Doctor of Medical Science

Discussion in 'Nursing and medical-related degrees' started by Kizmet, Feb 22, 2020.

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  1. Neuhaus

    Neuhaus Well-Known Member

    I have a psychiatric nurse practitioner who manages medication for my OCD. She maintains her own practice. She writes her own prescriptions. And her office exclusively works on psych meds. She is doing the work that a psychiatrist would do. At my GI's office the NP is who you see. All the time. The only time you see the doctor is if he's doing your colonscopy or endoscopy. It's her name on all of the prescriptions.

    As for pay, the going rate for a floor nurse in this town is around $45k - $55k. On the super low end, there are some public roles where an RN can make as little as $35k for similar work. I am confident that any employed NP is making at a minimum $80k in this town. Most are over $100k. With the caveat, of course, that if you're running your own practice then you're earnings are much more variable. This isn't Neuhaus speculating. I know the market rates and I've verified a few of them since the largest hospitals nearby is a state facility and therefore subject to public reporting requirements so I cna look up individual salaries.

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    Maybe we're just in very different areas, Rich. Or maybe you are operating off of less recent information. I'm not sure. But the pay gap between an RN and an NP is pretty vast these days. Nurses, like all people, get older. And to go back to being a floor nurse is not something that many nurses can actually pull off if they've been doing more administrative work for a while. Floor nurses have an incredibly high disability rate. Lifting people and slipping on floors can destroy a body especially over the course of decades. I've not encountered a nurse who ever went back to that after finding higher paying and less physically demanding work elsewhere.

    Now, have I seen NPs bounce to work for insurance companies reviewing claims? Yes, absolutely. And burnout may very well be a factor there since the pay is, at best, comparable for those making that transition. But NP to working a floor again? I've never seen it. That doesn't mean it doesn't happen. And, admittedly, it's been almost 10 years since I hired nurses. But the rush of RNs wanting to become nurse practitioners has only been going up and I haven't seen any data to suggest that they are churning at the rate you're describing.
     
  2. Kizmet

    Kizmet Moderator Staff Member

    Where I live APRNs, especially with Psychiatric specialization, are like gold. It's hard work. Lots of patients. I don't know what they make for salaries but there is high demand. More or less they work where they want to work and as many hours as they want. That's what I'm told.
     
  3. Rich Douglas

    Rich Douglas Well-Known Member

    You might disagree with what I'm saying, but I live with this issue every single day, and have for the past 25 years.
     
  4. Vonnegut

    Vonnegut Active Member

    [​IMG]
     
  5. Rich Douglas

    Rich Douglas Well-Known Member

    Yes. An informed one.
     
  6. Neuhaus

    Neuhaus Well-Known Member

    I have no desire to get into an anecdotal pissing contest over this. My observations are obviously different from your own. I'm speaking more to the fact that you are painting quite a picture of hopelessness for NPs with them being underpaid, overworked and having no more respect than a typical nurse. My experience is obviously different from that. Neither of these are invalid. I'm sure there are overworked and underpaid NPs. Just as I hope you can accept that there are not only NPs managing successful practices of their own but that they are also doing so in specialized fields and not just filling in the role of family medicine practitioners who have been priced out of that market.

    But I do keep an eye on industry trends. So if there is a study out there showing that NPs are fleeing the profession, I'd like to see it. I may not hire in that space any more but it's still an area of interest for me. Hiring medical professionals was a weird world. It was incredibly simple and incredibly difficult to do all at the same time. Simple because anyone with a valid license and board cert could be hired sight unseen in many cases. Difficult because practitioners in this world are some of the biggest prima donnas I've ever encountered in the hiring landscape.

    Slight tangent, I always think of this one pathologist who was being hired for a small, rural hospital. They were offering him $400k to work part-time. They just needed to have a pathologist on-site doing pathology things. Even if those things were only done 3 days a week, that was fine by them. Because the hospital was older, it had some out-buildings where administrators used to live. Fully renovated apartment came with it so he didn't even need to house hunt. Just come and work there three days a week, staying in this pretty swank little cottage (think granite countertops and stainless steel appliances). He refused because he also demanded a driver which they refused to provide because, seriously?

