Nurse practitioners make twice as much as family doctors per patient

Note: This article was originally posted on Dr. Shawn Whatley's personal blog on Feb. 14, 2015Nurse practitioners (NPs) make twice as much as family doctors per patient. It costs between $130,000 and $140,000 to hire one full-time NP. That is, an employer must fund salary, benefits, and salary for replacement staff when the NP is on holiday. This is a standard calculation for all salaried positions in hospitals, industry and private practice. An NP experiences this as an annual income of around $110,000, plus benefits.In capitated practices, individual providers roster (enrol) patients into their practice. Clinicians care for their rostered patients and see their colleagues’ patients if urgent needs arise.Note: Capitation pays doctors an annual fee, in monthly installments, for all the care each patient requires. Physicians can work toward earning small bonuses if they meet screening targets. These are bundled into the calculations below.A full-time family doctor (FP) rosters 1,600 to 2,000 patients; some carry more. A full-time NP rosters 300 to 400 patients and cares for them as their primary provider, with a physician serving as backup. An NP receives the same salary regardless of his or her patient roster size.Nurse practitioner pay per patient$130,000 income / 400 patients = $325 per patient per year.If 300 patients, NPs earn $433 per patient per year.Family doctor pay per patient$200,000 (net) / 1,600 patients = $125/patient/year.For 2,000 patients, an FP will net around $240,000 = $120/patient/year.At $125 per patient, family docs would earn $50,000 annually to see the same 400 patients as an nurse practitioner. This equates to $40,000, plus 20% benefit package. Per patient, family doctors get paid 38% to 29% of nurse practitioners.In addition, nurse practitionersDo not have the headache of paying overhead.Do not spend unpaid time managing overhead/office, and do not assume the legal risks of owning an office.Do not prescribe narcotics or controlled substances, distancing them from a challenging group of patients.Have doctors for backup, decreasing NP liability.Leave the most complex patients for FPs to sort out.Get lunch breaks.Do not take call after hours.Can forget the office when they go on vacation.Many family doctors tell me the NP deal looks attractive. These docs would love a slower pace. If the government offered to pay NP rates for a roster of, say, 500 to 600 patients with the same benefits, I know many physicians would jump at the opportunity ($325 x 600 patients = $195,000).But NPs spend so much time with patients! They practise unhurried holistic care. Family doctors rush and treat people like cattle.Many family doctors would love to practise the same unhurried holistic care, completely insulated from any concerns about anything beyond the 7.5-hour work day.Income inequalitySome doctors work faster, roster more patients and earn four times as much as a nurse practitioner. People then assume that all doctors are fat cats. No one cares about how hard a doctor works to earn a larger income. Voters see doctors working harder in terms of cheating patients with shorter appointments. The public assumes that taking longer to provide care equals more care overall.Insurance vs. managed careGovernment has changed medicare from health insurance into managed care. Central planners obsess over inputs instead of outputs, costs instead of service and quality. Time becomes a key component of any input-centered system. Longer care becomes quality care. Obsession with input combines with an ideological commitment to income equality. Perverse incentives arise when central planners arbitrarily fix incomes to meet chic social promises.In the end, patients lose out. When one provider makes twice as much per patient for easier work, the lower-paid provider adjusts his or her service accordingly. They don't do it consciously but it happens nonetheless.Nurse practitioners provide enormous value when properly trained to use all their abilities as part of an interdisciplinary team. But they are not cheap. Governments know that. For primary care, family doctors offer an incredible bargain. Politicians just won’t admit it.Addendum in response to comments and Tweets about this topic:Some folks have commented on my personal blog (where this article appeared Feb. 14) that NPs will sometimes enrol up to 900 patients, in some places in B.C., for example. They also say that, after benefits are taken off the roster, an individual NP might earn only $90,000 annual income.If these figures are taken as true for some jurisdictions, then we get:NP cost = $90,000 / 900 patients = $100 per patient per yearIf we use the $200,000 net family doctor income, that equals $160,000 salary, after 20% for benefits. Full-time family practice is generally thought of as between 1,600 and 2,000 patients.FP cost = $160,000 / 1,600 patients = $100 per patient per year ($80/patient/year if 2,000 patients)So, even if we grant an NP roster size of 900 patients, which I’ve never seen, and forget about the total cost to hire a full-time NP, we arrive at $100/patient/year for both NPs and FPs.Family doctors have many more years of training, assume much greater responsibility, have higher medico-legal risk and see the sickest patients. Even if we grant the numbers from the comment above, family doctors still provide an outstanding bargain for the services they provide.Dr. Shawn Whatley has worked in emergency medicine, as a coroner, in a vein clinic, and as a surgical assistant. He also held a leadership role at a large suburban hospital. He now practises family medicine in rural Ontario. Visit his blog at shawnwhatley.com.

Nurse practitioners make twice as much as family doctors per patient

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