Securing Nurse Practitioner Preceptors: Why Are Some Schools and Students Paying for the Privilege?
"Get a medical student. The medical schools pay you."
As a nurse practitioner (NP) student, it was shocking and discouraging to hear my physician preceptor say this to his colleague. Whether students are attending a school that supports them with placements or working toward securing one independently, securing preceptors for clinical rotations is a challenging task. Unfortunately, many are desperate enough to pay agencies to find preceptors for them. Has advanced practice education really come to this — all because medical schools pay offices to take on students?
According to a 2014 article from the Society of Teachers of Family Medicine, 23% of medical schools offered payment for community preceptors. In fact, 63% of those who received payment for precepting were also paid by other learners. The article cites the increased competition among other healthcare schools to place students in community settings as the leading reason for providing payment. This ultimately leads to decreased opportunities for NP students, which is why many are having a difficult time securing placements.
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During NP school, I saw the many challenges that preceptors faced. From meeting quality measures to seeing patients and charting, providers were required to fit teaching students into their already hectic schedules. According to "Incentives & Barriers to Precepting Nurse Practitioner Students" the stress involved in the daily workflow of the clinic makes it difficult for providers to precept students – despite their desire to give back to the next generation. If productivity is impacted, a provider's income is affected as well. It is not uncommon to hear providers question their capacity to take on students when they can barely sustain themselves. This is why many providers ultimately choose not to precept students, although they would ideally like to teach.
In the same article, the authors mention the potential benefits of providing some sort of stipend to preceptors as an incentive. While this may help students secure preceptors more efficiently, it won't be useful for a student who is already paying a hefty tuition to serve others.
As a newly minted family nurse practitioner (FNP), I decided long ago that I would eventually precept the next generation of FNPs. As one of my preceptors put it, "I'm going to be under the care of you one day. Therefore, I'm going to teach you my ways so that you can care for me and not kill me!" These words always stuck with me, and I've since committed to give back to the next generation by becoming a mentor. Seeing the work that NPs and other providers put in, I know it won't be easy. However, I also know that the issue of paying for preceptors isn't going anywhere.
Precepting students as a nurse practitioner has traditionally been done free of charge. It was a service that NPs committed themselves to as a way to encourage and empower new NPs to effectively serve their communities. However, the shift of medical schools now paying clinical sites to host students has affected both NP and physician assistant students. Some schools are paying up to $100-$450 per week, with anecdotal research revealing that agencies such as NPHub will pay preceptors up to $3,000 per month. Whether it's the school or students who pay for preceptors, it's the student who is ultimately affected.
Looking back at my experience overhearing my physician preceptor and his colleague, I recall my hours being rushed to completion in order for them to take on a medical student. This led me to the realization that incentivized stipends for preceptors can lead to poor clinical experiences. If clinics and their providers are interested in empowering the next generation of practitioners, more support needs to be provided outside of stipends and financial incentives. Should this trend of paying for preceptors continue, I'm curious to see the implications on students' clinical experiences at rotations and the way they practice upon graduation.
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