Why become a family medicine doctor?

[MrSunny1]

Seems pointless now considering nurse practitioner has the same practice authority as a physician and that only takes 3 years total to start practicing out of highschool(and from zero to 40,000$ in student loans)... Kind of feels like losing 8 years of your life for very little and all the stress and board exams.. Turns out NP have the same care levels as physicians(in primary care setting as many studies have shown) which woudlnt surprise me because they spend over twice as long(on average) with each patient encounter.. As we learned in medicine around 80% of the healthcare outcome is from actual patient interaction so it would make sense that an NP who spends twice as long with patients would have better outcomes...

Also NPs have far less stress, much better hours, and vastly superior quality of life not to mention probably a much higher lifetime earnings considering they have an 8 year headstart and zero debt or interest.. I think it all comes down to being able to except a lower salary. An NP is perfectly happy with 90-120k a year and doesnt mind seeing 10-20pts a day... Where as poor FP needs to see 20-40 patients per day in order to pay loans and achieve the 180-220k salary.

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[MrSunny1]

If you want to jazz it up, NPs can even get a 1 year doctorate and be called doctor. So what exactly is the difference LOl

 

[VA Hopeful Dr]

So I always appreciate when a pre-whatever decides to tell me why I made a poor career choice. But I'm bored so let's break this down a little bit.

First, midlevels like everyone else are flocking to specialties. If you look at the last few years, way more midlevels are going to things like cardiology, pulmonology, and dermatology. In fact, if you look most primary care is trending away from midlevels as well. Patients don't want to see them: they refer too much and do too much unnecessary testing.

Second, people always underestimate our pay. Its quite easy to break 200k doing family medicine, and 300k isn't super difficult either. Assuming you're paid via RVUs, which reimburse on average $40 per, you need 7500 wRVUs to make 300k. The average per patient wRVU nowadays is roughly 1.4. That means 5357 patient encounters/year. If you work 4.5 days/week and 46 weeks/year (you leave early on Friday and have basically 30 days off (including holidays)) that comes to 25 patients/day. Keep in mind, that's to make $300,000 per year. So yeah, very doable. If you see 30 patients a day with the same number of days worked, you're earning just shy of 350k. If you somehow see 40 patients/day you're up to $463k/year. So get the **** out with the "Where as poor FP needs to see 20-40 patients per day in order to pay loans and achieve the 180-220k salary.". Even only 20 patients/day is 231k/year.

Third, as an FP I can get a job literally anywhere. I live in SC and right now there are, just on the AAFP career website, 35 jobs scattered throughout the state. And I mean scattered, there is not a single area that doesn't have a job opening within 30 miles (that took an irritating 10 minutes to go through). No other specialty can boast that. Many of those jobs are not appropriate for midlevels because of the lack of specialists.

Fourth, in the 12 years I've been in medicine its been a constant refrain of "The sky is falling, the midlevels are going to take all the jobs". Things have actually gotten better for us in that time, money wise.

 

[Mad Jack]

Seems pointless now considering nurse practitioner has the same practice authority as a physician and that only takes 3 years total to start practicing out of highschool(and from zero to 40,000$ in student loans)... Kind of feels like losing 8 years of your life for very little and all the stress and board exams.. Turns out NP have the same care levels as physicians(in primary care setting as many studies have shown) which woudlnt surprise me because they spend over twice as long(on average) with each patient encounter.. As we learned in medicine around 80% of the healthcare outcome is from actual patient interaction so would it make sense that an NP who spends twice as long with patients would have better outcomes...

Also NPs have far less stress, much better hours, and vastly superior quality of life not to mention probably a much higher lifetime earnings considering they have an 8 year headstart and zero debt or interest.. I think it all comes down to being able to except a lower salary. An NP is perfectly happy with 90-120k a year and doesnt mind seeing 10-20pts a day... Where as poor FP needs to see 20-40 patients per day in order to pay loans and achieve the 180-220k salary.

Family Practice Physician $250,000 Jobs, Employment | Indeed.com

Here's 170 listings for FPs that pay an advertised rate of 250k+. FPs can also work as hospitalists in many hospitals, which is another career path that can net 250-300k. FPs generally manage the more complex patients within a given clinic, the sort of patients midlevels aren't willing to touch and will simply refer out, and they are more likely to do procedures. Finally, they are far more productive (NPs spend twice as long with patients for the same outcomes, but doctors are getting the same outcomes while seeing 25-100% more patients). A typical midlevel is seeing 12-14 patients per day, while a physician is seeing 22-28, it's not even a comparison. As a physician, you can also pick up side work (nursing home director, chart review, etc) that can pay substantial cash for very little work. Finally, if you're willing to offer ancillary services or want to own your own business, being a physician opens up a lot more doors. There's plenty of FPs in the area cracking 500k or substantially more by employing midlevels and offering extra services (cosmetic, pain management, etc).

