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.

[guest769224]

Gentleman_nurse said:

Hey Goldenfox

I recall reading many posts about nurses pursuing FNP vs. AGNP because it was a broader scope of practice. Do you think lack of subspecialty fields has anything to do with the glut?

There are plenty of "sub" specialty NP fields available to pursue.

FNP, ACNP, NNP, WHNP, PMHNP, Pedatric acute care, pediatric primary care, gerontology, etc.

That doesn't sound like a lack to me.

[Gentleman_nurse, MSN]

Let me clarify. It seems many pursue FNP which is a generalist field rather than a subspecialty as you mentioned. I was wondering if this root cause. The feeling FNP's are interchangeable and have a basic level of knowledge (in the eyes of others). Additionally they are competing with primary care physicians and physician assistants. So why pay a premium. I probably answered my own question but I want to know what others think especially those who are FNP's.

[djmatte, ADN, MSN, RN, NP]

It's hard to clarify why many pursue fnp over other options, but for many it's the most appropriate option for RNs. Especially those who don't wish to work in a hospital. Specialty nursing by and large doesn't make up the majority of nursing experience. And our general education is broader than a specific specialty so many may be drawn toward something that keeps options open. Also bear in mind, many of the np specialties are only in recent years coming in demand where before an fnp actually could more easily work anywhere. The consensus model is rightfully forcing everyone to to seriously think about their path.

I don't agree that we are competing with physicians. In many cases, clinics habe a good idea how many physicians they want/need. And the whole np profession more or less competes with PAs add their training gives them broad options. But even they will eventually get pulled into specific specialities they excel in and likely stick with whole careers. So imo outs a bit of a wash regarding the field.

I graduated in December, had two potential offers with solid interviews in other states, then my current employer whose local reached out, offered me a low ish number and jumped when I countered at 100k. There are jobs out there and while I'm not as optimistic as one specific poster around here, I do know there are recruiters actively searching for new and experienced NPs.

[Ree01]

I do want to provide a few more awakenings and truth to the reality that you have described in your post. In the last two decades there has been a rapid shift in the way that NPs are used in healthcare. Previously NPs were used to serve the underserved and increase access to quality healthcare. Today it is no more the underserved or patient that benefits the greatest from the NPs. It is the physicians. Physicians especially those that employ you in the nursing home or office will use you to generate income for them. I work with one hospitalist physician. He oversees about 5 nursing homes. He has two full time NPs . He told me how he makes $250000.00 on an average from each of them a year. This is after he pays them $90000.00 a year with little or no benefits. Another physician in Infectious Disease told me how she had a fall out with Administration for not paying her a bonus of $125000.00 a year for supervising a PA in the office. This PA was seen 25 - 30 patients a day whilst she cruised in the hospital, left work at 3 pm and did maybe a morning or two of office a week. Physicians abuse NPs- make them do all the hard work then take the profits. NPs are now income generators for Physicians. That is the reality. Also remember physician have to work harder today in this current healthcare system with computer charting, calls, patient volumes etc. Therefore be ware physicians will employ you, pay you a cheap salary and make you do all their work for them. They don't want to work hard but they want to earn that big fat physician salary. You are going to have to work just like a doctor, in some cases even harder just to earn a few dollars more than a RN and less than 1/4 that of a physician. This is the reality. Before you leave your secure job as an RN and sign up for those expensive online NP programs, stop and think very very carefully. The grass is no more green on this side .. it was 2 decades ago but it is quickly drying up.

[djmatte, ADN, MSN, RN, NP]

Ree01 said:

I do want to provide a few more awakenings and truth to the reality that you have described in your post. In the last two decades there has been a rapid shift in the way that NPs are used in healthcare. Previously NPs were used to serve the underserved and increase access to quality healthcare. Today it is no more the underserved or patient that benefits the greatest from the NPs. It is the physicians. Physicians especially those that employ you in the nursing home or office will use you to generate income for them. I work with one hospitalist physician. He oversees about 5 nursing homes. He has two full time NPs . He told me how he makes $250000.00 on an average from each of them a year. This is after he pays them $90000.00 a year with little or no benefits. Another physician in Infectious Disease told me how she had a fall out with Administration for not paying her a bonus of $125000.00 a year for supervising a PA in the office. This PA was seen 25 - 30 patients a day whilst she cruised in the hospital, left work at 3 pm and did maybe a morning or two of office a week. Physicians abuse NPs- make them do all the hard work then take the profits. NPs are now income generators for Physicians. That is the reality. Also remember physician have to work harder today in this current healthcare system with computer charting, calls, patient volumes etc. Therefore be ware physicians will employ you, pay you a cheap salary and make you do all their work for them. They don't want to work hard but they want to earn that big fat physician salary. You are going to have to work just like a doctor, in some cases even harder just to earn a few dollars more than a RN and less than 1/4 that of a physician. This is the reality. Before you leave your secure job as an RN and sign up for those expensive online NP programs, stop and think very very carefully. The grass is no more green on this side .. it was 2 decades ago but it is quickly drying up.

