When I finished writing my article, “How PAs and NPs Can Make Doctor Money,” for the White Coat Investor, I knew some of the topics might spark strong reactions, particularly from doctors. My intention was to help APPs navigate their careers more effectively, focusing on financial independence and professional growth—not to create controversy. While I expected the title to turn heads, I hoped the content would clarify that it wasn’t about achieving a mythical “doctor money” figure or demanding higher pay for our work. Instead, it was about maximizing our existing income and leveraging entrepreneurialism to create financial success as APPs.
It’s common to hear about doctors who make smart financial decisions and achieve independence, but we don’t hear enough success stories from providers at my level. I anticipated some resistance, especially around the idea that APPs could approach the financial success of doctors due to salary differences. What I didn’t fully anticipate was the intense backlash from those who felt that an APP seeking to earn more was challenging the traditional hierarchy in healthcare.
In this article, I want to talk about the controversial topics that were discussed in the comment section of my WCI article, how the backlash unfolded, and how I felt in the midst of it all. This isn’t about defending my viewpoint but fostering a more open dialogue on these issues. After all, APPs aren’t going anywhere in medicine, and we should continue to pursue financial independence while engaging in constructive conversations that help us all grow.
The Controversial Topics
Compensation for APPs vs. Doctors
One of the most heated points in the discussion was the idea that APPs—whether Physician Assistants or Nurse Practitioners—might strive for compensation levels traditionally associated with doctors. Critics argued that without the extensive schooling and training doctors undergo, it’s unreasonable for APPs to expect similar pay.
However, my suggestions in the original article were not about APPs demanding higher salaries. Instead, they were focused on how APPs could take the already generous six-figure salaries they typically earn and leverage that income to maximize their financial success. This might include smart investments, side ventures, entrepreneurship, practice ownership, working more than one job, or working beyond the normal hours of work to earn more income—similar to how many doctors work long hours early in their careers to pay off loans or secure their financial future.
Some commenters suggested that if APPs work beyond their normal job hours to increase their earnings, it might compromise the quality of care they provide. While it’s true that everyone has their limits, it’s not fair to put a number on someone else’s limit. Just as many physicians work long hours during residency or in their early years to build their careers, APPs are capable of managing their workload responsibly while maintaining the quality of care.
The goal isn’t to blur the lines between APPs’ and doctors’ roles but to ensure that APPs are making the most of the opportunities and income they already have.
Independent Practice
The topic of independent practice for APPs has sparked much debate, and I want to clarify my stance. I don’t necessarily believe that independent practice is the right path for APPs. In fact, the relationships I’ve built with my supervising physicians have been invaluable to my growth as a healthcare provider. Their accessibility and willingness to guide me have made me more confident in handling patients I was initially unsure about.
For example, working side by side with doctors in the ER taught me how to manage complex emergency cases. This hands-on experience under seasoned physicians has been crucial in shaping my abilities. It’s also made me very aware of the differences in training between APPs and doctors. Day one for a doctor fresh out of residency is vastly different from day one for a PA. The depth and breadth of their training equip them to handle situations that APPs might find overwhelming without additional guidance and experience.
This leads to an interesting discussion that arose in the comments: Can years of experience for a PA bridge the education gap between APPs and doctors? Experience certainly plays a role, but there’s a fundamental difference in the foundation of knowledge between the two. While experience can and does improve an APP’s ability to manage a wide range of patient scenarios, the question of when, or if, it bridges the gap entirely is complex and likely varies from one provider to another.
Scope of Practice
In discussing the scope of practice for APPs, I advocated that the greatest need for them lies in underserved areas, particularly in primary care and urgent care settings. In these environments, APPs can make a significant difference by providing essential services to populations that might otherwise lack access to care.
While PAs and NPs do play important roles in various specialties, as the field of medicine they choose to practice becomes more specialized, the need for supervision increases, in my opinion. In these settings, APPs often work side by side with physicians, adding value by assisting with clinic flow, follow-up, note writing, hospital rounding, and other tasks that free up the physician’s ability to do more surgeries/procedures or see more patients. This collaborative approach ensures that patients receive high-quality care, efficiently.
