Predictions for the NP and PA job market in 2011 were on the money: Employment offerings remained steady and even increased in some areas. This news alone is cause for celebration, but could the news get even better in 2012?
A Buzz in the Air
Word is clearly out about the benefits of nurse practitioners and physician assistants to healthcare organizations, and the Obama administration has championed NPs and PAs as an important part of the answer to our nation’s healthcare woes. In October 2011, the White House removed certain restrictions on hospitals and healthcare providers in consideration of “impending physician shortages,” stating that NPs and PAs “could provide immediate savings to hospitals.”1 And according to a Monster.com report on healthcare jobs, between May 2010 and April 2011, nursing was the No. 1 job listing and physician assistant was No. 6.2
Research organizations have begun to study NPs and PAs in more comprehensive ways. In a report released in 2010, the Robert Wood Johnson Foundation found that between 1995 and 2009, the number of NPs per primary care physician had more than doubled (0.23 to 0.48), as did the number of physician assistants per primary care physician (0.12 to 0.28).3 These data show that the combined NP-PA workforce is already three quarters the size of the physician workforce. And this growth is sure to continue. The PA population now numbers 83,000,4 double its size of 10 years ago, and the NP profession has grown to 140,000.5 A 2011 National Center for Health Statistics report documented that the percentage of hospital outpatient visits handled by NPs and PAs rose from 10% in 2000-2001 to 15% in 2008-2009.6 Considering all this, the impact these providers will have on healthcare is immense.
Several media sources named the NP and PA professions and their educational programs among the most desirable in 2011. For job potential, Forbes rated physician assistant No. 1 and nursing No. 7 among master’s degree programs.7 Physician assistant and nursing made the U.S. News and World Report list of the top 50 best careers.8 And physician assistant was ranked No. 9 among top jobs for working parents by CNN Money.9
“There are many reasons for this positive publicity, but the most visible is the U.S. shortage of physicians,” said Lisa Lenell, MPAS, PA-C, cohost of the ReachMD radio show Partners in Practice. “This is not a positive thing for the U.S. healthcare system, but it is a good thing for PAs and NPs, both of which are in high demand.”
NP and PA organizations are hard at work on ways to improve practice for their respective professions. The American Academy of Nurse Practitioners (AANP) is focusing on improving Medicare regulations to include nurse practitioners’ patients as beneficiaries in accountable care organizations, the ability of NPs to order/certify home healthcare services for Medicare patients, Title VIII funding for NP educational programs, and traineeships and funding for nurse-managed centers, AANP president Penny Kaye Jensen DNP, APRN, FNP-C, FAANP, told ADVANCE.
“Any new legislation that recognizes and includes nurse practitioners will facilitate the ability of nurse practitioners to practice, while at the same time bringing us closer to a solution to the primary care provider crisis,” Jensen said.
PAs are also part of these initiatives, which “would go a long way to remove the barriers facing PAs and increase their ability to treat patients,” said Robert Wooten, PA-C, president of the American Academy of Physician Assistants (AAPA).
Peering Into the Future
No crystal ball will tell you what your next career move should be, but the current landscape and trends in NP and PA hiring could help guide you as you make career decisions in the coming year. In terms of an overall picture, the Agency for Healthcare Research and Quality reported in 2011 that 52% of NPs and 43% of PAs work in primary care.10 The Bureau of Labor Statistics (BLS) predicts a 23% increase in overall nursing jobs and a 41% increase in PA jobs from 2008 to 2018.11 The BLS notes that all advanced practice nursing roles “will be in high demand, particularly in medically underserved areas such as inner cities and rural areas. Relative to physicians, these RNs increasingly serve as lower-cost primary care providers.”12 As for PAs, the BLS reports that employment is projected to grow much faster than in the average healthcare profession.13 The NP profession is growing quickly as well, with 9,500 to 10,000 new NPs prepared in each of the last 2 years, Jensen pointed out.14
“Public awareness and acceptance of NPs as mainstream providers in a variety of healthcare settings is continually expanding, and employers are continuing to recognize the value of NPs as providers of cost-effective, personalized, patient-centered care,” Jensen said. “The future for NP jobs has never looked better!”