I don't disagree with your assertion. I know for a fact providers are revenue generators and that is how the model is where I'm at. It's evident in our ratios. But I wouldn't characterize my income as "a few dollars more" than an RN. My annual salary jumped 30k a year the day I signed up. I am not blind to the fact that they will be making profit off me. But as a newer NP, they are taking a risk and technically have not likely recouped their salary so I still build me panel. But I'm still being paid a significantly higher salary that allows me to live more comfortably and I do a job that is reflective of what I set out to do. I'm pretty content with the model and I also feel I am meeting earlier altruistic goals of NP justification add I am serving one of the most impoverished communities in The United States.

[Ree01]

I do believe you but your situation is as a previous writer notes the " exception " not the norm. Your situation is how things should be not exactly how they are the majority of the time. I have been an NP now for 20 years. I work in a major acute hospital inner city. The majority of NPs that work in the hospital for different specialities feel abused by physicians. This is the a truth that I am sharing with prospective students. I will quote some of their comments; " I work longer hours", " I have less time with my family ", "I have big student loan debt", I feel as I am being spoken to as if I don't have a brain", " You have to put up with a lot of emotional abuse", " the benefits sucks" , and so forth. RNs should not be misled to believe that if they make an extra $30000.00 a year; it is going to come easy; there is a huge price to pay depending on the practice you get a job at. When you are a RN ; you might think it's cool to rock the white coat and stethoscope around your neck as an NP but first please get as much information and opinions from other NPs in your area, and research definitions such as scut monkey and so forth.

[djmatte, ADN, MSN, RN, NP]

Those comments are absolutely reflective of NPs I've worked with in acute/hospital care. Not to mention the typical "official note writer" title where the md makes a bunch of plans and sticks the mid levels writing the notes. But be careful laying your hospital experience on the broader np community. In primary care at many of the places I've worked and learned as a student, what I described is the model and the norm. That's 5 sites in two states. Now there are absolutely NPs who feel overworked gnat I've come across. One in my current place of business. But every provider that I've seen in this work area has been helpful, respectful, and willing to give advice when needed.

[Ree01]

I do believe you but your situation is as a previous writer notes the " exception " not the norm. Your situation is how things should be not exactly how they are the majority of the time. I have been an NP now for 20 years. I work in a major acute hospital inner city. The majority of NPs that work in the hospital for different specialities feel abused by physicians. This is the a truth that I am sharing with prospective students. I will quote some of their comments; " I work longer hours", " I have less time with my family ", "I have big student loan debt", I feel as I am being spoken to as if I don't have a brain", " You have to put up with a lot of emotional abuse", " the benefits sucks" , and so forth. RNs should not be misled to believe that if they make an extra $30000.00 a year; it is going to come easy; there is a huge price to pay depending on the practice you get a job at. When you are a RN ; you might think it's cool to rock the white coat and stethoscope around your neck as an NP but first please research the definition of scudmonkey

[Goldenfox]

Even outside the big coastal cities, there are not 'plenty' of good NP jobs that pay good salaries anywhere. Not anymore. And in some cases where an older, experienced NP have that locked up, he or she should not be surprised when they are let go and replaced with someone who will do the job for significantly less. I've seen that happen too. Its the nature of the beast: they will always want more.

