With equal levels of patient care outcome, why are NPs and PAs accepting half the salary of physicians?

[sensher]

I've seen lots of studies showing that nurse practitioners and physicians assistants deliver care on par with or even above the level of physicians yet salaries are about half that of physicians doing similar work. Are PAs and NPs being underpaid and not demanding salary commensurate with their skills and patient outcomes, or are physicians still riding their history of monopolized health care with hospitals and clients for much more than they are actually worth? And in the future, will mid level provider salaries rise to meet physician salaries, or will physician salaries fall to meet NPs and PAs? I don't see any rationale for the huge discrepancy especially in states where NPs can practice independently. If mid level providers can provide as good or better patient outcomes with less schooling and training, what is the purpose of the extra education and training? And is that the (flawed IMO) rationale physicians use to justify their higher salary? That seems equivalent to demanding more pay in a field because you attended a pricey private university and have two degrees versus a co-worker who attended an inexpensive community college and only took classes they needed for their degree but you're both doing the same exact worth - that wouldn't work in any other field.

[Nurse SMS, MSN, RN]

The laws of supply and demand for one thing. There are a lot more nurses and PAs than there are physicians. In my area FNPs are having trouble finding work and the pay isn't much better than floor nursing.

Physicians can bill higher for services, have attended more school and theoretically have more specific expertise. Additionally, they have a lot more political clout.

[Oldmahubbard]

Medical school is extraordinarily difficult to get into. NP school is not at all. Not even a little.

We are pumping out too many minimally prepared NP's.

The pay is market driven.

I am not expecting a big change anytime soon. If anything, the explosion of online NP programs will continue to drive the pay down.

[sensher]

4 hours ago, Oldmahubbard said:

Medical school is extraordinarily difficult to get into. NP school is not at all. Not even a little.

I do not disagree that medical school is very competitive and the schooling is likely much harder as well as longer. What I'm questioning though is if nurse practitioners (and PAs) provide the same level of care as physicians do within their area of practice and expertise, why are they accepting of a much lower salary? A stock analyst at JP Morgan isn't going to get paid twice as much as his coworker because he went to Harvard compared to Mid-central State University.

This is a pretty lengthy read and is one of many, but it generally backs up the assertion that that PAs and NPs can deliver care more efficiently.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3903046/

I don't have access to the complete article, but the abstract claims that medical outcomes for NPs was comparable to MDs (I've seen several other studies claiming the same)

https://www.npjournal.org/article/S1555-4155(13)00410-8/abstract

4 hours ago, Oldmahubbard said:

I am not expecting a big change anytime soon. If anything, the explosion of online NP programs will continue to drive the pay down.

I agree that online and direct entry nursing programs appear to be problematic. In fact, I looked into them as an option and ruled them out and have decided to get my BSN first (traditional brick and mortar school) and work in the field for a few years as an RN. I spoke with a good friend who works as a pediatric NP and she recommended against that route which also appears to follow a lot of the advice I see on nursing message boards like this one. However, I also have another friend who did a direct entry midwife program at Duke and while she said the first year or so was tough and stressful, she's been handling it fine. The pediatric NP works at a rural hospital with two physicians who each are on call for a week at a time. She doesn't know exactly how much her two physician co-workers make, but she is filling the same role they are when she is working.

4 hours ago, Oldmahubbard said:

We are pumping out too many minimally prepared NP's.

The pay is market driven. 

Market driven pay would make it so that these minimally prepared NPs either don't find jobs, or get paid that the level of their qualifications and skill dictates.

On ‎7‎/‎1‎/‎2019 at 2:10 PM, not.done.yet said:

The laws of supply and demand for one thing. There are a lot more nurses and PAs than there are physicians. In my area FNPs are having trouble finding work and the pay isn't much better than floor nursing.

Physicians can bill higher for services, have attended more school and theoretically have more specific expertise. Additionally, they have a lot more political clout.

The stats I see are that there are substantially more physicians than NPs and PAs. As of 2018, there are 270,000 licensed NPs and 115,000 PAs compared to right around 1,000,000 physicians. NP and PA school graduate rates are growing at much higher rates than medical school (but the growth rate is slowing), but it will be a long time before either (or combined) will overtake physicians.

Specific expertise matters a lot when you're dealing say with brain surgery and those medical professionals should be compensated for their skill and investment in training.

When a mid-level provider can just as accurately diagnose common illnesses and ailments like pneumonia and prescribe a course of medication for it as a physician could, why is a physician being paid twice as much? In promising news, it does seem like Oregon law compels insurance providers to reimburse NPs and PAs at the same rate as physicians for doing the same work: https://www.nursepractitionersoforegon.org/page/133

I guess I'm wondering why this isn't the case nationwide or the norm, and what will cause it to change. I'm currently in the midst of a career switch from architecture, and the job flexibility, job security, and pay of nursing as well as the logical and discrete advancement opportunities from RN to NP compared to the more typical seniority and years-based promotions in most other fields really appeals to me but at the same time I don't want to be artificially hampered by assumptions, outdated thinking, old norms of health care with male dominated physicians having a medical monopoly and female dominated nursing in a subservient, assistant type roll with lower pay to match (FYI - I'm a male), etc, etc. I'm going to be investing a lot of time and money into this career switch, and I don't want to be taken advantage of especially if I invest in a Masters degree.

[Nurse SMS, MSN, RN]

All commendable and thorough. My advice would be to steer well clear of FNP and go for the ACNP role or a specialized advanced practice role. FNPs are rapidly becoming a saturated entity and the job availability and salaries are definitely reflecting this where I currently live.