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NP or PA?

Discussion in 'Clinicians [ RN / NP / PA ]' started by Sofa, Feb 10, 2012.

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  1. Sofa

    Sofa

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    SDN Members don't see this ad. (About Ads)
    I know PA is insanely hard to get into. Lurking around, ive heard that in some cases it is even harder than med schools. I know next to nothing about NP programs.

    After taking that into account, what are key differences between the two careers? I cant distinguish them except for their title differences. I know they both practice medicine, prescribe medication, and diagnose conditions. What makes one different from the other?

    1. Pay scales are the same arent they?
    2. Is it possible to be an NP without going to nursing school?
    3. If yes to 2, How do np schools compare in competitiveness to PA programs?
    4. Can either practice without supervision?
    5. Whats the job market like for both fields? Ive heard PA is in dire need of fresh graduates. Nurses are always wanted, what about NPs? Saturated areas?


    If it isnt obvious enough, im really having trouble deciding on the path that i should choose. :)

    Thanks guys!
  2. emedpa

    emedpa GlobalDoc2B2015

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    Do some independent research into both fields somewhere other than sdn. start with www.aapa.org for pa's and American Academy of Nurse Practitioners http://www.aanp.org

    there are pros and cons to both fields and areas of practice that are more easily entered by one or the other. there are fundamental differences in training between the two which may or may not be important to you.there are several entry points for both professions.
    Last edited: Feb 11, 2012
  3. Daggum

    Daggum

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    Unfortunately, you have to go to nursing school first. Allnurses.com has some good threads on graduate nursing programs.
  4. emedpa

    emedpa GlobalDoc2B2015

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    if you do a direct entry np program nursing school is part of this. you can go from no medical background to np in 3 years via a direct entry program with a prior bs in almost anything if you have the acedemic prereqs. the rn is awarded after yr 1 and the msn/np after yr 3.
    sadly, there are now direct entry pa programs as well.
    not a fan of either.
  5. Sofa

    Sofa

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    My friend is actually in one of those direct PA programs.

    Why exCtly do you speak of those programs with such remorse? Ae you saying that they push out degrees to a bunch of quacks?
  6. emedpa

    emedpa GlobalDoc2B2015

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    The concept of PA education is to start with a paramedic, nurse, rt, etc and bulid on that experience not to start from scratch with some 22 yr old bio major with no prior medical experience. quality programs still require experience. some newer programs try to work around that to make a buck. there is a difference in the final product.
  7. sarjasy

    sarjasy I have action potential

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    Your first statement is correct. Your second one is not. ;)
  8. MedPsy82

    MedPsy82 Just a Thought

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    I read a lot of the different topic at that site every so often and I have to say, the junk that is stated on that site is funny sometimes, and scarily inaccurate at other times.
  9. sarjasy

    sarjasy I have action potential

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    I don't have a strong opinion one way or another about direct entry for PA's or NP's, though I tend to lean against it. For what it's worth, I am not doing direct entry. However, it seems to me that the debate is centered on how capable one is upon graduation. (This also touches on the lack of true residencies for most PA's and NP's.)

    Let's say two people go to a direct entry PA school. One has 5 years experience as an RT, the other has no health care experience. The argument is that upon graduation, the former RT, on average, is better prepared. But what about 5 years out? Is there really a difference between the two?

    In the case of PA's, and most NP's, they are supervised. What they can/cannot do is based on their ability as determined by the supervising physician. Upon graduation, the former RT is better prepared and thus will get to do more -- the other will do less while being more closely supervised until he/she gets the needed experience. In the end, say, 5 years out, does it really matter?
  10. emedpa

    emedpa GlobalDoc2B2015

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    Last edited: Feb 13, 2012
  11. chimichanga

    chimichanga misunderstood

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    Seeing procedures over and over, builds a certain (albeit) limited/anecdotal, comfort level, more so than never having seen it before.

    Being around the 'stuff' bedside nurses experience, witness, participate in, etc. certainly makes one more 'prepared' than a direct entry person with none of these experiences.

    (You had asked me in another thread a while back how 'wiping butts' better prepares someone for NP practice right out of school.)

    No way does a direct entry NP, with no HC experience, with only a 1000 hours of clinical, belong working in any capacity as an NP. This is where my 10 year plan (of direct relating experience in their area of NP specialty) would come into effect, and prevent this direct entry stuff from growing.

    There are minute clinics hiring these direct entry NPs into their drug store 'urgent cares'

    Yea, they might get most of the stuff 'right' but you can't tell me that they understand all of the differentials that led them to the diagnosis.

