PA vs NP

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fmbaig

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I am weighing out all my options as a Biology major. I am a certified nurse assistant and will start work soon. I am trying to decide which is a better way to go, PA or NP? Both of them are very similar yet have a few difference. My major concern is a job outlook... who will have more jobs, say 3-5 years down the line... which is a better field to choose in terms of job security and availability? Any suggestions are welcome.. thanks!
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both will offer good job security for the rest of your life.
np has the advantage of a better political organization backing them.
pa has the advantage of better and longer medical rotations(2000+ hrs vs 500-800 hrs).
you can't go wrong either way.
 
Also consider what specialty you're interested in. Is it surgical or EM? That would lean me towards PA. However, if it was out-patient, psych, or obs/midwifery, then I'd go with NP. If you're undecided, PA is a great choice because it's so flexible. But if you're interested in teaching, research, or management/policy, there are many opportunities in nursing. Some regions tend to "prefer" one over the other as well. If you live in (or plan on practicing in) an independent practice state, that might influence your decision as well. They're both good choices.
 
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An important factor is where you live/think you will live. Some political climates favor one over the other, and I think it pays to know your market place. I would be very familiar with the APN practice act where you live, as well as the hiring trends and projected needs.

good luck
 
Thank you for your response. I am interested in orthopedics... so while is PA school when can you choose your specialty ? do we have to do something like a residency like MD? I am looking into schools in Missouri and Indiana... any suggestions?
 
AnnoyedByFreud said:
Also consider what specialty you're interested in. Is it surgical or EM? That would lean me towards PA. However, if it was out-patient, psych, or obs/midwifery, then I'd go with NP. If you're undecided, PA is a great choice because it's so flexible. But if you're interested in teaching, research, or management/policy, there are many opportunities in nursing. Some regions tend to "prefer" one over the other as well. If you live in (or plan on practicing in) an independent practice state, that might influence your decision as well. They're both good choices.
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Good post overall. I don't really agree about the generalized "outpatient" comment however. In specialties like cardiology, GI, endocrine etc, PA's are all over the outpatient clinic. Same with primary care specialties. The only place I see more NP's or a benefit for NP is in ob and possibly psych.
 
I guess it depends. I know a lot of FNPs work in outpatient specialties. Anyway, I meant it as a rough idea. I agree that psych and obs are dominated by NPs.
 
sarjasy said:
Myth.
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WHICH PART?
2000+ > 800 HRS LAST TIME i CHECKED. ARE THERE ANY NP PROGRAMS WITH 2000 HRS OF ROTATIONS?
i AGREE FLEXIBILITY(ESPECIALLY VS FNP) CAN BE DEBATED.
PA'S GENERALLY HAVE AN EASIER TIME SWITCHING INTO ANY FIELD THAN AN NP. GRANTED SOME NP'S WORK IN SURGERY BUT IT IS RARE WHEN COMPARED TO A PA.
NP'S HAVE MORE FLEXIBILITY IN PSYCH AND WOMEN'S HEALTH WITHOUT A DOUBT, PEDS IN SOME LOCATIONS. NP''S CERATINLY HAVE THE UPPER HAND IF THEY WANT TO OWN THEIR OWN PRACTICE( A PA HAS TO HIRE AN SP).
(SORRY ABOUT CAPS...THAT'S WHAT HAPPENS WHEN YOU LOOK AT YOUR FINGERS WHEN YOU TYPE...:)
 
fmbaig said:
Thank you for your response. I am interested in orthopedics... so while is PA school when can you choose your specialty ? do we have to do something like a residency like MD? I am looking into schools in Missouri and Indiana... any suggestions?
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If you decide to go the NP route, you can specialize in ortho as an NP. Duke has a orthopedics specialty certification program for NPs and I have heard the director is considering adding a first assist option to it to provide an ortho surgery specialty in the future as well. Orthopedic NP does have a board certification exam, which I believe completing that course of study at Duke should make you eligible to sit for, but I am not certain. Just something to consider if you really have your heart set on ortho! Contact Dr. Michael Zychowhicz at Duke for the details.

Take care.
 
