DrZaphod

Right, because NPs are trained to be independent. This bill will actually cause more restriction - there will be no grandfathering. So you may have practiced for 10 years, yet you will need to jump through a bunch of hoops arbitrarily set by another profession to continue practicing. UNLESS you work for a physician. I foresee a grand exodus to any neighboring state where NPs have been independent for years. It's bizarre that the same old argument is used by organized medicine, that NPs don't have enough training and will risk patient safety, when decades of evidence, and years of NPs in independent states, prove otherwise. California is burning to the ground, both literally and figuratively.

The nursing consensus model recommended all RNs have BSN and all NPs have DNP by 2015, I believe. Although not required, nursing is trying to make a consensus so that when people see a credential, they know exactly what schooling it entails. Although, a huge caveat is that some nursing schools, to meet this model, are just shuttling people through these short, BSN > DNP programs, so I have grave concerns about the DNP.

Some states have special certifications in psych. Cali is one. It requires education beyond regular RN. That might be it, depending on your state.

I stopped supporting the CANP in favor of the AANP a couple years back, after 3 earlier failed bills.

I hear you. I am worried now, too. I just found out that the requirement to be an RN for 1-2 years before NP has been waived. And evidently there are schools with BSN > DNP in 2 years, and BSN > NP in 16 months. This will destroy the profession's credibility and prospects as far as I can see, just looking at supply/demand. Physicians have kept such high salaries by artificially limiting the supply due to over-training for most fields, but at least the path is long and hard. If you remove difficulty entirely, and don't have the experience as an RN to back up the knowledge learned at the advanced level, I also worry that all the research demonstrating equivalent outcomes as MD/DO will no longer be true.

This bill is useless and doesn't give us independence at all. The California BON has one older NP certificate nurse on it, no real advanced practice representation. The BON does not care about any APRN, possibly because we don't pay union dues. This bill does not allow independence unless you work in a physician owned practice, which of course isn't independence at all, and like the OP said, sets up that physicians are heavily involved in a totally different profession. It seems to continue the archaic hierarchical structure rather than embracing team-led care, which is how healthcare is evolving. I'm completely surprised the CANP supports this bill in its current state. Major organizations no longer support it. I've been fairly confused since I graduated in 2005 why the courts allow the organized medical lobby to have any say whatsoever over what happens in a different profession. Probably, again, something to do with unions and a lot of money. Despite decades of evidence and nearly half of the states having full independence with excellent outcomes, the lobbying groups "convince" the state legislature to restrain trade. AANP President has this to say: “California’s so-called ‘solution,’ the flawed AB-890, would establish a cascading set of new restrictions on NP practice that would maintain California’s position among the most heavily regulated and restrictive in the nation,” Thomas said.

I don't want to make you feel badly about your work, but around $50 per hour is definitely underpaid. I made that as an RN in 2005. Texas, Missouri, and Florida are unfortunately completely physician controlled and difficult environments for NPs. One really can't base pay on salaries. As this thread has detailed, NP salaries are extremely low. If you actually saw the superbills and reimbursement you were pulling in for the practice, you would be astounded. While many insurances do reimburse NPs lower than physicians, the discrepancy is not that large in most cases. One patient an hour would pull in at minimum about $65 for a typical outpatient visit. Obviously, reimbursement fees are difficult to pin down, because they vary by insurance, state, and even individual outpatient practice. The takeaway is to remember that NP salaries are arbitrary and artificially low. Why would an NP make $125,000 and a physician $275,000+ if the difference in reimbursement is so low? Then one looks at practices which also take cash patients and there is absolutely no difference. The physician who owns the practice is literally siphoning all the money the NP made for the practice. In return, the NP ends up with perhaps 30% of their gross billing.

I wasn't aware of the for-profit NP schools, but I suppose that's equivalent to all the "physicians" headed to Caribbean schools. I've heard all sorts of terrible things about them - particularly these NP to MD programs - but people are still scoring residencies. My friend actually just saw a physician who went to some unknown Caribbean school and was actually practicing in Beverly Hills. So I suppose the "anyone can get in" is a problem with a lot of greedy schools, NP, MD, or otherwise.

I'm not sure which data you are referencing. I've seen no evidence that NPs are being taught by many with minimal to no experience or that anyone can get in. Decades of research continue to show that there is no difference in patient outcomes or satisfaction. I would definitely advocate for one year of residency after school, though. I think a lot of the NP programs like the one at Columbia are starting to make a residency mandatory. Physicians have also started allowing accelerated 2nd Bachelor's degrees which guarantee admittance to med school - much like the accelerated BSNs which were offered to nurses in early to mid 2000s. So now one can do one accelerated year for a BS and then do a 4 year med school directly after. Several of those schools are also 6 year programs - 4 year med school plus two years residency (I'm looking at psych specialties.)

That's good work on your part. I bet they didn't cut physician wages. One of the clever things the AMA does is artificially limit the supply of physicians. This leads to shortages and higher wages. That's where NPs got an opening. Unfortunately, as that supply increases to meet demand, wages go down. All the while, the physicians state they are the "experts" and there is still a shortage. NP wages, overall though, do seem to be rising. I used to get headhunter emails for salaried positions of 95k. Now I'm seeing a lot more $125-$150k positions being offered. Just remember that billing insurance directly vs. taking any hourly or salaried job will always be beneficial. Even Medicare pays NPs around $50 per patient. 20 patients per day = $1000. With an S-Corp, you declare a "reasonable" salary and pay taxes on that. The excess you just take as a distribution at a much lower percentage rate. Again, if there were more NPs like you refusing to work for these wages, we would actually gain power and salaries would rise to reasonable amounts.

I'm originally from St. Louis. Went to SLU. I worked in MO/IL for awhile but the archaic, draconian regulations on NP practice were intolerable. I left the state for that reason. I was being undervalued and underpaid and had little recourse as the physician collaborator has to sign charts, be within 30 miles, no CSII Rx, it was ridiculous.

I'm in California. Sorry for the 4 year late response.

Hi guys, my post is years old. I have finished all coursework from Saint Louis University and am working on my research. Thanks!

There isn't one, it's difficult. One of the problems is that, even in independent states that don't restrict patient choice, insurance companies do it anyway. They may not panel NPs and they may pay as low as half as they would to physicians, despite not passing on the savings to patients. These things are changing, but slowly. You can negotiate after a year or so, if you see a lot of insurance patients. I got mine raised to about $70 per patient, but they started at $35 .

The reason is because the $300 per hour is outpatient. Then I have side things like training fellowship-MDs for significantly more, doing Fitness for Duty evals for a lot more, etc. You're right, though, I didn't state it well. Key point is for around 32 hours per week, you should make at least $200k.