NP degree worth the investment?

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lwc5ed
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NP degree worth the investment?

Post by lwc5ed » Fri Aug 09, 2019 12:15 pm

Hi all,

My wife is an RN and is considering going back to school to get her NP degree. Curious to hear bogleheads opinions on whether the degree will be worth it long term from a financial point of view.

While I think we can pretty easily afford it, I am trying to better understand the worth of the degree long term. Some details:

- Wife and I are both 28
- Degree would cost about 70K total (while I could pay for it in cash, I am leaning toward co-signing the loan at around a 4% interest rate)
- About 45k in student loan debt at 1.95% for 5 years (should be paid off in the next 2 years at current repayment rate)
- About 250K in assets (401(k), Roth, others savings, etc)
- His salary: 220K Her current salary: around 60k
- In Massachusetts
- Expenses have generally been less than $1500 per month, except for a few splurge vacations (we currently have housing, but this would change if we were to move)
- No kids, but they are in the future. The plan is that the wife would still work, but might try to find something part-time (this is obviously a big factor if she decides not to work...)

Would appreciate any wisdom.

Thanks!

Jack FFR1846
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Re: NP degree worth the investment?

Post by Jack FFR1846 » Fri Aug 09, 2019 12:22 pm

Take a hard look at salaries. I know NPs are used all over Mass (I live there). I'd also look at your life plans. From your description, it's sounding like:

1) You spend $70k on the NP degree while losing her salary
then 2) You have kids and she doesn't work

I'd add to that $70k the lost salary for what I'd assume is 2 years not working as a nurse. At $60k a year (low, I know), that's $190k.
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dm200
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Re: NP degree worth the investment?

Post by dm200 » Fri Aug 09, 2019 12:28 pm

lwc5ed wrote:
Fri Aug 09, 2019 12:15 pm
Hi all,
My wife is an RN and is considering going back to school to get her NP degree. Curious to hear bogleheads opinions on whether the degree will be worth it long term from a financial point of view.
While I think we can pretty easily afford it, I am trying to better understand the worth of the degree long term. Some details:

- Wife and I are both 28
- Degree would cost about 70K total (while I could pay for it in cash, I am leaning toward co-signing the loan at around a 4% interest rate)
- About 45k in student loan debt at 1.95% for 5 years (should be paid off in the next 2 years at current repayment rate)
- About 250K in assets (401(k), Roth, others savings, etc)
- His salary: 220K Her current salary: around 60k
- In Massachusetts
- Expenses have generally been less than $1500 per month, except for a few splurge vacations (we currently have housing, but this would change if we were to move)
- No kids, but they are in the future. The plan is that the wife would still work, but might try to find something part-time (this is obviously a big factor if she decides not to work...)

Would appreciate any wisdom.

Thanks!
Maybe I am missing it, but does she have a degree now, or did she get the RN without a degree?

"Seat of the pants" - $70 k seems like a lot to become a NP. How long will it take to get the NP?

What does she actually want to do in nursing? Would she be "happy" and "satisfied" being an NP? Of course, even with an NP, she is still an RN and can still do nursing jobs. Some states now even allow NPs to do certain things in their own practice.

Not a lot of such folks, but I never heard an NP express regret over getting the NP designation.

One benefit of the nursing profession, in my observation, is that there are a lot of flexible schedule and part time opportunities - including working just weekends - when child care is needed during the week.

daheld
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Re: NP degree worth the investment?

Post by daheld » Fri Aug 09, 2019 12:40 pm

You're leaving out the most important factor: how much do you expect she will make as an NP? Without your expected return, it's impossible to say whether the investment is worthwhile.

Aku09
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Re: NP degree worth the investment?

Post by Aku09 » Fri Aug 09, 2019 12:41 pm

I’d say go for it. She is young enough now that she would certainly see return in her investment. Generally hours for NPs are better than those of an RN. Instead of working 12s and nights and holidays I would say there are many more opportunities for working a somewhat normal M-F 8-5 job. That would make raising a family easier in the long run. There are exceptions to the hours (working in the ER for instance), but overall it has more flexibility. I’d say starting salary for NPs is around 80-90k for shift work.

Schools for NPs has turned to a doctorate so that will take 3 years. I know many NPs who were still able to work part time during school helping to supplement their income.

Another route to look into would be CRNA. I am a CRNA and love what I do every day. The same amount of schooling (3 years) although you wouldn’t be able to work at all during school as it is more rigorous. Pay is considerably more. I just got a raise to 200k with 8 weeks off plus decent benefits.