Adrienne Archer, president of AVA Search Group, a recruiting company for healthcare providers, noticed several NP and PA hiring trends in 2010. She saw a dramatic increase in job openings for NPs and PAs in the last half of 2011.
“The need for NPs and PAs is going to continue to increase . this is especially true in rural areas, where they are sometimes all that the community has because it’s so hard to find doctors for these locations.” She added that she has seen a pretty even split between hospitals and privately owned practices with jobs to offer.
Nontraditional positions, such as those in politics, media or healthcare technology, will be more plentiful, our experts predicted.
“First to mind is Karen Bass, the first PA in Congress, which is a tremendous opportunity for PA education and advancement,” Lenell said. In addition to cohosting the Partners in Practice radio show, which highlights the NP and PA professions, Lenell has started working with a cloud-based EHR company. “I am a good example of someone moving into a nontraditional role,” she said.
As for salaries, averages continued to rise modestly in 2010, according to results of the 2010 National Salary Survey of NPs & PAs. Full-time salary for PAs was $96,876, and NPs earned an average of $90,770. According to the survey results, PAs experienced more than twice the salary increase that NPs did. The average PA salary increase was $3,771, while the average NP salary increase was $1,191.15 (We will report the first results of the 2011 salary survey in the February issue of ADVANCE for NPs & PAs.)
Archer noted that although she didn’t see appreciable increases in NP and PA salaries last year, employers offered more aggressive benefit and bonus packages for hard-to-fill specialty positions. This practice is going to become more widespread, she predicted.
“The thing I don’t think clients are realizing yet is that it’s going to become a candidate-driven market,” Archer said. With economic improvement and more job openings, employers will begin to offer better incentives to potential employees. Archer warned that with increases in job openings will come an influx of recruiters who may not know much about the NP and PA professions. She advises job seekers to ask recruiters how many placements they’ve made for their profession and to be sure a recruiter will never submit a resume without permission.
Is There Fortune in Our Future?
Like the crunchy cookie with a hidden fortune inside, 2012 will only become clear as it unfolds. We can’t know for sure what 2012 has in store for the NP and PA professions. What is evident is that all the changes and publicity of the past year are a boon for both, Wooten said.
“As this country looks to shift from a fragmented to an integrated healthcare delivery system, much more attention has to be placed on a cost-effective care model,” Wooten said. “That means that PAs and [NPs] must be empowered to deliver care to the full extent of their education and expertise. Only then will we reach true efficiency and clinical effectiveness.”
1. Pear R. U.S. moves to cut back regulations on hospitals. New York Times. http://www.nytimes.com/2011/10/19/health/policy/19health.html?_r=1&ref=robertpear. Accessed Dec. 20, 2011.
2. Monster, Inc. Healthcare job conditions report, 2011. http://media.newjobs.com/a/i/intelligence/pdf/Occupational_Reports/2011_Healthcare_JobConditions.pdf. Accessed Dec. 20, 2011.
3. Robert Wood Johnson Foundation. 2010. Nurse practitioners and physician assistants in the United States: Current patterns of distribution and recent trends. http://thefutureofnursing.org/NursingResearchNetwork7. Accessed Dec. 20, 2011.
4. American Academy of Physician Assistants. Physician assistant census report: Results from the 2010 AAPA Census. http://www.aapa.org/uploadedFiles/content/Research/2010%20Census%20Report%20National%20_Final.pdf. Accessed Dec. 20, 2011.
5. American Academy of Nurse Practitioners. Nurse practitioners in primary care. http://www.aanp.org/NR/rdonlyres/9AF1A29F-5C82-4151-98CB-22D1F20A9BD9/0/NPsInPrimaryCare324.pdf. Accessed Dec. 20, 2011.
