According to the U.S. Bureau of Labor Statistics (BLS), the job outlook for advanced practice registered nurses (including nurse practitioners (NPs)) is projected to grow 31% from 2016 to 2026, as opposed to 13% for surgeons and physicians. Because the demand for NPs is increasing faster than that for physicians, NPs’ salaries are also increasing at a faster rate compared to family medicine physicians. Graduating NPs are entering a booming market, one that is demanding NPs to fill vital roles in the health care industry.
To learn more, check out the infographic below created by Ohio University’s online Master of Science in Nursing.
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The Demand for and Supply of NPs
The Health Resources & Services Administration (HRSA) projects a shortage of 20,400 physicians by 2020. Yet there is good news: NPs have the potential to alleviate this impending shortage.
There are several key factors that contribute to this predicted fluctuation. According to the HRSA, the combination of a large aging population and overall population growth are projected to account for 81% of the change in demand between 2010 and 2020. The HRSA also projects that between 2010 and 2020, the total demand for primary care physicians will increase by 14%, the number of primary care physicians will increase by 8%, and the supply of primary care NPs will jump by 30%.
Current State of NP Practice
Nearly 50% of NPs practice in primary care. However, state scope of practice (SOP) regulations substantially impact the NPs’ capacity to practice and/or prescribe medication. Additionally, the most restrictive states requires NPs to maintain a “collaborative agreement” with at least one physician to practice and/or prescribe medication.
NPs are an important part of primary care delivery. A 2014 study found that primary care physicians who work with NPs were more likely to accept new Medicaid patients than physicians working without an NP. Additionally, when it comes to states that don’t require collaborative agreements for either practice or prescribing, patients are more likely to receive primary care from NPs. Unfortunately, in states where NPs are reimbursed less than the physician rate (a ratio of 75% to 100%), practices may be discouraged from both accepting and employing Medicaid, per a 2012 study conducted by the Kaiser Family Foundation.
State Practice Environment
State practice and licensure laws in Alaska, Arizona, Colorado, Connecticut, Hawaii, Idaho, Iowa, Kansas, Maine, Maryland, Minnesota, Montana, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, South Dakota, Vermont, Washington, and Wyoming provide for all NPs to evaluate patients, diagnose, order, and interpret diagnostic tests, and initiate and manage treatment (including prescribing medications and controlled substances) under the exclusive licensure authority of the state board of nursing. This model is recommended by the National Academy of Medicine and National Council of State Boards of Nursing.
State practice and licensure laws in Delaware, Illinois, Indiana, Kentucky, Nebraska, New Jersey, New York, Ohio, Pennsylvania, Utah, West Virginia, and Wisconsin reduce the ability of NPs to engage in at least one aspect of NP practice. State law requires a career-long regulated collaborative agreement with another health provider for the NP to provide patient care or limits the setting of one ore more aspects of NP practice.
State practice and licensure laws in California, Florida, Georgia, Massachusetts, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Texas, Tennessee, and Virginia restrict the ability of an NP to engage in at least one aspect of NP practice. State law mandates career-long supervision, delegation, or team management by another health care provider for the NP to provide patient care.
A Picture of NP Wages and Employment
NPs going into the field can be confident in their value and earning potential in the health care industry. According to the BLS’ Occupational Employment and Wages survey (May 2017), the median wage for NPs is $103,880. The top 10% earn $145,630, and the bottom 10% earn $74,840.
Industries with the highest levels of NP employment are physicians’ offices, general medical and surgical hospitals, outpatient care centers, offices of other health practitioners, and colleges, universities, and professional schools. The top-paying industries for NPs include: personal care services ($139,460 mean wage); management, scientific, and technical consulting services ($132,200 mean wage), religious organizations ($117,720 mean wage), dentists’ offices ($117,270 mean wage), and office administrative services ($115,960 mean wage).
California has the highest employment levels for NPs with 13,570 positions. New York is second with 13,450 positions, and Texas is third with 10,730 positions. California is also the highest paying state for NPs, with an average salary of $126,770. Alaska ranks second with an average wage of $125,140, followed by Hawaii at a $122,580 average wage. Massachusetts is fourth on the list with an average wage of $120,140 per year, and Connecticut rounds out the top five list with an average wage of $118,500.