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Vulcan
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Re: NP degree worth the investment?

Post by Vulcan » Fri Aug 09, 2019 12:43 pm

My wife is currently getting her DNP from the state flagship part time (5 yr total) while working as an RN at the university's hospital.
Her part-time tuition is fully covered by the university's employee education program.

If similar scenario is available in your area, this may be worth looking into.
Last edited by Vulcan on Fri Aug 09, 2019 12:45 pm, edited 1 time in total.
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BarbBrooklyn
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Re: NP degree worth the investment?

Post by BarbBrooklyn » Fri Aug 09, 2019 12:45 pm

I have a dear friend who is an NP and a frugal person. Her only regret about graduate school is that she took out loans rather than attending a slightly less prestigious institution where she would have gotten a free ride.

Has your wife looked into State programs or programs offering substantial aid?
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almostretired1965
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Re: NP degree worth the investment?

Post by almostretired1965 » Fri Aug 09, 2019 12:48 pm

It is not just about the money. My wife was faced with the same decision in the early 1990s, and in retrospect, I wish I had pushed her to go for it. Money would have been tight while she was in school, but we would have been fine. Admittedly the up front cost we were looking at then was considerable less than what you are talking about. Some NPs are practically doctors in terms of the autonomy/problem solving aspects of the job. I know my wife would have been much happier if we had decided to make the investment regardless of whether it paid off financially.

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Nowizard
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Re: NP degree worth the investment?

Post by Nowizard » Fri Aug 09, 2019 1:18 pm

NP Association says average salary is $105,500.

Tim

rascott
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Re: NP degree worth the investment?

Post by rascott » Fri Aug 09, 2019 1:20 pm

Well what's the expected salary in your area? Kind of an important variable.

avidlearner
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Re: NP degree worth the investment?

Post by avidlearner » Fri Aug 09, 2019 1:54 pm

70K for NP seems way too high. My wife is also a RN and is in last semester of NP degree and she did from a state university and it will cost us somewhere like 25K or so in tuition. You should definitely look around for other colleges. That being said your salary is high enough that you can absorb the 2-3 year of her not working or working part time and future of NP seems bright so salary may go up only.

Aku09
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Re: NP degree worth the investment?

Post by Aku09 » Fri Aug 09, 2019 2:01 pm

70k isn’t that bad for tuition. A little high yes, but not unreasonable. It’s 3 years of tuition at the doctorate level. I went to the cheapest state school there was and my tuition was around 50k for 3 years. Every other school was considerably more. Plus they may have to take out loans to help pay for books, rent, daycare, etc.

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Re: NP degree worth the investment?

Post by runner3081 » Fri Aug 09, 2019 2:14 pm

daheld wrote:
Fri Aug 09, 2019 12:40 pm
You're leaving out the most important factor: how much do you expect she will make as an NP? Without your expected return, it's impossible to say whether the investment is worthwhile.
Depending on where they live and what specialty she goes into, it shouldn't be too hard to double that 60K salary (or at least nearly double it).

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dm200
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Re: NP degree worth the investment?

Post by dm200 » Fri Aug 09, 2019 2:39 pm

avidlearner wrote:
Fri Aug 09, 2019 1:54 pm
70K for NP seems way too high. My wife is also a RN and is in last semester of NP degree and she did from a state university and it will cost us somewhere like 25K or so in tuition. You should definitely look around for other colleges. That being said your salary is high enough that you can absorb the 2-3 year of her not working or working part time and future of NP seems bright so salary may go up only.
Might the difference be that your wife had a four year degree with her RN, while, perhaps, the OPs wife might not have had a degree with her RN? Maybe (?) the OPs wife would need to fund a four year degree as well as the NP?

fru-gal
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Re: NP degree worth the investment?

Post by fru-gal » Fri Aug 09, 2019 2:46 pm

There seem to be a lot of NPs and PAs employed in my area:

My internist's practice, 5-6 MDs, one NP who has her own appointment schedule vs. trailing around after the doctors.

My ortho doc has an NP and a PA, and I am guessing his partners do also. They also have an associated group of PAs and maybe NPs who can see people in about a day vs the docs' month or two schedule delay and the group filters patients into the docs quickly if need be, otherwise they deal with stuff themselves.

The local ER seems to have 1-2 MDs present and a bunch of PAs and maybe RNs/NPs.

It's clear these people have a lot of responsibility. Whether that translates into money, I don't know. Nor do I know the supply and demand.

