Key takeaways:
- In 2024, 83% of APPs in nephrology have been white and 89% have been ladies; 18% have been aged 50 years of older.
- Common wage was $128,000, barely larger for PAs than NPs, and barely outpaced inflation.
The Nationwide Kidney Basis Council of Superior Follow Suppliers conducts a web based survey each 2 years to evaluate modifications within the workforce and utilization of superior follow suppliers in nephrology.
These professionals, known as AAPs, embrace doctor assistants/associates (PAs) and nurse practitioners (NPs).
The survey covers subjects corresponding to medical setting and duties, general affected person load, APP demographics, pay and advantages. The 15-minute survey is carried out on-line through Survey Monkey and open to all nephrology APPs, no matter affiliation with NKF. It was printed through the Council of Superior Follow Suppliers e-mail listserv a number of occasions throughout the first quarter of 2024, and recipients have been inspired to share with nephrology colleagues.
Demographics
Survey individuals have declined in quantity over time regardless of a rising nephrology APP inhabitants throughout the group’s membership. There have been 218 respondents for this survey, which is roughly equal to 25% of the recognized membership and down from a peak of greater than 300 in 2020. Information got here from 47 states; Delaware, Rhode Island and South Dakota have been the one states not responding. Puerto Rico and different U.S. territories weren’t included.
When it comes to APP demographics, the bulk stay white (83%) and feminine (89%), with racial range declining since 2022. By age, the older inhabitants of APPs has declined considerably since 2020, probably as a result of impacts of the COVID-19 pandemic. Roughly 30% of responding APPs are aged 30 to 39 years, and 30% aged 40 to 40 years. Solely 18% of respondents are aged 50 years or older.
The common nephrology APP has lower than 10 years of nephrology expertise, and 25% have lower than 5 years as an APP. This might be associated to nephrology shortages being newly backfilled or an general youthful workforce.
As two-thirds of respondents by no means labored in a nephrology-related place previous to their APP function, coaching of recent hires is one other consideration. Nephrology coaching was reported as nonstructured, with 83% of respondents noting a casual mentor or on-the-job coaching.
NPs stay extra prevalent than PAs in nephrology (70% vs. 30%), and the info have been restricted for medical nurse specialists, who’ve been included with NP evaluation as in prior surveys. A grasp’s diploma is the predominant instructional achievement; that is value monitoring as doctorate packages for NPs and PAs increase in presence and recognition.
Greater instructional levels didn’t correlate to larger salaries, whereas longer work expertise did replicate larger salaries.
Office setting and duties
Comparable charges of respondents (close to 70%) reported doing hemodialysis (HD) and workplace/clinic work, which displays a slight drop in respondents masking HD throughout the previous two surveys (Determine 1). Practically 90% of respondents have been concerned in HD till 2022. Inpatient protection trended up from 2018 to 2022 however dropped barely on this survey to 46% of respondents. Pediatric care elevated starkly to 13%, whereas prior surveys reported minimal involvement. Of be aware, one of many pediatric nephrology APPs acknowledged she pushed her colleagues to take part within the survey, maybe influencing the speed of participation in contrast with prior years.
Duties throughout the inpatient hospital setting various; nonetheless, consults and rounding dominated at greater than 80%. Roughly 30% of respondents have been included as formal medical employees members, and barely greater than one-third mentioned they take name Monday by way of Friday. Workplace roles are predominantly in power kidney illness clinics, anemia clinics, new consults and hospital follow-up visits.
Outpatient HD duties maintain with conventional roles, together with weekly/fundamental rounds, treatment protocols and administration, and name protection throughout daytime Monday to Friday commonest. The common variety of sufferers seen per week by APPs was barely up from 100 sufferers in 2022 to 108 in 2024, and APPs averaged three dialysis models per week. About half of APPs reported masking three of 4 month-to-month visits, however 12% reported masking all 4 visits month-to-month.
Whereas APPs reported some involvement in outpatient peritoneal dialysis, this was largely confined to the hospital/inpatient setting. That mentioned, an increase in weekday PD name protection hit a peak of 45% of respondents from a earlier excessive of 36% in 2012. Finishing annual historical past and physicals and treating major care points have each been in decline and stay so. This may occasionally symbolize the nationwide pattern for nephrology shortages, for major care to be extra concerned within the care of sufferers with end-stage kidney illness and/or modifications in high quality care/medical residence fashions.
