www.wikipedia.org: Rather than a generic focus of education, Nurse Practitioners are able to specialize in an area of study they desire (e.g. Pediatrics, Family Practice, Adult, Geriatric, etc.), and provide care within the scope of their expertise. As well, Nurse practitioners in certain states can be “psychiatric clinicians” and perform similar practice (though at a different level) as a psychiatrist would.
Salary.com: Nurse Practitioner salary (25th-75th percentile) is $67,166 – $78,497. Generalist physician salary (25th-75th%) is $115,260 – $152,715.
Wikipedia: According to numerous salary reports throughout the years, CRNAs remain the highest compensated of all nursing specialties. Their average reported annual salary range in 2006, reported by the AMGA Medical Group Compensation and Financial Survey, was $140,396. The mean annual salary for an anesthesiologist in the United States in 2006 was $184,340. [1]
What’s my point? Fair question. First, NP’s have the same scope of practice as any physician. This is clear from my first statement about NP’s specializing. Whatever specialty you want as a physician, there’s an NP that can do the same thing. “But surely not for surgery?!” is the cry of retort. Well I promise you that within the next 10 years, some politician is going to realize that “Hey! PA’s and Surgical Tech’s can pop out gallbladders just as well as a surgeon can!”
Also note the salary differences. Now I can’t find information regarding the various NP specialties, but compare the lowest specialty to the most basic NP, the salaries are comparable, and the highest NP position to the highest (according to MSN.com) paid physician. When you do, you’ll note that physicians do, in fact, win. And NP’s must do 2 years of post bachelors work and one year of work experience (for a total of 3 years) compared to the 4 years post-undergrad for a physician. Big whoop. One year.
Well please note, the average med student graduates with around $200K in debt, while, according to Barry.edu (a school in FL that has both NP and PA programs) the PA program (the more expensive of the two) is $24,810.00 per year. This is roughly equivalent to medical school. However, you’re paying twice as much in med school because you go to school for twice as long. Also, one of the 3 requisite years for NP school is clinical experience. This is a paid job. RN’s make (again, 25th-75th%) $49,479 – $59,114. That means that if a med student and an NP were compared at the same time, 4 years post undergrad, the med student would be out $200,000 (roughly) and the NP would be out $521 (rounding to $25K/yr for both programs, and using the 25th percentile for RN’s). Add the interest on a med school loan, and that puts you at about $600,000 paid back (bc you pay back about 3x what you borrow, esp the financial geniuses that make up our MD population).
Now lets say that no matter what you do, you make $30,000/year more than your equivalent NP. You figure that after 30 years of practice (putting you at the nice comfortable retirement age of 66 for those of us that took the direct route) and you’re up $900K. Worth it, right? Well we haven’t incorporated malpractice insurance. Have you ever heard of anyone suing their NP? I sure as shit haven’t. Factor in 30 years of malpractice insurance bills, and I’ll promise you it brings you right back to even (not to mention that physicians’ salaries are trending down relative to inflation while all nursing salaries are trending up). Couple that with the hours worked by an NP relative to an M.D. and the paperwork/legal hassles handled by an MD that aren’t worried about by NP’s, and the conclusion is obvious.
Do the same thing for the same amount of money, and have a better quality of life. Become an NP.
Can someone explain how exactly NP’s are paid. Do they have to pay for overhead costs like MD’s and liability Insurance? If not, it would explain why MD’s are getting paid almost twice as much. (and med school debt)
NP’s can either be employed or bill independently. They are reimbursed at 80% of physician reimbursement for most insurances, but some insurances reimburse at 100%. If NP’s are employed, they get paid the average salary for NP’s. If NP’s have their own practice, their earning potential is almost as great as physicians because NP documentation is usually reimbursable at a higher level of care because of its comprehensiveness.
Hi Jon,
I an NP, I am self employed and bill independently. It just depends on which state you are practicing in. You are correct in stating that our earning potential is as great as physicians. I made more last year than most of my physician colleagues. And you are correct on the statement regarding reimbursement at a higher level secondary to our documentation skills!