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emedpa said:
WHICH PART?
2000+ > 800 HRS LAST TIME i CHECKED. ARE THERE ANY NP PROGRAMS WITH 2000 HRS OF ROTATIONS?
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No. The NP is designed to build on previous RN level training and experience. The PA is designed to build on any level of experience including CNA, tech, phlebotomist, med assistant, EMT, scribe, RT, PT, OT, rad tech, etc. PA training must accommodate all levels of previous healthcare experience, even the most basic, which is why PA curriculum may include such basic things as taking vital signs, H&P, labs, physical assessment, etc. in the first semester or two. These basic things are largely excluded from NP programs, as it is assumed these things are known on entry. Therefore, "clinical" hours requirements are fewer.

DE programs aside (which I disagree with for the most part), most NP students have had 600-900 hours of clinical training at the RN level (covering the things PA schools cover in the 1st and 2nd semesters), 4,000-10,000 real RN clinical experience hours, then 800 or so hours training in a specialty at the master's level. Even 600 clinical hours of RN school far exceeds the experience of many that enter into PA school, not to mention actual RN experience on top that most NP applicants have.

Are you willing to say that a phleb with one year of experience plus PA school exceeds an RN with 800 hours of RN training, 4,000 hours of RN experience in the ICU and 800 hours in NP school?

emedpa said:
i AGREE FLEXIBILITY(ESPECIALLY VS FNP) CAN BE DEBATED. PA'S GENERALLY HAVE AN EASIER TIME SWITCHING INTO ANY FIELD THAN AN NP. GRANTED SOME NP'S WORK IN SURGERY BUT IT IS RARE WHEN COMPARED TO A PA.
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Serious question. Take a PA with 7 years of derm experience immediately after graduation. Who will have an easier time moving into say, cardiology? The PA with 7 years of derm experience or the new PA grad?

emedpa said:
(SORRY ABOUT CAPS...THAT'S WHAT HAPPENS WHEN YOU LOOK AT YOUR FINGERS WHEN YOU TYPE...:)
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I suppose there are worse parts of your body to look at when you type. ;)
 
sarjasy said:
No. The NP is designed to build on previous RN level training and experience. The PA is designed to build on any level of experience including CNA, tech, phlebotomist, med assistant, EMT, scribe, RT, PT, OT, rad tech, etc. PA training must accommodate all levels of previous healthcare experience, even the most basic, which is why PA curriculum may include such basic things as taking vital signs, H&P, labs, physical assessment, etc. in the first semester or two. These basic things are largely excluded from NP programs, as it is assumed these things are known on entry. Therefore, "clinical" hours requirements are fewer.

DE programs aside (which I disagree with for the most part), most NP students have had 600-900 hours of clinical training at the RN level (covering the things PA schools cover in the 1st and 2nd semesters), 4,000-10,000 real RN clinical experience hours, then 800 or so hours training in a specialty at the master's level. Even 600 clinical hours of RN school far exceeds the experience of many that enter into PA school, not to mention actual RN experience on top that most NP applicants have.

Are you willing to say that a phleb with one year of experience plus PA school exceeds an RN with 800 hours of RN training, 4,000 hours of RN experience in the ICU and 800 hours in NP school?



Serious question. Take a PA with 7 years of derm experience immediately after graduation. Who will have an easier time moving into say, cardiology? The PA with 7 years of derm experience or the new PA grad?



I suppose there are worse parts of your body to look at when you type. ;)
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As a former 6,000 clinical hour ICU RN (and almost NP applicant), PA, and teacher of NPs, I agree that taking vital signs, certain basic procedures (IV/foley) are omitted, but you always have H&P, physical assessment, lab interpretation are always included. They are required in the curriculum for the school's accreditation. You have to be able to to train every nurse, which could be a highly trained ICU nurse, or a clinic nurse who has done little more than vitals and lab draws, or a long term care nurse who has done little of anything but basic care. Also, undergrad nursing training has little to do with differential diagnosis, interpretation of labs/tests/rads, and little pharmacology (compared to what's needed for being a provider).

Remember, NP schools teaches one to be a "specialist" and PA trains one to be a "generalist." A fnp is supposed to easily go into outpatient (and not go into acute care), ACNP is meant for adult acute care (not allowed to touch kids or work in "chronic" care), so on and so forth. So not as many hours are needed. A PA is designed to go into any core specialty (fm, peds, EM, ect) easily and be able to quickly trained in sub-specialties (neuro, nephro, trauma surg, ect). So they are not longer to accommodate less experience (I can teach a high schooler to take vitals, basic procedures in month because that's all it took in nursing), but to train generalists. Thus it's easy to see why they have way more clinical hours. Also, you can't exclude DE schools. They exists so they count. Same thing with PA schools that don't require HCE.