 

[MrSunny1]

So I always appreciate when a pre-whatever decides to tell me why I made a poor career choice. But I'm bored so let's break this down a little bit.

First, midlevels like everyone else are flocking to specialties. If you look at the last few years, way more midlevels are going to things like cardiology, pulmonology, and dermatology. In fact, if you look most primary care is trending away from midlevels as well. Patients don't want to see them: they refer too much and do too much unnecessary testing.

Second, people always underestimate our pay. Its quite easy to break 200k doing family medicine, and 300k isn't super difficult either. Assuming you're paid via RVUs, which reimburse on average $40 per, you need 7500 wRVUs to make 300k. The average per patient wRVU nowadays is roughly 1.4. That means 5357 patient encounters/year. If you work 4.5 days/week and 46 weeks/year (you leave early on Friday and have basically 30 days off (including holidays)) that comes to 25 patients/day. Keep in mind, that's to make $300,000 per year. So yeah, very doable. If you see 30 patients a day with the same number of days worked, you're earning just shy of 350k. If you somehow see 40 patients/day you're up to $463k/year. So get the **** out with the "Where as poor FP needs to see 20-40 patients per day in order to pay loans and achieve the 180-220k salary.". Even only 20 patients/day is 231k/year.

Third, as an FP I can get a job literally anywhere. I live in SC and right now there are, just on the AAFP career website, 35 jobs scattered throughout the state. And I mean scattered, there is not a single area that doesn't have a job opening within 30 miles (that took an irritating 10 minutes to go through). No other specialty can boast that. Many of those jobs are not appropriate for midlevels because of the lack of specialists.

Fourth, in the 12 years I've been in medicine its been a constant refrain of "The sky is falling, the midlevels are going to take all the jobs". Things have actually gotten better for us in that time, money wise.

More power to you if you can successfully see 30-40 patients a day good for you.. But wouldnt that salary be divided right in half on office expenses/nurses/.... everything else. and you dont seem to be accouting for even one second of paper work/insurance/preapprovals/everything else?

ANYWAYS i'm not saying that you cant do well being a FP.. But you could simply do the exact same thing as an NP(with zero debt and only 3 years of schooling).. There is no law that says an NP cant see 30-40 pts per day and make the same salary... Uncle Sam reimburses an NP the exact same as an FP.... (that use to be only 80% and use to require physician oversight.. all equal now)

 

[Mad Jack]

More power to you if you can successfully see 30-40 patients a day good for you.. But wouldnt that salary be divided right in half on office expenses/nurses/.... everything else. and you dont seem to be accouting for even one second of paper work/insurance/preapprovals/everything else?

ANYWAYS i'm not saying that you cant do well being a FP.. But you could simply do the exact same thing as an NP(with zero debt and only 3 years of schooling).. There is no law that says an NP cant see 30-40 pts per day and make the same salary... Uncle Sam reimburses an NP the exact same as an FP.... (that use to be only 80% and use to require physician oversight.. all equal now)

All of that is a pay for productivity position- there is no overhead.

Insurance providers are reluctant to contract with independent NPs, and banks are reluctant to finance independent NP practices. Couple that with the fact that you have far less training than a physician and you're not going to be seeing that many patients per day without making far more mistakes even if you can somehow convince an insurance provider to take you on and a bank to finance you. I can count the number of solo NP PC practices in my area that are not employed by either a large group or an off-site physician that skims their profits on zero hands, because there are none.

 

[Blessthefall]

More power to you if you can successfully see 30-40 patients a day good for you.. But wouldnt that salary be divided right in half on office expenses/nurses/.... everything else. and you dont seem to be accouting for even one second of paper work/insurance/preapprovals/everything else?

ANYWAYS i'm not saying that you cant do well being a FP.. But you could simply do the exact same thing as an NP(with zero debt and only 3 years of schooling).. There is no law that says an NP cant see 30-40 pts per day and make the same salary... Uncle Sam reimburses an NP the exact same as an FP.... (that use to be only 80% and use to require physician oversight.. all equal now)

So you just received a detailed response outlining the maintained relevancy of an FM physician yet you're still splitting hairs over compensation?

If you want to become an NP or PA, by all means, do it. I don't think the financials are what's causing you consternation; I believe it's a personal dilemma. Some people want to pursue NP/PA because of their advantages or that position better aligns with their personal preferences. The exact same arguement can be made with MD/DO.

Also, it seems as though you have a lacking understanding of the way businesses in general operate- not to mention healthcare. Moreover, the fact is that you don't necessarily have to own your own practice and could be employed by a major hospital/ healthcare organization where the overhead is not "deducted from your salary".