I am a psychiatric clinical nurse specialist in MA.. About 2 years ago I left a group practice to be on my own. Thankfully, all my patients moved with me. I was a psychiatric nurse from 1979 to 1993. I graduated from grad school in 1994. I will make $200,000 this year, which is about $50.000 more than I made in a group practice. I moved one city over. I am very pleased with my role, my success, and the patients I care about very much!
Thank you for your inspiration!
Hello; thank you for our comment, it is encouraging. I have been an FNP for 4 yrs and considering going back for my DNP in Mental Health. I had been struggling with the thought and was even considering a NP to MD program. But, after reading your post I think I will move forward in Mental Health, as I have a goal to open a girls home with a Mental Health Clinic attatched. Thank-You!
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I am a Adult NP- for over a decade now. Previous to that I was RN for a decade. Thats 20 years working in health care and I can tell you there is a huge difference between NP’s and MD’s-not just in the financial area. But since that is what this post is about let me tell you something that you are not addressing-which is that most NPs work for MDs and their groups. They drive down the cost of overhead, increase revenue for the practice and lighten the call schedule. They are also always not really independent-legally or financially as all states require some sort of arrangement with an MD to practice and sign off on your work.
From a business perspective its much better to be an MD because you can hire NP’s to work for you and you can do what you like with the difference between the salary/benefits you pay the NP and what you collect-pocket it or whatever.
This post is 4 years old and as time goes on it becomes less applicable to the fast changing realities of private practice and the current health care field. I mean really-any NP’s signing up for radiology? how about hospitalists? Not without working under a MD and letting them pocket the “change”- and they should because in the end they bear the malpractice cost and eventually the pt responsibility, but also along with that comes the financial rewards which comes from being the risk taker by running a small to medium health care business. It may be more school and debit in the short term but in the long run there is no doubt that it will pay off especially as we turn towards this new era in health care. My son is going to med school and I wouldn’t have it any other way. Being a NP isn’t bad work, but this isn’t a apples to apples comparison even in a remote sense in clinical or business reality.
Hi Paul; I have a question for you. I am an FNP and have been for two years but an RN for 16 yrs.I have a desire to open my own clinic but in NC we have to have a collaborating physician. Well, many physicians in NC look down on NP’s and consider us their mid-level’s. It is frustrating and I’m considering going for my MD, at the age of 46. There are programs that is NP to MD programs but they are foreign schools. What are your thoughts? Also, my understanding is that DNP’s will be able to take certain parts of the medical exam in the near future to practice as PCP’s without having a Collaborating Physician. What are your thoughts?
Kim if you truly want to open your own practice you might consider moving to a state in which NP’s can practice independently. Arizona is such a state. Good luck!
Thanks Kena! I am considering that! And to the rest of the idiotic comments……I know I am not an MD, trust I’m fully aware of that!
You are a mid-level…that is why you are considered one. You are not a doctor…
Agreed. If you want to be a doctor, go to medical school.
Don’t listen to these idiots. I have done rotations with md students and np students and I have to say that the NPs know more….maybe the MDs learn their knowledge in residency????
NPs and MDs bring different things to the table. They are not in competition for the same role, they perform different roles. And they both offer a unique perspective in an inter-collaborative practice, which everyone can benefit from, most importantly patients.
Kim,
Hello. I’m interested in the responses you received to your question regarding the possibility of pursuing medical school.
Thanks,
John
And why would Physicians not consider you a “mid level”?
You are considering becoming a physician… Very good for you.
( I remember a Dear Abby letter many years ago ” thinking of going to medical school but whe n I get out in 4. Years I will be 44, what should I do?” Dear Abby response: “And how old will you be in 4 years if you do not go to medical school?
NP is a very rewarding career, but it is not equal to being a physician in regards to knowledge( no disrespect ointended) .
I know some great NPs and some poor physicians.
Smart, hard working, intelligent NPs become outstanding doctors!
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My two sense:
I’m an experienced RN, BSN who is now about to graduate Med School.
Why? Well, I LOVE nursing b/c I LOVE helping people. I feel like I could help MORE as an MD.
Plus, I’m a total nerd with a photographic memory… why waste the brain I was gifted with? There’s so much room left for more knowledge so I’m soaking it up. You know what’s awesome? Doing clinical hours for medschool and NOT being nervous about patient care and such because I’ve already done it. You know what’s funny? Watching med students and residents SCARED about starting IV’s and Central Lines… and I breeze through it… but that’s all experience making me warm and fuzzy and comfortable.