Provider shortage? There are 141 medical schools in the USA, 236 PA schools, and 350 NP schools. All are putting out a steady stream of graduates every year. Certain entities out there are constantly pushing stories about physician shortage, but that story may be true or untrue---depending on who's telling it. There are multinational corporations whose business it is to source US green cards for foreign doctors and nurses. They make a lot of money for each one. Next time you read statistics about shortage of providers and nurses pay extra close attention to who funded the research and then look into their business interests and their who their business partners are. Also talk to physicians who you actually know and ask THEM about the 'provider shortage' and you will likely get a different response from what you read in the news journals. There is no provider shortage. There is however a shortage of providers who are willing to put up with the declining reimbursements and a host of other BS from CMS and the HMOs when it comes to getting paid. Many of them are selling their practices to managed care organizations. And the MCOs, like some doctors, will hire NPs, pay them cheap salaries, and work them like horses. But no matter how much they are paying you, they are making at least several times that amount off you. They have several versions of 'the model'. Typically, the model requires that you cycle through patients at a rate of 1 every 15 minutes (or less). It is a very good game---for them.

That's alright for them (and for many NPs too) but it wasn't enough for me. I play a better game. I rented a small, inexpensive space, set up my own practice, and keep 100% of the income I generate. Despite the fact that I pay a physician friend of mine a fee to review my charts every few weeks, and despite the malpractice liability my other overhead costs are low. I don't take insurance so I avoid all that mess. I marketed my practice specifically to working class folks who don't have health insurance, and I charge an affordable amount for the visit. I make better money than any doctor or MCO would ever pay an NP. And the business is new but growing.

The NP glut is somewhat subjective though. The point is that being an NP shouldn't automatically mean being limited only to working for someone else or being exploited by them. Create your own job and make YOURSELF richer instead. Its possible.

[Spadeforce]

People to lazy to start their own business, its "risky"

There def is a shortage of docs in a lot of areas though, good ole residency cap keeps that safe which NP/pa do not have

[djmatte, ADN, MSN, RN, NP]

Goldenfox I absolutely agree. Though I wouldn't consider setting up my own thing without some experience under my belt. I know I have a lot to see and do before I go that route. But I'm also considering reentering the military, finishing my retirement, and using that platform to go my own way.

[guest416560]

Goldenfox said:

Give it some time. It won't be long before someone comes along and posts that they recently graduated from NP school and received a dozen job offers and now earn a big 6-figure salary with everything on top. I've read a number of these stories posted on here over the years and I suspect that some of them are exaggerated. The nursing journals and the universities keep saying that there is an NP shortage and that NP salaries are going up. I have been in this field for a while now, and what I see happening out there is exactly the opposite. But when one's agenda is to recruit new students and bilk them for as much tuition and fees as one can get out of them then I suppose that changes one's perspective of reality. It's very easy to get into an NP school and easy to pass the board exam, and many nurses don't want to work at the bedside anymore so I suppose all of this was inevitable. Everyone and their mother is an NP now. LOL.

I am originally from Florida. I watched the glut happen there. I know many NPs there who had to move out of state because they couldn't find a decent paying job there. That was one of the reasons why I began working as a locum myself. I worked as a locum for a long time in many different parts of the country, and I have seen the glut take place in other areas over the years too. I have also watched the pay decline significantly in many of these areas. A wealthy dude whom I met at a plush Palm Beach gathering a year ago who operates a group of urgent care clinics in Florida told me that he would never pay high wages for an NP or a PA when there are so many unemployed and desperate ones out there who will take anything just to be working. He doesn't pay malpractice and he offers no benefits of any kind, just the flat (low) hourly pay. What he is offering is lower than what I was earning as a bedside RN years ago, and the sad thing is that he always receives an overabundance of applicants for his horrible job advertisings. The glut of NPs will get worse because the universities are now full of students who will be the next wave of new grads to have a very difficult time finding their first job.

The days of landing that cushy high-paying job in a nice practice environment with all benefits paid are over for the most part--- though one might get lucky and strike gold. But that has become the exception rather than the rule. Many of the jobs being pitched out there now are temp, part-time/per diem home health wellness stuff. No stability, no job security, no benefits, and not so great pay. Mostly stuff that RNs can do but they hire NPs to do it because the greedy people who run these operations get to bill clinician rates then keep most of the money for themselves.

Education is never a bad thing, but to anyone considering NP school out there please, please, please do your own research and think about employment prospects in your area and the ROI before you commit vast amounts of your time and money to pursuing this career. Don't just blindly accept what the nursing schools tell you because a lot of it is BS.

I could not agree more. There is a glut and those that disagree are in my mind naïve. 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 $$$