Before you get all mad, they both produce a fine product. They are just designed differently to accommodate generalist vs. specialist training.

Back to the "myth," a PA has more experience as a PROVIDER (that is not to say more experience in a particular specialty) and definitely has more flexibility as a generalist.
 
sarjasy said:
no. The np is designed to build on previous rn level training and experience. The pa is designed to build on any level of experience including cna, tech, phlebotomist, med assistant, emt, scribe, rt, pt, ot, rad tech, etc. rn's generally lack the science background necissary for entry into pa (or md) schools pa training must accommodate all levels of previous healthcare experience, even the most basic, which is why pa curriculum may include such basic things as taking vital signs, h&p, labs, physical assessment, etc. In the first semester or two. not true. Rn training certainly does not prepare you for the clinical level of knowledge and interpretation and ddx of labs, vital signs, h&p's ect. After you complete your pre-reqs just to get into pa school (similar to md/do) you compete at least 2-2.5 actual months of full-time education (8-5pm m-f) with medical pathology, clinical microbiology, histology, anatomy, gross anatomy, physiology, pharmacology, radiology, behavioral medicine, clinical medicine (e.g all body systems + hospital medicine, geriatrics, emergency medicine, surgery, reproduction, psych) and clinical labrabory sciences courses. You complete roughly 2000 classroom-didactic hours long before you complete any clinical hours (my classes were intergrated with pa students). Then you complete >2000 hours divided among core rotations such as surgery, em, psych, pediatrics, women's health/ob, family medicine, internal medicine, primary care elective, and then 1 elective. these basic things are largely excluded from np programs, as it is assumed these things are known on entry. Therefore, "clinical" hours requirements are fewer. this last comment makes no sense to me... Why np/rn programs exclude important science and clinical training from their curiculums. There is no excuse for the complete lack of and/or severely limited didactic education and clinical hours in emergency medicine, surgery, psych, geriatrics,ect. The task orientated nature of rn training and experience is simply lacking in science and clinical breadth and expertise to be recognized in pa school. I marvel that fnp's that i've worked have never completed surgery, psych, pediatrics, and minimal time (often less than 40 hours) in women's heath and emergency medicine. As an example, so much is learned in surgery rotations as it relates to pathology such as breast cancers, colon and anorectal dz, adominal/viceral dz, ect, which is so important to be a competent primary care provider.
de programs aside (which i disagree with for the most part), most np students have had 600-900 hours of clinical training at the rn level (covering the things pa schools cover in the 1st and 2nd semesters)there is no correlation between rn/np education and pa education. Pa school has more bredth and depth because they are trained as generalist and are not limited in scope of practice. , 4,000-10,000 real rn clinical experience hours, then 800 or so hours training in a specialty at the master's level. Even 600 clinical hours of rn school far exceeds the experience of many that enter into pa school, not to mention actual rn experience on top that most np applicants have.
are you willing to say that a phleb with one year of experience plus pa school exceeds an rn with 800 hours of rn training, 4,000 hours of rn experience in the icu and 800 hours in np school? without question the pa would be better prepared both in breadth and depth. This is because of the rigor of pa education and the quality of the students admitted to pa school)
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md
 
sarjasy said:
No. The NP is designed to build on previous RN level training and experience. The PA is designed to build on any level of experience including CNA, tech, phlebotomist, med assistant, EMT, scribe, RT, PT, OT, rad tech, etc. PA training must accommodate all levels of previous healthcare experience, even the most basic, which is why PA curriculum may include such basic things as taking vital signs, H&P, labs, physical assessment, etc. in the first semester or two. These basic things are largely excluded from NP programs, as it is assumed these things are known on entry. Therefore, "clinical" hours requirements are fewer.

DE programs aside (which I disagree with for the most part), most NP students have had 600-900 hours of clinical training at the RN level (covering the things PA schools cover in the 1st and 2nd semesters), 4,000-10,000 real RN clinical experience hours, then 800 or so hours training in a specialty at the master's level. Even 600 clinical hours of RN school far exceeds the experience of many that enter into PA school, not to mention actual RN experience on top that most NP applicants have.

Are you willing to say that a phleb with one year of experience plus PA school exceeds an RN with 800 hours of RN training, 4,000 hours of RN experience in the ICU and 800 hours in NP school?



