The "Elite" NP

MentalKlarity, BSN, NP · Nov 4, 2023

"Those rich people would rather pay a doctor for that.”

You seem to have a chip on your shoulder being an NP. You tell NPs to accept less money and now you just assume "rich people will always prefer a doctor.” I have plenty of rich patients who prefer me over my MD colleagues and say I provide better care. You really seem to struggle with self-loathing behavior of your chosen profession that does not really hold universally true.

Hoosier_RN, MSN · Nov 4, 2023

FullGlass said:

Some on this forum seem to think that I think NPs should be satisfied with poor pay. Quite the contrary, as one can tell from reading my posts carefully.

However, for something different, I found a website and service called "The Elite NP." (link below). Personally, perusing this site was rather disturbing. However, some of you may find this interesting. This NP is completely focused on making money and does not seem very interested in actually being an excellent NP. He is also making money off other NPs by selling his "consulting." He really pushes concierge medicine and informs viewers of his site that there are a boatload of rich people willing to pay NPs for concierge medicine. Those rich people would rather pay a doctor for that. He also reports that there are a lot of ways for NPs to make a lot of money for very little work.

One of his gems: A PMHNP should open a concierge psych practice for $50 a month, then they can make a lot of money by seeing their patients only once every 3 to 6 months. That is ridiculous. No psych patient is going to pay $50 a month for that. In addition, good quality psych care requires at least once per month appointments, or more often, until the patient has been stable for awhile.

https://elitenp.com/

To me, he is a scamster preying on other NPs.

There used to be a guy on here that became a PMHNP on the west coast remotely. He was from Florida. I almost wonder if this is him, as this is the type of thing he would push on here and brag about all of the time. I felt sorry for his "patients" I wish that I could remember his username on here...

As far as concierge medicine, I agree. I have wealthy relatives that participate in a concierge medicine group in CA (coastal area) and they think that NPs are a lower form of healthcare, they and others in this group think of them of servants/handmaidens to the MDs or for those too poor to afford a MD. Their friends feel the same way. I definitely see your point on this and agree. Many feel if they are paying for concierge service, they deserve a MD, not a mid-level provider (at least how they see it in their mind). I'm sure there are some that don't mind a NP occasionally, but in my family member's circle, that's definitely the minority

FullGlass, BSN, MSN, NP · Nov 4, 2023

MentalKlarity said:

"Those rich people would rather pay a doctor for that.”

You seem to have a chip on your shoulder being an NP. You tell NPs to accept less money and now you just assume "rich people will always prefer a doctor.” I have plenty of rich patients who prefer me over my MD colleagues and say I provide better care. You really seem to struggle with self-loathing behavior of your chosen profession that does not really hold universally true.

You appear to be projecting your feelings on to me. I am simply stating a fact. Your experience may be different, but the rich people in Beverly Hills and Silicon Valley who have to pay out-of-pocket feel, rightly or wrongly, that if they are going to pay top $, they want an MD, preferably one who went to a big name school like Hopkins or Harvard. Perhaps things are different where you are.

You repeatedly distort my words and it is getting tiresome. You are apparently irked because I can challenge your arguments in a substantial way.

Should NPs make decent money? Of course. Should they make as much as MDs? No, unless they open their own practice. An NP with their own practice can charge as much as the market will bear.

And for all of you with steam coming out of your ears reading that, if you want to make as much $ as MDs, then are you willing for NPs to have to:

1. Work their butts off their whole childhoods so they can get into a top college? None of the attitude that any school will do, or that the cheaper and easier the better.

2. Go to a difficult college and work like a dog to get excellent grades in order to get into a med school.

3. Endure 4 years of a very grueling education in med school. Oh, and likely incur a huge amount of student debt. Medical school is FT, only. No working one's way through med school.

4. Upon graduation from med school, wait in terror for matching. Not all med school graduates are matched. So some of those poor graduates may not even get to be doctors.

