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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Sharks of The NP World

I have been a nurse practitioner for almost a decade now. I have seen the multitude of states that have gained independent practice over the last 10 years. I have seen the radical changes in market saturation over the past 6 years secondary to schools pumping out thousands of grads every year. What I have also seen is an upswing in the SHARKS that take advantage of my fellow nurse practitioner brothers and sisters.

There are many people within the healthcare industry that take advantage of your education and hard work. The point of this article is to identify the predatory sharks that see the nurse practitioner as easy prey, and essentially, an easy source of money. As a nurse practitioner, you need to be aware of who these sharks are, so you do not fall prey to their predatory behavior.

These people are financial parasites to your well-being. They will nickel and dime you so they can put more money into their pockets at your expense. Many of them have no healthcare training but see you as an easy cash register. They could care less if you risk your license so as long they can continue to profit on your behalf. This should infuriate you.

I created The Elite Nurse Practitioner to help give BACK the power to the nurse practitioner. Its time that we tell these sharks to stop sucking us dry, because it will only get worse as the nurse practitioner market becomes more saturated.

One of the few saving graces is to become your own boss, so do not lose hope. Anyone reading this can become a nurse practitioner entrepreneur and earn what they deserve, instead of enriching others with your blood, sweat, and tears.

The following are a list of these sharks in no particular order:

1) Healthcare Administrators: This one is obvious. Every single person reading this has dealt with the utter incompetence shown by healthcare administration. These individuals see you as CHEAP labor, nothing more. It is supply and demand. As the supply of nurse practitioners increase, the demand will decrease because there just are not enough jobs to go around. Healthcare administration knows this. They receive 100 applications for one nurse practitioner job. Do you think they will go with the most experienced one who has high standards and demands $90 an hour? HAH, yeah right… They are going to go with the new grad or the person with 1 year of experience who is happy with $50 an hour. Your experience means nothing to them, they see you as a number that costs them a certain amount of money to employ. The cheaper, the better!

Outside of money, they see you as a work horse. They don’t care about patient safety. All they care about is increasing the volume and making sure “satisfaction” scores are high so they can circle jerk with their other healthcare administrator friends on whose clinic, hospital, and system is better than the others at extravagant conferences paid for by the money we produce. They want their clinics, emergency departments, and hospitals to be fully booked up at all times. They don’t care what that does to YOUR mental and physical well-being. Are you stressed? Are you depressed? Are you just totally burnt out? Suck it up buttercup, or we will replace you with someone else in a matter of weeks.

These people are sharks

2) Practice Owners: Many practice owners see nurse practitioners as cheap labor. Similar to the healthcare administrators, these individuals put profits ahead of anything else, including your well-being. They will work you to death in exchange for $55 an hour while profiting hundreds of thousands of dollars of the money that the nurse practitioner generates. They will say “oh, well my expenses are so high! I just cannot afford to pay the nurse practitioner anymore!” BS! Don’t be fooled, these people don’t work as hard as many people think they do. The expenses are not as high as they lead on. They are justifying their existence because they KNOW that YOU are the one generating the revenue.

These people are sharks

3) Health Insurance Companies: These companies are the gate keepers of healthcare dollars. They determine who gets paid and who does not. Medicare, Medicaid, and private payers control the healthcare industry and unfortunately, are more physician friendly. Why should we only get 80-85% of what a physician receives from insurance for the exact same work? The patient was seen for hypertension, prescribed amlodipine, and was treated safely. Is the end result not the same? Well… yes, it is, but in the eyes of the insurance overlords, the result was not the same and we should be paid 15-20% less. This should make you angry. It is only about the money, nothing more. It is a justification to save Medicare, Medicaid and Private payers money. Insurance companies are sharks

4) Physicians: Do I even have to explain this one? In restrictive states, physicians are at the top of the list of sharks that take advantage of the nurse practitioner. They lobby and lobby and lobby, preventing nurse practitioner independent practice from passing because they LOVE the easy money that comes off our backs. Not only that, they don’t want the business competition because they know the competent and intelligent nurse practitioners will break away and open their own practice, as they should.

I remember when I practiced in a restrictive state and had my “supervisor.” I never even saw this person ONE TIME in 2 years. I still have no clue what she looks like. She was making $3,000 a month “supervising” me. Oh bologna… There was no supervision going on. I called her ONE time in 2 years, that is it. She made $60,000 for practically doing nothing over the span of 2 years. Do you think this physician wants to give up that gravy train? Absolutely not, I wouldn’t either. Hell, you could supervise 3-4 nurse practitioners and pay off your mortgage in 2 years.