Educating different staffers has been about 50% of respondents’ duties for a number of years, and correlates to the more and more youthful APP inhabitants and pattern of coaching by mentorship.
Kidney illness schooling by APPs has dropped again to 2012 numbers of 30% and warrants a evaluation of this reimbursable exercise by nephrology practices vs. schooling by dialysis organizations for late-stage CKD. As kidney illness schooling is simply coded and paid by CMS, it could be that kidney schooling for business pay sufferers is coded as a “counseling” go to or a extra in depth workplace CPT E/M service and thus misplaced within the knowledge assortment.
Analysis involvement has remained at about 20% or much less of responders, principally throughout the sub-investigator function and duties (81%) and a few performing as major investigator (15%). That mentioned, about 20% of individuals reported performing as a examine coordinator regardless of their inherent {qualifications} as an APP for investigator roles. APP analysis actions span the normal wants in research, corresponding to investigator, and nationwide assembly shows, topic assessments and monitoring, writing manuscripts, and so on.
Wage and advantages
In 2024, the common nephrology APP wage was $128,000 and barely larger for PAs than NPs as seen in prior surveys apart from 2022, when it’s proposed that COVID-19 bonuses for nursing flowed over to NP salaries. The desk reveals the modifications in wage beginning in 2010, together with annual inflation charges. Utilizing an inflation calculator, the general common wage has marginally outpaced inflation at every survey time level aside from 2020 and 2022, when wage will increase didn’t sustain with inflation. This seemingly reveals the monetary pressures of the COVID-19 pandemic together with the intense inflationary surroundings within the subsequent 2 years.
About one-quarter of respondents have been informed they’re on the high of their wage vary. Most (70%) acquired a increase of about 3% in 2023, and 14% of respondents acquired a increase in 2022. Whereas these wage changes have been typically for advantage or competitiveness, one-third of respondents acquired a increase for no identifiable cause.
Hourly wages have been discovered to be $65 to $70 per hour, however knowledge have been restricted by the small cohort on this class. About half of survey individuals reported contracted employment, largely (90%) as a consequence of employer request. Roughly half of those contracts included a noncompete clause, which might be fascinating to trace because the follow is actively being challenged on the nationwide stage.
When altering positions, 92% reported they didn’t achieve this strictly for pay. Name compensation was given for 22% of these taking after-hours name and 25% for these masking weekend name. Some respondents famous that decision was a part of their normal compensation bundle whereas others mentioned name time was paid through comp time. Most paid name was for after-hours hospital calls (86%) adopted by after-hours dialysis unit calls (43%).
When it comes to advantages, greater than 80% of respondents reported CME protection, medical health insurance, malpractice insurance coverage and retirement advantages (Determine 2). CME budgets have been barely larger for PAs than NPs at $1,867 vs. $1,743 yearly.
Protection of Drug Enforcement Company charges, UpToDate entry and lab coats was reported by roughly 60% of individuals. Practically 50% of respondents acquired mileage reimbursement in addition to a work-provided cellphone.
When it comes to paid day off, most respondents acquired 21 to 30 days or extra, and 81% of APPs acquired 5 CME days per yr. Practically one-quarter of respondents reported work-from-home/telework choices. Most APPs have been additionally included on the follow web site and listing of suppliers.
Conclusion
This biennial survey has allowed for an everyday snapshot of the occupation since 2010. Over time, the duties have expanded to fill many roles in nephrology follow, past the normal CKD and dialysis inhabitants. On the similar time, the common APP is turning into more and more youthful, and extra skilled APPs have taken on the mentorship hat.
Future research might be fascinating to observe modifications in roles and responses to exterior and inside well being care market constraints.
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Amy Okay. Mosman, MMS, PA-C1, is a nephrology doctor assistant in St. Louis and a PA director at massive for Nationwide Fee on Certification of Doctor Assistants board of administrators. She thanks the Nationwide Kidney Basis Council of Superior Follow Suppliers for its help with the survey and Kim Zuber, PA-C, and Jane Davis, CRNP, DNP, for knowledge assortment and evaluation. She may be reached at amy.krieg.07@gmail.com.
