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Oversupply of Nurse Practitioners

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by FNP2B1 FNP2B1 (Member)

FNP2B1 works as a Family Nurse Practitioner/Dermatology.

10,037 Visitors; 118 Posts

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Spadeforce has 1 years experience.

1,658 Visitors; 191 Posts

I love thinking outside the box but if you are referring to a cash practice keep in mind that unless you want to waste valuable time doing MA tasks yourself ancilary staff is a necessary and an intelligent business decision. Why would you spend your time answering phones and chasing down labs when you could pay administrative staff $20 an hour to do it? Something else to consider is that many cash practice patients have insurance and will be submitting in which cases you will still have insurance invoices and prior authorizations to be completed. I know some wealthy people who go to boutique practices but none of them are paying out of pocet for medications.

Yeah one also has to assume people are willing to pay 100 to see a NP instead of a doctor. a lot of docs set up those practices since they are one of the only fm or im docs around without a 5 month new patient waiting period. "Three months wait for doc 1 week for NP"

Not bashing NPs but anecdotally this is usually how it is

nor sure how it is in psych but i know psychiatrists ain't cheap lol

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djmatte has 7 years experience as a ADN, MSN, RN, NP and works as a Family Nurse Practitioner.

2 Followers; 6,666 Visitors; 700 Posts

Yeah one also has to assume people are willing to pay 100 to see a NP instead of a doctor. a lot of docs set up those practices since they are one of the only fm or im docs around without a 5 month new patient waiting period. "Three months wait for doc 1 week for NP"

Not bashing NPs but anecdotally this is usually how it is

nor sure how it is in psych but i know psychiatrists ain't cheap lol

Not to mention the aca requirement of insurance put the pay as you go idea into questionable territory. I know the requirement is slowly going away, but it's still a concern. My other concern with cash models is it opens you up to further scrutiny as feds vie it as a method to circumvent methods they use to evaluate care. We've had a few passion clinics and pcps in our area shut down when they used cash models to avoid scrutiny. Thankfully DEA catches up with them eventually. But still gives a bad rap for cash model businesses.

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Spadeforce has 1 years experience.

1,658 Visitors; 191 Posts

Not to mention the aca requirement of insurance put the pay as you go idea into questionable territory. I know the requirement is slowly going away, but it's still a concern. My other concern with cash models is it opens you up to further scrutiny as feds vie it as a method to circumvent methods they use to evaluate care. We've had a few passion clinics and pcps in our area shut down when they used cash models to avoid scrutiny. Thankfully DEA catches up with them eventually. But still gives a bad rap for cash model businesses.

Feds shouldn't be involved in it as long as they aren't passing dope which should show up on state narc reports. Its not their business if government isn't footing the bill (private self pay) and proper tax filing is done.

Big govt lol

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2 Followers; 46,258 Visitors; 8,863 Posts

Yeah one also has to assume people are willing to pay 100 to see a NP instead of a doctor. a lot of docs set up those practices since they are one of the only fm or im docs around without a 5 month new patient waiting period. "Three months wait for doc 1 week for NP"

Not bashing NPs but anecdotally this is usually how it is

nor sure how it is in psych but i know psychiatrists ain't cheap lol

The cash practice psychiatrists are billing $300+ an hour and cash practice NPs are in the $150-$200 an hour range so a significant difference.

Not to mention the aca requirement of insurance put the pay as you go idea into questionable territory.

The cash practices I'm familiar with have patients who have insurance but are willing to pay for what they perceive to be a better quality care. Local clinics which have always used some NPs are now filling up with cheap new grad labor due to the oversupply. The quality of care is perceived to be lower at clinics that no longer have any psychiatrists. Patients have picked up on this and those who can are opting to pay out of pocket. It is sad for those who can't. No worries about govt as it actually isn't cash but credit cards so totally traceable.

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Spadeforce has 1 years experience.

1,658 Visitors; 191 Posts

The cash practice psychiatrists are billing $300+ an hour and cash practice NPs are in the $150-$200 an hour range so a significant difference.

The cash practices I'm familiar with have patients who have insurance but are willing to pay for what they perceive to be a better quality care. Local clinics which have always used some NPs are now filling up with cheap new grad labor due to the oversupply. The quality of care is perceived to be lower at clinics that no longer have any psychiatrists. Patients have picked up on this and those who can are opting to pay out of pocket. It is sad for those who can't. No worries about govt as it actually isn't cash but credit cards so totally traceable.

im on a psych rotation right now i know these guys make 300-400+k inpatient 6 hours 5 days a week with a little call lol. not sure what the NPs make here.

cush af

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FNP2B1 works as a Family Nurse Practitioner/Dermatology.