    Will they know when to get the pt to an ER?
    At least a seasoned ER nurse would, at the very least. Direct entry (with an accounting background): NO!!

    Again, it's a combination of years of doing our daily 'stuff' that gives us a better understanding of so many things (related to patient care)

    And direct supervision is key as well.

    You mentioned 'most' NPs being supervised.
    I fear (with all of the minute clinics opening) that the number of 'most NPs' practicing under a collaborative model, is shrinking, and more are branching out to do solo stuff.
    Scares me
    Last edited: Feb 13, 2012
  12. Makati2008

    Makati2008 Moderator

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    I agree with this for the current model. About a decade ago if you got into a PA school with no experience you were paired with someone who did have HCE-(At least I was fortunate enough too). And they show you the ropes. My mentor were 1.)Army PA 2.)IDC turning PA with me at the time. I think I am personally stronger than probably 80%(if not closer to 90%) of my classmates and that shows in salary, charting, and now my job paying for me to go to medical school. So I think that the schools now have gotten VERY lazy about this. I have seen a PA-S wanting to shock asystole but she is about to let loose in a year of clinicals.....(this was AFTER cardio mind you).....

    Also EMED is right about being scared of some procedures, am I scared to intubate-Nope. Am I scared of CL-Nope but pray to Got to never get a PTX am I scared of a Chest Tube-Yep. lol. Moreso due to the risk of me getting cut on a rib then anything else or getting splattered...
  13. RDlv

    RDlv

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    As I have mentioned here previously, I am in a final semester NP course discussing entry-to-profession stuff. Most of it is pretty useful, credentialing, certification, billing, etc. However, in regards to "collaboration," any student who so foolishly supports a supervised/collaborative model for NPs is essentially called out for cowardice by our (DNP) instructor. Well, ok, *I* was the one getting called out because my fellow students were smart and toed the Independent Practice party line.

    Point being, my group of novice NPs is being actively indoctrinated in the idea that nothing short of NP independence is acceptable, and that to hold a contrary opinion makes one a clinging child. A corollary to this is that we won't face any consequences from the medical community, either as regards to being hired or towards (my main concern) the formation of mentoring relationships.
  14. chimichanga

    chimichanga misunderstood

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    too bad.

    I teach (BSN students, traditional, NO online) nursing at the university level, and discourage all my students from going directly to an NP program (or any advanced practice, without first being an RN for a good while)
  15. Dranger

    Dranger

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    There was a large batch in my BSN program who wanted to go NP right out of school. What makes a fresh RN with 1.5 years of additional clinical education capable of being an independent practitioner (my state pretty much has full rights for NPs)? I asked them this question and just got a half-ass response with really no weight to the answer. The school I go to has a NP program and obviously all of my professors supported their decision. When I told them my desire to go the physician route, all I got was flak....:/
  16. sarjasy

    sarjasy I have action potential

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    You make all valid points. However, I think the best way to look at this when it comes to prior experience is to simply say, "it depends." A former RT who becomes a derm PA will not be helped much by his/her prior RT experience. A former med/surg RN who becomes an FNP won't be helped much (though perhaps, some) by his/her prior experience. In such cases, I suppose you can make the argument that the experience of simply being in a clinical environment helps some initially, and in the case of the med/surg RN, the little bit of pharm you learn, along with doing assessments and having some basic knowledge of surgical procedures is somewhat useful, but it really isn't that helpful in my opinion, especially a few years post grad.

    In the case of acute care, I think that is a different story. As you mention, the prior paramedic that goes into EM is helpful. Or, the RT that becomes a hospitalist or an intensivist, or the ED RN who becomes an FNP, or the ICU RN who becomes an acute care NP, etc.

    Prior clinical experience, however, simply doesn't help that much with many mid-level specialties, at least not to the point that there would be a significant difference in ability 5 years post grad between those with prior experience and those with no prior experience.
  17. sarjasy

    sarjasy I have action potential

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    That is not what I said. My exact quote was:

    "No way. At least 20 years. It takes a good two decades of giving injections, passing pills, assessing wounds, charting vitals, checking pedal pulses, listening to lung sounds, heart sounds (and pretending like you know what you are hearing), documenting, ambulating, monitoring for pressure ulcers, teaching incentive spirometer use, and hanging D5W before one can even think about becoming an NP. After all, these skills are ESSENTIAL to being, say, a family nurse practitioner."

