Until recently, I assumed the most lucrative NP specialty is PMHNP. However, now that I am job-hunting, it appears that Interventional Pain Mgt is also a very lucrative specialty. I'm in California, a little over 1 year experience, and was offered a job making $150K in Year 1 and $160K in Year 2 in Interventional Pain Mgt. There is another doctor advertising an Interventional Pain Mgt fellowship for NPs that is identical to the one offered MD residents - Year 1 and 2 pay aren't great, but the pay goes up to $270K per year in Year 3, after fellowship is finished.
Just wondered what others NPs thoughts and experiences are on the most lucrative NP specialties.
TheEliteNp, how did you get started with owning your own business? Also what state are you in?
Starting a business is simple. Create a LLC, find a niche service, market it, and go. There really is nothing to it. I am located in the southwest. I work in an independent practice state. It is the only way to practice.
Willing to train you to do rhizotomies under fluoroscopy? A 3 year "fellowship training"? This sounds quite unique to say the least. I would just be very hesitant, as the adage goes, "if it sounds too good to be true, it probably is." Like a previous poster stated, it would be much easier to hire a CRNA to perform these procedures and probably wouldn't take 3 years to train them to do so. The "dots" just aren't connecting here.
Willing to train you to do rhizotomies under fluoroscopy? A 3 year "fellowship training"? This sounds quite unique to say the least. I would just be very hesitant, as the adage goes, "if it sounds too good to be true, it probably is." Like a previous poster stated, it would be much easier to hire a CRNA to perform these procedures and probably wouldn't take 3 years to train them to do so. The "dots" just aren't connecting here.
No, they're not connecting. I don't believe it's because of the OP--unless this person is an employer "testing" how their "work model" would go over with actual NPs or this is a recruiting effort.
Everyone wants to practice by the same mantra that my ex did (at least he admitted it)--"The least for the most." He wanted to work the very minimum for the very maximum payout. This extended to everything in his life, however, which is a real indicator as to how he practiced actual medicine.
That being said. I am not "bashing" NPs. Whoever that was claiming that I was---is misguided and misinterpreting my words---and most likely is one of those people (there's always one) who wants to be offended by anything and everything.
I also find that if truth causes knee jerk anger---it hits a bit closer to home than some like to hear.
My ex attended 4 years of undergrad as a geneticist--a BS is required to attend medical school and they prefer hard sciences, and if you have a liberal degree be prepared to do 2 years of O-Chem, BioChem, Statistics, and other hard sciences to even compete on the MCATS or get into med school.
Then he did 4 years of medical school. 24/7 he was studying, practicing and doing.
Then he did 1 year of internship. 24/7 plus every 3rd night on call for 30-40 patients. DOING.
Then he did 4 years of 24/7 DOING. In his residency, he did procedure after procedure after procedure after procedure. He had oversight from an attending but he was The Guy right along with every other resident. As residency progresses, attendings pile more and more responsibility in preparation for that resident to become an attending themselves.
Then he did 2 years of Fellowship. DOING. Answering to an attending but taking 95% of the responsibility for the procedures and exams.
Let's see...
All of that education was IN PERSON, not "all online".
Could you imagine if your surgeon did his residency or medical school "ALL ONLINE"? Would you ever allow someone who did this to stick a needle into your spinal canal and administer a nerve block or to do an RF procedure, burning your nerves and possibly creating irrevocable harm??
I certainly would never, ever allow anyone who wasn't trained for years and after IN PERSON education and training to do it. And I did have an RF on my lower back!
My ex had 11 years of post undergrad medical HANDS ON and IN PERSON medical training before he was even allowed to go out there on his own and perform procedures like liver biopsies, breast biopsies and contrast injection of the spinal canal for myelograms.
I am tired of NPs acting like they can even approach the kind of training and hands on experience that some physicians have. They don't.
Let me ask you---would you trust your surgeon if he told you that all of his education was done "at home" and his "preceptorship" was done by a friend at his workplace for maximum 1-2 years...not even full time hands on experience?
I wouldn't.
NPs have their place. As do PAs and CRNAs. They are NOT doctors and they can NEVER replace the training and experience that physicans offer.
EliteNP--doctors don't "have it made". We had the same exact problems that NPs and PAs and CRNAs had---billing nightmares, malpractice insurance, transferring all of our assets into trusts because there's always that one patient who sees $$$$$ and thinks that doctors and their families "have it made".
OP---if you are looking at this opportunity for the $$$$ only---you are going to be sadly disappointed. You will either work so hard that by year 3, you will be ready to throw in the towel, or were so overworked that you made a horrendous mistake and were sued into oblivion.
Why don't you ask how many of their staff made it to year 3 and this "magical triple the salary"? How about how many of their NPs have been there for more than 5 years? How about number of lawsuits?