 

[Shinken]

MrSunny1, I don't feel you quite understand both careers well. There's a huge difference in salary and knowledge, and it's simply not true that "NPs have far less stress, much better hours, and vastly superior quality of life". Nor is it true that they "simply can do the exact same thing" as a family doc and make the same salary.

I don't have the inclination to type a lot and explain things to you, so I won't. Other posters will likely do so.

 

[Shinken]

...in the time it took me to type my brief reply above, posters already are explaining things in more detail.

 

[Mad Jack]

Also the only state I know of that reimburses NPs the same as physicians is Oregon, everywhere else they get the Medicare 85% fee schedule. So if a patient bill is for $100, medicare pays 80%, or $80 to a physician, while they pay 80% of 85% of that amount, or $68 to an NP. The patient pays $20 to a physician, and $17 to an NP as a copay. That results in a loss of $15 per patient for the NP. Insurers also generally pay NPs less, and sometimes substantially less, than physicians. Rates can be anywhere from 60-85% of their physician reimbursement rates, depending on what the service is.

 

[MrSunny1]

I dont understand why everyone keeps talking about ancillary services, becoming a hospitalist or other business ventures.. Heck an NP could invest his money wisely in the stock market and far exceed the FP's practice maybe by 100 fold if he gets really lucky(irrelevant)..

My comparison is simply a physician owned practice to one owned by an NP.. NP does not need physician oversight, can prescribe most all of the same medications and see as many patients as he wants to.. and make the same salary as the FP especially in Oregon... Then consider the zero debt, zero stress no board exams... little to no competition most NP programs require at least a 2.0 GPA... so much for sweating for each exam. Plus starting the career 8 years earlier would give an additional 800,000$ head start at a lower tax bracket... NP school is even online for most of the 1 year programs. would be nice to start a great career at 21 instead of 30.

 

[bashwell]

@MrSunny1, sounds like you really want to become an NP.

 

[Blessthefall]

I dont understand why everyone keeps talking about ancillary services, becoming a hospitalist or other business ventures.. Heck an NP could invest his money wisely in the stock market and far exceed the FP's practice maybe by 100 fold if he gets really lucky(irrelevant)..

My comparison is simply a physician owned practice to one owned by an NP.. NP does not need physician oversight, can prescribe most all of the same medications and see as many patients as he wants to.. and make the same salary as the FP especially in Oregon... Then consider the zero debt, zero stress no board exams... little to no competition most NP programs require at least a 2.0 GPA... so much for sweating for each exam. Plus starting the career 8 years earlier would give an additional 800,000$ head start at a lower tax bracket... NP school is even online for most of the 1 year programs. would be nice to start a great career at 21 instead of 30.

Ah, I see the issue: we genuinely believed that you were interested in gaining insight from the original question posed by you.

The reality is that you're a troll here to serve acknowledgement of only your own biases.

Our collective bad.

 

[Promethean]

NPs don't have full practice rights in all states.

Even where they do, patients still prefer to see physicians.

I'm an RN. I could have been an NP with a full patient panel by now. Instead, I'm a 3rd year med student. It will cost me about 10X as much and about 3x as long to go from RN to FM physician as it would have to get to the FM NP level of training.

I picked the medical school route because I know that the NP programs that I looked at were inadequate preparation for the quality of care that I want to offer my patients. It doesn't matter to me if I could have become a less thoroughly trained "provider" for faster and cheaper than to become a fully trained physician. Even if your premise that I could have earned the same amount and done all the same things either way were true.... I actually give a @@@@ about the patients and care deeply about what I bring to my relationship with them. This isn't just a business venture to me.

I think that patients will see that and fully expect that I will have a well-attended clinic. If any of my patients would prefer to seek care elsewhere, I will respect their choice... and let someone else in off my waiting list to fill their place.

 

[kjamess]

Turns out NP have the same care levels as physicians(in primary care setting as many studies have shown)

you clearly haven't read those "studies"...

 

[Promethean]

Regarding the money part... I'm currently planning to set a salary cap on myself, and to roll everything above that into a charitable trust. I believe that it is possible as a solo doc, to keep the overhead low, to serve underserved and low socioeconomic patients, to have adequately long appointment times, and to make more money than I will possibly know what to do with. And when I say believe, I mean that I have a sketched out business plan that is passing muster with my accountant / financial planner.

The only reason that it is just a sketch is that I have exams to study for right now. But there is significant money to be made in primary care if it isn't all handed over to administrators to parcel it out propping up an ancillary staff who mostly serve to create more distance between the physician and the patient. My biggest worry is earning too much to suit my ideals, so that I need to find ways to bleed the excess off into community service / nonprofits. That seems like a far more likely scenario than that I will be undercut and driven out of business by an NP,.

 

[Mad Jack]

I dont understand why everyone keeps talking about ancillary services, becoming a hospitalist or other business ventures.. Heck an NP could invest his money wisely in the stock market and far exceed the FP's practice maybe by 100 fold if he gets really lucky(irrelevant)..

