I have been exploring various health care professions before deciding to begin the long journey towards an MD. I have been looking closely at the Nurse Practitioner role for the last few months and it seems like a relatively good fit. However, there are still some lingering questions that I have:
1. How great is the demand for Nurse Practitioners and what are the future prospects for them? It seems that when I open the newspaper and check out the classifieds, there are usually an abundance of RN positions available. I have yet to see that many (if any) postings for NP's. Albeit, this may not be the best place to look, but I thought it might show some evidence.
2. The areas that sound the most interesting to me at this point are the ACNP, Neonatal Nurse Practitioner, and Nurse Midwife. I am a person who appreciates work-life balance. It seems that Nursing allows for that. In these areas (and for NP's in general), does this hold true? Or, does the greater responsibilities of the NP impede that balance?
3. Since I would be a Non-Nurse looking to get into Nursing, I have been looking at accelerated RN/BSN programs at some universities in my area. One program in paticular is an accelerated ND program (Doctor of Nursing). After the first 16 months I would be qualified to sit for my NCLEX exam. Upon passing the exam I would begin working full-time as a Nurse and continue towards my MSN part-time of the course of the next 2 years. Upon completing my MSN, I would then sit for the appropriate NP Certification Test. My question is…What is the likelihood of me being hired as an NP immediately after passing my test? Especially, since I would be entering this area with 3 1/2 years of work experience in my area of specialty? Also, can I expect to be offered less money as an NP who has less RN experience?
Here are some reasons why the NP seems like a good opportunity (Please let me know if any of my assumptions are not correct):
*A good deal of autonomy. NP's consult with attending Physicians, but are allowed the opportunity to assess, diagnose, and assign treatment plans to patients (for more common and less complet ailments).
*Still get all the benefits of being a Nurse with some of the decision making responsibility of a Physician (i.e. Nurses are more involved with treatment of patients and educating/ working with their families, ability to work in a number of settings, etc.)
*Command an extremely competitive salaries. Based on some research I've seen the starting salary for NP's (2 years ago) was in the neighborhood of $65-70k.
Please let me know if there are other things that I should be considering while looking at this profession. What are some reasons why I may not want to be an NP?
If there is anyone on here that works as an NP (or knows of anyone that does) I would be happy to hear from you!
As always thanks for your time.
Respectfully,
Justin
Justin:
Go NP. It’s what I’m doing (despite the username). Here’s why:
Medicine is going in the wrong direction. Which makes it even more special for those of you going into medicine. Reimbursements are going down, malpractice rates are going up, and docs are working more hours to keep the same salary. It doesn’t look like it’s gonna change soon either. What does this mean for NPs? It means the exact opposite. Docs are going to have to use NPs to increase their patient load to meet the need (especially in primary care) and to make their practice more productive. If you can negotiate a good deal between you and a doc, you can make a boatload of money and actually work a normal work week (40 hours). For instance: I’ve got a deal with a doc to take 50% of all collected fees for my services. The clinic I work in collects almost 100% (work comp, weight loss, and cash paying only urgent care). This means if the average patient pays $50 and I see 30 patients/day, then my pay is $750 day ($172,500/year if working 5 days a week and 46 weeks/year). This allows me to help people, make great money, and have plenty of time for my personal life (family, fishing, football, etc). Now with these kind of deals, you usually will not get benefits such as health/life/dental/disability insurances, 401k, etc etc, but you can easily afford to put $2,000/month into your own benefits, and still you’re making $148,500/yr, and using this in negotiation is key (ie "I only want 1/2 of what is collected based on my services, and you don’t have to provide me with any benefits. Be careful though; make sure to get the docs numbers to make sure your salary is going to be enough).
Hope this helps. Good luck!
Chris
dear justin, i haven’t posted in such a long time but i feel compelled to help answer some of the questions. I think you are probably in the ball park for the NP salary. As the RN-MD said reimbursement and what not is really affecting medicine and is quite discouraging. in the north east i know of 2 docs who are charging patients cash (like in the old days) because it was just too much BS. there is also a urology surgeon who has started doing the same thing. as a NP in an acute care setting most every meal time with the doc’s is spent talkng about reimbursement and how blue cross and medicare just keep getting more difficult to deal with. as someone pointed out on another post…a person with a couple years education is making decisions for you. regarding job availability…i am not sure what part of the country you are in but i would encourage you to check out the boston globe on line and under classifieds punch in Nurse Practitioner. Last i looked there were about 72 jobs…some of them pretty cool. I am in a different boat then most of my colleagues in my area in that i work in an acute care setting and function as the ‘house officer’ which makes my job interesting. I work closely with the intensivist on ICU patients and function independently in the rest of the hospital. I get to do alot of fun procedures and my knowledge has skyrocketed because of doc’s who are willing to help me be successful. They understand that is in their best interest if i function at my maximum as their patients will recieve the best care. I say that not everyone applauds or understands the role of the NP and there will be people who don’t love you. There will also occassionally be animosity from nurses and some of this to me is the sterotypical female in medicine type of attititudes. Most nurses i see and work with are glad to see me and know i’m there to try to help them care for a patient. There will be docs who won’t except a ‘consult’ from a NP (but will from a PA and our roles are sometimes similar) and that’s just silly. Now I will say honestly if i had to do it all again i would save myself a bunch of time & education and just go to med school. And while i work slowly at whittling away at the goal i sometimes think…‘why bother’…becuase of all the problems and baloney with malpractice and reimbursement. It is also important to look at income that you will not be able to rely on when you are in med school. Being older an with a family it is a huge issue. I do not know where i will end up but i will lose nothing but $$ tryng. As i’ve often thought at least i will be quite helpful when my kids start taking chem and bio and be able really help them. Lastly…as i read under a OPM’s post a long time ago (can’t remember who) 'imagine yourself as the person you always wanted to be" …or something to that effect. Follow your heart and if you get to the point where being an NP is the right thing for you…make it a great experience. Thanks for bearing with this long post and good luck.
http://www.oldpremeds.org/invboard/index.p…&t=298&hl=nurse
–a link to a prior thread on some of these topics.
