By Heather Zamarron, Guest WriterAfter completing my 27-month physician assistant program, I accepted a job at a local urgent care company. When I received the first paycheck from my new six-figure salary, I remember thinking, “How could I ever want more money than this?” Unfortunately, I had never heard of The White Coat Investor and had no idea how to manage this money. My husband and I bought a new Ford Raptor that he had wanted for a few years. I convinced myself he “deserved it” after supporting me through school. This purchase, coupled with a prematurely inflated lifestyle of travel and luxury, changed my attitude toward the amount of money I was making. Suddenly, I was slightly envious of the multiple six-figure salaries the new doctors around me were making fresh out of residency.
I considered medical school while in college but ultimately decided against it after a brief experience shadowing a PA. I felt I could fulfill my desire for patient care as a PA while starting my life a little sooner. I wanted to get married, and I was not interested in putting off starting a family for 10 years through medical school and residency. Despite previously being confident in my decision, I began to wonder if I made the wrong choice based solely on the salary difference. This led me on a mission to earn more money.
According to the US Bureau of Labor Statistics, the average PA made $126,000 in 2022, while the average physician made $352,000 in 2023 (Medscape in 2024 said it was $363,000). These statistics are a little misleading since physician salaries vary greatly depending on specialty. For example, the average primary care physician makes a more attainable $277,000 a year. Using this number as our goal, I see at least three ways advanced practice providers (APPs), including PAs and NPs, can earn “doctor money.”
Practice Ownership
One clear path to making more money in medicine as an APP is to start and own your private practice. Our role in practice ownership lies mainly in primary care and urgent care. As an employed APP, you are paid a salary to see patients, generating revenue as your employer bills for your services. Your employer earns a profit if what they collect is more than your salary and the overhead it costs to run the practice. Cutting out the middleman means more food at your table.
The Need
Let’s just throw the cards on the table. To some physicians (and patients), the topic of APPs owning their own primary care practice is controversial. Some patients still don’t know the difference between a doctor and an APP. Some know the difference but don’t care, and there is likely a small minority of patients who prefer only to see a doctor. However, I believe most people want to see a provider who listens to their needs, who is knowledgeable in their medical decision-making, who projects confidence (not arrogance), and (most importantly) who is accessible.
Perhaps this controversy is becoming moot as the US is experiencing a severe shortage of primary care providers. A February 2024 article from CNN titled Where Are the Nation's Primary Care Providers? It's Not an Easy Answer illustrates the problem. In the graphic below, via KFF Health News, the bigger and darker dots show how big the healthcare professional shortage is in that area.
Geography, therefore, may play a pivotal role in whether APPs are accepted by the public as primary care providers and practice owners. In urban areas with an abundance of doctors, physician-led practices may have an advantage. However, in rural, underserved areas, APPs have an opportunity to step in and fill a healthcare need while building a profitable business.
What Practice Ownership Requires
Patience and Patients
Building a successful medical practice takes time and requires patience. You can't expect to leave your job making $150,000 and make that amount of money in your first few years of practice ownership. You might take a pay cut before seeing the fruits of your labor. It is also not a short game. When you open your practice, you sign up for at least 10 years of hustle. After all, when you own a family practice, you are the business.
You also need to see a lot of patients to make doctor money. This isn't the job where you will see 10-15 patients a day and make multiple six figures. Successful family practice owners need to see 30-40 patients daily to make the kind of money we’re discussing. Eventually, you might have the opportunity to hire another provider and be more flexible with your scheduling, but initially, it's all you. You have to expect to work hard.
Expanded Services
Over the years, primary care providers have been forced to see more patients in less time to make the same money, partially due to lower reimbursement rates from insurance companies. As a medical business owner, there are only two ways to make more money in primary care: see more patients or collect more per visit.
If you want to make doctor money but don't want to have to see 40 patients or more every day to do so, you can create other streams of income. It is common to see medical spas or hormone replacement therapy added into family practices to create recurring cash-pay patients.
At my website, we interviewed an NP whose primary business is a single-provider clinic in Midland, Texas. Over the past six years, Kevin has grown his family practice to 30-50 patients daily and has opened an adjacent medical spa as well.
Disadvantages of APP Practice Ownership
While owning your practice can be lucrative, it isn't easy. Owning and running a medical practice is hard work. And, like all investments, increased returns come with increased risk.
Hard Work
Successful medical practices require hard work. As you grow your practice, throw away your dream of an eight-hour schedule and expect long days and sleepless nights. Expect to work weekends in the clinic to attract more patients or to hold community events. Get used to seeing your shining face on billboards and TV ads, because, in a family practice, you are the business.
Financial Risk
Becoming a clinic owner will likely involve taking on debt to cover the office buildout, supplies, furniture, and medical equipment. In addition to upfront costs, you'll need to consider your ongoing expenses, including payroll, utilities, insurance (malpractice and benefits), and your office lease. Most landlords will want a five-year lease when you start, whether or not your practice is ultimately successful.
Medicolegal Risk
As providers, we all assume some medicolegal risk when seeing patients. As a business owner, you carry more risk, especially if you live in one of the 28 states with full practice authority for NPs or the five states that allow autonomous practice for PAs. Without a supervising physician, you are ultimately responsible for everything that occurs in your clinic.
Should this encourage you to still seek collaborative agreements with physicians, even if it is not required? Studies have shown that working in a private practice carries the greatest risk for malpractice claims when compared to other specialties. The AMA has shown physicians in solo practice tend to have the most malpractice claims against them, and the CNA and NSO have shown that NPs in an office practice are at the highest risk for license complaints against them, with 60% of claims being for violations of the scope of practice and standards of care.
One way to mitigate this liability risk is to still have a collaborative or supervising agreement with a physician. This will increase the financial requirement of owning your practice, as you can expect to pay $500-$2,000 monthly to your supervising physician. This number will vary widely depending on time requirements, expectations, and involvement from the physician. However, having a physician you can collaborate with on patient care is one step you can take to provide better patient care and to share liability responsibility.
Financial Upside: The Sky's the Limit
So, how much can you earn owning and running a medical practice? This will vary based on location, payer mix, patient volume, and services rendered, but ultimately, the sky is the limit. I know a local PA who owned his practice and regularly made nearly $300,000 a year before selling his practice to a physician-based group.
This amount is likely the ceiling with you as the only provider. After all, you can only see so many patients in a day. Eventually, you will need to hire other providers to work for you to make more.
[FOUNDER'S NOTE BY DR. JIM DAHLE: Like most physicians, I’m not a fan of the independent practice of APPs. I think a significant level of supervision is important to maintain a high level of patient care, particularly for new providers. However, it’s important to recognize reality on the ground. Twenty-seven states, mostly in the West and Northeast, have granted NPs the legal right to practice completely independently. Another 12, mostly in the Midwest, allow “reduced practice authority,” while the remainder requires total supervision. While PAs are required to have some level of supervision in every state, the degree of required supervision is highly variable. From an economic perspective, the cost of supervision can be a significant issue. You’re going to have a hard time finding a doctor willing to provide any real supervision for $2,000 a month, much less $500. However, the more supervision you desire or need, the less money you make. The incentive is to get as little supervision as possible—which can have both medicolegal and, more importantly, quality of care implications. Choose wisely.
That said, this is a COMPLETELY different issue from practice ownership. I’m a big fan of being an owner, whether it be your house, your investments, or your practice. While the vast majority of APPs are employees and not owners of practices, there’s no reason they can’t be. A physician can certainly offer ownership to an APP and vice versa.]