My comparison is simply a physician owned practice to one owned by an NP.. NP does not need physician oversight, can prescribe most all of the same medications and see as many patients as he wants to.. and make the same salary as the FP especially in Oregon... Then consider the zero debt, zero stress no board exams... little to no competition most NP programs require at least a 2.0 GPA... so much for sweating for each exam. Plus starting the career 8 years earlier would give an additional 800,000$ head start at a lower tax bracket... NP school is even online for most of the 1 year programs. would be nice to start a great career at 21 instead of 30.

Lol, you're really reaching. You basically cranked every possible confounder to 11. "I'll be an NP that does an accelerated program in a specific state doing a specific thing and somehow do it all with a full scholarship and get a full private pay panel and bank financing and see the same number of patients as a physician and make no mistakes even though I have far less training and it'll be great!" You're basically saying "let's take the most exceptional NP position and pair them up against the worst possible FP!" That isn't reality.

On average, a physician is going to earn about twice what an NP earns, will have far more opportunities, and will have a little over twice as much debt (the average RN accumulates 30k in undergraduate debt and 60k in NP debt, for a total of 90k, while the last report I read on physician debt put it at around 208k). The average nurse is going to finish up 4 years sooner than a physician, for the following reasons. NP programs usually don't take fresh grads, plus you need to graduate from an RN program before you can apply for an NP program, so there's usually a year lag between graduation and matriculation. So you've got 4+1 gap+2, for a total of 7 years , or 8 years for a longer 3 year program, while physicians have 4+4+3, for a total of 11 years, 3 of which are paid and a couple of which you can moonlight during, with a going rate of $100+ an hour). The average NP is going to make 80-110k, while the average FP is going to make 200-220k. So you can be a nurse making 100k with 90k in debt at a realistic age of 25, or a physician making 200k with 200k in debt at the age of 29- personally I'd take the latter, particularly with the vastly improved opportunities, mobility, and autonomy.

Most of my NP friends are in 100-200k of debt. The fastest program out there is UPenn, so far as I know, which is 16 months and $106,000 on top of a nursing degree, which'll generally run you about $30,000-40,000. And that's without living expenses or anything- let's say you've got that covered, and your parents paid for undergrad. Well, that's still $106,000 in debt, about half of what the average physician has, and to earn about half what the average physician earns.

As to side jobs, these are important sources of income for many physicians that can pay extremely well, are very common, and simply aren't open to NPs. A typical example is an 4 hour a month position that pays 30k/year, which is the typical going rate around here. Hospitalist jobs are common as hell, they're not some unicorn position.

 

[MrSunny1]

Regarding the money part... I'm currently planning to set a salary cap on myself, and to roll everything above that into a charitable trust. I believe that it is possible as a solo doc, to keep the overhead low, to serve underserved and low socioeconomic patients, to have adequately long appointment times, and to make more money than I will possibly know what to do with. And when I say believe, I mean that I have a sketched out business plan that is passing muster with my accountant / financial planner.

The only reason that it is just a sketch is that I have exams to study for right now. But there is significant money to be made in primary care if it isn't all handed over to administrators to parcel it out propping up an ancillary staff who mostly serve to create more distance between the physician and the patient. My biggest worry is earning too much to suit my ideals, so that I need to find ways to bleed the excess off into community service / nonprofits. That seems like a far more likely scenario than that I will be undercut and driven out of business by an NP,.

Thats pretty subjective.. Some people would have trouble spending 40k a year... Im sure you can just see patients for free if you really want to give back.

 

[Mad Jack]

It seems @MrSunny1 SOAPed into either IM or FM, more likely IM given this thread. Trying to figure out why he's got it so out for the FM crowd- just looking for someone to hate on and feel better than, or do you figure since you've matched and don't need this site anymore you'd like to do some trolling on your way out?

 

[Promethean]

Thats pretty subjective.. Some people would have trouble spending 40k a year... Im sure you can just see patients for free if you really want to give back.

Indeed. I can live quite well on 40k a year, assuming loans are paid. But I was figuring on capping it at $250k. That seems a little high to me, and I might not actually take the full draw, but if one is setting a ceiling, it ought to be high enough to give some breathing room.

But yeah, the ultimate goal is to build a structure so that I could see people essentially for free if I want. Where those who choose to / are able to pay would basically be donating to a charitable trust that would operate the clinic, reinvest in the community, and upon dissolution, pay out its proceeds to other nonprofits. I don't expect everyone to emulate my schemes, but I've had money and found that the only things I care about doing with it are generally considered philanthropic, so why not just build it that way from the start.

