Golden Adam G, Xu Peixin, Wan Thomas T H, Issenberg Saul Barry
From the Orlando Veterans Affairs Medical Center, Orlando, Florida, the College of Medicine, the Department of Statistics and the College of Health and Public Affairs, University of Central Florida, Orlando, and the Gordon Center for Research in Medical Education, Miller School of Medicine, University of Miami, Miami, Florida.
South Med J. 2016 Jul;109(7):409-14. doi: 10.14423/SMJ.0000000000000484.
With a continual shortage of geriatricians, adult-gerontology primary care nurse practitioners have assumed a greater role in the delivery of outpatient care for older adults. Given the long duration of physician training, the high cost of medical school, and the lower salaries compared with subspecialists, the financial advantage of a career as a geriatrician as opposed to a nurse practitioner is uncertain. This study compares the estimated career earnings of a geriatrician and an adult-gerontology primary care nurse practitioner.
We used a synthetic model of estimated net earnings during a 43-year career span for a 22-year old person embarking on a career as a geriatrician versus a career as an adult-gerontology primary care nurse practitioner. We estimated annual net income and net retirement savings using different annual compound rates and calculated the financial impact of forgiving medical student loans, shortening the duration of physician training, and reinstituting the practice pathway for geriatric medicine certification.
Career net incomes for the geriatrician did not match the nurse practitioner until almost age 40. At 65 years of age, the difference between the geriatrician and nurse practitioner was 30.6%. A higher annual compound rate was associated with an even smaller percentage difference. Combining all three health policy interventions lowered the break-even age to 28 and more than doubled the difference in career earnings.
Small estimated differences in net career earnings exist between geriatricians and adult-gerontology primary care nurse practitioners. Health policy interventions had a dramatic positive effect on geriatricians' lifetime net earnings in calculated estimates.
由于老年医学专家持续短缺，成人老年初级保健执业护士在为老年人提供门诊护理方面发挥了更大作用。鉴于医生培训时间长、医学院校成本高以及与专科医生相比薪资较低，与执业护士相比，老年医学专家职业的经济优势尚不确定。本研究比较了老年医学专家和成人老年初级保健执业护士的估计职业收入。
我们使用了一个综合模型，该模型估计了一名22岁开始从事老年医学专家职业或成人老年初级保健执业护士职业的人在43年职业生涯中的估计净收入。我们使用不同的年复合利率估计年度净收入和净退休储蓄，并计算了免除医学生贷款、缩短医生培训时间以及重新建立老年医学认证实践途径的财务影响。
老年医学专家的职业净收入直到将近40岁时才与执业护士相当。在65岁时，老年医学专家与执业护士的收入差距为30.6%。较高的年复合利率与更小的百分比差异相关。将所有三项卫生政策干预措施结合起来，使收支平衡年龄降至28岁，职业收入差异增加了一倍多。
老年医学专家和成人老年初级保健执业护士之间的估计职业净收入差异较小。在计算估计中，卫生政策干预对老年医学专家的终身净收入产生了显著的积极影响。
