. My income went from 60K in the ICU with no benefits to around 300K 1099 (distance telehealth).  Had I been forced to attend a school that required preceptors there is simply no way that I could have gone back to school (indeed I did the MSN program over about 5.5 years part time).  Thus I am grateful for the diversity in opportunity that the current structure provides.

[strawberryluv, BSN, RN]

I don't see an oversupply of NPs. I see a lot of job openings for NPs especially in the city where I live. There are a lot of people where I live so there are not enough primary care providers..

Also, I took an economics class this semester which has helped me understand how physicians and NPs get paid and now I will be able tot negotiate my salary. I will not be low-balled.

[Subee2, BSN, MSN, CRNA]

On 2/21/2021 at 12:48 PM, myoglobin said:

I went to the University of Southern Indiana and had to find my own preceptor.  He was willing to work around my hours in such a way that I could continue to work part time in the ICU. The cost per hour was around $300.00. My income went from 60K in the ICU with no benefits to around 300K 1099 (distance telehealth).  Had I been forced to attend a school that required preceptors there is simply no way that I could have gone back to school (indeed I did the MSN program over about 5.5 years part time).  Thus I am grateful for the diversity in opportunity that the current structure provides.

Since you had to pay your preceptor (a lot!), did the school deduct  that  from your tuition or did you pay a preceptor on TOP of your tuition?

[myoglobin, ASN, BSN, MSN]

9 hours ago, Undercat said:

Since you had to pay your preceptor (a lot!), did the school deduct  that  from your tuition or did you pay a preceptor on TOP of your tuition?

I did not pay my preceptor he did it for free.  If I ever precept I too will do it for free.  

9 hours ago, Undercat said:

Since you had to pay your preceptor (a lot!), did the school deduct  that  from your tuition or did you pay a preceptor on TOP of your tuition?

When I say $300.00 per hour I'm talking about tuition.  My total cost for the PMHNP was about 10K over the entire program.