That said, I have had experience with a couple of NPs who shouldn't have been anywhere near patients, but that was years ago.

MI_bogle
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Re: NP degree worth the investment?

Post by MI_bogle » Fri Aug 09, 2019 2:54 pm

My initial instinct is to say yes, absolutely. But hard to say for sure without more details such as the length of time the program takes, and the expected salary once completed.

Is your wife actually an RN? Or is she BSN? My admittedly minimal knowledge is that you need a BSN first before getting NP

But back of the envelope, assuming a 3 year program: you're looking at 3 years without wife's salary (180K) plus the loan (70K) for a total of about 250K. And then assuming she makes about 120K a year after the NP... won't take too long to break even. She'd basically double her salary, maybe takes a half dozen years to break even

Yeah, it's a bit of an income/debt hole, but you're gonna be filling it with a much bigger shovel once you are on the other side

Kids and timing there is tougher to say, and more personal decision.

mhalley
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Re: NP degree worth the investment?

Post by mhalley » Fri Aug 09, 2019 3:04 pm

I have been reading some articles online about some NP schools that do not have clinical rotations locked in and the students are unable to get a physicians to agree to be their preceptor. So make sure the program is affiliated with drs/hospitals so that is not a problem.
Perhaps she could moonlight a few time a month on weekends to help defray costs during school?

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lwc5ed
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Re: NP degree worth the investment?

Post by lwc5ed » Fri Aug 09, 2019 3:07 pm

Thanks for all of the replies.

1. To the person who asked about her existing degree, yes she has a BSN.

2. I totally agree that the expected salary is one of the most important points in this analysis. I looked into salaries for NP's in Boston and there is a pretty big range (80k-160k) so I was having trouble pinning down a number (obviously things look a lot different if she is making 80K than 150K). I figure somewhere in the middle is realistic.

3. To the person who asked about what she wants to do, she is torn, but as one poster said, she thinks being an NP will lead to more 9-5 jobs rather than the 12 our weekend shifts and overnight shifts she does now (and hates) at the hospital.

4. State schools would be great, but MA is pretty short on them with NP programs.

EDIT

5. She does have the option to work part time. I am figuring maybe around $1000 ish per month after taxes.
Last edited by lwc5ed on Fri Aug 09, 2019 3:09 pm, edited 1 time in total.

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dm200
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Re: NP degree worth the investment?

Post by dm200 » Fri Aug 09, 2019 3:08 pm

As a patient over the years, I have dealt with many NPs and PAs.

From what I read, the two professions are very similar - but with some significant differences.

One advantage (as best I understand) of an NP is that he/she is still an RN and, if his/her circumstances change (long or short term) he/she is qualified for any employment that can be filled by an RN or RN with BSN.

daheld
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Re: NP degree worth the investment?

Post by daheld » Fri Aug 09, 2019 3:12 pm

lwc5ed wrote:
Fri Aug 09, 2019 3:07 pm
Thanks for all of the replies.

1. To the person who asked about her existing degree, yes she has a BSN.

2. I totally agree that the expected salary is one of the most important points in this analysis. I looked into salaries for NP's in Boston and there is a pretty big range (80k-160k) so I was having trouble pinning down a number (obviously things look a lot different if she is making 80K than 150K). I figure somewhere in the middle is realistic.

3. To the person who asked about what she wants to do, she is torn, but as one poster said, she thinks being an NP will lead to more 9-5 jobs rather than the 12 our weekend shifts and overnight shifts she does now (and hates) at the hospital.

4. State schools would be great, but MA is pretty short on them with NP programs.

EDIT

5. She does have the option to work part time. I am figuring maybe around $1000 ish per month after taxes.
I work in health care and though I'm in a much lower COL area than Boston, I'd assume average earning potential is right in the middle of the range you cited. I personally think it is a fantastic investment, as overall her earning potential will be much higher as an NP.

A couple things I think will help: your wife should form a better idea of what it is she wants to do if she becomes an NP. She doesn't need to know with 100% certainty, but having some idea will also tell you what job prospects are like in addition to giving a better idea of earning potential.

fuddbogle
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Re: NP degree worth the investment?

Post by fuddbogle » Fri Aug 09, 2019 3:21 pm

It will much easier to obtain a NP degree now than once the children are born, are in school or have graduated. If she's going to do it, now's the time.

I have a friend that's a PA. She got her PA degree, had twins and went to part-time work. Now they're in HS she's gone back to full time. IMO, that's the way to go.

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dm200
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Re: NP degree worth the investment?

