Someone Please Tell Me...

Trauma Columnist · Sep 10, 2008

I live near a large teaching insitution with affiliated med school. Tips:

1. Troll the specialists: nephrologists have to have rounding done on dialysis patients 3-4 times per month. Most MDs hate this duty and if you show its lucrative (as you can bill Medicare and get reimbursed 85% of MD visit) this might be an avenue.

2. NH MDs sometimes hire APNs to make NH rounds. Did some time with an NP who did this and set her own hours and loved it.

3. Occ health depts of large companies frequently hire APNs so that they don't necessarily have an MD onsite.

4. Contact your state's APN organization too for some more clues and leads.

Good luck - some markets are tighter than others.

ANPFNPGNP · Sep 12, 2008

Someone please tell me why it is so difficult to find an open NP position anywhere!!!! It's almost as if providers around here don't want NP's in their facilities!
Does anybody have any pointers on how to initiate some interest in NP's around here?

It seems that the concept of midlevels is just catching on in certain parts of the country. There are quite a few midlevels where I live, but a NP friend of mine told me that it was impossible to find any NP positions 8 years ago. A doctor told me that he couldn't believe how much more money he was able to generate, just by having a NP working with him. He can charge the "doctor rate" for her and he can double the volume of patients he sees. I don't entirely agree with that (the billing issue), b/c I think we tend to get abused, just so we can generate more $$ for a doctor. In TX, doctors can supervise up to 3 fulltime midlevels (or their part-time equivalent). A few years ago, they could supervise up to FIVE fulltime midlevels. I read the BOM website from time to time and I've seen quite a few doctors get into trouble for not supervising their midlevels appropriately. At that time, the board usually won't let them supervise any midlevels and you know that hits them where it hurts!

I read an article in the paper yesterday (it was also posted on Yahoo) and apparently less than 2% of 4 year medical students in the U.S. are planning on going into primary care. However, the majority of foreign doctors are going into primary care. There is supposed to be a large "primary care crisis" in the near future. Unfortunately, the article didn't mention NP's filling the void. That's amazing to me, b/c the whole concept behind NP's is that we are supposed to be filling that void!

MommyandRN · Sep 15, 2008

I read an article in the paper yesterday (it was also posted on Yahoo) and apparently less than 2% of 4 year medical students in the U.S. are planning on going into primary care. However, the majority of foreign doctors are going into primary care. There is supposed to be a large "primary care crisis" in the near future. Unfortunately, the article didn't mention NP's filling the void. That's amazing to me, b/c the whole concept behind NP's is that we are supposed to be filling that void!

I read that article too... and that is partly why I figure becoming a Family NP is a good idea. I really think there will be a need in the future between the lack of MDs in family practice, and health care changes.

core0 · Sep 15, 2008

I read that article too... and that is partly why I figure becoming a Family NP is a good idea. I really think there will be a need in the future between the lack of MDs in family practice, and health care changes.

A couple of issue here. The US has traditionally filled these spots with FMGs (physicians from foreign countries with medical degrees from foreign countries) and IMGs (US citizens with medical degrees from foreign countries). In addition many Osteopaths take Allopathic residency slots (many in primary care). In the last few years the number of Allopathic and Osteopathic medical students has increase by around 10%. Residency slots are capped by law. Therefore when this group start entering residency (cresting in about 8 years) the following affects are expected:

1. More allopathic slots taken up by allopaths forcing out IMGs, FMGs, and DOs.

2. More allopaths competing for and not getting desireable residencies and being forced to settle for primary care residencies.

All of this should put more US primary care physicians in the pipeline, but it won't solve the two problems with primary care.

1. there is no overall shortage just local shortages and local surpluses.

2. There is no good way to make decent (from a physician standpoint) money in primary care.

Most of these areas apply to NPs also. Its hard to make good money, most of the shortages are in areas where people don't want to live (for whatever reason).

Until Medicare changes number 2 (which means a fundamental shift away from procedure based medicine) then number 1 won't be addressed.

My opinion

David Carpenter, PA-C