 

[MrSunny1]

Lol, you're really reaching. You basically cranked every possible confounder to 11. "I'll be an NP that does an accelerated program in a specific state doing a specific thing and somehow do it all with a full scholarship and get a full private pay panel and bank financing and see the same number of patients as a physician and make no mistakes even though I have far less training and it'll be great!" You're basically saying "let's take the most exceptional NP position and pair them up against the worst possible FP!" That isn't reality.

On average, a physician is going to earn about twice what an NP earns, will have far more opportunities, and will have a little over twice as much debt (the average RN accumulates 30k in undergraduate debt and 60k in NP debt, for a total of 90k, while the last report I read on physician debt put it at around 208k). The average nurse is going to finish up 4 years sooner than a physician, for the following reasons. NP programs usually don't take fresh grads, plus you need to graduate from an RN program before you can apply for an NP program, so there's usually a year lag between graduation and matriculation. So you've got 4+1 gap+2, for a total of 7 years , or 8 years for a longer 3 year program, while physicians have 4+4+3, for a total of 11 years, 3 of which are paid and a couple of which you can moonlight during, with a going rate of $100+ an hour). The average NP is going to make 80-110k, while the average FP is going to make 200-220k. So you can be a nurse making 100k with 90k in debt at a realistic age of 25, or a physician making 200k with 200k in debt at the age of 29- personally I'd take the latter, particularly with the vastly improved opportunities, mobility, and autonomy.

Most of my NP friends are in 100-200k of debt. The fastest program out there is UPenn, so far as I know, which is 16 months and $106,000 on top of a nursing degree, which'll generally run you about $30,000-40,000. And that's without living expenses or anything- let's say you've got that covered, and your parents paid for undergrad. Well, that's still $106,000 in debt, about half of what the average physician has, and to earn about half what the average physician earns.

As to side jobs, these are important sources of income for many physicians that can pay extremely well, are very common, and simply aren't open to NPs. A typical example is an 4 hour a month position that pays 30k/year, which is the typical going rate around here. Hospitalist jobs are common as hell, they're not some unicorn position.

Well you remember we are talking about someone who would be that exceptional NP and complete an accelerated path assuming he would easily have gotten into a good medical school. I'm not talking about comparing the 2.0GPA highschool certificate NP to a stellar family medicine doctor. Im comparing a would be FP doctor who otherwise chose the path of NP over medical school(which he could have easily been accepted to with his 4.0 GPA and outstanding EC, letters of recs....) who decided that he would rather start practicing in 3 years instead of 11.

 

[VA Hopeful Dr]

Well you remember we are talking about someone who would be that exceptional NP and complete an accelerated path assuming he would easily have gotten into a good medical school. I'm not talking about comparing the 2.0GPA highschool certificate NP to a stellar family medicine doctor. Im comparing a would be FP doctor who otherwise chose the path of NP over medical school(which he could have easily been accepted to with his 4.0 GPA and outstanding EC, letters of recs....) who decided that he would rather start practicing in 3 years instead of 11.

Here's the thing: if it so easy for an NP to make bank like you're describing, why aren't huge numbers of them doing it?

 

[MrSunny1]

Indeed. I can live quite well on 40k a year, assuming loans are paid. But I was figuring on capping it at $250k. That seems a little high to me, and I might not actually take the full draw, but if one is setting a ceiling, it ought to be high enough to give some breathing room.

But yeah, the ultimate goal is to build a structure so that I could see people essentially for free if I want. Where those who choose to / are able to pay would basically be donating to a charitable trust that would operate the clinic, reinvest in the community, and upon dissolution, pay out its proceeds to other nonprofits. I don't expect everyone to emulate my schemes, but I've had money and found that the only things I care about doing with it are generally considered philanthropic, so why not just build it that way from the start.

Hhaha you are capping at 250k$ net?.. Thats a pretty lofty goal to ever reach maybe 20-30 years in if you are the only physician in town and reimbursements stay high. I think it would be more charitable to cap at 90k and donate everything else.

 

[Mad Jack]

Well you remember we are talking about someone who would be that exceptional NP and complete an accelerated path assuming he would easily have gotten into a good medical school. I'm not talking about comparing the 2.0GPA highschool certificate NP to a stellar family medicine doctor. Im comparing a would be FP doctor who otherwise chose the path of NP over medical school(which he could have easily been accepted to with his 4.0 GPA and outstanding EC, letters of recs....) who decided that he would rather start practicing in 3 years instead of 11.

You can't become an NP in 3 years. You need a BSN (4 years) and an NP (1.4-3 years), minimum investment/average investment 5.4/7 years straight out of high school, but it's unlikely things would go that smoothly since most NP programs aren't taking fresh grads. Your ridiculous exaggeration does nothing for your point and actually make it laughable.

 

[MrSunny1]

Here's the thing: if it so easy for an NP to make bank like you're describing, why aren't huge numbers of them doing it?