6. Hing E, Uddin S. Physician assistant and advance practice nurse care in hospital outpatient departments: United States, 2008-2009. NCHS data brief, no 77. Hyattsville, MD: National Center for Health Statistics. 2011. http://www.cdc.gov/nchs/data/databriefs/db77.htm. Accessed Dec. 20, 2011.
7. Smith J. The best and worst master’s degrees for jobs. http://www.forbes.com/sites/jacquelynsmith/2011/06/06/the-best-and-worst-masters-degrees-for-jobs/. Accessed Dec. 20, 2011.
8. Grant A. Best careers 2011. U.S. News & World Report. http://money.usnews.com/money/careers/articles/2010/12/06/the-50-best-careers-of-2011. Accessed Dec. 20, 2011.
9. Muse H, Rosato D. Best jobs for working parents. CNN Money. http://money.cnn.com/magazines/moneymag/best-jobs/2011/jobs-working-parents/1.html. Accessed December 5, 2011.
10. Agency for Health Care Policy and Research. Primary care workforce facts and stats no. 2: The number of nurse practitioners and physician assistants practicing primary care in the United States. AHRQ Publication No. 12-P001-3-EF, October 2011. Rockville, MD: Agency for Health Care Policy and Research. http://www.ahrq.gov/research/pcwork2.htm. Accessed Dec. 20, 2011.
11. U.S. Department of Labor Bureau of Labor Statistics. Career guide to industries, 2010-11 edition, healthcare. http://www.bls.gov/oco/cg/cgs035.htm. Accessed Dec. 20, 2011.
12. U.S. Department of Labor Bureau of Labor Statistics. Occupational outlook handbook, 2010-11 edition, registered nurses. http://www.bls.gov/oco/ocos083.htm. Accessed Dec. 20, 2011.
13. U.S. Department of Labor Bureau of Labor Statistics. Occupational outlook handbook, 2010-11 edition, physician assistants. http://www.bls.gov/oco/ocos081.htm. Accessed Dec. 20, 2011.
14. American Academy of Nurse Practitioners. Nurse practitioners in primary care. http://www.aanp.org/NR/rdonlyres/9AF1A29F-5C82-4151-98CB-22D1F20A9BD9/0/NPsInPrimaryCare324.pdf. Accessed Dec. 20, 2011.
15. Pronsati MP, Gerchufsky M. National salary report 2010: Inching forward with mixed results. ADVANCE for NPs & PAs. 2011;2(2):18-20. http://nurse-practitioners-and-physician-assistants.advanceweb.com/Features/Articles/National-Salary-Report-2010.aspx. Accessed Dec. 20, 2011.
Job Report: Good for Healthcare, Mixed for Most
While the employment outlook for NPs and PAs, along with the rest of the healthcare sector, remains strong despite shaky economic conditions, people in other sectors of the U.S. workforce haven’t fared as well.
The Labor Department’s Bureau of Labor Statistics (BLS) announced in December 2011 that the U.S. unemployment rate had fallen to its lowest level in 18 months, from 9% in October to 8.6% in November. But that trend may not be as encouraging as it appears. While a number of people out of work did find jobs, workforce experts said that many other long-term jobless people – more than 300,000 – simply gave up looking for work and thus no longer counted toward the unemployment figure. About 13.3 million people remained unemployed at the end of 2011.
While about 140,000 jobs were added by private employers in November 2011, about 20,000 federal, state and local government jobs disappeared. According to the BLS, government eliminated nearly half a million jobs in 2011. The BLS data (http://www.bls.gov/news.release/empsit.t17.htm) show that the healthcare sector added 17,200 jobs, although the report only shows the kind of facilities that hired, not whether the new positions were clinicians or custodians.