Salary Growth: Family Medicine Physicians vs. Nurse Practitioners
According to the Merritt Hawkins 2017 Review of Physician and Advanced Practitioner Recruiting Incentives, the average salary of NPs increased by rough 9% from 2014-15 to 2015-16, and approximately 5% from 2015-16 to 2016-17. The same review reported the average salary of family medicine physicians increased by approximately 10% from 2014-15 to 2015-16 and around 2% from 2015-16 to 2016-17. If this trend continues, NPs will see a greater rate of salary increase than family medicine physicians.
The Final Say on NP Education & Training
Although NPs are required to complete fewer years of education and training, studies indicate their potential to improve the quality of care and reduce costs.
Education and Training Requirements: Primary Care Physicians vs. Nurse Practitioners
NPs require about six years of education and training. This contrasts to 11 or 12 years of education and training for physicians, which includes education and residency.
Degrees Required and Time to Completion
Family physicians, either an MD or a DO, are required to complete a standard 4-year BA/BS undergraduate degree, followed by a Medical College Admission Test (MCAT). Next, they need four years of a doctoral program to obtain either an MD or a DO degree. After this is obtained, they are required to complete a minimum of three years of residency. This adds up to 11years.
An NP is recommended to complete a standard 4-year BA/BS. Next, they’re required to complete the Graduate Record Examinations (GRE) & National Council Licensure Exam for Registered Nurses (NCLEX-RN) required for MSN programs. After they follow this up with an MSN master’s program — a process that lasts 1.5 to 3 years, they’re finished. This adds up to between 5.5 and 7 years. It should be noted that although a standard 4-year degree (preferably a BSN) is recommended, there are alternate pathways for an RN without a bachelor’s degree to enter some master’s programs.
Medical/Professional School and Residency/Postgraduate Hours for Completion
A family physician will engage in 2,700 lecture hours and 3,000 study hours in their preclinical years. They will also engage in 6,000 combined hours in their clinical years, as well as work 9,000 to 11,000 residency hours. This adds up to between 20,700 and 21,700 hours. A Doctor of Nursing Practice (DNP), on the other hand, will engage in 800 to 1,600 lecture hours and 1,500 to 2,250 study hours in the pre-clinical years. They’ll also engage in combined hours during their clinical years and are not required to work any residency hours. This adds up to between 2,800 and 5,350 hours. It should be noted that in the case of both family physicians and DNPs, the study hours are based on 750 hours of study dedicated by a student per year.
This leads to significant differences between FP and NP hours in terms of professional training. When compared to NPs, FPs engage in 1,100 to 1,900 more lecture hours and 750 to 1,500 study hours during their pre-clinical years. FPs also engage in 4,500 to 5,500 more combined hours during their clinical years than NPs, and 9,000 to 10,000 more residency hours compared to NPs. The aggregate discrepancy in hours between FPs and NPs range from 15,350 to 18,900.
The Potential of NPs
According to an article published by the National Center for Biotechnology Information (NCBI), the coordination of care improves when NPs initiate daily multidisciplinary rounds. The study also shows that NPs working in the ICU setting, where they manage critically ill patients, allow for greater continuity of care. Additionally, nurses in advanced practice appear to generate outcomes that are comparable to those produced by physicians in the emergency and critical settings. It’s also stated that advanced practice nurses like NPs can add value and increase access to health care by potentially strengthening the health care workforce. The article also asserts that when patient care required cross-disciplinary communication, discharge planning, follow-up care, and administrative care, the involvement of NPs led to a shorter average length of patient stay. NPs have also been rated as performing better at patient education, listening, answering queries, and pain management when compared to physicians. Finally, the article states that implementing the advanced nursing practice role in emergency or critical care settings suggests a larger cost savings.
A Key Role to Fill
Students who pursue a career as an NP can help fill a shortage in the health care industry, one that’s currently not being fully met by physicians. What’s more, NPs will also be equipped to provide quality, cost-effective care to a large aging population, according to numerous studies. A future as an NP has the potential to be personally and financially rewarding, with the opportunity to positively impact an industry and the lives of many patients.