Selling Yourself Short
I have heard this low undertone of complaint from the nurse practitioner world and a recent blog was explicitly delineating about how nurse practitioners feel like they have been sold short as they are not paid the same as primary care doctors — and they want to be. Equal pay for equal work.
About this concept of being sold short, I have a comment. I had a patient, a lovely young lady who was going to go off to college to become a nurse and then go directly to become a nurse practitioner. I was very harsh with her. This happened last year, the first year in the literal history of the world that there were more women in medical school than men, 51% of medical students were female. Women have worked so hard to break into the world of medicine as doctors and she was going to directly go into a nurse practitioner program. She was selling herself short. She was not respecting herself, her gender, the past women who had worked so hard for this equity, she did not believe enough that she could get into medical school. Yes, medical school is far more difficult and yes, the training is far more arduous and yes, the training is far longer. The debt is higher. All these things are true.
But if she wanted in fact equal pay for equal work then we would all be paid the same.
In fact, I don’t work as hard as a ditch digger. Not even close. If I dig a tiny tiny hole I’m sore and miserable for days on end. So that work is much harder. If it’s not the physical amount of work, then maybe equal pay for equal work would mean equal training and there is no question that the training is not equal. Now a RN who has practiced for years who decides to go on for further training to become a nurse practitioner I applaud. They have advanced amounts of experience and now they are adding the training to it. But even that training is not equal. At this time many nurse practitioner programs are taught via YouTube. I have two recent graduate nurse practitioners still in my employ – neither of them could tell me if any of their professors had legs. They only saw them online. They are supplementing their terrible education with experience and are wonderful because they do ask questions. I had a nurse practitioner student rotate through and she was flummoxed by the concept that gallstones could cause pancreatitis, she had absolutely no idea about the anatomy of the biliary system because they don’t do rigorous anatomy, certainly not to any real degree and certainly not with actual cadavers.
The training isn’t the same, and right now a trend has risen where nurse practitioners have to be credentialed directly by the insurance companies as “incident to” billing is going away. This is for one reason and one reason only and it will manifest within about two years, nurse practitioners are going to be paid far less, about 80% on each E&M and per procedure code. Frankly, this is appropriate. If nurse practitioners want equal pay, go to med school. Don’t sell yourself short. I do think a nurse practitioner in med school would do great. They have a lot of experience and they have a lot of the basic understanding of how medicine works. They don’t know how to do the same things though.
I don’t want nurse practitioners paid the same as me, I frankly don’t want ditch diggers paid the same as me, and I don’t want either of their jobs. I trained in medical school and residency an average of 100 hours a week with studying and patient care. Average. I’m not complaining, I chose that, that was my choice and I did that choice because I wanted the privilege and rewards of being a doctor. Any nurse practitioner that complains needs to understand that their choices were their choices. It is interesting that I don’t hear physician assistants, or whatever they are called now, complaining nearly as vociferously. They seem to be much more comfortable with their choices. I do think that nurse practitioners who want independent practice are going to be very surprised when they go into practice for themselves. The medical assistant, the receptionist or two, the rent, the electricity, all those utilities they seem to be needing to be paid. I am not concerned about full practice authority for nurse practitioners. If one of those clinics opened up next to me and they were better than I was and cheaper than I was and could take care of people as well as I could then they would deserve those patients.
I would suggest that patients prefer the medical doctor; barring that they prefer a nurse practitioner that can ask their overseeing physician if they have any questions — and that physician would be under the same roof.
I have said this before and I will say it again. Nurse practitioners are wonderful. They are a fantastic adjunct to a medical practice and deserve the respect that they have earned. They have gotten an advanced degree and they take care of patients very well in the right environment.
But.
To say that they are the same as doctors is not only objectionable and insulting, it’s laughable.
“Equal pay” is for equal credentials. MD and NP ain’t the same. And no amount of politicking or advertising will change that fact.
Ahhhhhh, N.P.’s don’t take call. Some might work with a surgeon in a local, private, non-training institution to get there in the morning before the surgeon comes to make surgical rounds easier for the attendings. Then they work in the office as their nurse. In my group practice I retired from, a regular R.N. could do the job and it didn’t take an N.P. to gather up the labs and present the patient to the surgeon. They were like second year surgery residents except they didn’t “do” surgery. The ones were I worked were very smart and sharp.
The reason they believe that way is a significant amount of their “coursework” is advocacy seminars
The entire issue underscores questioning the worth and validity of medical licenses. Taking the LELT’s argument to its logical conclusion via capitalism is the most rational, even moral thing to do.
Do away with state licensing of physicians, and let the bona fides of doctors be certified by their own boards. That way the consumer could seek out a physician, or one of the growing legion of NP’s, doulas, shamans, witch doctors, crystal purveyors, drug dealers, social workers, or faith healers, and let the buyer beware.
I’m increasingly uninterested in protecting a public from the choices it has made, a society that continues to assault me with its laws and lawyers.
“I’m increasingly uninterested in protecting a public from the choices it has made, a society that continues to assault me with its laws and lawyers.”
Classic you, expertly put.