Who Do You See When We Go To The Doctor
Wow, I am so darn busy all of a sudden. Does anyone else get this creep effect? It seems like January is the new December for health care in the US or maybe it is just me. As a manager of a health plan I always counted on two things. First plan costs would escalate to almost twice the monthly average in December and second, January despite being a month with 31 days would be one of the least costly months for the plan.
It seems like for me at least, December was a big month for health care appointments and now January is just as much if not more. This week in particular I have 4 appointments and one of them (the Dermatologist) is a major deal. My goodness how does this happen?
The thing is I seem to see more Nurse Practitioners (NP). Has anyone else had this experience? This week for example I have the four appointments and three are with NP’s. Before last year I hardly ever saw an NP except for my endocrinologist office where the Certified Diabetes Educator (CDE) is also an NP. I suppose this is to be expected given what a NP can do (write prescriptions is the biggest thing) and the demands placed on doctors. I also think that NP’s are in high demand given the cost of health care. I speculate that a doctor’s office would rather hire an NP instead of paying a higher cost for a doctor? I think the answer is fairly obvious but I wanted to test the theory.
I first went to US News Money, a good place to find average salaries, job descriptions and projected demand for occupations in the US. This is not a regional look, but a broad picture look at occupations in the United States. I first searched for NP’s. I found two varieties. The first are certified as having passed the National Council Licensure Examination (NCLEX-RN). According to US News all NP’s must pass this exam to be called an NP (Bratcher, 2015b). Then if the NP wishes further certification the usual path is to become certified as an advanced practice registered nurse (APRN). The “APRN title requires board certification for your specialty such as (women’s health, pediatrics or neonatal, to name a few)” (Bratcher, 2015b).
“APRN defines a level of nursing practice that utilizes extended and expanded skills, experience and knowledge in assessment, planning, implementation, diagnosis and evaluation of the care required. Nurses practicing at this level are educationally prepared at the post-graduate level and may work in either a specialist or generalist capacity. However, the basis of advanced practice is the high degree of knowledge, skill and experience that is applied within the nurse-patient/client relationship to achieve optimal outcomes through critical analysis, problem solving and evidence-based decision making.” (Wikipedia, 2015)*. No matter the certification that seems like a lot so they must get paid a lot? Well not so much really.
The salary for an NP of any type in 2013 ranges from $110,000 at the 75th percentile to $80,560 at the 25th percentile, with the median salary being $92,670 (Bratcher, 2015b). Compare that to a doctor who in 2013 earned a median income of $186,000 (Bratcher, 2015a), and I think we understand the reason I am seeing more NP’s.
Is there a problem with seeing NP’s? No I kind of like the NP’s I see but I also like to see a doctor every once in a while. At the gastroenterology place I am going, the wait to see my doctor is a about 4 months. The wait to see the NP was one month. That is similar at the cardiologist, and neurologist’s offices. It is however not the same at the endocrinologist office. Where the wait to see a doctor is less than a month and the wait to see an NP is less than a week. The thing is my endocrinologist office was the first in my health care team to adopt the NP model and they seem to use them more efficiently, not substituting an NP for a doctor’s judgment when a doctor is required. So I suppose there is hope.
There is an interesting thing I saw while doing the research. NP’s are the rated as the 2nd best health care occupation, they are the 2nd best job in the top 100 jobs in the US (that mostly speaks to being demand) and they are the 13th best paying job in the US (Bratcher, 2015b). Compare that to the position of doctor where it was found they are the 3rd best health care occupation, 4th best job in the top 100 jobs in the US and 1st best paying job in the US (Bratcher, 2015a). Wow, on those scales a person will probably be in slightly higher demand as a NP than a doctor. I suppose people look at that and think medical school seems a lot less attractive given the cost of being a doctor versus being a NP.
In the meantime I am off to see the doctor; ah I mean NP this morning. To get a diagnosis, wait maybe it is a refill; maybe it is visit, like hi how are you? I might just stay home and call the office and talk to the operator at least when I talk to the operator I am clear about the roles. She answers, I talk, and that seems rather refreshing doesn’t it?
Bratcher, E. H. (2015a). Best health care jobs Physician. Retrieved January 27, 2015, from http://money.usnews.com/careers/best-jobs/physician
Bratcher, E. H. (2015b). Best health care jobs, Nurse Practitioner. Retrieved January 27, 2015, from http://money.usnews.com/careers/best-jobs/nurse-practitioner
Wikipedia. (2015). Advanced practice registered nurse. Retrieved January 27, 2015, from http://en.wikipedia.org/wiki/Advanced_practice_registered_nurse
* NOTE: Wikipedia is not considered a source for academic issues and it should not requoted using this source.