More information here:
Physician Assistant Financial Education
Life and Financial Lessons from a ‘Bad Ass’ Nurse
Hustle and Grind
The second way to make “doctor money” is to increase your workload. One of our greatest assets as APPs is career flexibility. You can use this to hustle your way to higher income. This will look different for everyone, depending on where you are in your career and life. It helps to start early when you have more energy, enthusiasm, and debt (and less money).
Logistics
If this is your strategy, pick a job that has a flexible schedule and shift work. For example, working in the ER or an urgent care facility may only require 10-14 monthly shifts to be considered full-time and receive benefits. This allows you half of the month to pick up extra shifts or get another part-time job.
Many remote or clinic jobs have flexible schedules if you want to avoid shift work. This flexibility allows you to find a second job to make additional money.
There are endless work arrangements available. For instance, I know a provider who works full-time in the ER and rounds on nursing home patients for a few hours every morning when he gets off. Another colleague works full-time as a fire captain as well as full-time in the ER. These arrangements bring two full-time salaries in exchange for grind and hustle.
The Downside of the Hustle
The biggest limiting factor is making sure you don’t burn out. I know very few people who can maintain this strategy for years. Most of us will reach a point where working 20+ days a month isn't feasible. I know a PA who made $250,000 a year working that schedule in urgent care, but they could only maintain it for a year or two. Hustle while you are young and hungry but expect you will one day reach your limit and tap out. The goal is to make some financial strides while you can still maintain the volume, pay off debt, learn to invest your money, and don’t overly inflate your lifestyle.
Financial Upside: Twice Your Current Salary
There are 168 hours in a week. Medical residents are legally capped at working 80 hours a week for a reason. Working more than this was shown to be counterproductive and dangerous. It's possible you could sustain 60 hours a week, earning 1.5x your current salary. Any more than this, and it's short-term only—with a theoretical maximum of 2x your current salary.
Entrepreneurship
The final way for an APP to earn doctor money is through entrepreneurship. This can include medical-related endeavors, such as opening a billing/coding company or a consulting business— or virtually any non-medical business you can think of. The possibilities and financial upside are endless, although my favorite method is real estate.
Starting and Running a Business
Finding a business you want to open is the first step. When I started down this path, I only knew that I did not want to do anything related to medicine. I already had a fulfilling medical career and wanted to try something new. Once I educated myself in personal finance and real estate investing, I opened a wholesaling business with the $20,000 we made from selling the Ford Raptor we had irresponsibly bought when I graduated. I learned about wholesaling by listening to the BiggerPockets podcast. I learned that you did not need an extensive amount of money for a startup, and you never had to acquire the property to make a profit. Growth and delegation are my two biggest struggles in this business currently, but I have learned what it means to be a business owner through the process.
One advantage you have as an APP is your above-average medical income, which you can use to start a business. Although maintaining a full-time job while running a business is certainly not easy, it is no different than options 1 or 2. Hard work is the recurring theme of making doctor money. When I started my real estate business, it was like I suddenly never clocked out. Every spare moment I wasn’t at work was spent working on my business.
Disadvantages of Entrepreneurship
Time
Other than the memes joking that entrepreneur is a synonym for unemployed Millennials, there are some real drawbacks to opening your own business. As an entrepreneur with a medical career, your workload will no longer be limited to your regular job. Your business continues running (and having problems) when you are trying to eat dinner with your family or going on vacation. Delegating tasks to others is the goal, but it usually takes time to get there. After 2 ½ years, I still have not gotten out of the day-to-day management of my business. I see the light at the end of the tunnel and I have witnessed this be successfully done in companies similar to mine, so I won’t lose hope that I can make this happen as well. But doubt occasionally creeps in. As an entrepreneur, fear of failure will be one of the biggest things you must overcome.
Risk
Like practice ownership, business ownership comes with a time commitment, financial risk, and even partnership risk. I ran our real estate business with my spouse for the first year and discovered how difficult it was for us to run a business together. We eventually decided for him to step away from the wholesaling business and focus on his own business as a real estate agent, which has been much better for our marriage. Friendships and relationships can be ruined unless clear boundaries are created and respected. You can make the wrong investment and lose a lot of money trying to make a business successful, or you can waste a lot of time and energy on a business that ultimately fails.
Financial Upside to Entrepreneurship: Unlimited
Entrepreneurship is high risk, but it can bring high rewards. The amount of money you can make is unlimited. Success is unlikely to occur overnight, but it is obtainable with education, hard work, and perseverance.
[FOUNDER'S NOTE BY DR. JIM DAHLE: A fourth way for APPs to make doctor money is to be more selective with your job and career selection. Just like with physicians, there is a very wide range of incomes within a given specialty, so it should be no surprise that the salary range of highly paid APPs overlaps with that of poorly paid physicians. Some fields, such as CRNAs, already enjoy physician-like incomes with salaries ranging from $190,000 (25th percentile) to $348,000 (75th percentile).]
More information here:
How I Made $30,000 Taking Doctor Surveys
Here’s the Best Way Ever to Get Passive Income – But Good Luck Getting It for Yourself
The Bottom Line
As an APP, I am thankful that I chose this career path. I don't envy doctors or their salaries anymore. I am grateful to have completed school and begun my career at 25 with under $100,000 in debt. But remember: whichever path you decide to take to make doctor money, none of it matters if you just spend it all. Plenty of physicians make multiple six figures but do not achieve financial independence because they spend all their money on their lifestyle.
It is important to understand that, as medical professionals, we have to take control of our financial lives through knowledge and disciplined financial management. Read blogs like The White Coat Investor and learn the basics of personal finance, investing, managing your taxes, insurance, and retirement planning. Pay off your debt quickly and efficiently, learn how to start investing your money to make money for you, and avoid prematurely inflating your lifestyle.
These are great steps to take in becoming FI—whether you’re a doctor yourself or a PA like me wanting to make doctor money.
If you're an APP, have you tried to increase your salary? What have you done? Has it worked?
Heather, this article is incredibly insightful and motivational for APPs looking to boost their income! Your personal journey and practical advice on practice ownership, hustling, and entrepreneurship are eye-opening. It’s great to see a focus on ethical financial management and the importance of not inflating one’s lifestyle prematurely. Thanks for sharing your experiences and strategies—definitely inspiring for anyone in the medical field!
Ah, so it was all about the money. The typical NPP thought process. It makes sense since you don’t place the time and effort to have the depth of knowledge to take care of patients independently, just how to make that doctor. Screw the patients, am I right? Absolutely disgusting.
Thank you for your comment. I want to clarify that my commitment to patient care is unwavering. I take immense pride in the care I provide, both in urgent care and in the ER. I strive to ensure that every patient I see receives the best possible treatment, and I believe that my dedication and compassion are integral to my practice.
However, the reality of my position is that I have a unique opportunity with my schedule. With 20 days off each month, I have the time and capacity to pursue entrepreneurial ventures that can secure a successful financial future for my family. I encourage any healthcare professional, including physicians, to explore opportunities that allow them to balance their professional responsibilities with personal growth and financial stability.
My focus is always on providing excellent patient care, and I firmly believe that it’s possible to achieve both professional fulfillment and financial success. Thank you for engaging in this discussion.
Dont listen to the trolls or read the comments. The article is great and I apologize on behalf of all the physicians that will try and bring you down.
This article is about pros and cons options of increasing reimbursement. Quality of care is when patients choose a provider and even leave with the provider if provider changes locations. I know 2 scenarios when patients decided to leave their physicians locations and follow APPs in a new practice.
You are disgusting for such an uneducated, disparaging remark. Equal pay for equal work is not disgusting, it is fair.
I think you’re missing the point. I’ll presume you don’t work urgent care or ER. We (APPs) work very hard, often out pace the MD/DO for a fraction of the cost. We work for large medical groups that are ran by business majors. The CEOs have become the queen bees and the trained medical professionals the worker bees. This article is about taking back control, cutting out the middle man – accountants/business majors.
