I pretty specifically listed the qualifiers for my opinion. If you generate the same charge, you should be paid the same. Medicare pays 85%, but not all insurers do. There are plenty of cases where NPs and MDs generate the same charges, but I also mentioned that if collaboration/supervision is involved then the physician should be reimbursed for that which will lower NP profit. I understand that physician spends a lot more time training, but at the end of the day if an NP and an MD see the same patient, do the same exam, order the same treatment, and bill the same, then they should be paid the same for that. There are a lot of convoluted if/ands/buts in there, but I think that's where it should start.