In contrast, in family practice and urgent care, APPs operate with a greater degree of autonomy. However, this does not mean working without supervision. Finding the balance of autonomy and supervision can be difficult, so I always advocate to APPs to work somewhere that you have access to a supervising physician to be able to learn from. Recognizing the limits of one’s knowledge and being able to ask questions to your supervising physician when you’re unsure is crucial for providing the best patient care.
Patient Preferences: The True Priorities
In my original article, I made a statement that seemed to resonate poorly with many doctors: “Some know the difference but don’t care, and there is likely a small minority of patients who prefer only to see a doctor. However, I believe most people want to see a provider who listens to their needs, who is knowledgeable in their medical decision-making, who projects confidence (not arrogance), and (most importantly) who is accessible.”
I believe this may have been misunderstood. My intention was not to diminish the importance of a doctor’s credentials or expertise but to emphasize what I’ve observed patients truly value when they seek care. Patients want to be seen and heard. They want to trust that their provider is making sound medical decisions on their behalf. They also want to have access to their provider when they’re sick or in need.
In essence, patients are looking for a provider—whether a doctor or an APP—who embodies certain qualities: knowledge, confidence (without arrogance), and accessibility. These qualities are not exclusive to any particular title. Great doctors often exemplify these traits, but there are also APPs who can fulfill these qualities effectively. The focus should be on the patient experience and ensuring they receive the care they need, rather than solely on the credentials behind the provider’s name.
The Backlash
Reactions from Doctors
When my article was published on White Coat Investor, the response was a mix of support and criticism. On one hand, fellow APPs appreciated the encouragement to maximize their income and improve their financial future. Some physicians, particularly those who work closely with APPs, also expressed support. They recognized the value APPs bring to patient care and acknowledged that a strong collaborative dynamic can enhance the healthcare experience for patients.
However, the majority of responses from physicians were negative. I was surprised by the intensity of some of these comments. While I anticipated some controversy, I didn’t expect such a strong reaction. Most of the criticism wasn’t directed at the specific content of my article, but rather at APPs in general, particularly regarding the issue of independent practice. Unfortunately, some of my points were taken out of context. For instance, my suggestion about practice ownership was often conflated with advocating for independent practice.
The backlash felt, at times, like a challenge to the success and presence of APPs in medicine, which caught me off guard. I haven’t encountered this level of criticism in my career before, so reading negative comments questioning APPs’ abilities and motives affected me more than I expected. I believe this backlash reflects broader concerns within the industry, including fears about maintaining the quality of care and preserving the value of a physician’s extensive training—neither of which I intended to undermine.
Personal Reflection
When I wrote the original article, my goal was to spark a conversation and encourage APPs to think proactively about their financial futures. I wanted to provide practical advice on how to achieve financial independence, leveraging the generous salaries that many of us earn. My intention was never to suggest that APPs should earn more than physicians or to diminish the value of a doctor’s rigorous training. Instead, it was about maximizing the income we already have, using it wisely, and setting strategic financial goals.
When the backlash came, I took some of the comments to heart. While I anticipated some pushback, the intensity of the response and the direct attacks on APPs surprised me. It was disheartening to read some of the more critical remarks, but at the same time, the encouragement I received from fellow APPs reinforced the importance of advocating for our community. This experience has strengthened my resolve to continue teaching APPs about personal finance and entrepreneurship, always with the goal of doing what’s right for our patients and our profession.
Conclusion
The lesson I learned from this experience is confirmation that the topics I discussed are vital for APPs to know and learn. Financial independence, practice ownership in our scope of practice, and entrepreneurship are essential for our professional and personal growth. Through my work here at BBM, I will continue to address the challenges we face, foster meaningful discussions, and promote the professional growth of APPs in both business and medicine. I believe that striving for financial independence is crucial not just for personal success but also for providing good patient care. By not being trapped in corporate medicine, APPs can advocate for themselves in their careers, pursue what they are passionate about, and avoid simply surviving in a job just for the paycheck. The conversations sparked by this article have only strengthened my resolve to support our profession and ensure that APPs can thrive in their career.