The point is: I had to decide between NP, PA, and MD. I could’ve done 2-3 years of school and a 15 month residency and been an NP, just the school to be a PA… but I went to 4 more years of school and am about to start a 4 year residency making less than I made as a full time RN. Lol!!! (I’ve been working part time as an RN while in medschool- it’s a blast!) So why why why go the more expensive and intensive route? Not for more money, and not for “prestige.” I want to help people, and I want to be THE BOSS. I have disagreed with decisions doc’s have made and now I’m trying to be the change I want to see in the world. As an MD I will have more power to make that change. As an NP, and even a PA, you are constantly having to try and prove yourself worthy and/or equal… having to explain to the lay person how similar you are to a doctor. I don’t want to have to do that. I want to spend my time explaining the plan of care and how I’m going to help you- my patient, not explaining who I am and why I’m important. That sucks and that’s just the way it is. I LOVE the PA’s and NP’s I have worked with and they are super important (especially in my “home” in the ER) but you have to do what you are passionate about. Ask yourself if, in each specific role, you will feel justified and proud and NOT like you are “settling” for less than your absolute passion! That’s how you decide which way to go!
And stop fighting about who’s better for crying outloud! Go work in the ER so you can appreciate each other
You are my idol. People thought I was crazy for considering an RN before med school. You actually worked part time while in Med school? WOW, I would love to contact you to ask you many more questions.
Ditto what Jasmine said! I am an RN, BSN for 7 years now, contemplating NP, PA or ultimately MD. I have questions if you are willing? Thanks!!
Awesome post. I am a BSN, RN and I’m in the process of trying to find the best way to go from a BSN to MD. Any advice? What school did you go to? Also did you have to go back and complete the basic Med school prerequisites? I know some of them are required for nursing which i have but it appears i still have to take Organic, and Physics….
Nice try.
NP’s will be like LVN’s, pushed out when real qualified people take their place as shortages are addressed the proper ways. Also, not the American public is educated, demanding and litigous, not leaving much room for pseudo-doctors except in backwater areas.
I will have no qualm about throwing any NP under the bus when they mess up. This is quite often and the scary thing is NP’s often neither have the ability to assume true responsibility for patients or to realize how little they know.
Oh, and who will really make NP’s second-class providers? RN’s themselves. I suspect they won’t be keen on taking orders from someone from a mediocre background who took a few years of online classes.
Angry spice! Your thoughts are unfounded and totally foolish. Grow up and become confident in who you are as a professional. You shouldn’t be threatened by another profession.
I don’t know about the Wikipedia references to salary. I am a relatively new NP and make 125k per year with quarterly bonuses based upon revenue. And just to set the record straight to all the jealous/intimidated MDs…I have 3 bachelor degrees and 2 masters…4.0 average. One of those degrees was computer science. NPs are not the dumbed down medical provider that some would like to believe (I’m sure it would make some feel better if we were all a tad bit less intellectual). Longitudinal studies have shown that NPs perform 100% on the same par as MDs…and…that patients prefer NPs over MDs.
First let me say this is a great blog full of great info. I am in no means in the medical field so I can only speak from my experiance as a patient. many (but not all of course) doctors I have seen threwout my life I have always felt like they could care less why you are seeing them and just try to get you out the door to move on to the next patient. Granted I understand from a business stance the more patients you see the more $$ you make.
My prime example.
I injured my back at the age of 15 and because of the doctors I had seen for the next 6 years it was never correctly diagnosed and I suffered in pain for many years. All this was due to the doctors saying i was too young to have these type of problems or treat me as a junkie looking for a fix even though i told them all i did NOT want drugs but to find what the problem was and how to “fix it”. On top of that since I grew up poor I was on state medical so doctors treated me like a second class citizen. At age 21 I was in such sever pain I could no longer function. Regardless of Sitting, laying, standing or walking it all caused me horrible pain. I asked my doctor at the time for a MRI and he responded by saying. “Well nothing looks wrong on x-rays and your insurance won’t want to pay for that” as if that was his problem to worry about. Make a long story short I found a good doctor that cared and listened and had a MRI done and found I had 3 herniated disk and badly needed surgery. Now again I am not saying all doctors are bad but I have met many that were.
