The wide world of healthcare
January 29, 2014 10:00 AM   Subscribe

Calling all nurse practitioners: tell me about your career.

I'm a humanities Ph.D. student planning on switching to a healthcare career when my dissertation's done in a couple of years. I asked this question about the feasibility of medical school a couple of weeks ago and got some great answers, but I've been doing a little reading about nurse practitioners and am thinking that the NP path might be a better option for me, especially because my interest is in primary care. I have no interest in being a hotshot specialist; I want a stable but flexible career that lets me help people every day. I am also a bit of a public health geek and feel very strongly about preventative and holistic care.

If you are (or have a loved one who is) a nurse practitioner working in primary care, what does your everyday look like? Do you ever regret not having the MD? Do you have opportunities to work in public health advocacy? Bonus: Did you (or someone you know) become an NP after working in a completely unrelated field?

Because I know that the job market for NPs varies by state, I'm in the Northeast and am planning to stay in New York or New England long-term. I'm quite interested in the MGH direct-entry MSN program and similar options.

(This question was asked before, but all the way back in 2005-- I'm thinking that the expanded user base and new developments in American healthcare might make answers look a little different this time around)
posted by oinopaponton to Work & Money (10 answers total) 5 users marked this as a favorite
I'm in a professional doctoral program in the health sciences right now (not nursing), but I've heard from nursing students that they're having a really hard time finding jobs out of these direct-entry MSN programs. Since 2005, the number of these programs have gone up immensely and entry into the programs and job-finding has led to a lot of anxiety and worry and trouble. There are lots of the direct entry master's programs that lead to becoming an NP, and some are insanely expensive. There were a bunch of WaPo articles about how hard of a time some of these graduates
were having in finding employment, never mind finding flexible hours and so forth. So be realistic.


A lot of people are clambering for this kind of thing right now (understandably) and to be perfectly honest, lots of students in the health sciences are very interested in preventative and holistic care. You might want to do more research, reading, and shadowing of real life NP's. Not to say researching and asking on the internet isn't a good idea, it's just that meeting students and people in your desired profession with well-thought out questions is better.

Also, it might make sense to just drop of of your PhD program right now if you really are serious about becoming an NP. There's really no purpose in delaying it if you really want to do it.
posted by discopolo at 10:23 AM on January 29

One thing you might want to do if you are looking at staying where you are located, is check the local job boards for np positions. The thing you're looking to see, beyond if there are jobs listed, is whether they require the nurse practitioner have a year or two of
RN experience.

The market for nurse practitioners varies by region, specialty and supply. For example gerontological nurse practitioner positions may be in high demand in your area, or psychiatric nurse practitioners, but not family nurse practitioners. Also, the market for nurse practitioners with RN experience is great your area, but not so great for those who went straight through an MSN program, because they lose out to candidates with acute care RN experience.

You can work around this sometimes, by the way. Some students take a year off from their program after getting the RN licence to work as an RN, and then finish up their NP program.

Anyway, I know a number of NPs who do find their work rewarding, but as I said, it depends on the market in your area, and specialty choice. So probably finding out about career services at any school you are considering, and how their graduates are doing, as well as talking to nurse practitioners in your area, will be key. Also, you can see if there is a local nurse practitioner association in your area that you might be able to connect with.

Sorry for the disjointed post....I'm on my cell phone.
posted by anitanita at 10:58 AM on January 29 [1 favorite]

Sorry, not to threadsit, but as I mentioned I am planning to stay in NY or New England (most likely MA). NY and MA have among the highest employment levels and salaries for NPs according to the Bureau of Labor Statistics.
posted by oinopaponton at 11:06 AM on January 29

Oh, wait, to answer your question. I know o number of NPs, mostly in out patient settings, like a clinic or private practice. Several went through accelerated programs, transferring from other careers. Often they are seeing patients in fifteen to thirty minute appointments, similar to physicians. They are involved in assessment, diagnosis and treatment maintenance of patients. For newer NPs I highly recommend working in a practice where you aren't the only one. It helps to be surrounded by others for mentorship, particularly if you never worked as an RN.
posted by anitanita at 11:06 AM on January 29

Remember that if youre a NP you are nurse and are 'doing' nursing, so make sure that appeals to you (although your interest in preventative care suggests it does).

Do you ever regret not having the MD?

MD's are pathologists, nurses aren't, and thats a pretty big difference so it seems like it would be really rare for someone to regret not becoming a MD if they are an NP.

