Empowering Nurses at the Bedside and in Business

Should NPs Be Paid The Same As MDs?

With 23 states along with D.C., Guam and the Northern Mariana Islands having full practice authority (independent practice without physician oversight), it would seem that nurse practitioners (NPs) in those places should be reimbursed at the same rates provided to physicians (MDs). However, these NPs are paid 85% of what physicians are paid for the same services.

Although there are few studies comparing MDs versus NPs, it is clear that NPs are sued less their MD counterparts.  However, there are some adverse studies showing that NPs order more labs and diagnostic tests, perform more inappropriate skin biopsies and place more inappropriate referrals than MDs do.

Another study shows that NPs prescribe more prescriptions than MDs, including antibiotics, steroids, opioids, and psychotropic medications.

Some of the those noted studies surprised me.

How can a referral be inappropriate?  If an NP is staying in his/her lane then shouldn’t he/she refer patients to experts when needed?

Additionally, yet another study showed that NPs prescribed more medications than MDs.  One spotlighted area of increased prescribing is with psychotropic medications.  This could be due to the decline in physicians going into psychiatry but there is an increase of primary mental health NPs.

In a study reported in Forbes, it was shown that there are 28,000 psychiatrists in the United States that number is decreasing as 3 in 5 practicing psychiatrists are currently over the age of 55.

Senate Bill 5222 in the Washington state legislature is requesting equal pay for both NPs and MDs.  MDs argue that why should NPs’ pay be increased to the same level as MDs when the latter have invested much more in the way of money for their medical educations and have a undergone many more hours in training, internships, and fellowships before being allowed to independently treat patients.

NPs who perform the exact same services as MDs should be paid the same rate regardless of what it took it took to get them to their level of skill and expertise.  The value of their services is no less than those of a MD.

Medicare also pays physician assistants at a rate of 85% of that paid to MDs.  However, unlike NPs, physician assistants are unable to practice independently and must have the oversight of an MD.

This is going to be an interesting battle for which I am looking forward to seeing what comes of it.

What are your thoughts?  Do you think NPs should be paid the same as MDs?  Let me read your comments below.




  1. Francis (Ed) Neuzil

    I believe that it could even be compared to a gender bias. Most nurses are female including most nurse practitioners. Most MDs are male. Even though multiple studies show at least equal if not in some cases better outcomes we do not receive same pay for the same job. Could this be related to a gender bias? Physicians, mostly males are making 15% more than the female NP who does the same job. If we are truly trying to work toward equality in all areas I think this may be a consideration.

  2. Donna Buchanan

    Medicare pays 85% of what a physician would get for reimbursement. I think for insurance such as MC that NPs should get the full reimbursement rate.
    Providers worry about fraud, for over or under billing MC, or not appropriately billing. But NPs such as myself consider fraudulent activity when it comes to reimbursement from the SAME service as an MD/DO.
    How can we make our legislatures more aware of this issue and of the MC/CMS rules that are unfairly being applied to NPs?
    As for hiring MD vs NP, MDs should get more in salary than an NP, afterall, they have spent more time with education, residency, internship.

  3. Denise

    No, there is still a different level of responsibility therefore liability.

    I do think a paramedic should be paid equal to a NP!

  4. Susan Hurd

    As a consumer. I am opposed paying the same amount for an NP as I do for an MD for an office visit. I do feel an NP usually takes the time with oatients and is generally more thorough.

  5. Marsha Blount

    In my practice at a large tristate children’s hospital, we are reimbursed at a lower rate and interestingly, we do the MAJORITY of the work. Luckily, our MD’s agree that we should and would LOVE for us to have higher reimbursement because quite frankly, they have to go behind us and sign notes in order to bill at the higher rate. Signing notes to work that the NP’s did! So ridiculous. Hopefully we will get that full practice authority soon!
    PS. Just NOW approved to sign Home Health orders. Geez.

  6. Jay kay

    The value my physician gives me is not in prescribing or giving me shots. It’s to be able to look at all my maladies and all the ambient contributors like genetics, life style etc etc and make a diagnosis and manage care.

    The years of education gives them the knowledge of the expansive area of medicine and know where to do further research to treat my conditions.

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