Heather, a few points. Be content with what you make financially for the amount of schooling you had and responsibility you take on. Don’t forget that there are nurses and other para-professionals who look at you and think they wish they made “PA or NP money”…..some have a BS degree and an MS, MPH, MBA or MHA and don’t make your type of money but feel they should. Physicians have a lot more education and responsibility than mid-levels. Please remember this when wishing for a higher salary. Just remember, “be careful what you wish for…..you may get it”.
Thank you for your comment. I truly appreciate the opportunity to earn a six-figure salary with my educational background, consisting of three years of undergrad and 27 months of grad school. I love the work I do and take great pride in caring for patients independently as a PA.
However, I believe that I don’t have to settle for my base salary when there are opportunities to use my extra time to hustle, make more money, and achieve financial independence. It’s possible to balance professional responsibilities with entrepreneurship to create a better future for my family. I think everyone, regardless of their profession, should be encouraged to find ways to maximize their potential and financial stability.
This is well side Heather. None of us should settle for less if we can earn more. I love your article and it provides multiple valid points for many of us AAPs to consider working on. Thank you for sharing.
Uh … I had 25 years of critical nursing and teaching/supporting house staff before I got my masters degree and became NP. I have the training and skills to manage almost any clinical position an md is employed in. I do not do surgery. I diagnose and treat just the same as an md in either a primary care setting , an a urgent care setting or an acute care setting so yeah, I should earn what any md makes doing the same work . Yes it is about the money, I earn it
An MD has much more education and more clinical training than an APP. NPs go to school for 6.5 years which includes the clinical rotations. MDs go to school (and residency) for a MINIMUM of 11 years and up to 15 or 16 years before they are practicing independently. There is no comparison in the fund of knowledge and education.
I’m an NP with prior non nursing bachelors degree and I do not expect to make the same amount of money as an MD.. I don’t understand why any NP or a PA would feel entitled to make the same amount as a medical doctor.
That pathway to being an NP is becoming more and more rare these days Suzanne. Some people are going straight from nursing school into online NP programs and many are going after just 1-2 years of clinical experience. That’s very different from what you did. The variation in what you get with an NP is dramatically larger than what you get with a residency trained doc. As far as your last sentence, do you think a brand new NP should get paid the same as you to see the same patient? If not, how would a system be designed that would pay differently?
Thank you so much for your positive comment! I love being able to encourage other medical professionals on how to maximize their time, income, and achieve financial independence. Sharing my experiences and strategies is incredibly rewarding, and I’m glad to hear that you found the article insightful and motivational. Your support means a lot!
“there is likely a small minority of patients who prefer only to see a doctor.”
I lol’ed
This post is distasteful. I see very little mention of the responsibility of caring for patients or the hard work and time it takes to safely care for patients. This writer has become so distracted by “doctor money” that she can’t actually think clearly. And you know what, I worked hard and earned my money. I didn’t wake up one day and say I WANNA MAKE DOCTOR MONEY. Really really disappointed to see this garbage here.
It’s a financial website. I’m not surprised to see the focus is on compensation and income.
Hey, why focus on patient care when you can make DOCTOR MONEY without all that boring med school and residency and fellowship stuff?!
There are certainly plenty of docs asking that when the burnout rate is 50%+. At some level, it’s still a calling right?
To be fair, most posts on this website don’t give much mention to the responsibility of caring for patients safely. It’s a financial website.
Nowhere did I get the impression that it was all about the “doctor money” without regard to patient care when I read this article. My impression was that we were discussing business, and various options that would increase revenue. However, I do take issue with the comment made about APPs needing extensive “supervision”, and I think my 2 collaborating physicians would have as well. There are a vast difference in caliber of APPs and I suggest to the MD who made that comment to “choose well” as in the right “collaborative “ agreement with an experienced APP known to you, especially if you’ve worked together previously and practice similarly, will not require you provide a lot of “supervision”. I’d advise against entering a Collaborative Agreement with an NP who went straight from an RN program to NP program without several years’ clinical practice experience between the two programs. Or a PA with no clinical experience, in an independent practice role early in their career.
I agree the amount of supervision needed falls as the years go on, but personally, I don’t think it ever falls to zero.
Certified Registered Nurse Anesthetists (CRNAs) are a part of the Advanced Practice Provider (APP) group. We are highly compensated and in high demand, often serving as solo practitioners in small centers and rural areas. Despite our crucial role, CRNAs remain relatively unknown to many people.
Thank you for your comment! Certified Registered Nurse Anesthetists (CRNAs) are indeed an essential part of the Advanced Practice Provider (APP) group. It’s incredible how highly compensated and in demand CRNAs are, often serving as solo practitioners in small centers and rural areas.
Living in a small community that relies almost exclusively on CRNAs in the OR, I can personally attest to the invaluable role they play. Our local healthcare facilities wouldn’t be able to staff their operating rooms without the expertise and dedication of CRNAs. It’s truly a great career, and we’re fortunate to have such dedicated professionals in our communities.
What about earning doctor $ by doing things the right way aka going to med school?
I had many female classmates who married and had children in med school and residency, so your implied argument is pretty cheap.
Lastly, I’ll leave this here. This is the WCI, right? Nothing comes for free in this world.
https://www.bloomberg.com/news/features/2024-07-24/is-the-nurse-practitioner-job-boom-putting-us-health-care-at-risk
Thank you for your comment. I know several physicians who have successfully managed both their medical education and raising a family. However, for me, I did not want to delay starting a family and wanted to be an integral, hands-on part of raising my children without the added pressure of balancing medical school and residency.
I encourage all medical professionals to explore ways to maximize their time and income to achieve financial independence. Whether through entrepreneurship or other avenues, it’s important to find a balance that allows for both professional fulfillment and personal well-being.
Thank you for sharing the article. It’s crucial to have discussions about the evolving roles in healthcare and how we can all contribute to improving patient care as I would never want patient care to decline.
You know what is disgusting. Spending half my day trying to figure out what particular medication a specific insurance covers. Then spending hours on a phone trying to get testing done for a patient and pleading with said insurance company to get me the proper diagnostics covered. What I would like to do is sit with the patient I just told she has cancer and answer her questions, or do some down and dirty education for the patient that just popped a 10+ A1c. But no I am too busy seeing my 20th patient today because I am booked out for 4 weeks now and I am burning myself out trying to take care of people.
It’s a financial website…she was merely discussing the pros and cons regarding a potential course of action with which an APP could take that could lead to making more $ (and would inherently mean taking on more risk). Going to medical school and becoming an MD is not the only “right” way to make an equivalent or comparable salary, and you insinuating that it is feels insulting. I’m a PA and, while I would never personally want to take this route, I don’t appreciate you (and others) acting as if this is a ridiculous proposal.
Her sharing her reasoning as to why she chose her path wasn’t exactly an “argument,” it was her story. A primary appeal to becoming an APP is the fact that there is less time spent in school (and therefore less debt). This, of course, comes with the need for professional oversight and a lot of continued education and training after graduation/certification. If an experienced/qualified APP wants to try and increase their salary by taking on more risk, what difference does that make to you? Competition is a good thing for the consumer, and the consumer in this instance is the patient…so what’s the harm?[*again, this assumes a competent, skilled, well-trained/well-educated APP, that is comfortable in filling this type of role*].
Finally, that link you attached is to an article titled “The Miseducation of America’s Nurse Practitioners,” and I just think that it’s worth noting that the author is a PA, not a Nurse Practitioner (and there are fairly substantial differences in the education/training between the two…).
Did April Fool’s Day 2025 come early?
