I was recently speaking with another master's prepared nurse who works in informatics about becoming an Acute Care NP and my experience as an NP student. Her immediate response was "why would you want to do exactly what the physician does for a dramatically reduced salary"? At first I was offended and was really peeved that a nurse would be so unsupportive of advanced practice nursing and gave her the long winded "why advanced practice nursing is awesome speech" but after a few days I gave thought to what she said.
In my area (NYC metro) NPs start as low as high $90k (RN start out at the same salary) and may hit maybe $160k at the top of the range, with a few outliers here and there. As a student I have witnessed how much work the acute care NP may contribute to a medical service and have seen the MD being the ''overseer'' on some units with the NP & PA managing quite sick patients and responsible for many emergent procedures such as intubation, central line placements.... Although I love the thought of being so involved in patient care I have wondered if NPs (specifically acute care) will be compensated more by facilities for our ever increasing scope of practice? I was surprised to see some services where the so called "midlevels" entirely manage extremely sick patients and the attending only appears when the patient is deteriorating.
I was also at a conference recently where some rural and highly experienced NPs stated that at times they were the only provider in a hospital overnight with maybe an ER doc, or that they managed emergencies on their own or as part of a team of NPs.
I'm wondering if this is part of a whole push by hospital executives to use advanced practice nurses as cheaper medical provider for cost savings.
This has dramatically altered my outlook as a soon to be graduate. I question if I want to be a ''forever resident'' performing all the scut work on the unit while only being payed a small fraction of what the attending (who seem to have the last say in regards to patient management) makes.
Acute care NPs diagnosing, managing, and running emergencies, also having to have the knowledge of a full fledged physician to only make 30-40% of what the attending makes sounds a bit troublesome to me. I still love the nursing profession, it's been my career home for 15 years but I do wonder if this is setting up to be a catch 22 with the corporate hospital system reaping massive benefits off of cheaper labor?
With the push for more autonomy and scope, will our salaries commensurate?
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
29 minutes ago, myoglobin said:
What you are saying is no doubt true and would be more of an issue for CRNA only groups. However, even ARNP's in IP states that practice under physicians are in a significantly superior position because "their license is their own". Which is to say in Florida if I work as an ARNP at hospital "A" and want to switch to hospital "B" I must find a physician willing to act as my "collaborator" as part of the process. However, in an IP state like Washington if I switch from hospital "A" to hospital "B" there may still need to be a leading "attending" but he would not have to be a "collaborator" for the state as far as licensing goes. This leads to a better "market" for NP providers and generally higher pay.
For what role though? a Psych NP? a Hospitalist NP? That's really all NP's can "infiltrate" and have the same exact role as a physician. In fact even the Hospitalist role can be a stretch. Some Hospitalists do more procedures than most Acute Care NP programs train us for (LP's, thoracentesis, etc). Medical Staff boards in hospitals set rules on who gets empaneled for certain procedures and what board certifications are required to achieve them. That has nothing to do with independent practice, it's Hospital By-Laws.
Look, I'm in Critical Care and my pay is already at the level of a Hospitalist physician in a non-independent practice state. Yes, our Physician Intensivists make more because they have multiple other side hustles between their ICU weeks (i.e., Anesthesiology roles in the OR, Interventional Pulmonology, etc). Those guys have other sources of revenue generation than my 36 hours a week in the ICU.
I am talking particularly about the acute care role (still gaining benefits by Independent practice). I believe that you live in California and it is somewhat of an exception. That is to say in spite of restricted practice pay is still decent for NP's for a variety of somewhat specific reasons including:
a. High cost of living which tends to increase pay.
b. Difficulty entering the market. That is to say I have four NP licenses (Florida, Colorado, Washington and Arizona) some of these I had to send two or three sets of fingerprint cards. I still haven't even received my California RN license. This helps to increase pay.
c. Decent working conditions and pay for RN's (relative to other states) which somewhat reduces the "pressure to become an NP".
My former fellow worker here in Florida was an ICU nurse for 15 years went back to school for his acute care NP and it took him six months to get a job for about 100K per year (only slightly more than he was making as an RN). I would assert that in most states Independent Practice would facilitate higher pay even though for critical care NP's it might not be "truly" independent it at least would be from a state licensure stand point.