However all the times I have delt with a RN or PA I have never gotten that feeling. I have always felt like they truly care and listen and genuinely wanted to help. Regardless if it had been in the hospital for surgery or just a office visit I have yet to have a bad experience with one.
So my point being is if I didn’t have the doctor I have now I would much rather see a PA without hesitation regardless of what the issue may be.
I’m just a random web surfer, but this conversation appalls me. I can’t believe how hostile some MDs are towards NPs. Maybe some of you are just amazing at what you do, but amazing MDs have not been my experience. I have never seen an MD who diagnosed correctly the first go around for anything above a cold, flu or sinus infection. To pay $150-200 to see a general practitioner to not even get a correct diagnosis pisses me off. I took my son to three different general practitioner MDs when he had molluscum contagiosum, which is a common childhood issue…we are not talking about an obscure disease here. The first two completely misdiagnosed it. One prescribed unnecessary antibiotics. The third had the balls to admit he didn’t know what it was and referred me to a dermatologist. So I had to see four different doctors to find out that this is not harmful and will go away on its own. Hours and hours of time and probably close to a $1000. This has happened more times than I can count when dealing with MDs. A NP could have done all those things for half the damn price.
To pay one $150-200 for very basic stuff like a strep test and a prescription for antibiotics is just as frustrating. NPs who work within their scope of practice can do stuff like this for half the cost. You do not need four or more years of medical school plus a residency to diagnose and treat thousands of very common, simple health problems.
Please don’t get me wrong, I do respect and appreciate all MDs who can do their job well. But these MDs are doing work beyond the NP scope of practice, so they shouldn’t feel threatened by NPs. Or PAs for that matter. If any MDs should be freakin’ out, it should the mediocre ones who are using their years of school (where they apparently didn’t learn as much as they could have) as a crutch to make bank while not providing real value.
I am a new graduate of an NP program with a few concerns about the debt calculation. With 4 years of undergraduate education and three years of graduate school (which is the average for NPs), I graduated with 7 years of student loan debt. I owe a total of $200,000 in student loans. Unfortunately, I will have 1/2 the earning power of an MD to repay the principle amount. When calculating in clinical hours, required experience as an RN, and education, I spent a total of 9 years achieving the goal of becoming a NP. In addition, there are often fewer grants/scholarships for NPs than MD’s. I graduated top of my class for both degrees and still have a massive amount of student loan debt.
I will say, I believe the NP track is more challenging than it is often credited for. Just to get into undergraduate nursing school, NPs are required to take the same science courses as MD students (chem, biochem, patho, anatomy and phys, statistics, pharmacology, microbio…etc). Once in undergraduate nursing school, student nurses spend 3 years learning about human pathology, medical pharmacology, as well as both MD and nursing interventions. At the end of undergraduate school, students must pass the RN NCLEX certification exam to become a licensed nurse. After at least a year of experience (working night shifts and holidays b/c new nurses do not have any seniority) and paying back undergraduate student loans, the RN can apply to a graduate NP program. Once in the program, they complete additional clinical rotations within their specialty. In addition, they are required to complete another full year of pharmacology to build on their undergraduate training, additional pathophysiology courses, and an additional health assessment course. NP students do not have to repeat undergraduate clinical rotations in OB, Psych, Peds etc. if they are outside of their specialty. So, it is a long process that begins at year 1 of 9. It is not an easy course, and I would not say it is easier than other tracks designed to educate clinicians.
Becoming an NP is not cheap or easy. However, it is a rewarding career that offers a better work/life balance than most MDs have (just with 1/2 the pay). Speaking for myself, I am satisfied with my career choice because I have more time to enjoy life than most of my physician peers.
Hello,
Adding my two cents! I am a psychiatric NP; in practice for 6 years. I started reading this blog out of curiosity. My original search involved NP to MD programs. However, after reading the comments I am leaning back towards being satisfied with my current career choice. All comments where very helpful!