They are.. They make 90-120k per year to see just a few patients per day. I think a lot of them choose lifestly of just working a few hours per day either that or they dont have the volume to see 30+ patients per day.. Honestly that is a large amount of patients per year I dont even know how some rural areas can even sustain more than 3-4 FPs.

 

[MrSunny1]

You can't become an NP in 3 years. You need a BSN (4 years) and an NP (1.4-3 years), minimum investment/average investment 5.4/7 years straight out of high school, but it's unlikely things would go that smoothly since most NP programs aren't taking fresh grads. Your ridiculous exaggeration does nothing for your point and actually make it laughable.

Everything Ive read says you only need an associates degree which is 2 years and the NP is 1 year online. 12 months not 1.4-3.

 

[Promethean]

Well you remember we are talking about someone who would be that exceptional NP and complete an accelerated path assuming he would easily have gotten into a good medical school. I'm not talking about comparing the 2.0GPA highschool certificate NP to a stellar family medicine doctor. Im comparing a would be FP doctor who otherwise chose the path of NP over medical school(which he could have easily been accepted to with his 4.0 GPA and outstanding EC, letters of recs....) who decided that he would rather start practicing in 3 years instead of 11.

Yeah. I know some of those NPs and PAs, who thought they'd found a short cut. Bunch of them in med school with me right now, in fact.

The best NP programs are still full of make work, poster presentations on literature reviews counting as "research" and barely more clinical education than was obtained in the first two years of basic RN associate level training. So many friends who went that route are now saying that they feel overwhelmed by the complexity of patient presentations and that they feel under trained for the work that they are trying to do. So many of them keep going back and adding more letters after their names because they are trying to replicate an education that they never received.

Informed people who want to be physicians go to medical school.

People who take another route, thinking that it is a short cut, end up regretting it.

There is a role for NPs and PAs. It isn't in private solo practice. The educational preparation they receive is appropriate to being part of an effective, physician lead team. It isn't adequate for the role into which some of them are attempting to expand. The smart ones know that and either work closely with a physician or go back to school to become one. The foolish ones make a mess by exceeding their effective scope. There is no cohort of bright, thoughtful, coulda shoulda woulda gone to med school NPs who happily practice beyond their level of training. That isn't a thing.

 

[Mad Jack]

Hhaha you are capping at 250k$ net?.. Thats a pretty lofty goal to ever reach maybe 20-30 years in if you are the only physician in town and reimbursements stay high. I think it would be more charitable to cap at 90k and donate everything else.

What are you even talking about, I know plenty of people that make more than that right now as FPs right out of residency in employed gigs with all expenses/malpractice paid, tuition reimbursement, and six figure sign-on and relocation bonuses.

 

[Promethean]

Everything Ive read says you only need an associates degree which is 2 years and the NP is 1 year online. 12 months not 1.4-3.

This is true. I have a 22 month RN diploma. I could do an online program through Kaplan for 12 months and $20k that would make me an NP. 3 total years to become a dangerously incompetent provider.

 

[MrSunny1]

Yeah. I know some of those NPs and PAs, who thought they'd found a short cut. Bunch of them in med school with me right now, in fact.

The best NP programs are still full of make work, poster presentations on literature reviews counting as "research" and barely more clinical education than was obtained in the first two years of basic RN associate level training. So many friends who went that route are now saying that they feel overwhelmed by the complexity of patient presentations and that they feel under trained for the work that they are trying to do. So many of them keep going back and adding more letters after their names because they are trying to replicate an education that they never received.

Informed people who want to be physicians go to medical school.

People who take another route, thinking that it is a short cut, end up regretting it.

There is a role for NPs and PAs. It isn't in private solo practice. The educational preparation they receive is appropriate to being part of an effective, physician lead team. It isn't adequate for the role into which some of them are attempting to expand. The smart ones know that and either work closely with a physician or go back to school to become one. The foolish ones make a mess by exceeding their effective scope. There is no cohort of bright, thoughtful, coulda shoulda woulda gone to med school NPs who happily practice beyond their level of training. That isn't a thing.

"There is no cohort of bright, thoughtful, coulda shoulda woulda gone to med school NPs who happily practice beyond their level of training. That isn't a thing.[/QUOTE]"
Well honestly there wasnt the option of becoming a nurse practioner with the equivalent rights and pay to a physician until just the last few years so that may change.

 

[Promethean]

What are you even talking about, I know plenty of people that make more than that right now as FPs right out of residency in employed gigs with all expenses/malpractice paid, tuition reimbursement, and six figure sign-on and relocation bonuses.

Dude clearly doesn't know whereof he speaks. Like at all.

 

[Mad Jack]

Everything Ive read says you only need an associates degree which is 2 years and the NP is 1 year online. 12 months not 1.4-3.