Also, with Medicaid and Medicare deficits mounting to the point of where benefits will have to be cut, premiums greatly increased or payroll taxes greatly increased it is probably only a matter of time until that Medicare provision requiring physician oversight is dropped (especially if RN's and NP's who are also RN's use their theoretically massive lobbying power and voter participation). Even "for profit" hospitals and insurance companies would likely support this since it ultimately saves them money. The AMA will in the long run be outgunned. Also as you may know I am in favor of "nursing owned" (both NP and RN) in states and metro areas that will support them. These would be non profit institutions dedicated to translating the trust and holistic approach that nurses have built over decades into high quality outcomes that would compete with the finest physician led institutions.
I could go along with the only 30% of what the MD makes,because,the doc does have more education and more rigorous ,no matter how you slice it.
What i see is NP s being taken advantage of by some lazy/entitled docs.Some refuse to do what they are supposed to do because they do not know how or have lost the touch,especially deep line insertion,intubation,blood draws,..they stall until they can get someone PA/NP to leave all her assignments on another unit to help him/her out.
On top of that some female docs seem jealous of the RNs expertise in hands on situations,and abuse the NP to no end with endless meaningless lab draws, writing charts,discharge summaries,and prescriptions....During which time the docs remain in on call room in bed,...or look up nonesense on internet.
Specializes in Former NP now Internal medicine PGY-3.
14 hours ago, myoglobin said:
I am talking particularly about the acute care role (still gaining benefits by Independent practice). I believe that you live in California and it is somewhat of an exception. That is to say in spite of restricted practice pay is still decent for NP's for a variety of somewhat specific reasons including:
a. High cost of living which tends to increase pay.
b. Difficulty entering the market. That is to say I have four NP licenses (Florida, Colorado, Washington and Arizona) some of these I had to send two or three sets of fingerprint cards. I still haven't even received my California RN license. This helps to increase pay.
c. Decent working conditions and pay for RN's (relative to other states) which somewhat reduces the "pressure to become an NP".
My former fellow worker here in Florida was an ICU nurse for 15 years went back to school for his acute care NP and it took him six months to get a job for about 100K per year (only slightly more than he was making as an RN). I would assert that in most states Independent Practice would facilitate higher pay even though for critical care NP's it might not be "truly" independent it at least would be from a state licensure stand point.
Also, with Medicaid and Medicare deficits mounting to the point of where benefits will have to be cut, premiums greatly increased or payroll taxes greatly increased it is probably only a matter of time until that Medicare provision requiring physician oversight is dropped (especially if RN's and NP's who are also RN's use their theoretically massive lobbying power and voter participation). Even "for profit" hospitals and insurance companies would likely support this since it ultimately saves them money. The AMA will in the long run be outgunned. Also as you may know I am in favor of "nursing owned" (both NP and RN) in states and metro areas that will support them. These would be non profit institutions dedicated to translating the trust and holistic approach that nurses have built over decades into high quality outcomes that would compete with the finest physician led institutions.
I feel you may have been rubbed the wrong way in the past by doctors. Nontheless to have a nursing lead hospital it would require all facilities to have physicians replaced including surgery, critics care, IM specialties, and ER. we know NPs have an important role but to advocate they replace physicians is silly. But I am pretty free market so you want a hospital with NPs doing surgery go for it. Let the patients speak and the lawyers rumble when it goes downhill
Ive heard of people advocating for replacement of PCPs by NPs which I doubt will happen but replacement of surgical specialties and consults? Nah
By nursing, I mean owned and managed, but not without physicians. They would be hired where necessary in appropriate specialties and compensated at market rates. Many for profit hospitals have owners that are not doctors or nurses where decisions are guided mainly by the interests of stockholders rather than patients and staff. It is in putting patients and staff first that I believe a nursing led institution could compete and excel. Certain fields like psychiatry would be more conducive than others for sure. The real point is that mounting economic pressure on Medicare creates a favorable political climate to see the “Medicare rule” overturned increasing the role of critical care NP’s.