What a joke this has all become.
What a ridiculous state of affairs we find ourselves in.
Shame on any doc taking $500 a month to take on that liability.
The only good to come out of this is full autonomy practice should open them up to liability.
How true. I feel sorry for the doctors who “assume” such liability for 500-2000$ per month. I LOLed. So own your practice as an NP and find out how much it costs in malpractice costs. And if you should be sued then it’s the end of your career and potentially your finances. Your practice will be indefensible.
As someone else said earlier- be careful what you wish for.
YOu raise an interesting question and then make a bizarre argument.
# 1 How much IS enough to provide real APC supervision? If $500-2000 isn’t enough, is $10,000 a month? $20,000 a month? What does it take? I suspect the right number is in the $3-8K/month range but if every practice had to pay it, the whole APP model may not be so financially viable.
# 2 Nobody’s career ends because they get sued once, even successfully. Give me a break. It must be incredibly stressful to practice with a belief like that. In reality, it’s extremely rare for a doctor to lose personal assets to a lawsuit and even more rare for an APP to do so. No, the medicolegal system is a terrible way to attempt to regulate quality care into existence. Most of what’s sued isn’t malpractice and most malpractice isn’t sued.
Heather this is a very informative and insightful article. Please ignore the negative physicians who are shocked that a PA discusses financial issues on a finance website. As a CRNA I have seen CRNAs out earn physicians either by working a large amount of hours per week or by starting their own independent CRNA group. Personally, I don’t make doctor money – mostly because I work part time. However, I do demand a high hourly rate to work off shifts at a level one trauma center. If I am not there an anesthesiologist must take my place and then that is one less anesthesiologist to work the next day.
In today’s world all healthcare workers have to find a work way to work together. The negative comments reflect a lack of understanding of the current healthcare environment. For example, an orthopedic surgeon can knock out six total knees in less than 8 hours because he/she has a PA closing each case for him and managing the patients afterwards. And believe me that orthopedic surgeon is thankful and gives those PAs large bonuses for the hard work that they do because it increases the surgeon’s income ultimately.
Don’t get me started on physicians that question your ability to give good patient care. The number of times that an anesthesiologist wouldn’t get out of bed to help with complex transplants or traumas is shocking.
Good luck to you and thank you for this article.
Why is there a difference in salary between APPs and physicians? Generally because physicians have years of training, board certifications, and the depth of knowledge to be the expert leader of a medical team. There is no way a PA’s three years of school equates to physicians’ three or more years of residency training. That is why physicians command higher salaries as an attending. Don’t forget while in training residents do not get paid well financially. This post is full of hubris. Your schemes for greater income include a larger scope of practice you’re not safely qualified to do. Seriously. Can you safely think through 30 patients a day? Primary care is not easy. You’re a fool to think this is safe and you’re a fool to think you are entitled to a physician’s responsibility or salary.
Isn’t PA school still 2 years?
PA school is typically held year-round so it’s 3 academic years but shortened to 27-30 months due to attending summer semesters.
Good point, but not too different from medical school. Med studs get their first summer off, but that’s it. 2+ years would have been a better description.
Thank you for your comment. I am not naive enough to think that day one of an APP’s career and day one of a physician out of residency are the same in terms of knowledge and training. Physicians undoubtedly have significantly more training, knowledge, debt, and responsibilities when they start their careers.
However, I believe that APPs who choose medicine for the right reasons—driven by the calling to provide high-quality patient care—can uphold high standards while also pursuing financial independence. It doesn’t have to be one or the other.
Creating family practices in smaller communities and providing care to underserved populations are vital roles that APPs can fulfill. Staffing urgent care centers with APPs without physicians can provide access to care for patients who might otherwise end up in overcrowded ERs. This approach ensures that more people receive the medical attention they need, contributing to the overall health and well-being of our communities.
Thank you for engaging in this important discussion.
I watched surgical PA assisting a surgeon in interventional radiology and this surgical PA was skillful and talanted, able to perform a procedure the surgeon could not. This PA receive official recognition. Of course he got knowledge and experience not at the first day. New doctors btw frequently quite lost too especially in the area they are not familiar.
For those considering your advice to own your own practice, I would suggest you look into your state laws. In Texas it is illegal for a PA to be a majority owner of a medical practice.
Interesting. I wonder what other states have similar laws.
The corporate practice of medicine (CPOM) laws vary from state to state. A licensed physician must own a medical practice in Texas, although exceptions exist.
Under Texas law, joint ownership of medical practices is facilitated through Professional Associations (PAs) and Professional Limited Liability Companies (PLLCs). Physicians and Physician Assistants can have joint ownership of PAs and PLLCs, with physicians owning at least 51% of the business. Physicians may also partner with Chiropractors and Podiatrists.
Physicians may not partner with Nurse Practitioners in Texas. However, NPs may own their medical practices, provided they stay within the scope of practice outlined by their license. Certain hospitals and hospital districts in Texas also have exceptions to the CPOM laws.
Although I do not condone it, there are workarounds to every state’s CPOM laws. Otherwise, there wouldn’t be so many private equity-backed CMGs and Practice Managers.
I wonder if it’s the same in CA. They have a similar corporate practice of medicine law. I don’t know of any other states. Interestingly, that law gave docs a huge PSLF associated benefit in TX and CA.
Kind of weird that NPs can own their own practice but can’t be partners with docs in Texas though. Not sure anyone thought that one through.
As a long-time listener and supporter of WCI, I am incredibly disappointed that this article was allowed to be published. Why should NPPAs be entitled to “doctor money” when they don’t have the same level of education, experience, credentials, or medicolegal liability as doctors? Many articles have shown that NPPA-led care without supervision is more expensive and more dangerous. Why is WCI supporting advice that will lead to substandard care? I appreciate Jim Dahle’s comments but (at the very least) they should have been at the beginning as a disclaimer.
The physician/APC turf war is an incredibly important aspect of medicine these days and has massive financial consequences for both docs and APCs. Here at WCI we’re trying to help everyone have a great financial life so they can concentrate on what matters most. But for some reason you think WCI should just ignore this issue and not have it be discussed in our community at all? No, that’s not the right answer.
I totally get where the docs in this comments section are coming from. In fact, we basically predicted all of the comments made so far BEFORE publishing this piece. We knew there was going to be this sort of knee-jerk reaction to any discussion of APC financial success because this topic gets discussed every day on the forum, the subreddit, the Facebook group etc. We STILL thought it was an important discussion to have. Many docs would like the entire professions of APCs to just disappear but guess what, that’s not reality and wishing it were isn’t productive. Just like there are APCs that wish they made doctor money so there are docs who wish they hadn’t spent a decade in school and training just to end up making less than a hustling CRNA. Should have chosen better on both sides, but now it’s time to make the best of your situation. That’s what this post is about. How can an APC still be financially successful despite having chosen a profession that on average pays less than some others? It’s really no different, financially speaking, from helping a general dentist or pediatrician or PM&R doc do as best they can without going back to try to do orthodontics or orthopedics.
Full disclosure, I am an APP that has been an equal partner in a medical practice since 2011. The replies here are typical of physicians and their continued need to drag down APPs at every turn. If anything, the author implies she is content with her work as an APP in the ER/urgent care, but grateful for the opportunity to pursue other opportunities that her chosen vocation allows.
What exactly is wrong with the desire to earn more money? There is a large section of readers of this very website that are “hustling” to achieve their own side gigs to the very same end. Not to mention the many articles written by physicians about the success/struggles of their side gigs. No one mentions their distraction toward their own patient care while they pursue these opportunities.
Like it or not, her proposed methods of increasing one’s income are the same that Dr. Dahle and many others have recommended in the past for everyone as ways to increase their income and are reasonable and available to anyone with the gumption to take them on.
