I want to thank Nursing Economic$ for publishing the article "APRNs: Overcoming Clinical Bias" (Bryan, 2021).
It is still a painful, ongoing struggle to overcome the misogynist infrastructure that governs so much of what we do. It has been more than 15 years since Suzanne Gordon published Nursing Against the Odds, and I sometimes feel that nothing has changed. And I speak with the benefits of white male privilege
We made so much progress toward autonomous practice but failed to make this independence economically viable. For example, one of the largest third-party payers in Arizona reimburses nurse practitioners (NPs) at just 60%-65% of the physician pay schedule. I might have total autonomy, but I can't afford the gasoline to make it to my office. (This includes fixed-cost items. A physician receives $100 for ordering a pneumococcal vaccine; I get $65. Even though a medical assistant will likely administer it in either case.)
Perhaps due to necessity, low self-esteem, or feeling that we're up against behemoths, NPs have become complicit in maintaining this structure. The overwhelming majority of NPs are billing under an incident tomethod. It gets the NP a fair wage, but it reinforces invisibility. I also think it really isn't so grey; it is fraud.