At my place of employment, the novice psychiatrist will earn 150k and max at 225k (supervising). At the same company, NPs start at 75k and max at 125k. MDs and NPs perform the same function at my place of employment. We are both responsible for every order, signature, incident, consent… as an MD. There is no difference in our responsibilities, or our job function. However, you will notice a huge difference in the pay. I am not a MD. I didn’t go to medical school. As an NP, I approach my patients/clients with a holistic frame of mind. I believe that knowledge separates me from my physician co-workers. The patients definately appreciate and acknowledge the difference. By the way, top of my class with an Ivy grad degree. NPs are not mid- anything. We are prescribers of another route and achievement.
Loco,
thank you for your comment! As I have been struggling with the decision of furthering my career. I’ve been an FNP for 4 yrs and was considering either DNP-Mental Health or MD, and I agree…we are not mid-anything! I think you have helped my decision a great deal. Thanks!
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This article was humerous and entertaining. I am currently graduating with my Master’s degree to be an NP. First of all, I have to laugh about the pissy, insecure rant posted by “AK”. ‘NP’s will be like “LVN’s” when qualified people pushed them out’…hahaha…I think “LPN” was meant, but that aside what an all around close-minded view of the medical world. I certainly can see his/her point, but realistically it won’t happen. Too many doctors and facilities depend on the reduced work load and expenses, a majority of patients respect nurses, and we have certainly established our importance in this advanced role (especially with the changes in health care). I do work in the ER with amazing MDs, PAs, and NPs who all work so well together and treat one another with respect and professionalism. I am a very smart person, took advanced classes, and made the decision early in my education to skip med school and be an NP. I alwasy saw an NP in the clinic and I enjoyed her very much. I knew I wanted to be a typical family medicine practitioner for my career. When I was a senior in high school I researched the education and salary differences for NPs vs MDs in family medicine clinics. Sure docs made more, but holy shit, what a difference in loans and schooling! BFD, I won’t make as much money, I’m not out to live a lavish lifestyle. I just want to work in a job I love thats laid back, great hours, and good pay. If you are smart and good at what you do, you don’t need to prove yourself or feel insecure. That’s why I am so proud and excited for my future career. AK, you go ahead and throw NPs under the bus when they mess up, I’m sure you’ll recieve the same kind of compassion and treatment from those you work with…because we are all human, and even the best doctors make mistakes.
Katie,
Well said!!!! Thank-You!!!
As a specialty-boarded physician realtively new in practice- I graduated from medical school 10 years ago and finished residency 6 years ago- I can say with complete honesty that I cannot recommend medical school to any young person interested in a career in the healthcare field. Simply put, for anyone paying attention over the last several years with the signing into law of the ACA and looming Medicare cuts to fund this legislation, the writing is on the wall: mid-level practitioners are the way of the future in medicine. Physicians, particularly PCP’s, will be pushed aside, starved out of practice and ultimately made irrelevant in this brave new world. Medical school tuition continues to climb along with malpractice premium rates, at the same time as third-party reimbursement continues to be cut across all specialties; meanwhile medical school enrollment increases while Medicare funding for residency programs dries up. There is a perfect storm on the horizon. It won’t be long before we see many newly minted physicians in a state of financial devastation due to their high student loan debt (non-dischargable via bankruptcy, by the way) and inability to pay it off on future physician reimbursement rates. The exceptions will be those lucky enough to get into specialties which can bill for elective/cosmetic procedures out-of-pocket (derm, plastics, general surgeons who do bariatric procedures, etc.) . Any physician who ends up in a specialty which relies solely or primarily on third-party reimbursement, whether Medicare, Medicaid, or private insurance, will be screwed.
In a nutshell, the ROI for students going to med school is disappearing fast at the same time as mid-levels are rising to prominence and gaining expanded practice rights rapidly in the healthcare field. The “prestige” factor and income difference between mid-levels and MD’s/DO’s isn’t even there anymore; the CRNA’s at the hospital where I work make significantly more money than I do and are treated with greater respect than many docs (and I say this from the perspective of a specialist, not a PCP, for whatever it’s worth). It’s frankly insulting and it’s truly a shame, but that’s how it goes, not gonna gripe about it. This is the way of the future. Aspiring young docs, heretofore consider yourself warned: don’t do it. Become an NP or CRNA instead, your future will be much brighter.