Instead of dragging down coworkers and colleagues let’s remember that this, specifically, is a financial website. I’m sure the author could post a similarly eloquent article on patient care and the fruits thereof.
Thank you for your positive response. Congratulations on your success as a partner in a practice since 2011! I love seeing other APPs hustling in their careers and achieving great things. The versatility we have as APPs allows us to provide excellent patient care while also having the time in our schedules to create other avenues for financial independence. It’s inspiring to see how we can balance our dedication to patient care with the pursuit of additional opportunities.
Nothing is wrong with earning more money. But why does the writer need to attack physicians to make that point? This isn’t just an article about financial goals.
I would like to see some evidence to back up this nasty statement: “ Some know the difference but don’t care, and there is likely a small minority of patients who prefer only to see a doctor. However, I believe most people want to see a provider who listens to their needs, who is knowledgeable in their medical decision-making, who projects confidence (not arrogance), and (most importantly) who is accessible.”
Thank you for your comment. I want to clarify that my intent was not to attack physicians but to highlight what I believe is important to patients in their healthcare experience. I understand that not everyone has access to a doctor, and my statement about patients wanting a provider who listens to their needs, is knowledgeable, and confident was not meant to imply that doctors lack these qualities. Rather, I was emphasizing that these attributes are crucial to patient care, regardless of whether the provider is an MD or an APP.
There are certainly instances where patients have a preference for one type of provider over another. I’ve experienced situations where patients have refused to see an APP or have specifically requested to see a PA over an NP.
Throughout my career, I’ve had the privilege of working with outstanding NPs, excellent PAs, as well as bad APPs. I’ve also encountered great doctors and, unfortunately, some who were not so great. My goal is to ensure that all patients receive the best possible care, and that involves collaboration and respect among all healthcare providers. My goal is to ensure that all patients receive the best possible care, and that involves collaboration and respect among all healthcare providers. Thank you for engaging in this important discussion.
It’s okay to disagree with a statement without saying it’s “nasty” and feeling personally/professionally attacked by it. I disagree with that statement and I suspect most docs do. I think most of us believe that most patients prefer to see a doctor when given the choice. But it’s okay to read stuff you don’t agree with. It’s even okay to publish it on a website you own. The world won’t end. Take what you find useful and leave the rest. Don’t throw the 2000 word baby out because the bathwater has 1 sentence in it you don’t like.
And yet no one has answered my questions about why it’s ok for Heather to write untrue and disparaging things about doctors here. I have yet to see a physician post on this site that calls APPs any names. Maybe we should have one to balance this (seriously). The fact that you can’t see that this is an undercurrent throughout the article and not just one sentence is your own bias. It’s clear many other commenters picked up what WASN’T said in all of what WAS said.
Read the other comments if you want to see docs saying disparaging things about APPs.
I’m also curious about the “untrue and disparaging” things in the post. Can you be more specific?
These “undercurrents” exist all the time in my writing and that of others. Read articles on this site about attorneys and financial advisors for example. But the undercurrent identified usually says more about the reader than the writer.
I’ve been a collaborating physician for many NP & PA and still do. I’ve never charged a monthly fee to them. I love teaching them. As they improve, they help me more. We work as a team with rad techs and PTs. The bigger team allows me to help more patients than just me by myself.
You may be able to find a doctor out there who is as generous/naive as me!
I absolutely love this. Collaboration in medicine is indeed what’s best for our patients. I have immense respect for physicians and work closely with many in our ER, as well as our supervising physicians in urgent care. Your approach of teaching and fostering improvement is truly admirable.
When APPs improve, they can support physicians more effectively, which is key. The more we learn and collaborate, the more independent and capable we become. It’s dangerous to have a know-it-all mentality as an APP, and I would never condone that. Instead, we should strive to be confident and humble, knowing our limits and building strong relationships with physicians who can guide us.
Thank you for sharing your perspective and for being such a generous and supportive collaborator.
The know it all attitude is dangerous in physicians as well! Experienced docs and APPs know their limits.
Heather, I’m surprised that you think collaboration in medicine is so important. It seems like you actually think you deserve to earn “doctor money” and that all doctors are arrogant and most patients don’t want to see a doctor anyway. Maybe we should just let midlevels run our ICU’s and OR’s too – you know, since doctors are so mean and awful. Oh wait, there is evidence showing that that actually costs more and isn’t safer!
Seems that you are not aware that APP run at least Step Down Units, Respiratory Units, Cardio Units and these is not new. Successful hospitals employ APPs for those positions in a large cities and smaller communities.
I think there is a vast difference between collaborating with an NP/PA directly, in the same location, while working together, versus those who collaborate or supervise from afar. It sounds as if you perhaps employ these NPs and PAs and have a great model. This is how physician-led teams work well. In many situations, however, NPs and PAs work in different locations, are employed by someone else, and their supervising or collaborating physician is taking on significant malpractice risk for this legal relationship. The time and energy it would take to adequately supervise in such a model definitely warrants compensation.
Just be sure to disclose to any collaborating MD that they take on full and unlimited liability for your clinic when you offer them $500 per month. If there are any takers, then we have no one but ourselves to blame. Otherwise, I have nothing against anyone hustling to make a buck (ethically of course)
—MD
It is disappointing to see so much venom-spitting here. Clearly the author struck a nerve, and that reflects the insecurity doctors feel about physician extenders.
There is a risk premium for all of that time and capital you spend going to medical school.
Med school = buying stocks
APP school = buying bonds
APPs also sacrifice upward mobility for greater lateral mobility. That limitation is the whole undertone of this article, and the pretext to its criticisms. APPs need to understand this tradeoff upfront when making career choices.
I work with APPs and I enjoy them. They are wonderful people and can provide excellent care within their scope of practice — just like I can within mine. There is a role for them in our healthcare system. That role is for them to be supervised by physicians.
What is the role for doctors? To be mentors, teachers, and supervisors for APPs. If we don’t embrace that role, then our physician extenders will become — more and more — physician replacers.
Although I do not support the independent practice of NPs, and I believe their current educational program to be deeply flawed, the comments here seem petty at best. I have worked with many intelligent, hardworking, and well-trained NPs and PAs during my 18 years in practice whom I would confidently let treat my family. The author, Heather Zamarron, is one of them. I’ve also met plenty of doctors that I wouldn’t let near my family.
WCI is a financial website. Do APPs have the right to try and maximize their income, or is that only available to those with MD or DO behind their names? Is every physician who chooses to go into a high-paying specialty or who works extra hours simply greedy? If trying to make more money automatically disqualifies you from providing good patient care, then pretty much everyone I know is out.
It seems that most of the article’s suggestions revolve around APPs working harder: working more hours, starting a side hustle, or opening their own practice. What are the basics of personal finance that are espoused on this site? Work hard and keep your expenses low, especially at the beginning of your career. How does this differ from what Heather suggests?
The vitriol in this comment section doesn’t seem to be directed toward the content of the article but rather at the audacity that APPs would try to raise their income into (gasp) “doctor territory.” Would your feelings be different if the title were changed to simply “How PAs and NPs Can Make More Money?” What about, “How PAs and NPs Can Make Computer Programmer Money?” Would that be more acceptable, appropriate, and tasteful? I believe Heather stepped on a few fragile doctor egos here.
This is absolutely the correct take on this article. Best of luck to Heather. Making more money isn’t a sin, and every doc here who sits astride their moral high horse would be furious at a 10% pay cut…even though it’s not *supposed* to be “all about the money.”