By nursing, I mean owned and managed, but not without physicians. They would be hired where necessary in appropriate specialties and compensated at market rates. Many for profit hospitals have owners that are not doctors or nurses where decisions are guided mainly by the interests of stockholders rather than patients and staff. It is in putting patients and staff first that I believe a nursing led institution could compete and excel. Certain fields like psychiatry would be more conducive than others for sure. The real point is that mounting economic pressure on Medicare creates a favorable political climate to see the “Medicare rule” overturned increasing the role of critical care NP’s.
It sounds good, but with the AMAs lobbying power, and the often at odds with itself ANA, I think CMS will keep MDs as leaders. Just my .02, whether right or wrong...
It sounds good, but with the AMAs lobbying power, and the often at odds with itself ANA, I think CMS will keep MDs as leaders. Just my .02, whether right or wrong...
the docs stick up for one another and have a lot more lobbying money. Nurses stab each other in the back all too often. Legislation is influenced by lobbying money.
Specializes in Former NP now Internal medicine PGY-3.
4 hours ago, Tegridy said:
I feel you may have been rubbed the wrong way in the past by doctors. Nontheless to have a nursing lead hospital it would require all facilities to have physicians replaced including surgery, critics care, IM specialties, and ER. we know NPs have an important role but to advocate they replace physicians is silly. But I am pretty free market so you want a hospital with NPs doing surgery go for it. Let the patients speak and the lawyers rumble when it goes downhill
I think ownership of a hospital And patient success would depend more on individual than whether they are a nurse or doctor or MBA. Physicians aren’t allowed to own hospitals anyway I don’t believe. Just clinics, and other outpatient things
the docs stick up for one another and have a lot more lobbying money. Nurses stab each other in the back all too often. Legislation is influenced by lobbying money.
Yes, but times are changing. Nurses managed to get ratio laws through in California and have come close in other states. Also, Nurses and NP's (who are also nurses) have managed to gain independent practice in essentially half of the states in the United States and recently won a victory in the VA system https://www.forbes.com/sites/brucejapsen/2016/12/13/nurse-practitioners-win-direct-access-to-vas-patients/#3b55645d6edd which should provide something of a "template" for overturning the Medicare, physician supervision rule. Note this occurred during a Republican administration not known for progressive healthcare policies (thus progress will continue to be possible perhaps to an even greater extent under a Biden, Sanders or Warren administration, but even under a continued Trump administration). All of these victories were achieved via a combination of research, lobbying, and ground level political activism against stiff competition from the AMA. Pharmaceutical companies and the physicians who often do their bidding (by prescribing the most expensive medications, taking perks ect) are wealthy, but we are many. Already many MD's are reticent to even go into family practice due to increasing competition from nurses "bringing salaries down" and other factors https://www.washingtonpost.com/health/america-to-face-a-shortage-of-primary-care-physicians-within-a-decade-or-so/2019/07/12/0cf144d0-a27d-11e9-bd56-eac6bb02d01d_story.html .
Specializes in Former NP now Internal medicine PGY-3.
Primary care doc salaries are on the rise. You make it sound like doctors are doing evil bidding sitting in the corners getting rich. This is not the case. Most people go into specialties out of interest and yes more pay but not out of fear of mid level encroachment.
The AMA doesn’t do much for doctors much less “protect” them from encroachment.
It’s also illegal to get kickbacks from pharm companies as a physician so I’m not sure what kind of fact that comment is based on
Corey Narry, MSN, RN, NP
8 Articles; 4,475 Posts
For what role though? a Psych NP? a Hospitalist NP? That's really all NP's can "infiltrate" and have the same exact role as a physician. In fact even the Hospitalist role can be a stretch. Some Hospitalists do more procedures than most Acute Care NP programs train us for (LP's, thoracentesis, etc). Medical Staff boards in hospitals set rules on who gets empaneled for certain procedures and what board certifications are required to achieve them. That has nothing to do with independent practice, it's Hospital By-Laws.
Look, I'm in Critical Care and my pay is already at the level of a Hospitalist physician in a non-independent practice state. Yes, our Physician Intensivists make more because they have multiple other side hustles between their ICU weeks (i.e., Anesthesiology roles in the OR, Interventional Pulmonology, etc). Those guys have other sources of revenue generation than my 36 hours a week in the ICU.