IV. Impression of job market for NPs

Fifty-four percent of NPs reported that they did not have a difficult time finding a satisfactory position as an NP, although 38 percent said that they did. Among those who reported such difficulties, the most common reason given was an overall lack of practice opportunities for NPs (32 percent), although 26 percent faulted their geographic location, and 17.5 percent felt that there was a lack of opportunities in their desired specialty (Table 3).

Table 3.  Reasons Given for Having a Difficult Time Finding a Satisfactory NP Position, NYS, 2000

While a majority of NPs reported that they did not have difficulty finding a position, their assessments of job opportunities in their specialty within a 50-mile radius of their principal practice appeared bleak. When the respondents were asked to rate opportunities on a scale of 1 (no job openings) to 5 (many job openings), 24 percent reported no openings in either hospital setting, 25 percent reported no openings in nursing homes, and 48 percent reported no openings in home health agencies. Thirty-six percent reported no opportunities in community health, and 18 percent reported no opportunities in physician offices. (It should be noted, however, that large numbers of respondents reported “don’t know” for their setting-specific evaluations; the numbers reported here include only valid responses.) Their overall assessment, however, was somewhat better. Only 10 percent of respondents reported no job openings overall (Figure 32).

[D]

Job Market Experiences by Age

Perceptions of the job market for NPs varied by graduation cohort, with those who graduated between 1995 and 1999 expressing more negative attitudes (Figure 33).  Asked to express their perceptions of the job market on a scale of 1 to 5, with 1 representing no jobs and 5 representing many jobs, the mean assessment for this cohort was 2.57, the lowest assessment since the 1980 to 1984 graduation cohort (2.54). 

[D]

Recent NP graduates also reported steadily increasing difficulties in finding satisfactory positions.  Only 24 percent of those graduating between 1980 and 1984 reported difficulty in finding a position, but this had risen to 48 percent in the 1995 to 1999 cohort (Figure 34).

[D]

Job opportunities by specialty

Perceived job openings by setting were rated on a scale of 1 to 5, with 1 representing no job openings, 3 representing some job openings, and 5 representing many job openings.  Overall, as shown in Figure 35, neonatologists saw the best job opportunities for themselves (mean score of 3.3, and 19 percent believed that many jobs were available), while acute care NPs saw the least (mean score of 2.4). Pediatric NPs were most likely to report no jobs, however (17 percent).

[D]

Examining evaluations by certification rather than by setting, adult health NPs felt their opportunities were best in nursing homes and hospital inpatient settings. Family health NPs and geriatric NPs also believed that their opportunities were best in nursing homes. Neonatology and psychiatry NPs clearly felt that they had the most opportunity in hospital inpatient settings (pediatric NPs did also, but the mean score they assigned to inpatient settings was only slightly higher than for other settings), while ob/gyn and women’s health NPs evaluated their opportunities in physician offices most positively. The responses of acute care NPs were difficult to evaluate, because many acute care NPs responded “don’t know” to several settings, making the number of valid responses in those settings too small to be meaningful. They reported good opportunities for themselves in both types of hospital settings, and in physician offices, with the score for hospital ambulatory/emergency care slightly higher than for the other two.

The NPs reporting the highest mean score for job opportunities in hospital inpatient settings were neonatologists (3.06), although gerontologists were most likely to report many jobs in this setting (7.6 percent). The group that clearly perceived the least opportunity in this setting is NPs in obstetrics/gynecology, who gave a mean score of only 1.83, and 52 percent of whom believed that there were no jobs in hospital inpatient settings.

The NPs reporting the highest mean score for job opportunities in hospital ambulatory care/emergency care were those whose specialties were in adult health (2.48), although gerontology NPs were the most likely to report many jobs in this setting (5 percent). NPs in women’s health appeared to have the least opportunities in this setting, with 42 percent reporting no jobs available, and a mean score of only 2.0.

The highest mean score for jobs opportunities in nursing homes was reported by NPs in gerontology (2.79), followed by adult health (2.70). In terms of the likelihood of reporting many jobs, however, those with certifications in adult health reported the greatest opportunity in nursing homes, with 8.6 percent reporting many jobs, followed by psychiatric NPs at 5.5 percent. Geriatric NPs were also likely to report many jobs available in this setting (5.3 percent). The lowest mean score was for obstetric/gynecological NPs (1.62), although neonatologists were those most likely to report no jobs available, at 67 percent.

There was relatively little variation in the average scores given by NPs to job opportunities in home health agencies. The highest mean score was given by those in pediatrics (2.1), while the lowest was in obstetrics/gynecology (1.4). Although 69 percent of ob/gyn NPs perceived no job opportunities in home health, 5.4 percent of pediatric NPs perceived many job opportunities.

Psychiatric NPs perceived the greatest opportunities in community health settings, with a mean score of 2.4, while neonatologist perceived the least (mean score of 1.8). Neonatologists were also the most likely to perceive no jobs in community health. Those most likely to perceive many jobs in community health were those in adult health and women’s health (6.8 percent and 6.7 percent respectively).

Ob/gyn NPs believed themselves to have the highest job opportunities in physician offices (2.7), while acute care NPs believed themselves to have the lowest (2.2). Neonatologists, however, were the most likely to report no jobs in this setting (33 percent), while those in adult health were most likely to report many jobs (3.8 percent).

NPs in independent practice

Eight percent of NPs reported being in group or solo NP practice at either their principal and/or secondary practice site. These NPs were most likely to be in family health (37 percent), adult health (23 percent), or psychiatry (17 percent), and 54 percent reported having at least one other practice site. Their median age (45) was the same as that for all NPs, and they were slightly more likely to be male (6.4 percent versus 5.4 percent for all NPs).

They were 90 percent white compared to 87 percent for all NPs, and held similar educational credentials. They had practiced as NPs for a median 5 years, and as RNs for a median 12.0 years.

They were more likely to have DEA certification to prescribe controlled substances (74 percent versus 68 percent), more likely to have a Medicaid provider number (41 percent versus 23 percent), and more likely to have a Medicare provider number (48 percent versus 30 percent). They were more likely to be listed with a health plan (42 percent versus 23 percent) and to be listed as a PCP with a managed care plan (13 percent versus 10 percent).

The appeared, on average, to be slightly more likely to have hospital-related privileges: they were more likely to have visiting privileges and be permitted to write notes and orders (18 percent versus 15 percent), and they were more likely to have admitting privileges (12 percent versus 7 percent).  They were less likely to perform histories and physical examinations (88 percent versus 96 percent), were slightly more likely to order lab tests (99 percent versus 97 percent), and were more likely to be able to make direct referrals to specialists (97 percent versus 92 percent) and to provide on-call services (50 percent versus 32 percent). They collaborated with their designated collaborating physician somewhat less often, with 16 percent only meeting the minimum legal requirement compared to 12 percent of all NPs who observed only the minimum requirement.