The hopeful figures are national averages, and where you live influences how positively you’ll view the numbers. Job market conditions in parts of Michigan and Ohio dropped sharply, for example, but unemployment in El Centro in southern California still approached 29%, and parts of Washington state saw joblessness increase by 1.7%.
While higher-paying professional and business jobs were created between October and November of last year, more than half the jobs added were in retail, restaurants and bars – seasonal hires that may or may not be permanent. And despite the glimmer of hope offered by the government’s report, the U.S. economy has regained only about 2.5 million of the 8.7 million jobs cut during the official dates of the recession, between February 2008 and March 2010.
Look for current events to continue to create employment uncertainty in 2012. In addition to this being a presidential election year, Europe’s financial crisis and Congress’s dithering and dickering about extending the Social Security tax cut and long-term jobless benefits could slow U.S. economic growth.
‘It Can Happen to Anyone’
It was a Wednesday afternoon in May 2011, and Mary Ellen Roberts, DNP, RN, APN-C, FAANP, had two more patients to see. The physician she had worked side by side with for 21 years called her into his office to share some news.
“He told me that he and his wife weren’t making enough money, and that reimbursements were down,” Roberts said. “He looked at me and said, ‘You’re simply too expensive.'”
Roberts had started working in the cardiology practice in New Jersey in 1990, and she and the physician had renegotiated their contract and collaborative agreement about every 5 years. The contract contained no language about a severance package, and the physician told Roberts he wouldn’t be providing one.
“This came as a total surprise. I was devastated,” Roberts told ADVANCE for NPs & PAs recently. “I felt degraded and my self-esteem was destroyed, particularly because I knew I was doing a good job there.”
At this time, Roberts’ three children were in various stages of collegiate need: One was scheduled to graduate from college, one had just completed his freshman year on campus, and one was headed into his senior year in high school. Roberts herself was a month away from earning her DNP degree.
“I started having panic attacks. I didn’t know where I was going to go or what I was going to do. I wasn’t sure I knew how to look for a job again,” Roberts said.
The demands of May and June turned out to be helpful. She celebrated her daughter’s graduation, helped her son move back home for the summer, and successfully defended her capstone for the DNP. She then headed to the American Academy of Nurse Practitioners (AANP) conference in late June, where she gave a few presentations and reconnected with colleagues and friends. Roberts is a particular star in the AANP; she is a past president, a fellow, a trustee of the organization’s political action committee, and a past winner of the academy’s state award for excellence. And in late 2011, she was elected to the board of commissioners for the AANP’s certification program.
By the time the conference rolled around, Roberts had begun to circulate her impressive resume. In addition to 21 years in cardiology and her accomplishments on the national stage for the nurse practitioner profession, Roberts had published articles in the NP literature and was a decorated member of Sigma Theta Tau, the international nursing honor society. She applied for all types of clinical positions and had several interviews. She even received a couple of job offers, but the work hours and patient visit expectations were excessive, particularly in relation to the compensation. The presentations at the AANP conference had reawakened her teaching interest, and she applied for a faculty spot in the College of Nursing at Seton Hall University in South Orange, N.J. She joined the staff as an assistant professor in September.
“My advice to others who are laid off is to take time for yourself,” Roberts said. “Do some soul searching to figure out what you really want to do. Don’t take the first job you are offered, because it might not be the right one.
“Above all, I hope my story emphasizes this: It can happen to anyone.”
-Michelle Perron Pronsati
Recent Grads Find the Landscape a Little Rocky
Recent graduates report a fair selection of job options, but they’ve had to employ creative strategies to find positions.
Getting Hired Early
Timothy Loerke, PA-C, began searching for a job when he was about 3 or 4 months away from graduation in May 2011, and he set his sights on a job in orthopedics. He posted his resume on job sites, talked with recruiters, made a few cold calls, and basically informed everyone he knew that he was looking.