Post by dm200 » Fri Aug 09, 2019 3:21 pm

A couple things I think will help: your wife should form a better idea of what it is she wants to do if she becomes an NP. She doesn't need to know with 100% certainty, but having some idea will also tell you what job prospects are like in addition to giving a better idea of earning potential.
Yes, I agree.

One possibility, for some NPs in states where it is allowed (Virginia just allowed it this year) - having an practice independent of being in a Physician's office should be considered.

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Re: NP degree worth the investment?

Post by Vulcan » Fri Aug 09, 2019 3:31 pm

dm200 wrote:
Fri Aug 09, 2019 3:21 pm
One possibility, for some NPs in states where it is allowed (Virginia just allowed it this year) - having an practice independent of being in a Physician's office should be considered.
There are also hospitalist tracks (acute care). That is what my wife is doing (she's currently an ICU RN and prefers to stay in the hospital setting rather than doing office primary care as a DNP). Those are more likely to be 12 hours shift jobs, but there are some benefits to that type of schedule.
If you torture the data long enough, it will confess to anything. ~Ronald Coase

jeroly
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Re: NP degree worth the investment?

Post by jeroly » Fri Aug 09, 2019 3:40 pm

My ex got her FNP degree at night while working full time until her last semester (or year, forget which) when she needed to do clinical rotations and then found a part time (1/2 time?) visiting nurse gig for that year. She went to a private school in NY and still spent way less than $70k. Granted it was 20 years ago, but still... WAY less than $70k.
She saw her income jump, perhaps from $75k to about $100k (now about $130k) after getting the degree, but she did do a post-degree fellowship in a specialty practice (HIV primary care).

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Re: NP degree worth the investment?

Post by Notsobad » Fri Aug 09, 2019 4:07 pm

Job satisfaction is a great thing. All the NPs I know like their jobs and the pay is clearly well above most nursing jobs. CRNA pays well, but one has to enjoy that sort of thing. Also, NPs can change from primary care to specialties and from hospital to office based work if they wish.

The value of paying all that tuition depends on what her other options for this degree are in your area.

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southerndoc
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Re: NP degree worth the investment?

Post by southerndoc » Fri Aug 09, 2019 11:50 pm

Don't do it.

NP schools have popped up like crazy. It's hard for newly graduating NP's to get jobs because the market is flooded. Salaries have been driven down because so many are looking for jobs.

NP schools have done a disservice to nursing by the number of schools that offer online degrees. Students sometimes have to arrange for their own clinical rotations, and that does not allow proper supervision to ensure there is adequate clinical teaching.

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Re: NP degree worth the investment?

Post by fru-gal » Sat Aug 10, 2019 7:16 am

southerndoc wrote:
Fri Aug 09, 2019 11:50 pm
Don't do it.

NP schools have popped up like crazy. It's hard for newly graduating NP's to get jobs because the market is flooded. Salaries have been driven down because so many are looking for jobs.

NP schools have done a disservice to nursing by the number of schools that offer online degrees. Students sometimes have to arrange for their own clinical rotations, and that does not allow proper supervision to ensure there is adequate clinical teaching.
I'm pretty sure if I were looking at NP resumes, I would toss ones from places like that. So I am not sure that is a factor.

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Re: NP degree worth the investment?

Post by stoptothink » Sat Aug 10, 2019 9:01 am

fru-gal wrote:
Sat Aug 10, 2019 7:16 am
southerndoc wrote:
Fri Aug 09, 2019 11:50 pm
Don't do it.

NP schools have popped up like crazy. It's hard for newly graduating NP's to get jobs because the market is flooded. Salaries have been driven down because so many are looking for jobs.

NP schools have done a disservice to nursing by the number of schools that offer online degrees. Students sometimes have to arrange for their own clinical rotations, and that does not allow proper supervision to ensure there is adequate clinical teaching.
I'm pretty sure if I were looking at NP resumes, I would toss ones from places like that. So I am not sure that is a factor.
Not going to debate about how effective an online program would be at educating, but how would you even know? The degrees don't say "online" on them and many highly regarded universities now have countless online programs. My PhD is from a good regional university that is top-5 in my specific field, they now have an online doctorate program that is quite similar to my PhD. Georgetown, Alabama, Iowa, Texas A&M, Central Florida, UT-Arlington...that's just a few of the several dozen well known universities that now have completely online NP programs.

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dm200
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Re: NP degree worth the investment?

Post by dm200 » Sat Aug 10, 2019 2:26 pm

One friend of ours got her NP - and was hired by a private prep school in New England to handle primary care type duties at the school. She did that for a few years, and then returned to this area working in an Oncology office.

