Will NPs Destroy the Job Market?

[MedicalRN]

Hello everyone,

 

I posted here lightly a few months ago, when I was in the middle of deciding between NP and PA. I'm a BSN-RN who could follow either route without a change of plan (aka: I have the pre-reqs for both). My grades are good, I went to very competive schools, I have two bachelor's degrees (other in chemistry from a top 10 ranked school before nursing school) and my GRE score is above the 85th percentile in both sections. My understanding is that I would be competetive for both PA and NP programs without much issue - and alas, and I am still undecided.

 

The main point of this post, though, is not to argue the merits of PA va NP - I have applied to both schools for next fall and will decide eventually. Right now I'm looking at the "midlevel" (for lack of a better term) job market as a whole. In general, PAs and NPs are hired for the same position types. The two professions, no matter how much they squabble, are more similar than they are different, and one cannot succeed if the other is floudering. Having said that, I am worried that the proliferation of NP programs (especially online ones) that have increased the NP graduation rate by 1000% over the last few years will harm the job market for both PAs and NPs. As I researched NP programs, I knew it seemed like there were just TOO MANY of them, and considering some seemed to take everyone who applied and were available online, I came to the conclusion that anyone who wants to be an NP can do it with little difficulty and few barriers. That caused me to lean more toward PA, as I figured the NP market was soon to be extremely oversaturated and I should avoid it - but then I realized that an oversatured NP market will also hurt the PA market. For me, who is interested in primary care or urgent care, no employer will hire a new grad PA for 85-95K when the new hire NP is willing to take 50K.

 

This is extremely concerning for me, and something I worry about often as I prepare for graduate school. I do not want to take on this debt and graduate in a few years unable to find a job, or finding that salaries have slid dramatically lower. I blame nursing entirely - they did the same thing to nursing in general, allowing hundreds of direct entry ABSN programs and online programs to open with little oversight, causing a glut of nurses not seen at any point in history. I don't want the same thing to happen to the "midlevel" profession and I am concerned that as it happens to NPs it will effect PAs as well. Anyone have any thoughts on this?

[SocialMedicine]

in my opinion the market is about to become super saturated. Over EIGHTY PA PROGRAMS ARE IN DEVELOPMENT. The university system in the United States is absurd in how it creates a business out of degrees regardless of how it positions students. PA's might be better off than NP in the future in that PAs are versatile. This is my opinion, I am sure any will disagree.

[MedicalRN]

Well FNPs are versatile as well, and that is my main concern: FNPs ruining the market for other FNPs as well as PAs. I didn't realize PA programs were exploding like that as well, very scary.

 

Part of me feels like the NP profession does have one built in "safety" that the PA profession does not - all NPs are RN's and must maintain their RN license to remain an NP. As such, the NP salary could never dip below the RN salary for an area, as NPs would simply be able to return to their RN roots. This creates a floor of about 50-60K in most areas, and as high as 70-80K in other areas. PAs on the other hand have no fallback - if an out of work PA had to pay bills and the only job offer was for 45K, they have no choice but to take it.

 

I know it seems odd to imagine a career where current salary average are 90-100K to drop to the 40-50K range, but that is exactly what saturation does. Look the the veterinarian profession - they used to make in the 100K range a few decades ago, but due to saturation (many offshore vet schools graduating hundreds of vets per year and flooding the market) most veterinarians are unemployed and the US average veterinarian salary has dropped to $45,000 annually!! I really want to be a PA or NP, but I have trouble justifying it for such low salary. Is this a likely scenario in the future??

 

P.S. - Is the "autonomy" thing that NPs have (in theory) also a protection for low salary? NPs could just bill directly under their own license if salary became anemic, right?

[rn2pa]

MedicalRN,

I am doing the exact same thing right now.  I would rather do PA over NP (nursing education is a lot of fluff ie: nursing theory etc) but I am applying to an online FNP program as a backup to PA school.  This is primarily because of my age and I just want to be an advanced practice provider already!  I also wonder if the fact the most NP programs are turning into doctorate programs will change things?  This will mean a lot less NPs graduating every year, but now when they do graduate they will have more (albeit unnecessary) education.  Not sure what the best answer is...