    And you've yet to explain how such RN-level experience is essential to being, say, an FNP.
  18. sarjasy

    sarjasy I have action potential

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    I have researched and spoken with numerous NP schools throughout the country and have heard nothing even close to this. Many NP's taught in my BSN program (including DNP's) and none of them thought like this. I'd love to know what school you attend so that I can avoid it.
  19. sarjasy

    sarjasy I have action potential

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    Hey, it can't hurt, right? :)
  20. chimichanga

    chimichanga misunderstood

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    Pardon my last misquote about wiping butts.

    You've based this on what, your prior 20 years experiences as an RN?


    We don't agree on this, fine.

    And my 'evidence' is only anecdotal, but I've worked with direct entry NPs (with no HCE) and they (overwhelmingly) lack the comfort and knowledge base that is gained by years of bedside care, and just being around the day to day life of an acute care RN, period.

    How can a new midlevel (with zero HCE) recognize an acute change in condition for example, if you don't have that experience, or, say, know what parts of their history are important or not?

    Midlevels are important, and have their place (supervised), but when it comes to the 'big stuff' I want a doc. They simply have (way) more training and education than a midlevel. And when you throw an inexperienced midlevel into the mix, it can be dangerous, even with the 'minor' stuff. The point is, they haven't spent shift after shift, year after year, around the environment, to know what's 'minor' or not.

    Epiglottitis can present very benign, and has been missed by ED docs (in my 20+ years as an ED RN, it's happened twice)

    It may walk in to a minute clinic, with a brand new NP, who diagnoses strep, for example. If that FNP hasn't cared for (even) one (as a bedside RN), she is at a huge disadvantage. At least the new doc has a better chance of having seen it once in residency, and sure as hell thinks about all the differentials (that just can't be adequately covered in a fast track NP program.)

    It's that simple, and black and white for me, and is why all those years as an RN in acute care are so important when pursuing an ANP degree.



    So you called programs and asked them these questions on the phone?

    The poster talked about what he actually experienced in the program. Yea, his n=1, but it's real, versus having a fluff conversation on the telephone, or email. Do you think you'll actually get their real attitudes that way?
    Last edited: Feb 14, 2012
  21. zenman

    zenman Senior Member

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    Kinda mirrors this site doesn't it?:laugh:
  22. zenman

    zenman Senior Member

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    That was just your instructor. I've never personally met anyone doing the same. However, I'm in an independent practice state and will not work in one that is not. Here's why. I want to opportunity to consult a physician but not be forced to have oversight. There have been quite a few NPs who have had their collaborating physician drop them for some reason, death, change of mind, getting remarried and their spouse doesn't like you, etc.. These NPs have had to drop a full caseload of patients immediately if they can't get another collaborating physician. Won't happen to me. I currently work in a hospital so have a medical director. She's there if I need her and she never "bothers" me.
  23. Makati2008

    Makati2008 Moderator

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    All noble reasons except the bolded part. You need to have supervision(Would you be willing to work in a nonindependent state if they gave you a extreme circumstance waiver if any of the following occurred we give you independence for X amount of time?). Are you telling me you know as much as a BC/BE Physician in your field. And yea I have heard DNPs say they know more than Doctors because they do wait for it..... A THESIS. SMH.
  24. zenman

    zenman Senior Member

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    I'll explain what I did from my first nursing job in a level 1 ED. I learned everything I could about meds, procedures, etc. I was always standing there at the viewing box learning how to read x-rays with all the interns and residents. I listened to all the"educational moments." All though my career I'd "second guess" everything from listening to lung, heart and bowel sounds for example, then re-listening after the physicians documented their findings. I'd come up with meds for certain conditions then see what the physicians ordered and would question them. Ditto for all these things you mentioned above...and it didn't take 20 years either. You learn to deal with multiple physicians, families, patients, and other healthcare workers. In short, you should always be learning something that will help you later. And with experience you see all kinds of things, like the 7 yr old who informs you about the voices telling her to kill her brother with a butcher knife or seeing the 13 year old who suddenly can't walk in a straight line. It all counts. Hell as an orderly, I was even in the OR and taking a course with that ancient textbook...what was it...Dubin's Easy EKG or something like that.
  25. MedPsy82

    MedPsy82 Just a Thought

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    Kinda, but this site does seem to have more factual information. At least with the physician and medical student topics, and some mid-level topics. :D
  26. zenman

    zenman Senior Member

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    I'm not a DNP and never will be. Ok, there may be some reason for me to work in a non-independent state but it would have to be a darn good one for me to risk it. No, I don't know as much as a BC/BE physician in psych. I do read all their textbooks, for whatever that's worth. One of my preceptor shrinks gave me his boards book to study when I was with him. I just try to be safe and keep my "white knuckles" with me.
  27. zenman

    zenman Senior Member

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    Yep, I do pick up a lot of good info over in the psych section.
  28. MedPsy82

    MedPsy82 Just a Thought

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    :thumbup:
  29. RDlv

    RDlv

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    In the real world, I agree...practicing NPs, those who precept, our clinical instructors, none have pushed this on us.

