Who Do You See When We Go To The Doctor

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.

If all I need is to do some basic tests and get my prescription refilled I think an NP would be fine. My experience is also that often a specialist will give you only the minimal amount of time and attention while an NP will often listen more and be willing to hear you out and explore your health concerns in more detail.

My endo does not use an NP. On the other hand I saw a hematologist last week and he used an NP.

The only time I've seen a NP was in urgent care. Otherwise I see a regular doctor.

Never seen an NP. Not sure anyone uses them around here. PAs are becoming more and more common, though. As it is, I only see a GP at present and I always meet with him directly. Guess I'm lucky.

No Daivd, I like my NP's. They take time and i enjoy speaking with them. However they cannot do it all. Some doctors do not yet know that about them.

I see a NP. This started when my Dr left for Iowa, then his replacement left for New Zealand for a year. I must be hard on doctors LOL


I see NPs at my GPs office, I rather like them they are knowledgeable and tend to have more time than a doctor does. I get more personalized care from the NPs than the doctor.

It used to tick me off that I still paid the same for an office visit when seeing the second string so to speak but I realized that I am getting what amounts to better care from the NP.

I should have explained more clearly. One of the reasons I like this doc so much is that he does take the time. My typical appointment lasts anywhere from 20 to 40 minutes, depending on how routine things are at the time.

Really Gary? My health plan pays about 2/3 of the amount for a NP visit when compared to a doctor visit.

If I make an appointment with my endo, I see my endo. If I make an appointment with my CDE I see her. If I have an emergent problem and call my primary care doc, I'm perfectly happy to see the NP or my Doc. I usually find the NP spends more time with me than the Doc and is generally quite competent.

I usually see the docs everywhere but at my gp, I rarely see her if I'm going in for a problematic visit then I see an np and they have just "ok" to be honest although in the past I have had good np or pa. I'm not sure if my cde is a nurse or not, but I see her only when I make an appointment, otherwise I always see my endo.