5. Endure 1 year of abuse and long, grueling horrors as an intern for horrible pay. Average pay = $50K per year.

6. Endure 1-6 years of residency, with slightly better, but still bad pay: $60K to $80K per year.

7. Many doctors then become a medical fellow for 1 to 3 years, with only slightly better pay than a resident.

8. Finish all of the above with an average of $300K of student debt. That's 8 years of undergrad plus grad school, plus 2 to 10 more years of working like a dog for very little pay, before finally starting to earn a good income. That's 10 to 20 years to become a full-fledged doctor.

Let's take a look at an "average" NP:

1. Decent grades are OK in primary and secondary education.

2. Can go to community college for ADN, then do a bridge to RN program.

3. Can get into a plethora of crappy NP schools with no admissions standards.

4. Can work while going to NP school and some really do graduate from an NP Program without any debt. Many RN employers will pay for part of the NP Program.

5. Total education:

4 years undergrad

1-2 years grad school

6. Internship - very few available, so most NPs go right into a job making full pay. They don't have to work the insane hours of a medical intern or resident.

7. Residency - may be interchanged with internship, see #6.

8. Fellowship - N/A

Total: 6 years school, no internship or residency required

So please don't delude yourselves that you have the same level of education and training and deserve the same pay as doctors. You don't. I don't

All the highly paid professions, like law, business, finance, have much more grueling education and training requirements than becoming an NP. Law school is 4 years and it is very hard, much more difficult than RN or NP school. Watch the old movie "The Paper Chase" for an idea. Those who want elite business or finance careers have to get an MBA from a top school, which is a 4 year, very grueling program. As a former high tech management consulting executive, I worked way, way harder than I do now as an NP. I was working 50-80 hours per week, with long commutes and lots of out-of-town travel (those hours not included in work hours). I was a total stress monster and had no life.

I am very happy as an NP because I feel that for 18 mos of an ABSN, then 18 mos for an MSN, then 9 mos post-master's certificate completed while working, I am making a very good income. I work 8.5 hours a day on average, with no extra "on call" or weekend work. Out of the goodness of my heart, I check email on the days I don't work, so my patients don't run out of meds, but it is not required. I work from home, so no more horrendous commutes in Los Angeles traffic or constant travel. I don't have to deal with toxic office politics, as I work from home. My employer generally leaves me alone so I can just focus on seeing patients. I now have a personal life.

So, personally, I'd say $100 per hour, a total of 4.5 weeks paid time off per year, and the ability to set my own schedule are great! My income will continue to increase at a decent pace.

Oh, but you will say, NPs should be paid based on billing and should make 85% of what docs make. I have answered that numerous times, but here I go again:

1. Unless someone is in a commission job, salaries are based on more than billing.

2. I actually am making almost 85% of a psychiatrist in CA. I only have 3 years of psych experience, so I'd say that's quite good. In a couple more years, I will indeed be making 85% of the average psychiatrist. Any PMHNP could do this, not just if they are in CA. They can get a CA license and work via telehealth.

3. There are numerous telehealth platforms for NPs that want to make more $, but these are contractor roles w/o benefits.

4. In FPA states, NPs can open their own practices and keep all their billings. Interestingly, more and more doctors don't want to own a practice, as it is a big pain.

5. NPs making poor money can get another job. They can move if needed. With telehealth, in some specialities they don't have to move to work virtually in a state that pays well.

NP is NOT the road to incredible riches. Sorry, but it is not. If you want to make a boatload of money, then learn to sell and become a top salesperson of anything - you can make over $1 million per year that way. Or start your own successful business or larger practice and you can make a boatload of money that way, too.

So why doesn't everyone go do those things? Because it is HARD. My brother is a successful entrepreneur. When he started out, he and his family literally slept in their business place. They were trying to save $, so they turned the heat way down in Winter and slept with all the coats on, under all the blankets they could get, on the floor. 15 years later he was a multimillionaire. That is what it takes to build a successful business. Mark Cuban tells a similar story about his early days.

By comparison, it is EASY to become and be an NP making 6 figures. That is why I am happy!