You need a bachelor's degree and a minimum of an ASN to matriculate to an NP program, as all non-MSN programs have been phased out. Back in the day there were NP programs that one could attend after an ASN and without a bachelor's degree, but the last of those was phased out in the 80s and they were generally geared toward military-trained nurses that had additional skills. Oh, and if you've got an ASN+bachelor's degree, most NP programs require you to meet extra requirements that would qualify you for a BSN before you can complete your NP, so you've got to take 6-10 extra courses, depending on where your deficiencies are.

 

[Mad Jack]

Dude clearly doesn't know whereof he speaks. Like at all.

I really think he's someone that's done with the site and figures he'd like to do some trolling on his way out. Whatever floats your boat I guess.

 

[MrSunny1]

This is true. I have a 22 month RN diploma. I could do an online program through Kaplan for 12 months and $20k that would make me an NP. 3 total years to become a dangerously incompetent provider.

You dont have to go right out and start solo practice though.. you could always work under a physician gradually increasing the level of difficulty of patients you see making 90-120k a year. You could do this for 8 years and THEN tell me who would be more competent an NP with 8 years of in clinic training or a fresh out of residency FP. Plus you would also have an additional 1 million dollars and zero debt.

 

[Promethean]

I really think he's someone that's done with the site and figures he'd like to do some trolling on his way out. Whatever floats your boat I guess.

God. That is tragic. I can't imagine having so little to do with my life and so few interests and so little respect for my own time as to bother trolling SDN. Like, if you are over it, just wander off and do something else that furthers some goal you have, or satisfies some basic need for yourself or someone else. Go outside, ffs. Fap. Something useful and interesting and life affirming.

I come to SDN because my friends are here and I like to chat with them. Even braindead threads like this are useful, because I am leaving ideas for other people to stumble across. I'm contributing to a community that matters to me.

I genuinely can't grasp what is the reward of just coming here to try to spoil it and waste other people's time and attention. How pathetic.

 

[Mad Jack]

You dont have to go right out and start solo practice though.. you could always work under a physician gradually increasing the level of difficulty of patients you see making 90-120k a year. You could do this for 8 years and THEN tell me who would be more competent an NP with 8 years of in clinic training or a fresh out of residency FP. Plus you would also have an additional 1 million dollars and zero debt.

Where is this magical zero cost NP program? Where is this mythical perfect physician preceptor that isn't busy with their own patients and is willing to take you under their wing? And I'd still say the fresh out of residency FP is more competent than the NP, I'd take a BC/BE physician over a NP any day of the week. Their core deficiencies are just too great to overcome with on-the-job training.

 

[Light at end of tunnel]

I really think he's someone that's done with the site and figures he'd like to do some trolling on his way out. Whatever floats your boat I guess.

Oh not this again...a member says some non status quo stuff so they must be a troll?

It's like clockwork.

Is it that hard to believe that some people just think outside the box and refuse to be brainwashed by the mainstream?

This member clearly has substance supporting their position...can't we just accept it as a valid perspective rather than resort to the ultimate crutch of troll-labeling/ad hominem to discredit them?

 

[Apollyon]

Oh not this again...a member says some non status quo stuff so they must be a troll?

It's like clockwork.

Is it that hard to believe that some people just think outside the box and refuse to be brainwashed by the mainstream?

And isn't this the point where you urge the OP to lawyer up?

 

[Mad Jack]

Oh not this again...a member says some non status quo stuff so they must be a troll?

It's like clockwork.

I'm just saying, I can't imagine someone has made it all the way to residency and is this oblivious about the medical system, nurse training, physician training, salaries, and everything else. It's possible people like this exist, but I'm giving him the benefit of the doubt and assuming he's far more intelligent and knowledgeable than he appears to be.

 

[Light at end of tunnel]

I'm just saying, I can't imagine someone has made it all the way to residency and is this oblivious about the medical system, nurse training, physician training, salaries, and everything else. It's possible people like this exist, but I'm giving him the benefit of the doubt and assuming he's far more intelligent and knowledgeable than he appears to be.

I guess...I wonder why we move so quickly to quash such views rather than being more accepting of them. It's almost as though these views hit on some sensitive points for all of us we would rather not deal with.

 

[MrSunny1]

I really think he's someone that's done with the site and figures he'd like to do some trolling on his way out. Whatever floats your boat I guess.

How is it

Where is this magical zero cost NP program? Where is this mythical perfect physician preceptor that isn't busy with their own patients and is willing to take you under their wing? And I'd still say the fresh out of residency FP is more competent than the NP, I'd take a BC/BE physician over a NP any day of the week. Their core deficiencies are just too great to overcome with on-the-job training.

The NP program cost would be negligible considering you have made over 1 million over the missed years of your MD colleague. I'm not sure that I would agree that an NP with 8 years of "relevant" clinical experience would have worse healthcare outcomes than a fresh out MD.