She covered basic entrepreneurialism in her article and approached it as someone who makes a low six figure salary as their baseline. The tag line “doctor money” seems to have gotten all these doctors (following a financial website amusingly) clutching at their metaphorical pearls at the fact that someone would deign aspire to *their* level of income while not going through medical school.
The bottom line is PAs/NPs don’t get paid what we do because of training and liability, but there’s no reason they can’t make more money by being entrepreneurial. In that, I wish them the absolute best of luck. Heck, I’m a clinic guy and am trying to get all my income sources high enough to make “plastic surgeon” money!
It was a great title huh! Not sure who came up with it but it’s gold in this business. Just the right mix of triggering, clickbaitiness, and true isn’t it?
LOL WCI totally on point
Top comment here. Thank you for being sane.
APPs don’t make doctor money. Sure, an APP can approach the compensation of the lowest end of the doctor’s pay by working 50% more. But a doctor could easily moonlight to earn 50% more (at their higher rate) by putting in those same extra hours and crush APP earnings. If an APP pursues opening their own practice, they are business owners, which is a different job (I see running a clinic and seeing patients as doing 2 jobs). A non-medical business owner could theoretically open a clinic by hiring APPs and doctors to do all the clinical work and also make “doctor money”.
Like it or not, APPs will be a growing part of the US health care system due to the doctor shortage and rising costs. So doctors will need to learn how to work with APPs in their ever expanding role. I agree with commenter Alan who says “If we don’t embrace that role, then our physician extenders will become — more and more — physician replacers.” Due to growing healthcare needs, limited physican supply and the need to lower costs, APPs will continue to do more tasks traditionally done by doctors. The tidal wave of APPs in this country is rising and unstopable. Rising healthcare demands and the need to reduce costs is going to ensure APP growth.
Everyone wants to talk about your second paragraph even though the article was about your first paragraph.
Email box full of comments on this one, most similar to what has already been posted. I responded to all of them privately. As a general rule docs hate it, PAs like it, and few were able to take what they found useful and leave the rest.
# 1
I am anesthesiologist and chronic pain physician. I have learned a great deal from your writing and really enjoy your podcast/blog/books. I’m thankful for all you do.
I am not thankful for the recent post about how PA’s can make “doctor money”. I know you put some editor’s notes and I understand that independent practice is a reality in some places (and some might argue it’s necessary due to severe primary care shortages). However this article wasn’t focused on how mid levels can “do good” by serving areas like this or the nuances of what independent practice means or even what physicians should know about these changes. It was (as the author repeated many times) how to make “doctor money.” Yes, WCI is a blog all about asset management and investing in a smart fashion. But I’ve always gotten the sense that you value earning the money in a respectable way, not flaunting your wealth and not just making money to make money.
What this author seems to sort of understand but also totally miss is that she had a choice of being a doctor and she chose something different. Then she got jealous and I would argue she still is:
“I wanted to get married, and I was not interested in putting off starting a family for 10 years through medical school and residency. Despite previously being confident in my decision, I began to wonder if I made the wrong choice based solely on the salary difference. This led me on a mission to earn more money.”
This post is crass and frankly disrespectful. I’m sure during Heather’s 27-month training she didn’t gain 1/10 of the experience most of us did in training.
I guess I would ask Heather why her main goal is to MAKE MORE MONEY SO SHE CAN BE JUST LIKE A DOCTOR WITHOUT THE TRAINING, HEHE. I have no problem with people earning money or choosing a path where they can do that. I have a problem with grifters and people who confuse wanting money with deserving money. Sure Heather can be an entrepreneur and make more money than most PA’s through hard work and taking risks. But again, her main points read more like a petulant toddler and not like a thoughtful adult.
And then we have the truth of what Heather thinks about doctors. Feels pretty shitty after I spent most of my weekend helping a colleague’s mom who was admitted for a pain crisis for pretty much free (and didn’t think of money once in regards to that until I read this). Heather thinks doctors are arrogant and don’t listen. Way to generalize.
“ provider who listens to their needs, who is knowledgeable in their medical decision-making, who projects confidence (not arrogance), and (most importantly) who is accessible.”
I’m disappointed in WCI for promoting this post. I hope others will write to you and you will respond.
# 2
Great article and very accurate from a PA practice owners perspective!
# 3
What is this junk? It is a shame that a trusted site like TWI sends out articles like this? Did you read it before sending it?? The quote below is garbage! Most patients want to see REAL DOCTORS, not these charlatans. If they knew the trick that was being played on them, they would not allow it. You shouldn’t distribute this false information, too many drink the proverbial Kool-Aid already.
“However, I believe most people want to see a provider who listens to their needs, who is knowledgeable in their medical decision-making, who projects confidence (not arrogance), and (most importantly) who is accessible.”
# 4
I love the WCI but surprised by this post.
While financially lucrative for the NPP, not the best care for the patient to have a NPP managing their care.
Just a thought and thank you for what you do for the physician/etc community.
# 5
as a fellow physician i cannot believe you would publish this garbage, as a PCP in the trenches (not early retired) it is crap like this that makes our lives harder, we have been dumbed down to the lowest common denominator when referred to as providers, it takes grit and hard work to get through medical school residency and a fellowship, no mid level exhibits the same grit, they do not know what they do not know and that is why unsupervised APP’s are a danger and increase the cost of care. ask me how i really feel
So strange that the author and white coat investor are shocked and offended at rightfully-placed criticism.
Maybe people are up in arms because many systems and practices are training midlevels to do everything a doctor can, so they can save some money and cut corners. Maybe docs who are regular readers have actually read notes and were alarmed by recklessness and the absurdity of pointless procedures and medications.
Maybe people are up in arms because some PA’s have a lax physician overseeing them and literally refer to themselves as “doctor”, market themselves as such, and trash talk nearby practices. I have always noticed physicians tend to be more collegial in that regard.
When I hear about these folks wanting “doctor money” I cannot help but think of all the legal corner cutting and patient care diminishing. “But it’s a financial site” you say. I truly do not care and will vocalize my criticism along with everyone else.
But what do we know?
Neither shocked nor offended. Completely expected response. For lack of a better term, there are a large number of doctors who are “triggered” by anything APC related. Some would even prefer I put WCI content behind some kind of firewall that is unaccessible without proving one is a physician.
Turf wars aren’t new in medicine. Osteopaths. Naturopaths. Chiropractors. APCs. Family trained docs doing plastic surgery. Ortho doing spine stuff. FP doing OB. The battle of what APCs can do with and without supervision is going to continue to move forward in every state for many years to come. But it’s entirely possible to step back for a moment from whatever you believe should happen with that turf war and help a PA maximize their income or let a PA talk to their colleagues for a moment about how to boost income or talk about whether it’s possible to partner with an APC or for them to own a practice or whatever.
I feel like you are rationalizing the post without acknowledging the financial incentive you have publishing these types of articles. Should I prepare myself for the upcoming chiropractor articles pushing sports physicals to boost their income?
I’m not sure how much more acknowledgement I can make about financial incentives around here. Here’s the latest version:
https://www.whitecoatinvestor.com/state-of-the-blog-2024/
Is there financial benefit if we can have both docs and APCs and other types of professionals in our audience? Absolutely.
But let’s clarify what your concern is. Do you think WCI should not have any PA related content? Or is there some part of this particular post that you think should not have been published? What exactly is the issue?