There is much much more to "how much can I make per year and do the least amount of work possible" ideology.
My ex settled for less salary in exchange for an easy workload and the minimal exposure to lawsuits.
I think that you need to find a position that balances the two---while preserving your license and your assets. Doing invasive procedures is NOT a way to preserve your license or your assets.
Specializes in Psychiatric and Mental Health NP (PMHNP).
5 hours ago, TitaniumPlates said:
No, they're not connecting. I don't believe it's because of the OP--unless this person is an employer "testing" how their "work model" would go over with actual NPs or this is a recruiting effort.
Everyone wants to practice by the same mantra that my ex did (at least he admitted it)--"The least for the most." He wanted to work the very minimum for the very maximum payout. This extended to everything in his life, however, which is a real indicator as to how he practiced actual medicine.
That being said. I am not "bashing" NPs. Whoever that was claiming that I was---is misguided and misinterpreting my words---and most likely is one of those people (there's always one) who wants to be offended by anything and everything.
I also find that if truth causes knee jerk anger---it hits a bit closer to home than some like to hear.
My ex attended 4 years of undergrad as a geneticist--a BS is required to attend medical school and they prefer hard sciences, and if you have a liberal degree be prepared to do 2 years of O-Chem, BioChem, Statistics, and other hard sciences to even compete on the MCATS or get into med school.
Then he did 4 years of medical school. 24/7 he was studying, practicing and doing.
Then he did 1 year of internship. 24/7 plus every 3rd night on call for 30-40 patients. DOING.
Then he did 4 years of 24/7 DOING. In his residency, he did procedure after procedure after procedure after procedure. He had oversight from an attending but he was The Guy right along with every other resident. As residency progresses, attendings pile more and more responsibility in preparation for that resident to become an attending themselves.
Then he did 2 years of Fellowship. DOING. Answering to an attending but taking 95% of the responsibility for the procedures and exams.
Let's see...
All of that education was IN PERSON, not "all online".
Could you imagine if your surgeon did his residency or medical school "ALL ONLINE"? Would you ever allow someone who did this to stick a needle into your spinal canal and administer a nerve block or to do an RF procedure, burning your nerves and possibly creating irrevocable harm??
I certainly would never, ever allow anyone who wasn't trained for years and after IN PERSON education and training to do it. And I did have an RF on my lower back!
My ex had 11 years of post undergrad medical HANDS ON and IN PERSON medical training before he was even allowed to go out there on his own and perform procedures like liver biopsies, breast biopsies and contrast injection of the spinal canal for myelograms.
I am tired of NPs acting like they can even approach the kind of training and hands on experience that some physicians have. They don't.
Let me ask you---would you trust your surgeon if he told you that all of his education was done "at home" and his "preceptorship" was done by a friend at his workplace for maximum 1-2 years...not even full time hands on experience?
I wouldn't.
NPs have their place. As do PAs and CRNAs. They are NOT doctors and they can NEVER replace the training and experience that physicans offer.
EliteNP--doctors don't "have it made". We had the same exact problems that NPs and PAs and CRNAs had---billing nightmares, malpractice insurance, transferring all of our assets into trusts because there's always that one patient who sees $$$$$ and thinks that doctors and their families "have it made".
OP---if you are looking at this opportunity for the $$$$ only---you are going to be sadly disappointed. You will either work so hard that by year 3, you will be ready to throw in the towel, or were so overworked that you made a horrendous mistake and were sued into oblivion.
Why don't you ask how many of their staff made it to year 3 and this "magical triple the salary"? How about how many of their NPs have been there for more than 5 years? How about number of lawsuits?
There is much much more to "how much can I make per year and do the least amount of work possible" ideology.
My ex settled for less salary in exchange for an easy workload and the minimal exposure to lawsuits.
I think that you need to find a position that balances the two---while preserving your license and your assets. Doing invasive procedures is NOT a way to preserve your license or your assets.
Reading your post, I stand by my comment - you seem kind of negative towards NPs.
1. Again, not all NP schools are created equal. That is true in any profession. There are outstanding schools and crappy schools. I went to Johns Hopkins and I stand by my education and training.
2. I stated that I am not aware of reputable interventional pain mgt practices that allow NPs to perform procedures like spinal injections and rhizotomies.
3. I also stated previously that the job that was recruiting NPs for a "fellowship" seemed suspicious to me. That is not the job I interviewed for and got an offer for. I was very clear - I got an offer for an interventional pain mgt practice at $150K per year to start, then $160K per year the 2nd year. The doctor went to a top medical school, has been doing interventional pain management for almost 30 years, and has a very solid NP training plan and was very clear on what he expected an NP to do. He isn't in it just for the money, either, and has made a good effort to serve the underserved and provide cost-effective services to all his patients.