    But there ARE these people in the academic realm. I know it extends beyond just my humble program because I've been to national conferences, read the statements of the certifying agencies, etc.

    This puts you 100% in accord with the positions of the AANP and the ANCC. Physician oversight is an onerous burden on NP practice, and should be eliminated from every state practice act. This is a huge part of the "Consensus Statement." You completely fail your image as a rebel (on this one point, at least).

    As do I...I actually put my focus on producing good RNs, ironically a MUCH more grueling educational process than that of the NP. Standardized tests at every level, including the final one (NCLEX), 2 chances to perform a skill before being booted from the program, strict rules and oversight of clinical rotations, etc. I'm not clear on why things go on "cruise control" at the NP level. Well yeah, I do...paying instructors is pricey, and you need a certain ratio of instructor:student to meet accreditation requirements at the BSN level. No online for the core classes, clinicals AND labs AND lectures mandatory. I'm a huge cheerleader for the RN, my students know it and it keeps them motivated. I impress on them to take PRIDE in the rigor of the program, not to bemoan it.
  30. RDlv

    RDlv

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    Then you will have to find a school that doesn't support the Consensus Model, and who opposes the stated views of the AANP and the ANCC. Hope they are an accredited program.

    I didn't get of this until I got to the NP level. I have the SAME instructors (largely) I had as a BSN, and wasn't privy to these discussions until I got to MSN courses on health policy, role of the NP, entry to practice, etc.

    I'm honestly not sure if any of my NP instructors (including the non-politicals, and the ones I personally respect as clinicians and educators) oppose independent practice for NPs. I'm a bit scared to find out. I am quickly learning it is heresy to hold the opposite position, a sign of weakness or dependency not worthy of an NP.
  31. sarjasy

    sarjasy I have action potential

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    No, based on my experience talking to practicing NP's. Why would I ask an RN what it takes to be an NP when I can I ask an NP what it takes to be an NP?

    Training and a brain?

    As with your other posts, your reasoning does not allow for the differences in individuals. In my opinion, if someone needs 10 years of RN experience before they think they can take on an MSN to be an NP, they have no business being an NP. Some are ready with little experience, others aren't ready with two decades of experience.

    Strep at the bedside? Must be one serious case of strep. :)

    Yes.

    I know and/or have met 20+ NP's, many in practice, academia or both. I have asked them specifically their thoughts on NP independence. Add that to the programs I have spoken to along with their grads and/or current students. Exactly ZERO have supported complete independent practice for NP's, with the exception of some who support it in retail walk-in/minor care type clinics.
  32. Paseo Del Norte

    Paseo Del Norte

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    Many NP's are militant supporters of complete, independent practice in my area of the country. States such as Arizona already have highly autonomous APN's. In addition, there is a very strong CRNA presence that works with little collobrating and accountability other than their specific state BON's. Also have a couple of schools over in Texas cranking out CRNA's who have had very little post nursing school experience. Your mileage may vary, but that's how things role in other parts of the country.
  33. AnnoyedByFreud

    AnnoyedByFreud

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    So these independent NPs are drowning in lawsuits, right?
  34. Paseo Del Norte

    Paseo Del Norte

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    Can't say; however, my underlying point was not about lawsuits.
  35. MedPsy82

    MedPsy82 Just a Thought

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    In my opinion lawsuits are a cheap shot when taking about quality of care, or anything else for that matter.

    The fact is the majority are unable to sue anyone for any reason, if the person feels that care is inadequate most will just find someone else to care for them and no one will be the wiser outside of that little circle.
  36. zenman

    zenman Senior Member

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    Nope, but I do have my $800 malpractice policy...for psych.
  37. J1515

    J1515 Member

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    http://doctorsofnursingpractice.ning.com/forum/topics/our-place-at-the-table-lets-get-this-party-started

    "we also need REAL residency programs--regardless if you have a doctorate ar a master's. AND they need to be paid for by the government--Just like the MDs have.