My concern in particular is your rationalization of this published article. You stated: “ it’s entirely possible to step back for a moment from whatever you believe should happen with that turf war and help a PA maximize their income or let a PA talk to their colleagues for a moment about how to boost income or talk about whether it’s possible to partner with an APC or for them to own a practice or whatever.” I don’t believe it is possible as a physician to ethically and morally step back and encourage midlevels to start independent practices. And I think you know why. Here are just a few reasons why midlevels need oversight:
1. Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1939374
2. Nonphysician clinicians were more likely to prescribe antibiotics than practicing physicians in outpatient settings, and resident physicians were less likely to prescribe antibiotics. https://www.ncbi.nlm.nih.gov/pubmed/15922696
3. The quality of referrals to an academic medical center was higher for physicians than for NPs and PAs regarding the clarity of the referral question, understanding of pathophysiology, and adequate prereferral evaluation and documentation. https://www.mayoclinicproceedings.org/article/S0025-6196(13)00732-5/abstract
4. NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescription-restricted states. https://pubmed.ncbi.nlm.nih.gov/32333312/
___________________________________________
You run the website. You can publish whatever articles you want. I will be forever grateful to you for the majority of your content. But in this case, I think we disagree. Primum non nocere – our fundamental principle. It may have been better not to post anything at all in this case.
Go back to your first paragraph and read it again. I said “whether it’s possible to partner with an APC or for them to own a practice or whatever”
Then you somehow took that to mean I support independent practice of APCs (“I don’t believe it is possible as a physician to ethically and morally step back and encourage midlevels to start independent practices.”) despite me publishing a statement saying I do not.
Owning a practice does not equal the independent practice of medicine.
Owning a practice does not equal the independent practice of medicine.
Owning a practice does not equal the independent practice of medicine.
Owning a practice does not equal the independent practice of medicine.
As I’ve said a dozen times already today, I don’t support the latter but have no problem with the former. You are arguing against a position I do not hold. If you want to have that argument, go have it with someone who does hold that position. So yes, “I know why” because I hold the same position you do.
What I can’t figure out is why you have a problem with the publication of this article. Does it bother you that a PA wrote an article that talks about practice ownership (as a relatively small part of an article on boosting PA income) and some APCs will apply that to an independent practice model and we published it? It seems so. Apparently I’m much more comfortable with alternative viewpoints than you are. It’s okay to disagree with me and it’s okay to disagree with a guest poster. I think this article does far more good than bad and that’s why we published it. I included my note just so people like you would be clear where I personally stand on the issue. Apparently that wasn’t clear enough because some still think I’m an advocate for independent practice.
You published an article. In that article it stated: “One clear path to making more money in medicine as an APP is to start and own your private practice.” Where I am located, APPs have independent practice rights. Opening their own practice is synonymous with practicing independently. If you choose to publish an article that encourages this, it should come as no surprise when people think you support it. I read your disclaimer statement- which lead to my comment about your bias – one that you agree with and post in your State of the Blog article every year.
You wanted to know why I have a problem with this article? One of the midlevel practices in my town (no oversight!) convinces their patients not to vaccinate. Do you know what happens when their patients show up sick to the hospital and need admission? Do you think their NP admits them? No, it’s me and my partners who are the only ones left covering children in the hospital where I live. The NPs can’t be expected to work more than a 9 to 5, and they sure as shit can’t take care of an actual sick kid.
We all have our biases I guess.
I disagree. I don’t think those are synonymous, even if they frequently concur. But even if they were, given that it is completely legal in your state, why do you think whether WCI runs an article that says that or not will make any sort of difference?
For the reasons stated above. As physicians, we have a responsibility to uphold standards in healthcare. Medical ethics principles encourage physicians to respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient. In my opinion, midlevel owned practices are not in the best interest of the patient – for all the reasons I stated earlier. Your Founders Note not withstanding, running an article that encourages midlevels to open their own practice is not medically ethical in my opinion. Financially ethical… maybe. But I think it’s best to strive for both.
I respect that you feel differently on this concern. We are each entitled to our opinions.
I think we’re going to have to agree to disagree on whether WCI should have run the article or not, even if I think we agree on your main point about unsupervised practice. I don’t have a problem with an APP owning a practice so long as they are still practicing in a supervised manner. I can see how this article could encourage someone to open an unsupervised practice too but don’t see that as a big enough concern to keep me from running the article as submitted.
I feel like a chump even posting, as this seems like a clickbait article designed to promote engagement with the website, and not to shed any light for the audience (I kid!) 😉
Let’s all just pause on the pearl-clutching for a moment…. The OP is exploiting an inefficiency in the payment system. The system pays for widgets, i.e. patient encounters. It does not *necessarily* pay for the value produced by those encounters. In my experience, APPs who are over their skis grossly overuse imaging and lab tests to cover themselves, creating costs for the system that can never be adequately deducted from the rate they are paid for doing these patient encounters. On the other hand, if getting in to see a PA/NP spares a patient from going to the ER for their acute-on-chronic indigestion, then most likely a service has been provided. Personally, I think this is only true for the situation of a PA that works alongside an MD with whom you have already established care.
I echo all the posters (and Jim) who have said that independent practice is just truly a bad idea for someone without a full medical school and residency training. It’s just asking for trouble. Most of the time it’s fine, but you’re playing Russian roulette with people’s lives. There are a handful of serious pathologies that you’ll only encounter once or twice in an entire career, which could kill a person, and which you will likely not recognize without having had the full residency experience.
OP, I am not hating on your hustle, and I don’t think you have any moral obligation to make less money than a doctor, but please consider carefully whether you are really practicing within the scope of your training and experience. Just because they’ll let you do it and pay you for it, doesn’t mean you should be doing it.
Next up, “Follow These 10 Whole Life Insurance Selling Strategies to Triple Your Income” by a guest NW Mutual financial advisor. Sure to further increase reader engagement!
I’d probably run that actually, but not to help the salespeople! NML agents are the subject of this blog, not part of its target audience. On the other hand, APCs ARE part of the target audience and ARE NOT the subject of the blog.
I don’t work in medicine (I’m a dentist)… but I am surprised to hear so much criticism of this article.
Also, I suspect the income gap between APP’s and family practice MD’s will shrink over time. I mean, a physician has significantly more training and experience than a PA early in their career. But after 20 years of clinical practice, I wouldn’t expect much of a difference in clinical knowledge between the two.
Maybe I’m naive, but seems like the market should reward any high level clinician from either background.
There’s some element of truth in this statement, but I don’t think it’s quite right. I think doctors are often a bit overtrained for what we do. Just because the path was arduous, doesn’t mean every step along the way was necessary. We spend a lot of time acquiring a broad background of knowledge, but then often end up performing narrower, mechanical tasks that don’t draw on the knowledge. We can end up resentful of those who seemed to take a shortcut, even if that doesn’t typically translate to a clinical difference at the point of contact. With that said, docs do encounter situations that call upon that additional knowledge and experience. It’s not every day, but it’s not that rare either.
I think many docs rightfully feel that, “you’re not paying me for what I do, you’re paying me for what I know.” i.e. most times, anyone with minimal training can handle the situation. But you’re not being paid for “most times,” you are being paid for those moments when the full breadth of your knowledge and experience are required.
It’s hard to sort this out because medicine is complicated. It’s hard to know exactly when that extra education and experience matters and when it doesn’t. Clearly it often doesn’t, and that’s not just in the thinking world. In many IR departments it’s the PAs doing the vast majority of the procedures that hospitalists etc either can’t or don’t want to do.
If docs really want to see fewer PA-patient encounters, the way to do it is economically. Push for payment changes where visits without real supervision are reimbursed at a dramatically lower rate. At least then patients (at least indirectly) are benefitting financially. They could get a lower copay/coinsurance too theoretically so they benefit directly too. Medicare already does this in EM to some extent (reimburses at 85% of what a doc would get) but most insurers don’t. The business (hospital, partnership, private equity group, solo practice whatever) is paid the same whether a doc lays eyes on the patient or not.