 

[Light at end of tunnel]

And isn't this the point where you urge the OP to lawyer up?

Don't tempt me.

 

[Mad Jack]

How is it



The NP program cost would be negligible considering you have made over 1 million over the missed years of your MD colleague. I'm not sure that I would agree that an NP with 8 years of "relevant" clinical experience would have worse healthcare outcomes than a fresh out MD.

I disagree, but hey, I know good doctors. As to cost... Well, an NP makes an average of $105,670 while a FP makes an average of 209K. Let's do some math:

First off, the NP with an average debt load will have student loans of $1017/mo.
Let's run an after-tax monthly income for someone working in, say, Texas.
$6,494.08 is what it comes out to after tax, assuming no deductions (there would be deductions, but we're keeping things clean).
Basic cost of living in the Houston area in a decent spot, we'll say you spend $1,600 on rent/mortgage, $600 on a car/insurance, $600 on food, $400 on utilities/communications, that puts you at $4,217 in total expenses per month. This assumes your single and don't have kids by the way, which jacks up costs by another $1,500... But anyways, that leaves you with a net of around $2,500 you can actually save and invest. You get out of school 4-5 years earlier than the doctor, but that's all you've got to work with. Or $1,000 if you've got a couple of kids and you're cheap about it, less if you aren't.

Now as a physician, you'll pull $12,006 after taxes in Texas.
Your loans will cost you $2,441. You've got the same cost of living as above, which gives you total expenses of $5,641. That gives you a net of roughly $6,350 to save and invest per month, or $4,850 with the kid deduction, certainly a lot more wiggle room financially and a lot more opportunity to actually save and invest. You put in an extra half decade, but you get a better rest of your freakin' life.

That's just the averages though. I think the trade off is worth it.

 

[evilbooyaa]

You dont have to go right out and start solo practice though.. you could always work under a physician gradually increasing the level of difficulty of patients you see making 90-120k a year. You could do this for 8 years and THEN tell me who would be more competent an NP with 8 years of in clinic training or a fresh out of residency FP. Plus you would also have an additional 1 million dollars and zero debt.

Fresh out of residency FP and it isn't close.

 

[LucidSplash]

Oh no not this again... the member who fully embraces postmodernism to the point that they don't believe in objectively knowable reality and only comments to scold others for calling a troll a troll (or telling someone to hire a lawyer).

OP's supposition in their original and subsequent posts has been analyzed and answered and found wanting yet continues to try to argue their point based on minutiae and incomplete or blatantly wrong facts using logical fallacies to boot. So either obtuse or troll, either way, if the shoe fits...

 

[RadOncDoc21]

Fresh out of residency FP and it isn't close.

8 yrs is a long time to practice bad medicine.

 

[Light at end of tunnel]

Oh no not this again... the member who fully embraces postmodernism to the point that they don't believe in objectively knowable reality and only comments to scold others for calling a troll a troll (or telling someone to hire a lawyer).

OP's supposition in their original and subsequent posts has been analyzed and answered and found wanting yet continues to try to argue their point based on minutiae and incomplete or blatantly wrong facts using logical fallacies to boot. So either obtuse or troll, either way, if the shoe fits...

There may not be a right or wrong answer, though, and that is the point really. We could beat the argument out of any member with enough posts by members who know what they are talking about, but might does not always make right.

It is OK to not agree with the instant status quo, here or IRL.

 

[IM2GI]

Well you remember we are talking about someone who would be that exceptional NP and complete an accelerated path assuming he would easily have gotten into a good medical school. I'm not talking about comparing the 2.0GPA highschool certificate NP to a stellar family medicine doctor. Im comparing a would be FP doctor who otherwise chose the path of NP over medical school(which he could have easily been accepted to with his 4.0 GPA and outstanding EC, letters of recs....) who decided that he would rather start practicing in 3 years instead of 11.

Stop feeding the troll.

Go back to allnurses.

 

[LucidSplash]

Except there is definitely a right answer here, based on facts and logic. As previously stated OP's post has been analyzed and answered and found wanting. It's ok to disagree with a viewpoint, but not with facts.

See also climate change, round earth, old earth. There are plenty of people who don't believe in these things based on emotions but facts win every time and it's ok to call people out when they selectively ignore facts in favor of feelings.

You can have a debate but eventually for most things there is an end to the debate and a winner. In the case of this post, the OP is wrong and we wouldn't be doing anyone any favors by cradling them softly while whispering "ignore the haters, you can believe whatever you want."

 

[MrSunny1]

8 yrs is a long time to practice bad medicine.

You say bad, but all the studies conducted says great... And thats all uncle Sam cares about (equal pay equal+practice rights as proof) obviously that wouldnt happen if they were "practicing bad medicine"