    We are going to take over primary care. We need to start acting like it. 2014 is going to be a rude awakening.
    "




    Still don't think NPs are trying to practice independently? Get a clue. Read through that website to get a clear idea of what DNPs want.
    .
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  38. ghost dog

    ghost dog

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    I spent a bit of time on the web trying to find some concrete numbers on the proportion of NPs working in an independent fashion, and was unable to do so. However, I suspect this number will grow as the number of NPs increases.

    In regards to "minor visits": such walk in visits are frequently the first point of contact in a primary care relationship. This type of care will often turn into an ongoing provider / pt relationship. However, this type of medicine is not nearly as profitable as that of "walk in medicine " ( and thus the reason for this niche).

    I can't count how many times my pts have been inappropriately scripted antibiotics in walk in clinics. ( apparently these providers have forgotten guidelines such as the centor sore throat score, pneumonia prediction rules ,etc: pure laziness. ) Not a good way for people to get care.

    " Nursing schools want the doctor of nursing practice degree to be the entry-level degree for NPs by2015. Some worry such requirements could impede filling an expected shortage of nurses. The US Bureau of Labour Statistics has forecast increased demand for NPs of 22%, or more than 2ยท2 million, by 2018."

    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60214-6/fulltext

    And some militant stuff:

    "How insulting that we keep taking these stupid things. NPs are approaching 50% of the PCPS in this country. How about that???AND do you know how powerful we are going to be 2014?"

    http://doctorsofnursingpractice.nin...lace-at-the-table-lets-get-this-party-started
    Last edited: Feb 24, 2012
  39. J1515

    J1515 Member

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    It just doesn't make sense. NPs want equal reimbursement rates, yet their "claim to fame" is that they provide cheaper care than physicians. Anybody with a brain can see what's going on here.
  40. MedPsy82

    MedPsy82 Just a Thought

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    Except most, or at least a lot of, politicians. They seem to still think it is a good idea, for some reason, and keep agreeing with these Nurses that want to play Doctor/Physician :rolleyes:. They must be getting a nice pay off ;)
  41. PamEganNP

    PamEganNP

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    I am an NP, currently working on becoming an MD. NPs can do nearly everything a general practice MD can do. The main difference is that NPs must have a collaborating physician sign off on their work.

    I've had a thriving private practice of my own for years now, and the recent changes in America's healthcare laws appear to be working to the benefit of NPs.

    There appears to be a growing trend in support of Wellness and Preventive care, which is one of my personal specialties. Previously, insurance companies would not reimburse for Wellness visits, but BC/BS not has a plan that does, and it appears likely that others will follow suit.

    All-in-all, having started out as an LPN and working my way up to RN and eventually NP-C, I personally have done quite well in my career and would encourage the individual who initiated the thread to take a close look at nurse practitioner programs, as I believe they offer more in the long-run in terms of potential for career development.

    Nurse Practitioner Pam, NP-C, CDE, ABAAHP, MN
  42. PamEganNP

    PamEganNP

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    What's with the hostility toward NPs? Are you feeling threatened?
  43. zenman

    zenman Senior Member

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    SDN 7+ Year Member
    I started at the bottom, as a CNA, and gradually worked my way up! And there are also quite a few states where no physician collaboration is needed, as in my current state.
  44. PamEganNP

    PamEganNP

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    Congratulations on your success! Also, thanks for clarifying my initial remarks about collaboration.
  45. zenman

    zenman Senior Member

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    SDN 7+ Year Member
    No problem. I think it's up to 16 states now where NPs have independent practice.
  46. PamEganNP

    PamEganNP

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    Maybe it's time for me to consider a move...
  47. ghost dog

    ghost dog

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    The literature seems mysteriously silent on the above phenomenon of the independently practicing NP.

    Does anyone have stats / proportion of independently practing NPs ? I have looked , and not been able to find any numbers.
  48. ghost dog

    ghost dog

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    I can definitely see why insurance companies would not want to reimburse for "wellness visits" (as you call them) if you are counseling patients about their zinc deficiencies or convincing them to take bioidentical hormone replacement therapy.

    These modalities have absolutely no evidence base for effectiveness, and also have a motive for profit. These 2 issues are not a good combination, and make legitimate practitioners look bad.

    source: http://www.eganmedical.com/Vitamins-and-Supplements-s/91.htm
  49. RDlv

    RDlv

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    SDN 7+ Year Member
    God
    Damn
    It
  50. Dranger

    Dranger

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    Army SDN 2+ Year Member
    I don't know, my GP (MD) also tries to get me to take massive units of D3 every time I am in for a visit like its the end all be all for my immune system health.

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