4. I'm not aware of anyone on this forum arguing that NPs should be performing massively invasive procedures. NPs do not have the education or training for that. If I need surgery, I want a surgeon.
5. I'm not sure why you are so defensive about MDs. Yes, MDs have more education and training that NPs. We all know that.
However, sometimes "good enough is good enough." If I have the sniffles, seeing an NP or PA is just fine. A stable patient that just needs med refills can see an NP or PA, for goodness' sake.
Your argument is also a bit inconsistent. CRNAs do a good job and they are replacing anesthesiologists in many settings. Med students are told that and anesthesiology isn't the hottest specialty of choice for them. So, an APRN, with the right education and training, can perform some pretty delicate procedures. PAs perform simple surgeries and run central lines.
MDs are not all created equal and I don't care how much education and training they have versus NPs. There is a very famous case of a neurosurgeon in Texas who is in prison for killing several patients due to gross negligence and/or incompetence! Patients should always vet their providers carefully, no matter what the initials after their name.
Something else to be aware of - many doctors go to a weekend seminar and then start performing a procedure. That is not a lot of education, training, or practice, so patients be careful about this. Just because they have an MD does not make them an expert on everything.
Caveat emptor.
I greatly respect most doctors. Healthcare needs MDs, DOs, PAs, and NPs, and there is more than ample opportunity for all these roles.
Reading your post, I stand by my comment - you seem kind of negative towards NPs.
1. Again, not all NP schools are created equal. That is true in any profession. There are outstanding schools and crappy schools. I went to Johns Hopkins and I stand by my education and training.
2. I stated that I am not aware of reputable interventional pain mgt practices that allow NPs to perform procedures like spinal injections and rhizotomies.
3. I also stated previously that the job that was recruiting NPs for a "fellowship" seemed suspicious to me. That is not the job I interviewed for and got an offer for. I was very clear - I got an offer for an interventional pain mgt practice at $150K per year to start, then $160K per year the 2nd year. The doctor went to a top medical school, has been doing interventional pain management for almost 30 years, and has a very solid NP training plan and was very clear on what he expected an NP to do. He isn't in it just for the money, either, and has made a good effort to serve the underserved and provide cost-effective services to all his patients.
4. I'm not aware of anyone on this forum arguing that NPs should be performing massively invasive procedures. NPs do not have the education or training for that. If I need surgery, I want a surgeon.
5. I'm not sure why you are so defensive about MDs. Yes, MDs have more education and training that NPs. We all know that.
However, sometimes "good enough is good enough." If I have the sniffles, seeing an NP or PA is just fine. A stable patient that just needs med refills can see an NP or PA, for goodness' sake.
Your argument is also a bit inconsistent. CRNAs do a good job and they are replacing anesthesiologists in many settings. Med students are told that and anesthesiology isn't the hottest specialty of choice for them. So, an APRN, with the right education and training, can perform some pretty delicate procedures. PAs perform simple surgeries and run central lines.
MDs are not all created equal and I don't care how much education and training they have versus NPs. There is a very famous case of a neurosurgeon in Texas who is in prison for killing several patients due to gross negligence and/or incompetence! Patients should always vet their providers carefully, no matter what the initials after their name.
Something else to be aware of - many doctors go to a weekend seminar and then start performing a procedure. That is not a lot of education, training, or practice, so patients be careful about this. Just because they have an MD does not make them an expert on everything.
Caveat emptor.
I greatly respect most doctors. Healthcare needs MDs, DOs, PAs, and NPs, and there is more than ample opportunity for all these roles.
Good response. I get tired of people treating doctors like gods all of the time. Honestly some of them suck, lets just say it. Some nurses and NPs and CRNAs are awesome and some of them suck as well. This whole medical school is the pinnacle of all knowledge is also very flawed. Yes, your dermatologist and orthopedic surgeon who went to Yale and Harvard for school and residency are incredibly capable and high achieving. Your med school grad that went to Samoa for their education is not. You can get Cs all the way through med school and still pass, not all of them are geniuses.
No, they're not connecting. I don't believe it's because of the OP--unless this person is an employer "testing" how their "work model" would go over with actual NPs or this is a recruiting effort.
Everyone wants to practice by the same mantra that my ex did (at least he admitted it)--"The least for the most." He wanted to work the very minimum for the very maximum payout. This extended to everything in his life, however, which is a real indicator as to how he practiced actual medicine.
That being said. I am not "bashing" NPs. Whoever that was claiming that I was---is misguided and misinterpreting my words---and most likely is one of those people (there's always one) who wants to be offended by anything and everything.