    He was indignant. He was yelling. He couldn't believe that the hospital would not grant him this full-time employee to ferry him about as he saw fit (on his personal time only since he would be living within walking distance of work). After all, he argued, how could they expect him to get around? His drivers license was still suspended from a DUI! He said this with such force and confidence as if he had no sense that this was not the sort of thing that an employer wanted to hear about their new employee.

    In the end he took the job for an extra $50k to offset his inconvenience, but the hospital then negotiated two on-call weekends per month for him in addition to his 3-4 day work week.

    It's a wild world.
     
  7. copper

    copper Member

    How does one "see successful practices" exactly? Do you judge success by the number of patients the provider sees? I know a Family Medicine Physician that sees very few patients because he charges a monthly premium for concierge services. He is seeing 1/5th the patient load and making 3 times the income! On the other hand, I see independent providers working 70 plus hour weeks and scraping by. These anecdotal conversations are futile. Yes, I agree, there are successful NPs! What's your point? My point was that we are seeing an emergence of collaborative multi-specialty practices because the cost of doing business is going up overall and there are a lot of cost savings in sharing infrastructure!
     
    Last edited: Mar 6, 2020
  8. copper

    copper Member

    ............It's kind of like the paradigm shift we've experienced over the past three decades in retail. Small towns had a Bakery, Hardware store, Pharmacy, Shoe store, Cobbler, etc. Now the town has a super mega retailer with one stop shopping. Sure, you may make it as an independent provider but you can also lose your a$$!
     
  9. Vonnegut

    Vonnegut Active Member

    Everyone can make their own definition of what a successful practice is. I was referring, in this instance, as a small business enterprise that is not all time consuming (not buying a job) and generate enough revenue to satisfy the proprietor. Similar to the model you reference above with a Family Medicine Physician. My point was simply in your response of it being too cost prohibitive for an NP to have an autonomous practice. Simply that it can and is being done, albeit with a different business model, just as you now reference some MDs are transitioning to.
     
  10. Rich Douglas

    Rich Douglas Well-Known Member

  11. Vonnegut

    Vonnegut Active Member

  12. copper

    copper Member

    Just a reminder, The Doctor of Medical Science degree is a doctoral degree for PAs, not NPs! I have nothing against the advanced nursing profession but as a PA, I ask the question, why are we so easily lumped together? To me, the educational framework seems a lot different. Also, any comments on CalU of Penn are appreciated as well as the utility of a DMSc for PAs.
     
  13. Vonnegut

    Vonnegut Active Member

    The distinction between an NP and a PA is fairly ambiguous to the general public, or at least from my perspective. Both can sometimes issue prescriptions (depending on the state), both can operate general clinics in place of a traditional physician (depending on the state), both can specialize into more niche fields. While graduate programs from the different fields may be different, if I am representative of the general public, the difference is not visible. If anything, it would lead me to wonder if it makes a difference, as I understand there are PAs without graduate degrees.
     
  14. copper

    copper Member

    Duquesne Univ has an article that explains the differences quite well:
    "marked differences that fall into three primary areas: work focus, education, and degree of autonomy. "

    In addition: "The nursing model looks holistically at patients and their outcomes, giving attention to patients’ mental and emotional needs as much as their physical problems. The medical model places a greater emphasis on disease pathology, approaching patient care by looking primarily at the anatomical and physiological systems that comprise the human body."

    https://onlinenursing.duq.edu/blog/difference-between-fnp-and-pa/

    In regards to your comments about PAs without graduate degrees, there are a few but for the most part, the entry level is the Masters in PA studies and now the emergence of Doctor of Medical Sciences for post graduate work. I've met some NPs with certificates as well that are grandfathered. Over the years, I've seen Bachelors of Pharmacy, Physical Therapy and other allied healthcare professions progress to the masters and doctoral levels. Today, PAs like Nurses can become commissioned officers in the military where years ago they were Warrant officers and perhaps enlisted.
     
    Last edited: Mar 7, 2020
  15. copper

    copper Member

  16. copper

    copper Member

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