Alain

To be very succinct, FNPs are extraordinarily common nowadays with a slew of online and "degree mill" (less reputable and profit-hungry) options available. They are not at all selective so long as you pay them. This leads to a torrent of graduates who, I would assume given the lack of selectivity, probably shouldn't be NPs or were not trained very well. This 'torrent' of graduates drops starting salaries and lowers expectations of what NPs can do (more they can do, more billing, more money for employer, more compensation for NP). Also it leads to favouring PAs. So given the above, differentiating oneself is a very good idea. A brick and mortar school is ideal. I specifically chose a very reputable, brick and mortar NP Program for this reason : to stand out. Many online programs have perhaps 1 or 2 periods where you go on-campus to "intensives" and learn the hands-on skills in a few days each time usually. My program has hands-on skills learning for each class! This is huge. I don't know about you but I can read a book all day long, but until I get to actually practice the skill it doesn't stick very well. That's why residencies/good preceptorships are key in skill development and competence acquisition. In a world of thousands of degree mill-type programs, the name matters. It's common sense that if a prospective employer recognizes the school and it is of good repute that it puts you at an advantage. It communicates "quality" and "competence". Now this is all the more important with the massive FNP graduate pool we see nowadays. Now, if this is NOT a possibility for whatever reason (I.e. you live far away from any schools and can't change physical locations), then there's other ways to differentiate oneself such as : - Post-Graduate certificate programs (a common one is for FNPs who wish to specialize in Emergency Medicine to do the ENP post-grad programs that are offered by a good number of schools) - Fellowships (many offered in many areas - not as much for FNPs but more so for acute care NPs in the hospitals) In general doing an Acute Care NP may be better as there's far less graduating and many fellowship options available and growing. CRNA is a good investment, even if you take 3 years off work and accrue say $400,000 in debt. You can make $400,000 as a CRNA if you play your cards right (I have CRNA friends who did just that as private contractors to hospitals) and thus easily pay it off). Just some things to consider! Best of luck to you and feel free to ask questions. I have many close NP/CRNA friends and colleagues and have been researching this for some time.

Thank you! This is exactly correct. Many many do not think about it like you've stated and it's very important to make this broadly known. You earn what you are worth and in medicine this is billings. You are an FNP and do Emergency Medicine but can't do procedures or treat more acute issues? Probably will be fast track, far less in way of billings, far less income. But you're able to do many key procedures (thora/paracentesis, CT, bedside US, intubation, etc.) and see sicker patients? That bills for a lot more! You can negotiate a lot more and an employer would be moronic not to negotiate so long as he can still make more off you than you cost them.

Here are my thoughts: --> Standardize Quality of NP Education Too variable. Should be more standardized. Should be standardized in the way of requiring direct interaction between proffs and students, requiring preceptors be arranged by the program (NP programs are a dime a dozen. Can't arrange preceptors for students? Too bad. It'll improve program quality through competition in this way as many struggle to get preceptors and shouldn't. Or maybe they should - maybe preceptors don't want students from said programs for a good reason - either way this solves the issue) --> Standardize and Increase practical / in-program clinical requirements PA programs do about 2000 clinical hours of experience. In my opinion, as I'm sure many agree, this hands-on experience with a competent clinician interacting with patients is invaluable if it is of a high standard consistently throughout for all students. PA programs "piggy back" off MD/DO programs so many of the experiences form what I understand of quite similar and of a good quality as MD/DO programs have been doing their thing for nearly a century. Lots of time for refinement! Also the usual NP Program 600 - 800 hrs pales compared to 2000 PA hours. Yes PA don't have the prior clinical experience RNs do going in to it, and it should be valued and does help, but it's not the same at all as practice as a practitioner as your focus and role are totally different. A BIG thing is the hands-on aspect of doing procedures that RNs would never do (like pelvic exams, central lines, chest tubes, suturing, etc. as some random examples). So more clinical hours for NP programs but also more STANDARD experience. You can preceptor with whomever with little oversight and have a vast array of varied experiences from graduates of the same program : some having terrible experiences or minimally helpful ones while others got lucky and got amazing preceptors that taught them very well. This isn't fair to anyone. There should be some prior associations between the programs and specific clinics or hospitals or clinicians with payment to these stakeholders to make them motivated to be involved and active. Some formal relationships would be key. Med Schools and PA programs have this and it shows. --> Offer fellowships/post-grad certificate as a standard option So in med school you can specialize in whatever area. All are quite distinct. As a fresh MD graduate sans residency you are pretty limited. However, NPs get didactic and clinicals (just like MDs) but no residency/fellowship. The latter solidifies and expands knowledge and breeds competent, confident clinicians. There are more and more fellowships. There are post-master's certificates (like the ENP Certificate after an FNP program). These can be offered more standardly and made known more broadly to students to facilitate excellence and competence that breeds performance and a command of a much higher salary. --> Basic Economic and Business Knowledge So people are paid what the market deems they are worth. Not what any morals, virtues, or general opinion of their value deems. It's simple. An MD earns what he earns based on his speciality as he bills X dollars for Y and Z procedures that compensate so much (or not). Med Schools charge what they do knowing what an MD can make, and so they are aware it is still a good investment. So an MD makes what he does as he brings that much money to a clinic or organization for billings. An NP would follow same economic laws unless they were being exploited due to ignorance of these facts. If an NP graduates and can't do much in the way of procedures, has minimal experience, requires much hand-holding, patience, teaching, guidance, and investment from a clinic or organization, and sees few patients per day (slow), then they command a much lower salary as all this investment from the organization costs money. The better prepared the NP, the more more they make as the more they make for their employer as well. A fellowship or post-grad certificate (like ENP from Emergency Specialists) is pursued as it DOES command a higher salary. This is obvious. You learn a ton of relevant procedures. These procedures are billed for. This earns employer more $. You can also care for more patients and need to rely less on Attending MDs. You can also be trusted with more responsibility given your developed competence, knowledge, and skills. This all translates to better patient care, more money for employer, and so of course they're fine with paying you more as well. It's all logical and viewed from an economic and business vantage point makes total sense. I feel many lack this awareness or knowledge and so are taken advantage of. You get what you're worth as defined by the above : patients per hour (obviously while providing skillful, competent, safe care), procedure you can do, scope of patients you're willing to see as major factors Yes no need to go back to "You're not an NP for money" well DUH! Of course. You're not an MD for money either ideally. Or an RN for money. But money is part and parcel to life and living and is a key factor and it's silly to ignore this and presume it is not. Life is economics and compensation is key. Why invest X Y and Z if payout is minimal - it won't happen. So that is a major consideration. The better we make NP graduates, the better they can earn as well as they will have that key leverage to command more. Money is not the devil. Nothing wrong with earning more. Very obviously those who earn more put a lot more into getting to that point, be it attending medical school and lengthy residencies, doing gruelling CRNA schooling and the GREs and not working 3 years, or doing an NP Program and working non-stop either with study or your day job for 3 years to get to the point where you can do advanced practice. My two cents