 

 

 

Well FNPs are versatile as well, and that is my main concern: FNPs ruining the market for other FNPs as well as PAs. I didn't realize PA programs were exploding like that as well, very scary.

 

Part of me feels like the NP profession does have one built in "safety" that the PA profession does not - all NPs are RN's and must maintain their RN license to remain an NP. As such, the NP salary could never dip below the RN salary for an area, as NPs would simply be able to return to their RN roots. This creates a floor of about 50-60K in most areas, and as high as 70-80K in other areas. PAs on the other hand have no fallback - if an out of work PA had to pay bills and the only job offer was for 45K, they have no choice but to take it.

 

I know it seems odd to imagine a career where current salary average are 90-100K to drop to the 40-50K range, but that is exactly what saturation does. Look the the veterinarian profession - they used to make in the 100K range a few decades ago, but due to saturation (many offshore vet schools graduating hundreds of vets per year and flooding the market) most veterinarians are unemployed and the US average veterinarian salary has dropped to $45,000 annually!! I really want to be a PA or NP, but I have trouble justifying it for such low salary. Is this a likely scenario in the future??

 

P.S. - Is the "autonomy" thing that NPs have (in theory) also a protection for low salary? NPs could just bill directly under their own license if salary became anemic, right?

[MedicalRN]

MedicalRN,

I am doing the exact same thing right now.  I would rather do PA over NP (nursing education is a lot of fluff ie: nursing theory etc) but I am applying to an online FNP program as a backup to PA school.  This is primarily because of my age and I just want to be an advanced practice provider already!  I also wonder if the fact the most NP programs are turning into doctorate programs will change things?  This will mean a lot less NPs graduating every year, but now when they do graduate they will have more (albeit unnecessary) education.  Not sure what the best answer is...

Hi rn2PA,

 

I'm not sure the DNP will stop people from becoming an NP honestly...it's just an extra year or two of extra fluff courses, and again can be done online. If it were actually doctorate level education, maybe it would be a road block, but as it is now, I doubt it. I interact with nurses on a daily basis, and while there are many great ones, less than 10% are intelligent enough (IMO) to perform at the graduate level, yet it seems they are able to go on for their doctorate easily. The only conclusion one can make from this is that doctorate level nursing education is NOT being taught or graded on a doctorate level, maybe not a graduate level at all. As an RN, I am sure you have read posts over at the forum-that-must-not-be-named, and see the level of writing from "graduate" prepared nurses. The bottom line is that it is extremely easy to become a nurse practitioner and unless those in charge do something to put some barriers up, the market is on its way to EXTREME levels of saturation. The combination of hundreds of recently opened NP programs (to give you an idea, I read an article from 2001 that stated there were something like 180 NP programs in the US. There are now 800+), a lax accredidation board that will accredit pretty much any program, very easy admissions (many schools have dropped the GRE requirement and do not even require an interview), an easy licensing exam (so even subpar programs can get high levels of pass rates by forcing their students to pay for a cram course at the end), and a huge oversupply of RNs to begin with = only a matter of time before the NP market is saturated. I would go straight into PA if I didn't think the NP glut would affect PAs as well...

 

I think the biggest issue is accrediation of these degree mill schools. I think the nursing groups see more NPs as more power, but they fail to realize that a smaller group of those with more respect and influence is superior to a large group that patients and the medical community do not respect. They are focusing on quantity of quality, creating legions of poorly trained NPs that are hurting the profession.

[LKPAC]

Further diluting the quality of NP education does not necessarily adversly affect PAs. Most docs who truly understand the difference in PA vs NP education and training already prefer PAs.  If NPs make their "brand" less desirable by giving diplomas online and causing a glut, it may actually make PAs look even better in comparison.  Our profession must do more to separate ourselves from NPs and show our advantages.