There seems to be a wide variety of things NPs can do.

ENT Doc
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Re: NP degree worth the investment?

Post by ENT Doc » Sat Aug 10, 2019 3:09 pm

I would echo what southerndoc said. She needs to be cautious about were she is going to school for her degree. What is the pipeline to post-graduate employment? Are the clinical rotations locked down, and where are they? School reputation? The market is awash with new NP grads, many of whom having graduated from programs that were happy to take their money and not give them a great education in return.

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Re: NP degree worth the investment?

Post by goodenyou » Sat Aug 10, 2019 3:16 pm

NP is a fantastic gig. You can become an "expert" in whatever specialty just by working in an office that does that specialty. You can be an "ortho" NP one day and a "urology" NP the next if you change jobs. It's unique to these types of "providers" (PAs included) :oops:

There are significant differences in earning potential and opportunities for a BSN with an advance degree (NP).

Full disclosure. My wife is a Dermatology NP that is certified. She had to log thousands of clinical hours in order to sit for and pass a certifying exam to have that designation.
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

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southerndoc
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Re: NP degree worth the investment?

Post by southerndoc » Sat Aug 10, 2019 10:33 pm

fru-gal wrote:
Sat Aug 10, 2019 7:16 am
southerndoc wrote:
Fri Aug 09, 2019 11:50 pm
Don't do it.

NP schools have popped up like crazy. It's hard for newly graduating NP's to get jobs because the market is flooded. Salaries have been driven down because so many are looking for jobs.

NP schools have done a disservice to nursing by the number of schools that offer online degrees. Students sometimes have to arrange for their own clinical rotations, and that does not allow proper supervision to ensure there is adequate clinical teaching.
I'm pretty sure if I were looking at NP resumes, I would toss ones from places like that. So I am not sure that is a factor.
I can tell you that many medical directors simply don't consider NP applications because of the many online programs (at least for ER medical directors).

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Re: NP degree worth the investment?

Post by InMyDreams » Sun Aug 11, 2019 12:42 am

lwc5ed wrote:
Fri Aug 09, 2019 3:07 pm
3. To the person who asked about what she wants to do, she is torn, but as one poster said, she thinks being an NP will lead to more 9-5 jobs rather than the 12 our weekend shifts and overnight shifts she does now (and hates) at the hospital.
There are RN jobs that are M-F: Same day surgery, wound care (cert required), oncology/chemotherapy. And there's teaching (with additional degree).

She's developed clinical skills since graduation, giving her a background to use as an NP (e.g., worked on an ortho floor, work for an orthopedist).

Interest interview? Can she talk with another NP about how they see the work and the opportunities?

Look for additional funding sources? Like:
www.peointernational.org
Better loan opportunity, for one - if you have two co-signers.

Cyanide123
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Re: NP degree worth the investment?

Post by Cyanide123 » Sun Aug 11, 2019 2:57 am

lwc5ed wrote:
Fri Aug 09, 2019 3:07 pm
Thanks for all of the replies.

1. To the person who asked about her existing degree, yes she has a BSN.

2. I totally agree that the expected salary is one of the most important points in this analysis. I looked into salaries for NP's in Boston and there is a pretty big range (80k-160k) so I was having trouble pinning down a number (obviously things look a lot different if she is making 80K than 150K). I figure somewhere in the middle is realistic.

3. To the person who asked about what she wants to do, she is torn, but as one poster said, she thinks being an NP will lead to more 9-5 jobs rather than the 12 our weekend shifts and overnight shifts she does now (and hates) at the hospital.

4. State schools would be great, but MA is pretty short on them with NP programs.

EDIT

5. She does have the option to work part time. I am figuring maybe around $1000 ish per month after taxes.
From a strictly financial perspective, cRNA school is the best way to go for a BSN nurse. If she has ICU experience then that's something to think about. Salaries 150-200k often.

70k for NP school is ridiculous by the way, but still worth the cost. I saw its ridiculous because my med school tuition for 4 years was roughly 80k. Granted that was a state school, and a lot of bang for the buck. There have to be cheaper options.

The estimated salary depends on what kind of a NP she eventually becomes. NPs working in the ER are around 120-130k. Similar salary for psych and derm. If you go into family medicine, you're looking at around 100k. So really comes down to what her interest is. Most will make around 110-120k.