Eric & Katie both had great things to say. I worked my butt off to get into medical school out of college and I left after one semester. I never felt so relieved as I did the day I cleaned out my anatomy locker, but it’s been a hard road since. I keep wondering if I made a mistake and should go back, or if I should change directions and go for my RN then my NP. While in medical school, the constant reminders of my future (which is dead on the way that Eric described it) was not making the workload any more bearable. I felt trapped and I was scared- what was the medical world going to be like when I was out of school? I thank you all for your truthful insights and it looks like my decision to pursue an NP is the right one.
Hello all, here is my story to share with you and I am seeking your suggestions.
I was a Physician in China and had practiced 9 years in field before came to US in 2002. I tried to prepare myself well for USMLE test, so I went to a nursing school and obtained a BSN degree. After I graduated, for many reasons that my application for USMLE test could not be completed. While I am waiting for that, I work as a RN at a university hospital and entered a NP program.
Now after 2.5 years in NP program, I am graduating at next month and will become a NP. At meantime, my USMLE test application was approved finally.
My question is, if I take USMLE, it may cost me 2 more years to pass all the steps (I could work as a part time NP at same time) and 3 more years residency to be a MD (if I could match a program). Is this plan worth my time and cost comparing with the outcome? By the way, I have a PHD in biology.
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Several years ago, while working as a nurse (BSN), I applied to both the FNP and DO programs in my area. Fortunately, I was accepted to both programs. After a careful analysis of both programs and consideration as to what type of practice that I ultimately saw myself working in, I opted for the FNP program. While several factors came into play with regards to my decision, the strongest factor was ultimately the monetary investment. I had no problem putting the extra time into residency and I had all of the medical school prerequisites and then some, so it was not a matter of taking the easy road. My passion is family medicine and serving clients with limited access to primary care. To owe $300,000 in student loans without a significant increase in salary would have had a strong financial impact upon my family and ultimate quality of life. Additionally, I would have been entering medical school as an older student (38 yrs), so I had to consider how long it would take me to pay off the debt.
I disagree with the statement that referred to NP’s as being pseudo doctors. The nursing model and medical model are different and both have their place in today’s ever changing health care system. Interestingly, as a DNP, I have more scholastic and residency hours than several of the foreign educated medical school graduates that I work with. I have a great deal of respect for the MD’s that I work with and we work very well together to best serve our clients. Ultimately, we all bring value to the table and working together in coalition is a fundamental requirement in our health care system. There is no room for throwing anyone under the bus and I would question the motives of anyone who makes that type of statement in health care. Regardless of the educational route that someone takes, the decision to become a care provider should be primarily based upon an altruistic desire to help others.
Nice article. To all you mid levels (not my word, just inclusive of non physicians), I would never, ever recommend medical school to any one unless you just really like learning. I can tell you that I clean up a lot of cases screwed up by internists, FP’s and mid levels. No one has a monopoly on screwing up patients. The problem I see with mid levels is the cost factor generated by unnecessary testing and pharmacy costs. In that respect, mid levels do have a monopoly. It’s not out of any malevolence or fear, just unguided and wanting to “care so much” for patients. But with all residencies under this new rule of limited training time, I think NP = PA = MD = DO. Medicine is truly a dying art and a little more dies with each year physicians retire. Definitely go to NP/PA school. Our contry has decided the standard of care must be brought down.
To the poster with the molluscum contaigion kid, 10 years ago your pediatricians nurse would hav diagnosed it and you would have been out the door with paying 75 bucks. Now you get to see the PA at urgent care, while the MD sits at home collecting money for “supervising” the PA– what a racket.
I am a Board Certified Psychiatrist and charge 250/hr. I can tell you that seeing me vs a GP, PA or NP will save that patient at least 1000/yr in pharmacy, testing and treatment costs. I have sat on the pharmacy board for Medicaid in my state, and by far the number one cost driver is drugs, unneccessary ER visits because NP/PA’s are nt required to have after hours coverage and MRI’s for depression.
But I didnt go to med school to save the system money. You have to be nuts to pay for med school, a real nerd or an idealist.