Loerke attended school and now works in the metro area of Dallas and Fort Worth, and he described the opportunities for new PAs there as “plentiful.” He advises new grads to apply for multiple jobs, so that they have options. “Interview as much as your schedule will allow,” he said. “The main thing is to get a job and work. Your ideal job will be down the road.”
The Facebook Strategy
Timbolin Holmes, MSN, NP, worked in emergency departments (EDs) as an RN before she decided to enroll in an NP program. As she approached the completion of her acute care nurse practitioner studies in May 2011, she applied for an NP position in the ED where she had been working. But the hospital moved slowly on the application. She did a Facebook search for “emergency” and liked the pages that showed in the results for her region of Illinois. One of these was for Midwest Emergency Department Services, and as she scanned the company’s Facebook newsfeed one day, she saw an option to post a resume.
“The phone rang almost as soon as I had closed my laptop,” Holmes said. She interviewed and was hired for a position at Ottawa Regional Hospital in Ottawa, Ill., and started working in November 2011. Holmes also works part time at a convenient care clinic. “I think today’s new grads have to be creative in their job searches. A lot of it depends on where you live and what your certification is in,” she said.
A Smooth Transition
Jenna M. Lombardi, PA-C, started interviewing a few weeks before her graduation in August 2011. Emergency medicine interested her most during her rotations, so she focused her job search there. She received a job offer before graduation day and started working at Bryn Mawr Hospital in Bryn Mawr, Pa., in November.She found career websites helpful during her search. “I also reached out to people I had met on rotations during the clinical year to see if they knew anyone hiring, and emailed job listings from my program were helpful, too,” Lombardi said.
She considers the job market for recently graduated PAs to be good in the Philadelphia region. “However, a lot of where you begin to practice depends on what type of position you’re looking for,” she said. “For more common fields, like family/internal medicine or surgery, it’s certainly easier to find a job here.
“The main thing I would advise new graduates is to consider all options and to take your time looking for that first job,” Lombardi said. “Most of us have loans breathing down our necks and are very excited to start working, but your first job is an important one.”
Beverly Clayton graduated from an acute care NP program in June 2009 and didn’t find her first position until February 2010. She began her job search at the hospital where she’d been working as an RN (Clayton graduated from nursing school in 1987), but the ED wasn’t hiring NPs at that time. “I looked at job sites and talked to my professors. Nothing presented itself for about 3 months, and then things blossomed,” she said. “I learned of a few opportunities, mostly through personal networking. One of these was at a hospital where I’d worked in the past, and I decided to wait for the position. I passed up other opportunities, but the one I waited for fell through. Then I had no prospects.”
Clayton said she was quite nervous at this point. She decided to expand her search to include practice settings outside of her top interests of cardiology and emergency medicine. She responded to an ad for NaphCare, a correctional healthcare staffing firm, which was seeking to hire an NP at the Hamilton County Justice Center in Cincinnati. She enthusiastically accepted the position when it was offered.
“At this point in my career, it’s a good fit for me,” Clayton said. “… I think it’s a tough market for new NPs, at least in my area. My advice is to be open to opportunities that you once might not have considered. I think that for new grads, almost anything is worth taking a chance on – especially if the collaborating physician is someone you want to work with.”
Dream Job on the First Try
Elizabeth Huston, MSN, NP, began volunteering in community health settings at a young age, and she quickly realized she needed to become a nurse to accomplish more there. Working as an RN, she saw how effective NPs were in this setting, and she enrolled in an NP program. So when she graduated in October 2011, her destination was clear: community health.
Huston applied online at the website of the North Carolina Office of Rural Health, which she described as a state version of the National Health Service Corps. “Within an hour, I received a phone call. I interviewed on a Friday and received the job offer on Monday. I didn’t hesitate; it felt so right,” Huston said.
Huston said her advice to new grads is this: “Know what you want and where you want to be. You have to know yourself first; that will help you focus your job search.”
-Michelle Perron Pronsati