Since she is still young, the math is still in your favor, she will likely double her salary easily and there opportunity cost plus tuition will be easily covered. Financially it makes sense. If I was a BSN, I personally would have gone into CRNA school.

Flyguy
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Re: NP degree worth the investment?

Post by Flyguy » Sun Aug 11, 2019 7:34 am

I would seriously consider not doing the NP and having the kids sooner . If she's 28 and you want a few kids, you shouldn't wait very long. You're in a good financial position.

My wife and I were in a similar situation (slightly older). She went to school and we realized later that having the kids sooner would have been the better choice.

Dmanse02
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Re: NP degree worth the investment?

Post by Dmanse02 » Sun Aug 11, 2019 8:04 am

NP is one of the most lucrative fields today when considering cost/benefits. However, the rest of the country and academic institutions have figured this out as well. Institutions are collecting tuition fees and pumping out too many new grads. In my area, NPs are graduating and going back to their old jobs because there are no openings anywhere. If she could line up a job beforehand to mitigate this risk, the benefit would be fantastic. As the competition stiffens, i do think online NP degrees will lose out most of the time - you have to see patients clinically to learn medicine

JPM
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Re: NP degree worth the investment?

Post by JPM » Sun Aug 11, 2019 8:25 am

NP pay rates probably vary a lot by region and somewhat less by specialty.

In our midwestern exurban locale, NPs in primary care start at c $100-130K but their limit depends on their arrangement. Productivity is measured as "relative value units" AKA RVUs. An RVU= approximately $100 gross revenue for an MD in our locale, $80 for an NP. RVU value is set by Medicare and varies by locale and most insurance contracts work off the medicare rates, i.e. 95-110% of the medicare rate for the locale. In practice, a doctor who produces less than 4000 RVUs is a marginal doctor and less than 3000-3500 is a failed practice because it can't support its overhead and make a reasonable living for the doctor. 5000-6000 RVUs is common. You are working really hard to produce 8000+. Some produce 10,000. An NP working in nursing homes can produce 6000 working 40 hrs/week but it's unpleasant work for most tastes. Not as hard as ER because the ER has a rougher clientele unless you are in an upper middle class suburban ER. Primary care practice overhead is c 60-65%, more in low productivity practices and less in high productivity ones. In some practices the NP's RVUs are captured by the collaborating doctor as part of his productivity and the NP paid salary + bonus. In others the NP captures her/his own RVUs in which case she/he can earn similar to what a doctor in primary care earns minus the 20% differential. NP can earn $200K and maybe more if she develops a practice and is popular. In contrast a beginning physician in family practice or internal medicine starts at $125K-$220K depending on whether she/he works in a big city or an outlying town. Most new MDs finishing training and entering practice want to stay in the big cities nowadays and will accept lower pay rates to remain there. Practices have to pay up in order to get them to come to exurbia. I don't know if NP pay is comparably reduced in the big city.

CRNA (certified registered nurse anesthetist) is the best paying RN job on average but again situations vary a lot. Some work for the anesthesiologist on salary and the doctor captures most of the income she/he generates, sometimes not. Surgical RN staff nurses make $100K out here with OT and call pay.

NPs in surgical or procedurally oriented specialties may earn more because the top line of the practice is greater. The NP or PA in surgical practice allows a popular surgeon to be more productive in the OR by doing more of the preop preparation and postop followup care. In private practice, the NP starts at a guaranteed salary usually for the first two years. If at the end of the two years he/she is not earning the guarantee, the economics of the private practice require his/her discharge. In a situation where he/she is employed by a large group, (think Mayo, Intermountain, Kaiser, Cleveland Clinic, Advocate-Aurora) with hundreds of doctors and several hospitals then the employment is more secure and the NP's economic value is in extending the productivity of the collaborating physician in terms of RVU output in specialty practice, or referral volume into surgical and other services from a primary care practice.

Even at $70,000 school cost, the cost can be recaptured by salary differential in 3-5 years and an NP job in primary care is far more satisfying for most people than staff nurse or ER jobs. Smart experienced ER RNs make great primary care NPs by the way. Demand for primary care NPs out here is still good if for no other reason than that fewer physicians are going into primary care. Out here in midwestern exurbia where recruitment of physicians is difficult, NPs are becoming more common in primary care. It does take about 5 years in practice with a collaborating doctor to become proficient in adult primary care because there is so much to know and so much variety in the diagnostic part of it. At that 5 year point an NP who has had some hospital or ER experience as a staff nurse can be as independent as a newly minted primary care MD.

WWV
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Re: NP degree worth the investment?