These physicians charge up and coming nurse practitioner entrepreneurs’ ridiculous amounts of money to “supervise” them when they start their own practice as well. This nurse practitioner could have been practicing for over 10 years and needs no supervision, but the law requires it, and the physician preys on this. I know some nurse practitioners paying upwards of $5,000 a month for “supervision.” Total robbery… This should boil your blood.

Most physicians are good people, they really are. I have several physician friends and I know many physicians who supervise and collaborate with nurse practitioners at affordable rates. But a lot are also sharks… Moving to an independent practice state or opening a telemedicine practice in one, allows you to swim around these sharks, just FYI.

5) Corporate Staffing Companies: Large staffing agencies like Team Health, EmCare, and locums companies prey on nurse practitioners for cheap labor. I remember working in a busy emergency department for one of these companies once. I was paid a handsome $60 an hour and saw 4x the number of patients my supervising physician did while he sat there and watched Netflix on his tablet. A physician assistant and I ran that ER… This company had to have made millions off our backs. I left after being a slave for 8 months. Never again…

Locums agencies are contracted out by practices and healthcare systems to fill in employment gaps. They are paid roughly $120-$200 an hour in exchange for filling in those gaps with a nurse practitioner. They are doing us such a favor by giving us a whole $65 of that…

These people are sharks

6) Malpractice Insurance Companies: Medical malpractice companies are another predatory agent within the nurse practitioner and medical world. These companies charge nurse practitioners ridiculous amounts of money for “coverage” for even mundane and low liability services such as weight loss or medical cannabis evaluations. They know we don’t have many options for coverage, and many of these companies take advantage of this. They are sharks

7) Accessory services: Medical billing and credentialing businesses, EMR companies, specialty marketing and web design businesses, various consultants and so forth, take advantage of the healthcare industry because they know that the pockets of practices are “deep”, or so they think. This becomes problematic for the nurse practitioner entrepreneur who is just getting started. Healthcare specialized marketing firms charge 2-3x what they would another business to market your practice. Medical billing companies take 7% of your money to click a few buttons. Various consultants who come into your practice to make it more “efficient” charge tens of thousands of dollars for doing very little, but you signed a contract and if you don’t pay, they will take you to court… The ridiculous fees and costs associated with many of these accessory businesses in healthcare are preying on us… they are sharks

8) Nursing Schools: Last but not least, far too many nursing schools are preying on nursing students. They publish a bunch of fluffy numbers saying there is a “shortage” of nurse practitioners and that our country will be faced with a provider shortage in the years to come. Oh really? What about the tens of thousands of nurse practitioners RIGHT NOW that cannot find jobs? Is the answer to lower admission standards and keep pumping out more and more grads? Of course it is… especially when you are reliant on tuition dollars and the dean of the school needs a big fat bonus to pay for her new BMW!

Not all nursing schools are guilty of this, but there are far too many that are. These diploma mills are saturating the market which does nothing but compound the issue. The supply goes up, and the demand goes down. This results in lower salaries and ultimately significant disappointment among the new grads who were led to believe that there was a “shortage” and an “abundance of jobs.” People are being robbed blind… This is criminal in my opinion.

Nursing schools, the AANP, and the ANCC work together to feed each other tuition, testing, and certification dollars… Many of these people are sharks

This list is not an all inclusive list of the sharks within the nurse practitioner world, but they are the top predators. These are the great white, tiger, and bull sharks within our world.

It’s like throwing chum over the side of a boat and watching the feeding frenzy that happens with sharks. The same thing is happening within the nurse practitioner world. Market saturation is the chum and healthcare administrators, predatory physicians, various business owners, and a multitude of other companies and individuals are the sharks. They are chewing for the bits to get a piece of the nurse practitioner.

There is good news though: YOU ultimately have the power to shape your life. You can swim around these sharks. You can carry a harpoon gun with you and take care of the problem before they take a bite of you. You can safely swim to shore and avoid these sharks by knowing your true worth.

You have an enormous amount of financial power. The astute nurse practitioner can make what they are worth, they just need to know the steps on how to do it. I designed The Elite Nurse Practitioner Model as a guide for those that would prefer not to fall prey to the sharks:

  1. Have multiple part-time businesses and/or side hustles.
  2. Maintain a part-time job that pays you fairly. You must know how to negotiate a salary; it is a vital aspect to success.
  3. Live below your means within your personal and business life.
  4. Avoid debt.
  5. Stick with cash only businesses if you can.

Do you know what happens when you know how to safely avoid the sharks? Your income increases EXPONENTIALLY. Why? Because you keep the money, instead of allowing the sharks to steal it from you. I know millionaire nurse practitioners, and I am on track in joining their ranks. The only way to do so, is to avoid the sharks. Leaving a restrictive state was the first step I took in swimming around the sharks, what’s yours?

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