I know a lot of nurses and NPs, my SO is one, and when she was looking at second degree programs one thing that turned her off from programs like Yale's is that they did not offer a BSN on the way to the MSN, so that's something to keep in mind.
posted by MisantropicPainforest at 11:16 AM on January 29

I'm not a nurse practioner but a PA. Not the same thing but for the most part very similar. My everyday is probably different from the everyday you are hoping for because currently I work in a very narrow specialty. Prior to this job I did work in internal medicine for some time.

My days in primary care basically consisted of seeing a mix of same day sick visits (think urgent care type of stuff) and routine visits for chronic conditions (diabetes, blood pressure, etc). Visits were 15-20 minute slots. Some of the senior PAs were 10-15 minute slots. Essentially I was seeing anywhere from 15 patients on a slow day to 23 on a busier day, roughly speaking. Then, of course, there were prescription refill requests to take care of and lab results to review and patient call backs to take care of during the day. Often I would be bringing home my computer to finish my notes and check on labs. I really, really hated it. But, some of my colleagues loved it so it all depends on your personality.

I will tell you that there was very little time for education with these patients. If they were diabetic I sent them to the nurse who did diabetes counseling, etc. For PAs there was little opportunity where I worked to get involved in patient health education. I did work with a NP who headed up our hospital discharge program who essentially worked as part practitioner, part educator, part social worker, and part therapist. A few times I filled in for her and I thought it was a very cool job.

I left primary care because I didn't like the fast revolving door. The specialty I'm in now has longer visits and nearly half of my time is spent in education. I like it much better. I don't know how I would ever stomach going back to internal medicine.

As a NP I do think that there is more room for moving into areas like education and administration, which is nice. I agree with whoever said you really need to look at how NPs are used primarily in your area. For instance, is it a more NP or more PA friendly state (there are more NPs in my home state but I had heard it was opposite in NY). Are there more NPs in primary care or specialty care?

A random piece of advice, unsolicited, is whatever program you go into get your FNP unless you are absolutely positive you don't want to ever work with kids. I have a good friend who is an ANP and regrets doing this big time.

Finally, do I ever regret not going to medical school? Sometimes. Even after many, many years working in my specialty I will always make significantly less than my MD/DO counterparts. Mostly though the only time I feel any pangs of regret are when patients or doctors treat me like I am subpar because I'm a PA. Even when they turn around and get the same exact information and assessment from my supervising MD. That's super annoying. But it doesn't happen that often.

Good luck.
posted by teamnap at 11:51 AM on January 29 [3 favorites]

The wife of a coworker graduated with a PA degree about a year ago. It has been a rough year for her. The available jobs for new PAs tend to be at health clinics for the poor. The work load is heavy and the pay is low. Her hope is to gain experience and move on to a better paying position, but nothing is guaranteed.
posted by parakeetdog at 1:26 PM on January 29

My dad is a GP and my mom is a NP. If you're trying to decide between the two, the MD wins because simply because it pays at least 2.5-3x as much. It's also more flexible... my dad has done medical volunteer work in Haiti, been a coroner, delivers babies, does minor surgery, was the doctor for golden gloves matches and high school football games. He has a lot of options in retirement to work part time for $80-$100/hr. He also made the same salary in a rural area as he did in suburban Chicago.

My mom did ok and liked her work, but to advance in salary she had to move into managing other nurses, which was entirely an office job.
posted by BabeTheBlueOX at 1:30 PM on January 29

Please let me talk you out of this. Here's why:

1. You're not the only person that wants to get an NP. There are already legions of nurses in school working towards the same degree. Most of them have experience as regular floor nurses too.

(1.5 - You're definitely not the only RN/NP/Student that wants to work in Boston / NYC)

2. Employers will always first choose people with regular floor nurse experience. Period. Master's entry programs can work, but you you really need to have an "in" at a facility.

3. The market is already saturated in the Boston-NYC-Philly-DC metro area. Go on indeed or any job site of your choosing and run a search for NP or nurse practitioner.

4. I know several people who have NPs and make more money as regular floor nurses.

Please pay close attention to what those before me have said.

If you want to be a data wonk, finish your PhD and get an MPH. If you want to be a doctor, be a doctor.
posted by NYC-BB at 2:04 PM on January 29 [2 favorites]

Thanks for your advice everyone; I'm doing a whole lot of thinking lately and appreciate every perspective I can get. I am honestly pretty surprised by the answers here given the employment statistics and growth outlook. I'm also not at all expecting to walk into a plum job in New York City (I'd be more than happy to work upstate or in rural New England). I've looked at jobs on Indeed, etc. and thought there were quite a lot (something like 3000+ listings in my preferred geographical area), but of course I'm coming from the perspective of an academic so my expectations are very low. In any case, if my understanding of the data is wrong I'm much happier learning that now than 5 years and $XXX in debt from now.
posted by oinopaponton at 4:32 PM on January 29

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