[winterallsummer]

This forum is notorious for being negative about the future.  Unless someone owns a crystal ball, it is all speculation and nothing more.  In medicine we don't say "this medication will likely work because I think so," we base our ideas off data and facts.  Unfortunately we do not do the same for our job outlook, even though there are many articles which show great projected growth for PAs.  Undoubtedly the increase in NP and PA schools will not help us, but at the same time, there will always be more patients than there are practitioners.  This will only be more true with an increasing and aging population and increased access to health care.

 

We have more PAs now than ever, and our mean and median salary is higher than ever.  Every year it goes up.  And every year more programs are added.  When our salary begins to downtrend, we have some evidence to base all this negativity off of.  Until then, it is just that - negativity - and nothing more.

[FSUnoles]

considering i just lost a job offer because they hired a NP and my classmate just got denied a position because they cant hire a PA and get benefits for the EMR program they are using (a stupid clause that allows NPs) i think unless we stick up for ourselves NPs will start moving in on us. Though i think some of that will be diminished because right now they seem more concerned about picking up all the influx of people that are about to enter the system due to the ACA. They want to practice independently in a lot more states so they can fill the primary care gap. So i say let the MDs and NPs duke it out for turf. We would benefit in that situation

[MedicalRN]

This forum is notorious for being negative about the future.  Unless someone owns a crystal ball, it is all speculation and nothing more.  In medicine we don't say "this medication will likely work because I think so," we base our ideas off data and facts.  Unfortunately we do not do the same for our job outlook, even though there are many articles which show great projected growth for PAs.  Undoubtedly the increase in NP and PA schools will not help us, but at the same time, there will always be more patients than there are practitioners.  This will only be more true with an increasing and aging population and increased access to health care.

 

We have more PAs now than ever, and our mean and median salary is higher than ever.  Every year it goes up.  And every year more programs are added.  When our salary begins to downtrend, we have some evidence to base all this negativity off of.  Until then, it is just that - negativity - and nothing more.

 

I agree with you here, but I think I base my negativity off of prior examples: namely, RNs and Veterinarians. Both had salaries that were high and rising, until numbers saturated the market and caused issues both in finding jobs and salary growth. I don't see how PAs and NPs are protected against this sort of trend when they are following the same path.

[LT_Oneal_PAC]

This forum is notorious for being negative about the future. Unless someone owns a crystal ball, it is all speculation and nothing more. In medicine we don't say "this medication will likely work because I think so," we base our ideas off data and facts. Unfortunately we do not do the same for our job outlook, even though there are many articles which show great projected growth for PAs. Undoubtedly the increase in NP and PA schools will not help us, but at the same time, there will always be more patients than there are practitioners. This will only be more true with an increasing and aging population and increased access to health care.

 

We have more PAs now than ever, and our mean and median salary is higher than ever. Every year it goes up. And every year more programs are added. When our salary begins to downtrend, we have some evidence to base all this negativity off of. Until then, it is just that - negativity - and nothing more.

Well said

[eddoc]

I just went to an interesting presentation that addresses the "we have no data" suggestion and the data is pretty scary.  The BLS has predicted the need for 30% more PAs by 2020.  Given the current number practicing (~82,000) that suggests that a total of 106,000 will be needed.  However, with 183 current programs and more starting we are producing, conservatively, 8000 per year.  Do the math - in 2020 we will have 130,000 PAs.  You might want to quibble with the BLS numbers but their margin of error is 1.6% - not a lot of wiggle room.  Will they all go into primary care?  Possibly but at the moment those jobs don't exist.  Will it drive the salary down?  Hard to say but it seems like they would at least plateau.

[LT_Oneal_PAC]

I just went to an interesting presentation that addresses the "we have no data" suggestion and the data is pretty scary. The BLS has predicted the need for 30% more PAs by 2020. Given the current number practicing (~82,000) that suggests that a total of 106,000 will be needed. However, with 183 current programs and more starting we are producing, conservatively, 8000 per year. Do the math - in 2020 we will have 130,000 PAs. You might want to quibble with the BLS numbers but their margin of error is 1.6% - not a lot of wiggle room. Will they all go into primary care? Possibly but at the moment those jobs don't exist. Will it drive the salary down? Hard to say but it seems like they would at least plateau.