My take: consider which kind of training you’d like best. If you are most concerned with the time each takes, go with NP. If you are most concerned with the expertise you’ll get, go with MD.
Also consider that although as an NP you will jump into patient care soon, you will in some ways be thrown into it; residency can be seen as a form of torture, but it is also a form of support for you as you take on what is a very significant responsibility. Consider what it would be like to come out of medical school and have no residency, and the terror this might induce; and then consider how much support you’d be likely to get as an NP just out of school.
Mileage varies considerably on this, with different NP supervisors apparently being very different in how much support they offer, and there’s probably also some possibility for NP and/or PA residency programs for the future. In re: your question about getting hired vs. NPs with more RN experience–my impression is that this also varies widely, and probably depends on the kind of job and what you bring to it individually–so it’s impossible to answer in advance.
Still, the NP timeline is hard to beat, and life-work balance is definitely a strong argument for the NP side of things.
On money. I realize that some people see medicine as a business. I do not see medicine as a business, I am upset by the system which designs it this way, and I expect to live as much of my career as possible earning a salary from non-profit organizations. (The salaries you mention are not out of line with what you could expect from many such organizations as an NP, I think.) By so doing, I will probably earn less than some of my fellow physicians, but I’ll avoid a lot of the nonsense associated with doing business, whether as a doctor or an NP. Whether as a doctor or an NP, if I work for a salary, I also won’t be tempted to restrict my scope of practice to stuff like weight loss and worker’s comp claims in order to keep the cash flow up; I can do things I find more interesting like, say, treating people with HIV or cancer, who can’t possibly pay cash for their treatment. As a physician, I can do so with a good grounding in science and probably a deeper understanding of the mechanisms of the treatments I’m prescribing. So, this stuff about how your business will be structured is only important if that’s why you’re getting into this. (If it is, a well-run cleaning business could probably make you more money, with a lot less training.) Not that managed care won’t affect you if you do it my way–just that your paycheck will be more or less the same moderate but still (in my view) highly-compensated amount each month regardless of the effects of the managed care bureaucracy.
Anyway, my contribution in the previous post is better-written and more even-handed, so check that out.
joe
you sure about the 172,500 salary?
thats higher than the median income for all doctors! (165k according to US Labor dept)
i agree with previous poster regarding the high salary…i think that is a pretty aggressive estimate. my colleague who is an NP and pretty much in private contractual practice with a speciality group of pulmonary made a little over 110,00 last year (gross) She brought about 250,000 into the practice and kept 53% of what she brought in then she had to pay overhead etc. she worked about 46 weeks and she hustled. also remember…an NP only gets 80% reimbursment. so that has to be factored in when it is a reimburement issue and not a cash patient.
she keeps 100% of what she is reimbursed and then she pays an overhead to the group for the rent/ fixed expenses and office staff. and she also purchases her own medical equipment or has reps help pay. she pays to have a company collect her fees. this is an additonal 10% of what she 'brings in". she pays for the overhead of the practice too. every paper is the copy machine is partly hers. she pays her own health benefits. if she takes time off she is not making money…she takes call. this is every 3rd weekend and every thursday. this includes ED admits and in house patients who get sick and consults. i think she sees about 10-20 patients a day. She works about 50-60 a hours a week, sometimes more.
she has her own patients but geographically if she decides to hang a shingle she has to be at least 25 miles away from this practice. She pays all her dues/medical fees to the hospital where she is credentialed.
In short for an NP to make 172,000 bucks that means they have to bring in double that to the practice which i think is almost physically impossible without killing yourself. i guess as mentioned if you do weight loss, workmans comp etc. then cash flow would be more but i think after a while you might be terribly unfulfilled (unless you were having such a blast spending that money you didn’t care…)
the most i have ever known a fellow NP to make was 125,000. this was in an ortho pedic practice and he worked as a first assist in the OR too. I also think he knew how to negoiate a pretty good deal !!
| QUOTE (MD/PhD slave @ May 27 2003, 08:59 AM) |
| you sure about the 172,500 salary? thats higher than the median income for all doctors! (165k according to US Labor dept) |
Hey, I'm just doin the math. The numbers are there, and the doc that wants me to work with him is the one that sat down with me and showed me all the numbers from his office.
| QUOTE (RN-MD2B @ May 27 2003, 07:46 PM) | ||
Hey, I'm just doin the math. The numbers are there, and the doc that wants me to work with him is the one that sat down with me and showed me all the numbers from his office. |
It's true, in a 'regular' medical practice, a NP would have to bust their arse to make that kind of money, but keep in mind the collection vs billing rate. I'm not sure, but I believe it's somewhere around 1/2 of all billed is collected. In weight loss/work comp/urgent care cash only, the collected revenue is almost 100%!!! And, it's very very busy. The doc just wants his half for the liability/overhead/chart review, and he wants me to have the other half. (it also helps that this doc is a long time buddy of mine/friend of the family).
$172,500 is based on the numbers I quoted before, but I actually quoted very conservative numbers. They routinely see 40 patients/day, and I think the average collected fee/pt is about $72.00. That alone is $1440 per day for me!!! If that were done every day, it would be almost $350,000 a year!!! I know this is not very realistic, but the doctor I'm gonna work with says he wants to have the best nurse practitioner in the USA, and pay them the highest in the USA. I guess I'm lucky I've known him for years.