Post by WWV » Sun Aug 11, 2019 9:26 am

southerndoc wrote:
Fri Aug 09, 2019 11:50 pm
Don't do it.

NP schools have popped up like crazy. It's hard for newly graduating NP's to get jobs because the market is flooded. Salaries have been driven down because so many are looking for jobs.

NP schools have done a disservice to nursing by the number of schools that offer online degrees. Students sometimes have to arrange for their own clinical rotations, and that does not allow proper supervision to ensure there is adequate clinical teaching.
I would echo this and add a couple of points
-large/ginormous medical groups are the future. They will look carefully at each position-can a PA or MA work rather than a NP

-the educational market is flooded with options for educating all of these positions (NP/PA/MA) which IMHO suggests a flooded market in the future, driving down the salary

However quality and love/passion for career trumps all. So if this is present-go ahead even if the market is saturated and the salary doesn't hold.

As background I'm a retired primary care MD. DW is an RN+MS-spent happy decades as a professor of nursing at a local community college-past students will come up to her in public and update her-I am amazed where some of them end up.
"The average investor has only 11,000 more genes than a worm"-New York Times

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BolderBoy
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Re: NP degree worth the investment?

Post by BolderBoy » Sun Aug 11, 2019 11:22 am

lwc5ed wrote:
Fri Aug 09, 2019 12:15 pm
My wife is an RN and is considering going back to school to get her NP degree. Curious to hear Bogleheads opinions on whether the degree will be worth it long term from a financial point of view.
In general, this is almost always a good thing to do, particularly at her age. The educational costs will be recouped in a reasonable amount of time and usually, NP work is more satisfying than RN work.

Some questions:

What NP specialty would she choose? Are you locked into living in MA going forward? Is she wedded to an NP program that will cost $70k?
"Never underestimate one's capacity to overestimate one's abilities" - The Dunning-Kruger Effect

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Re: NP degree worth the investment?

Post by mtmingus » Sun Aug 11, 2019 11:29 am

NP can be obtained thru online part time programs such as Chamberlain.

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galving
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Re: NP degree worth the investment?

Post by galving » Sun Aug 11, 2019 2:31 pm

Strongly recommend asking what she wants to do and then move to support the team decision.

Simple economics are below and I can forward the sheet if you're interested.
Ultimately, depends on the assumptions that you make.

Year 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028
Discount Year 0 1 2 3 4 5 6 7 8 9
Discount Factor 1.0 1.1 1.2 1.3 1.5 1.6 1.8 1.9 2.1 2.4
Discount Rate 10%
Investment 70 kUSD over two years
Nurse Salary 60 kUSD/yr
NP Salary 105 kUSD/yr

Base Case 60 60 60 60 60 60 60 60 60 60
Project Case -35 -35 105 105 105 105 105 105 105 105

Cash Flow -95 -95 45 45 45 45 45 45 45 45
DCF -95.0 -86 37.2 33.8 30.7 27.9 25.4 23.1 21.0 19.1
NPV 36.9 kUSD
IRR 4% %

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Re: NP degree worth the investment?

Post by Arlington2019 » Sun Aug 11, 2019 8:08 pm

Having worked in very large multistate healthcare systems and large corporate practices, from the financial standpoint, mid-level providers such as PAs and ARNPs can be a license to print money for larger practices. After a few years of practice, what they generate in revenue vs. their salary/benefits is a win for the practice. Here in the Seattle area, a lot of the large corporate healthcare systems are snapping up mid-level providers, which will likely increase in the future as physician supply continues to drop vs. demand for healthcare services. From my perspective in risk management and patient safety, I see the quality of care delivered by a PA vs. ARNP to be essentially identical, and more dependent on the specific person as opposed to PA vs. ARNP training. This is a very political issue, and the NPs in particular like to generate literature showing their quality of care is superior, which opinion is not necessarily shared outside the NP community. As long as the mid-level provider is aware of their scope of practice and refers/consults with a physician as necessary, I am fine with it.

For the OP, given your wife's age, I think going to NP school will have a very positive ROI over the long term.

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Re: NP degree worth the investment?

Post by Mrxyz » Sun Aug 11, 2019 10:48 pm

Definitely worth it....
You may want to read this article..
https://www.medscape.com/slideshow/2018 ... rt-6010997

BTW, they do not like to be called "mid-level provider". Also many have PhD and wear badges which say "doctor" (but not "physician"). Quite confusing to patients and relatives IMO.

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Re: NP degree worth the investment?