I also find that if truth causes knee jerk anger---it hits a bit closer to home than some like to hear.
My ex attended 4 years of undergrad as a geneticist--a BS is required to attend medical school and they prefer hard sciences, and if you have a liberal degree be prepared to do 2 years of O-Chem, BioChem, Statistics, and other hard sciences to even compete on the MCATS or get into med school.
Then he did 4 years of medical school. 24/7 he was studying, practicing and doing.
Then he did 1 year of internship. 24/7 plus every 3rd night on call for 30-40 patients. DOING.
Then he did 4 years of 24/7 DOING. In his residency, he did procedure after procedure after procedure after procedure. He had oversight from an attending but he was The Guy right along with every other resident. As residency progresses, attendings pile more and more responsibility in preparation for that resident to become an attending themselves.
Then he did 2 years of Fellowship. DOING. Answering to an attending but taking 95% of the responsibility for the procedures and exams.
Let's see...
All of that education was IN PERSON, not "all online".
Could you imagine if your surgeon did his residency or medical school "ALL ONLINE"? Would you ever allow someone who did this to stick a needle into your spinal canal and administer a nerve block or to do an RF procedure, burning your nerves and possibly creating irrevocable harm??
I certainly would never, ever allow anyone who wasn't trained for years and after IN PERSON education and training to do it. And I did have an RF on my lower back!
My ex had 11 years of post undergrad medical HANDS ON and IN PERSON medical training before he was even allowed to go out there on his own and perform procedures like liver biopsies, breast biopsies and contrast injection of the spinal canal for myelograms.
I am tired of NPs acting like they can even approach the kind of training and hands on experience that some physicians have. They don't.
Let me ask you---would you trust your surgeon if he told you that all of his education was done "at home" and his "preceptorship" was done by a friend at his workplace for maximum 1-2 years...not even full time hands on experience?
I wouldn't.
NPs have their place. As do PAs and CRNAs. They are NOT doctors and they can NEVER replace the training and experience that physicans offer.
EliteNP--doctors don't "have it made". We had the same exact problems that NPs and PAs and CRNAs had---billing nightmares, malpractice insurance, transferring all of our assets into trusts because there's always that one patient who sees $$$$$ and thinks that doctors and their families "have it made".
OP---if you are looking at this opportunity for the $$$$ only---you are going to be sadly disappointed. You will either work so hard that by year 3, you will be ready to throw in the towel, or were so overworked that you made a horrendous mistake and were sued into oblivion.
Why don't you ask how many of their staff made it to year 3 and this "magical triple the salary"? How about how many of their NPs have been there for more than 5 years? How about number of lawsuits?
There is much much more to "how much can I make per year and do the least amount of work possible" ideology.
My ex settled for less salary in exchange for an easy workload and the minimal exposure to lawsuits.
I think that you need to find a position that balances the two---while preserving your license and your assets. Doing invasive procedures is NOT a way to preserve your license or your assets.
You are totally right. MD's have much more training than a NP. No question. This is not an argument. Our point is that many straightforward fields do not require MD training. General primary care is simple for the most part. Sure there are complicated cases and you better know when to refer out or not. I knew a MD in primary care who did NOTHING. He referred everything out, and I mean EVERYTHING. He was lazy. I also know many MDs who stopped practicing in the ER to open a Suboxone clinic. They did nothing more than take a class, just as much as we can. There are some fields that are simple and easily learned. Most NPs are not looking to take over specialist or surgeon jobs. Screw that. We are not prepared for that by any stretch of the imagination. A NP who does something very simple such as suboxone, aesthetics, testosterone replacement, weight loss, etc... and is just one hell of a business minded individual. That person like any entrepreneur can become a millionaire and it did not require a 6 year orthopedic residency. This is reality.
I agree with everything you said. Sometimes its better to meet the middle ground and get something a little easier for less money and less liability. Don't push your limits.
5. I'm not sure why you are so defensive about MDs. Yes, MDs have more education and training that NPs. We all know that.
However, sometimes "good enough is good enough." If I have the sniffles, seeing an NP or PA is just fine. A stable patient that just needs med refills can see an NP or PA, for goodness' sake.
I totally agree. For the majority of NICU babies in community Level II and even quite a few in Level III settings, an experienced NNP is "just as good" as a neonatologist. Same with an experienced PNP vs a pediatrician as a newborn rounder.
Of course- the neo or the pedi is going to have stronger background knowledge. Absolutely- facts are facts. But for uncomplicated patients, it's a bit overkill. Just because they know more doesn't mean they are using it to improve patient outcomes over a NP- the knowledge base to have comparable care just simply doesn't require that extra knowledge.
dncc, DNP, APRN
10 Posts
TheEliteNp, how did you get started with owning your own business? Also what state are you in?