10,037 Visitors; 118 Posts

The oversupply of NPs just hit me where it counts. I was told last week by administration that they love what I do but think I'm overpaid. I was told that I needed to take at least a $50,000 cut in pay if I wanted my job. I declined. I was let go today and replaced by a new grad who will start at the clinic making around $85,000. This is very rural California. Takes me an hour to get to a grocery store. The job search starts today and quite honestly I know I won't be able to replace my income with the flood of new grads. I'm not being a negative Nellie. I'm just stating the facts in my local situation although I'm not alone.

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djmatte has 7 years experience as a ADN, MSN, RN, NP and works as a Family Nurse Practitioner.

2 Followers; 6,666 Visitors; 700 Posts

Feds shouldn't be involved in it as long as they aren't passing dope which should show up on state narc reports. Its not their business if government isn't footing the bill (private self pay) and proper tax filing is done.

Big govt lol

Ugh at my autocorrect. While in theory the feds *shouldn't* be involved, self pay does open you up to question as there are people who exploit it specifically because their books/diagnosis choices aren't easily reviewed and they can get away with poor medicine practices easier. You can easily circumvent the opiate scrutiny by just not topping out the lists of opiate prescribers. Regardless while I like the ideas of the model, I would still be concerned about the government and any misinterpretation of what I'm trying to do clinically. One patient busted diverting an opiate that I prescribed with the best of intentions tells them they pay out of pocket for their care and my whole livelihood is in jeopardy.

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2 Followers; 46,258 Visitors; 8,863 Posts

The oversupply of NPs just hit me where it counts. I was told last week by administration that they love what I do but think I'm overpaid. I was told that I needed to take at least a $50,000 cut in pay if I wanted my job. I declined. I was let go today and replaced by a new grad who will start at the clinic making around $85,000. This is very rural California. Takes me an hour to get to a grocery store. The job search starts today and quite honestly I know I won't be able to replace my income with the flood of new grads. I'm not being a negative Nellie. I'm just stating the facts in my local situation although I'm not alone.

I am sorry this happened to you and foresee it happening more as the sheer numbers of NPs increase. I don't have too many years left and will tap out early if it comes down to working for less than I make now. It is disgusting that our profession virtually sold the farm but when you think about many of the RN heavy hitters are from academia. Fox guarding the hen house much?

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52,101 Visitors; 1,551 Posts

The oversupply of NPs just hit me where it counts. I was told last week by administration that they love what I do but think I'm overpaid. I was told that I needed to take at least a $50,000 cut in pay if I wanted my job. I declined. I was let go today and replaced by a new grad who will start at the clinic making around $85,000. This is very rural California. Takes me an hour to get to a grocery store. The job search starts today and quite honestly I know I won't be able to replace my income with the flood of new grads. I'm not being a negative Nellie. I'm just stating the facts in my local situation although I'm not alone.

I am so sorry that happened to you. I hope you are OK financially and on a personal level. Are you going to try to remain in your same specialty and state for your next position?

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FNP2B1 works as a Family Nurse Practitioner/Dermatology.

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Thanks guys. Yes I am going to try to stay in California and still work in dermatology and/or family practice. My home is a yacht so it's fairly easy for me to unhook the lines and drive up or down the west coast to find a new position. At this point I'm probably either going to wind up in the Sacramento/San Francisco/Stockton area or just say screw you California and move up the ocean to Oregon. I"m fine financially but still need to pad my retirement account. I never thought I'd see the day when NP saturation reached this type of critical level. It makes me regret changing careers to be a NP.

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52,101 Visitors; 1,551 Posts

You were in nurse anesthesia school prior, right? There are plenty of coastal rural towns up that way that hopefully will provide a great job and great pay. After all, derm. is such a golden specialty and all your experience will be impressive.

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Goldenfox has 12 years experience.

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I was let go today and replaced by a new grad who will start at the clinic making around $85,000.

Sorry to hear this happened to you. This is sad. $85,000 for an NP in a state like California. Before I became an NP I worked as an ICU travel RN in California. Don't want to date myself, but that was a while ago. Actually, quite a good while ago, and I was earning more than $85,000 a year. I know many RNs in California who earn as much or more than the average NP salary there now.

This happened to a friend of mine a while back too. This was the point at which I realized what had actually happened to this profession and decided to become self-employed. This very thing will eventually happen to every NP who is earning a high salary. No reason at all for them to pay us big money with full benefits when they have thousands of new grads hungry to accept low pay and no benefits just to have a job.

Most RNs don't want to do bedside nursing anymore but I suspect that many who became NPs to get away from the bedside will eventually either go back to the bedside or quit nursing altogether.

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