Post by celia » Sun Aug 11, 2019 11:25 pm

lwc5ed wrote:
Fri Aug 09, 2019 3:07 pm
3. To the person who asked about what she wants to do, she is torn, but as one poster said, she thinks being an NP will lead to more 9-5 jobs rather than the 12 our weekend shifts and overnight shifts she does now (and hates) at the hospital.
With this schedule, it seems she should be making more then 60K (assuming she works 3 (12) hour shifts per week. There should be extra pay for night shifts and weekends compared to the preferred 9-5 jobs.

Maybe she should look around at other hospitals who pay better. And to get a more interesting assignment, she could look for a telemetry ward, ER, or something other than the general floor. If she is still in touch with her former nursing classmates, they can provide a wealth of perspectives.

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Re: NP degree worth the investment?

Post by southerndoc » Sun Aug 11, 2019 11:35 pm

Mrxyz wrote:
Sun Aug 11, 2019 10:48 pm
Definitely worth it....
You may want to read this article..
https://www.medscape.com/slideshow/2018 ... rt-6010997

BTW, they do not like to be called "mid-level provider". Also many have PhD and wear badges which say "doctor" (but not "physician"). Quite confusing to patients and relatives IMO.
Some states strictly forbid this in a healthcare setting.

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Re: NP degree worth the investment?

Post by Arlington2019 » Mon Aug 12, 2019 6:22 am

southerndoc wrote:
Sun Aug 11, 2019 11:35 pm
Mrxyz wrote:
Sun Aug 11, 2019 10:48 pm
Definitely worth it....
You may want to read this article..
https://www.medscape.com/slideshow/2018 ... rt-6010997

BTW, they do not like to be called "mid-level provider". Also many have PhD and wear badges which say "doctor" (but not "physician"). Quite confusing to patients and relatives IMO.
Some states strictly forbid this in a healthcare setting.
Washington is one of those states; so all the PAs with Ph.Ds and ARNPs with DNP degrees cannot call themselves 'Doctor' or put the word 'Doctor' on their name badges. And yes, many of the ARNPs especially do not like to be categorized as a 'mid-level provider' or 'physician extender'. Add this to the number of physicians who don't like to be called a 'provider' and point out that they went to medical school, not provider school.

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Re: NP degree worth the investment?

Post by dm200 » Mon Aug 12, 2019 9:50 am

I have no idea whether this choice is relevant or not, but my former Primary Care Physician's office (four Physicians), there were two NPs that patients might see for their annual physicals or for some kinds of medical appointments. I noticed that the two NPs had different initials after their names on the list of Physicians and NPs in the practice. At one appointment with one NP, I asked her about that and she said there are two, different certification organizations for NPs - and each of the two of them was certified by a different organization.

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Re: NP degree worth the investment?

Post by Bandit390 » Mon Aug 12, 2019 11:04 am

RN pay around here is 40k-60k. When my wife got her NP, everyone found a job that was around 80k-120k. Also, my wife's NP degree cost about 30k. I would say it's well worth it. My wife would say she now doesn't have to wipe someone's ass. She is also completing her DNP with a cost of about 30k, but there won't be a huge increase in pay.
Last edited by Bandit390 on Mon Aug 12, 2019 11:06 am, edited 2 times in total.

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lwc5ed
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Re: NP degree worth the investment?

Post by lwc5ed » Mon Aug 12, 2019 11:05 am

Thanks for the discussion everyone, very helpful all around.

A few responses:

I definitely agree that ultimately this choice comes down to what she wants to do. I will support her decision regardless. Getting an advanced degree worked out for me, but I was in a different boat financially (parents were able to fund).

I 100% agree that 70K for the degree is absolutely insane, but unfortunately, there does not seem to be a significantly cheaper options around here. While we might move back South at some point, making state school a possibility, I don't think that is realistically in the cards for another 2-3 years at the soonest.

As far as specialties go, she wants to do dermatology.

Agree that CRNA makes the most sense from a financial point of view, but she is not really interested in that path.

If she were to not move forward with the the degree she would likely leave the hospital and try to find a job at a doctors office. My understanding is that this would likely entail a pay cut, though I am not sure how much.

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dm200
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Re: NP degree worth the investment?

Post by dm200 » Mon Aug 12, 2019 1:02 pm

If she were to not move forward with the the degree she would likely leave the hospital and try to find a job at a doctors office. My understanding is that this would likely entail a pay cut, though I am not sure how much.
A pay cut from being a BSN, RN to an NP?

I have never seen or encountered an NP in a dermatology office.

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