So no one is going to retire in the next 7 years? More than 16,000 are over 50 as of 2010.

[MedicalRN]

There has been a rampant increase in the number of nurse practitioner enrollees and graduates in the past few years. Data from the American Association of Colleges of Nursing (AACN) and the National Organization of NP Faculties shows enrollment has increased from 20,824 in the 2004-2005 academic year to 35,371 in 2009-2010. Graduates have increased from 6,220 in 2004-2005 to 9,203 last year, almost a 50 percent increase. With enrollment and graduation numbers looking up, it's a strong indicator that it's a good time for those that are interested to enter the field and to find jobs as NPs. - Healthcareers.com

 

In a little less than 5 years, the number of people in NP programs has nearly doubled. The number graduating has gone up by nearly 50%. PA programs, too, have had a similar increase percentage wise. Both professions are opening new schools at an alarming rate. All of the "we need more PAs and NPs" talk is based on data extrapolated from previous years, without taking into account the mid-level "gold rush." Everyone and their mother is going to school to either be an NP or PA, and I think we will far exceed the "need" by the year 2020.

 

If there wasn't historical evidence of this happening before, I would be less worried - but it happend with RNs. For decades they talked about the "nursing shortage." They talked about how by the year 2020, we could have such a severe shortage we have to close down hospitals. They extrapolated data showing the US needing hundreds of thousands more nurses. What they didn't account for, though, was the dramatic increase in people going to nursing programs in the last decade. It's skewed everything, and now the new graduate RN unemployment rate is nearly 50% in some areas of the country. I saw one statistic that California could close EVERY nursing program in the state, and they would still have a 20+ year oversupply of nurses. It's very scary, and I see the same thing happening with the NP and PA profession in the future.

[Lexapro]

Go into psych. Problem solved!

[aquafresh11]

Even if you are right (which I don't think you are, the sky is not falling) by the time it happens, you would have graduated school years earlier. You will have had years of experience, and developed many professional relationships. You as an experienced provider would have little problem getting or keeping a job, it would be the new grads who are screwed.

 

You see that in the nurse saturated areas of the country, a new grad is SOL but experienced nurses can still get jobs. But then again if the new grads branched out, they could still easily get a job. The critical access hospital in my town still offers sign on bonuses for RN's.

[MedicalRN]

Even if you are right (which I don't think you are, the sky is not falling) by the time it happens, you would have graduated school years earlier. You will have had years of experience, and developed many professional relationships. You as an experienced provider would have little problem getting or keeping a job, it would be the new grads who are screwed.

 

You see that in the nurse saturated areas of the country, a new grad is SOL but experienced nurses can still get jobs. But then again if the new grads branched out, they could still easily get a job. The critical access hospital in my town still offers sign on bonuses for RN's.

 

If we are talking 10 years+ from now, yes I agree with you I would probably be okay. My concern is, for both PA and NP programs (which I applied for Fall 2014) I will be graduating sometime in late 2016 early 2017. By then the market may have already been saturated - that's my major concern.

[EMEDPA]

So no one is going to retire in the next 7 years? More than 16,000 are over 50 as of 2010.

I was thinking the same thing. many em pa's I know are > 55 yrs old and already talking about an exit strategy....

[aquafresh11]

If we are talking 10 years+ from now, yes I agree with you I would probably be okay. My concern is, for both PA and NP programs (which I applied for Fall 2014) I will be graduating sometime in late 2016 early 2017. By then the market may have already been saturated - that's my major concern.

 

There can be an argument I suppose about what job prospects look like long term, but I think you have absolutely nothing to worry about in either profession with regard to the next 3 years. It almost defies logic to think otherwise in such a short time frame. 

[CeliaKayPA]

Hi MedicalRN,

 

I just graduated in August and when first starting to look for a job was feeling very discouraged.  I relocated to a new city following graduation, and realized that it was a much more NP-dominated city than where I went to school.  I received countless emails responding to positions I had applied for stating that they were only looking for an NP.  Luckily, right before taking my boards I was able to get a position working in Urgent Care starting at a higher salary than I would have expected.  I've wanted to be a PA since I was in high school, so I thought the risk was worth going for.  As several others have already stated, I think that once you get out of school and begin practicing, having the experience will be invaluable in a surge of new graduate PAs and NPs does occur.  Best of luck to you in making your decision! 