I’m not sure that experience can close the gap, but there is no doubt at all that a seasoned APC is far more valuable than a new one both financially and in regards to quality of patient care. One debate that medicine has not yet really sorted out is whether it’s better to have 6 years of school and 10 years of 40 hour a week apprenticeship (i.e. the PA model, at least theoretically) or 8 years of school and 3 years of 80 hour a week apprenticeship (the doc model). Maybe there is some wisdom there. I mean, how useful was undergraduate physics lab really?
Great article for sharing with your colleagues. As a GP, I’m always envious that the PA’s can specialize into many different specialties, to include surgical specialties. I wonder if they get paid more in those specialties.
Also as an MD, I personally feel that the premise of PA/NP needing to make “doctor’s money” may be misguided. Sure, everyone should strive for advancement in education, career, and in turn, higher income. However, if an electrician constantly strive to earn “an electrical engineer income”, that is a significant mismatched of skills vs expectations vs reality. Such cognitive dissonance, according to Buddhism, is a primary source of our misery and disappointment in life.
Thanks for the supportive comment! The title certainly did turn some heads, right? But the premise isn’t necessarily about making ‘doctor money’; it’s more about maximizing the income we do have as PAs to improve our chances of achieving financial independence. It’s not unrealistic for PAs to earn $200-300k or more through entrepreneurship or their own practice. While that level of income might not be everyone’s goal, as someone with a visionary mindset, I’ve wanted to pursue entrepreneurship to secure financial independence for my family.
US educated MDs spend a lot of time and money on medical education that has low ROI. It is for medical schools to see the writing on the wall and fix this redundant and inefficient system. This redundancy is not all about quality medical education but $$$ to Universities and Colleges.
If we could clear up this issue of redundant education for MDs, then we can focus on the added value of the clinical training during residency +/- fellowship.
The bare minimum of 8 years of training (4 undergrad and 4 med school) is ridiculous. Many foreign medical graduates wrap up the whole process in 5 or 6 years after high school (same as APPs) before they show up for residency training. How many times does a person need to hear about Glycolysis? Does a student with NO inclination to do surgery be dragged through General Surgery and Ob rotations?
APP training has found a problem to fix in the system – the very expensive and inefficient process of training MDs. This is for MDs to fix and not a burden for APPs to understand or resolve.
Congrats to WCI for uncovering another hot topic for MDs 🙂
I think there is great value to rotating through other specialties in med school and residency. I wish I’d done more, not less, but I am in a fairly broad specialty.
It may not be clear, but the author lives and works in Texas. The articles’s example of the NP with a successful solo practice is also from rural Texas. For everyone stressing about the insupportable risk of supervising APPs, remember that Texas has had meaningful tort reform since 2003.
Tort reform in Texas has several components, including a strong expert report requirement that leads to the dismissal of frivolous cases, but the real backbone of the law is the cap on non-economic damages.
While there is unlimited liability for economic damages, what malpractice lawyers really care about is the $250,000 cap on non-economic damages. This prevents the multi-million dollar pain and suffering awards, and in practice, keeps most malpractice lawyers from taking cases in the first place. Not surprisingly, without the lure of a 7 or 8 figure payday, most lawyers aren’t interested.
Malpractice insurance in Texas is now inexpensive. The supervising physician of an APP will typically have their malpractice insurance covered by the owner of the practice. A $200,000/$600,000 policy for FP or UC costs around $3500 dollars a year per provider. This is the standard coverage amount for these types of practices given that Texas has one of the lowest payout rate per capita of any state.
The standard amount for the ER in Texas is $1M/$3M. To be found guilty of malpractice, you must commit gross negligence, often referred to as “willful and wanton negligence.” Essentially, you have to know you are doing something that will hurt someone and do it anyway.
I was taught in my EM residency in Georgia that “if you haven’t be sued, you haven’t seen enough patients yet” and “it’s not if you get sued, but when.” However, I literally don’t know anyone who has been sued. I also don’t know anyone who knows anyone who has.
I feel sorry for those of you working in states without this protection. I mean that sincerely. It must be a terrible burden to practice under the constant threat of litigation. So, while there may be other legitimate reasons you wouldn’t want to supervise an APP, in Texas at least, the fear of litigation just isn’t one of them.
Where I work, medical professionals don’t stand around the proverbial water cooler talking about who is getting sued and how much malpractice insurance costs. While I do my best to steer the topic of conversation to financial literacy, my colleagues usually talk about more important things – like high school football. And college football. And professional football. And BBQ.
Also feel like a chump for even replying. To echo and emphasize:
What I (and others) take most offense to is the clear envy and feeling of entitlement on the author’s part without true acknowledgement of what it takes to get to “doctors money.” It’s not just the time, sacrifice, and energy but what’s trained into you during residency: responsibility, grit, a level of accountability, and even if a lot of it is irrelevant, being exposed/forced to memorize the breadth makes one realize all that you may not know. So many APPs have surface level knowledge but no humbleness, just irresponsibly projecting “confidence” and hiding behind “compassion” and “patience” and “providing the best patient care” (which in their minds is often scattershot tests and prescriptions). Doesn’t matter how much experience there is if they don’t study /learn in the first place and don’t get feedback/take care of the consequences of their actions (ie don’t know what they don’t know).
And quite frankly, not all, but a lot of APPs simply did not have what it took to get into medical school despite what they tell themselves later. There was a reason for it and that reason carries through….. be it a lack of commitment, willingness to sacrifice, lack of hard work, lack of test taking/memorization ability, etc. Sure, there may be those that chose it based on finances, but regardless, they need to make their peace with that and be honest with themselves. Are there plenty of “bad” doctors? Yes. Are there plenty of “bad” APPs. Yes. Are they equivalent? No.
Ironic the author is willing to hustle and take time away from her family in order to make more money now…. But I don’t blame her for her timing. However, if she had approached the article with humbleness and self awareness, less would take issue. Real estate side hustling, increasing productivity, doing locums, geographic arbitrage, switching careers, owning a business (within safety, scope, and supervision ) — all applaudable and fine. Thinking you’re just as good as a doctor and somehow deserve getting paid at the same rate for less work is what angers people. It’s not just a take the good parts and leave the rest alone. There was absolutely nothing in the article except obvious fluff… no meat. The only interesting thing was the mention of wholesale real estate investing which I had to look up…. So I guess there’s that. The rest was an noneducational list.
Lots of things that seem noneducational to someone who already knows them are educational to someone else who doesn’t already know those things.
Spoken like a true narcissistic and long winded physician. Yep, I am a PA specializing in cardiac surgery. I make good money and I’ll make more if I want to and it’s none of your damn business. I know a lot about things and do a lot things medical doctors are scared to death of. I work collegially with most of the doctors I know. But they don’t act like or sound like you. Minds like yours are an obstacle in medicine. Patients know it. Nurses know it. PA’s know it and your physician colleagues know it as well. PS they talk about you behind your back. We are well aware most of you are not Michael Jordan’s and we warn our friends, families and yes OUR patients about your kind. My advice to you is lose your attitude, worry about yourself and do a better job everyday. Oh and include your fulll name and rank next time you comment!
Thank you for sharing your perspective. I’m sorry if the title caused offense, as that was never my intention. The article wasn’t meant to suggest that PAs should make more money than doctors. Rather, it aimed to encourage APPs to fulfill their purpose, especially in underserved areas where we can meet real healthcare needs. I wanted to show that with the right hustle and entrepreneurial spirit, it’s possible for APPs to earn $200-300k, which approaches ‘family practice doctor’ levels—not as a comparison to physicians’ roles or training, but as a path for APPs to grow in their own fields. I hold deep respect for the extensive training and responsibility that comes with being a doctor and fully acknowledge the differences between physicians and APPs.