FullGlass, BSN, MSN, NP · Nov 4, 2023

Hoosier_RN said:

There used to be a guy on here that became a PMHNP on the west coast remotely. He was from Florida. I almost wonder if this is him, as this is the type of thing he would push on here and brag about all of the time. I felt sorry for his "patients" I wish that I could remember his username on here...

As far as concierge medicine, I agree. I have wealthy relatives that participate in a concierge medicine group in CA (coastal area) and they think that NPs are a lower form of healthcare, they and others in this group think of them of servants/handmaidens to the MDs or for those too poor to afford a MD. Their friends feel the same way. I definitely see your point on this and agree. Many feel if they are paying for concierge service, they deserve a MD, not a mid-level provider (at least how they see it in their mind). I'm sure there are some that don't mind a NP occasionally, but in my family member's circle, that's definitely the minority

You are referring to myoglobin. He hasn't been active lately. He definitely could stir up controversy!

I know some clinicians that have wealthy patients and in private, they tell me most of them are a pain. They can treat doctors like garbage.

Hoosier_RN, MSN · Nov 4, 2023

FullGlass said:

You are referring to myoglobin. He hasn't been active lately. He definitely could stir up controversy!

I know some clinicians that have wealthy patients and in private, they tell me most of them are a pain. They can treat doctors like garbage.

Thanks, it was myoglobin! Oh, the memories...

djmatte, ADN, MSN, RN, NP · Nov 6, 2023

The guys essentially pushing a direct primary care model. Not exactly new or groundbreaking. It's definitely something I'll consider depending on where the military takes me. He's got a model he thinks works and is selling it. He's literally following his own model in this.

djmatte, ADN, MSN, RN, NP · Nov 6, 2023

FullGlass said:

You are apparently irked because I can challenge your arguments in a substantial way.

People aren't irked because you challenge. They're irked because your idea of "substantial" is long winded professional equivalents of mansplaining about things most of us professionals are acutely aware of. Every. Single. Response. Is characterized pages and paragraphs needing numbered/bulleted points as you rant about how the whole world is judging or mischaracterizing your comments. Even your initial post here started with a comment on what people here perceive of you (on wages). You seem to be overcompensating in these posts and it's been a consistent theme since you first started posting here.

FullGlass, BSN, MSN, NP · Nov 6, 2023

djmatte said:

People aren't irked because you challenge. They're irked because your idea of "substantial" is long winded professional equivalents of mansplaining about things most of us professionals are acutely aware of. Every. Single. Response. Is characterized pages and paragraphs needing numbered/bulleted points as you rant about how the whole world is judging or mischaracterizing your comments. Even your initial post here started with a comment on what people here perceive of you (on wages). You seem to be overcompensating in these posts and it's been a consistent theme since you first started posting here.

You really have a bee in your bonnet regarding me. You repeatedly make personal attacks on me, which is a sign of great insecurity on your part. I sincerely hope you learn to feel better about yourself so that you are not driven to make personal attacks on others in an attempt to compensate.

FullGlass, BSN, MSN, NP · Nov 6, 2023

djmatte said:

The guys essentially pushing a direct primary care model. Not exactly new or groundbreaking. It's definitely something I'll consider depending on where the military takes me. He's got a model he thinks works and is selling it. He's literally following his own model in this.

I agree he is pushing Direct Primary Care. However, no need to pay him for info on how to do this. Plenty of free info out there:

https://www.dpcare.org/

djmatte, ADN, MSN, RN, NP · Nov 7, 2023

FullGlass said:

You really have a bee in your bonnet regarding me. You repeatedly make personal attacks on me, which is a sign of great insecurity on your part. I sincerely hope you learn to feel better about yourself so that you are not driven to make personal attacks on others in an attempt to compensate.

I call a spade a spade. Though I'm shocked this latest retort wasn't as long and ridiculous as every over response you take personal offense to. Send to be a common thread. ?

Editorial Team / Admin · Nov 7, 2023

Closed for staff review