[mr.misnomer]

First, let me say that I am not 'bashing' NPs in this post. This is my personal experience and I am sharing this in response to the OPs quandaries. 

 

Medical RN, I'm a recently graduated PA that has earned my chops in Family Med and am transitioning to Ortho clinic/surg. In school, during rotations, I worked with a number of MDs, DOs, and groups that hosted NP students while I was rotating. I asked a few what their thoughts were on NP vs. PA students. Two (one MD and one DO) stated that they found NPs more difficult to host because they had learned medicine in the 'nursing model' not the 'medical model'. After working with a few NPs I find them knowledgeable and pleasant. I do believe there is a difference between us though i cannot put my finger on it. I think there is a grudge match buried somewhere in there but, who knows...

 

One thing I know for sure is that PAs make more and statistically, hold more specialty and sub-specialty positions. PAs get bigger raises and, although some argue that NPs can run their own practice, few do (there are some states that allow PA run practices too). There is no mid-level crystal ball to tell our futures. The ACA will create thousands of jobs and, eventually, PA/NP jobs will be like lawyer jobs, both coveted and hard to break in to. I know that once you are established and have proven yourself to be an excellent practitioner you will have job security. This is not a 'bargain basement' field. Doctors and hospitals pay top dollar for good mid levels so that they can profit and not get sued for malpractice. I think your concerns about loosing your $80k job to a $50k low baller are probably unfounded. 

 

I wish you the best and have one bit of advice for grad school. Take naps!

[rcreek]

One group of emergency physicians I know well have told me that they will never look to hire an NP because they prefer the medical model of training that a PA receives. The orthopedic physicians feel the same way and have told me that they all eventually want their own PA after seeing how great they are. This is in the western United States just to give you an idea.

[bobuddy]

In my state -there are no independent physicians left.  They have all become employees of the hospitals or work for contract groups.  The docs now have no say so on who is hired - PA vs NP.   They are just another employee. 

[Bodiggler]

Well FNPs are versatile as well, and that is my main concern: FNPs ruining the market for other FNPs as well as PAs. I didn't realize PA programs were exploding like that as well, very scary.

 

Part of me feels like the NP profession does have one built in "safety" that the PA profession does not - all NPs are RN's and must maintain their RN license to remain an NP. As such, the NP salary could never dip below the RN salary for an area, as NPs would simply be able to return to their RN roots. This creates a floor of about 50-60K in most areas, and as high as 70-80K in other areas. PAs on the other hand have no fallback - if an out of work PA had to pay bills and the only job offer was for 45K, they have no choice but to take it.

 

I know it seems odd to imagine a career where current salary average are 90-100K to drop to the 40-50K range, but that is exactly what saturation does. Look the the veterinarian profession - they used to make in the 100K range a few decades ago, but due to saturation (many offshore vet schools graduating hundreds of vets per year and flooding the market) most veterinarians are unemployed and the US average veterinarian salary has dropped to $45,000 annually!! I really want to be a PA or NP, but I have trouble justifying it for such low salary. Is this a likely scenario in the future??

 

P.S. - Is the "autonomy" thing that NPs have (in theory) also a protection for low salary? NPs could just bill directly under their own license if salary became anemic, right?

 

**Be careful what you read. When they made the $45,000 claim they counted all of the students who went to veterinary medical residencies making $25-30k per year. My fiancé is a veterinarian and she started in the mid 60's with no call weekends at a humane society. Humane societies are on the lower end of the pay scale. She has friends that did private practice right out of school. They started at $80k. People will start to realize that NP programs aren't doing their job. How does an advanced nursing statistics course compete with a surgical skills class? I am willing to get into debt about $150k to be a PA. I am the cheapest person on Earth. I believe!!!

[Guest JMPA]

dont feed the troll