Serious question. Take a PA with 7 years of derm experience immediately after graduation. Who will have an easier time moving into say, cardiology? The PA with 7 years of derm experience or the new PA grad?



I suppose there are worse parts of your body to look at when you type. ;)
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"The PA is designed to build on any level of experience including CNA, tech, phlebotomist, med assistant, EMT, scribe, RT, PT, OT, rad tech, etc."

I don't think PT belongs in this sentence. Do everyone a favor and stop blabbering baseless and projected nonsense.
 
Denatured said:
As a former 6,000 clinical hour ICU RN (and almost NP applicant), PA, and teacher of NPs, I agree that taking vital signs, certain basic procedures (IV/foley) are omitted, but you always have H&P, physical assessment, lab interpretation are always included.
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(Old thread, but I haven't had a chance to respond.)

Of course they are included, that really wasn't my point. My point is that most nurses in NP school have alot of familiarity with these things already - they are not starting from scratch as many, if not most, PA students are (to one degree or another). An RT going into PA school has never done a neuro assessment, an EMT knows next to nothing about laboratory medicine (esp. inpatient), and a CNA has done and knows nothing - a complete blank slate. The average nurses in an NP program, especially ER or ICU nurses, have done these and every other kind of assessments countless of times and have quite a bit of exposure to labs and other diagnostics, unlike many PA students.

Denatured said:
Also, undergrad nursing training has little to do with differential diagnosis, interpretation of labs/tests/rads, and little pharmacology (compared to what's needed for being a provider).
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But NP schools don't need to start from scratch in the way that PA schools largely do. Nurses have 2 years of formal educational training in these areas, not to mention most NP students have worked with these things, on some level, for 2000+ hours beyond their undergraduate training. While not at the level required for a provider, it is infinitely more experience than what many PA students have their first semester or two.


Denatured said:
Remember, NP schools teaches one to be a "specialist" and PA trains one to be a "generalist." A fnp is supposed to easily go into outpatient (and not go into acute care), ACNP is meant for adult acute care (not allowed to touch kids or work in "chronic" care), so on and so forth. So not as many hours are needed.
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I completely agree, but it's not just that. It's everything described above as well.


Denatured said:
. Also, you can't exclude DE schools. They exists so they count. Same thing with PA schools that don't require HCE.
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But I don't think anyone here defends direct entry NP schools or PA schools that don't require experience, so I've excluded them for the sake of the discussion.


Denatured said:
Before you get all mad, they both produce a fine product. They are just designed differently to accommodate generalist vs. specialist training.
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I wholeheartedly agree and is, ironically, my point. The blanket statements that "PA's have more clinical training/experience" grossly oversimplifies and as a statement is meant by many to suggest that PA training or PA's in general are inherently better trained and superior, which is nonsense. It is often stated by those who truly do not understand undergrad nursing training and how valuable nursing experience is in becoming a provider.
 
Fiveoboy11 said:
"The PA is designed to build on any level of experience including CNA, tech, phlebotomist, med assistant, EMT, scribe, RT, PT, OT, rad tech, etc."

I don't think PT belongs in this sentence. Do everyone a favor and stop blabbering baseless and projected nonsense.
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Huh? PT's can't go to PA school?
 
sarjasy said:
I wholeheartedly agree and is, ironically, my point. The blanket statements that "PA's have more clinical training/experience" grossly oversimplifies and as a statement is meant by many to suggest that PA training or PA's in general are inherently better trained and superior, which is nonsense. It is often stated by those who truly do not understand undergrad nursing training and how valuable nursing experience is in becoming a provider.
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See, this is all I have to quote as I have both in abundance. Unless you have been to both BSN and PA school, you are unqualified to comment on their quality and quantity of education in comparison. I'm glad you agree.
 
Denatured said:
See, this is all I have to quote as I have both in abundance. Unless you have been to both BSN and PA school, you are unqualified to comment on their quality and quantity of education in comparison. I'm glad you agree.
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I think RN + PA (like you) is the absolute best path for a mid level. Would you agree?

And, are you prepared to say that a CNA with 1 year of HCE + PA school is superior to an RN with 5 years of ICU or ER experience + NP school?
 
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sarjasy said:
Huh? PT's can't go to PA school?
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It's possible you are thinking of a PTA (physical therapist assistant) which is a 2 yr undergrad degree. A PT is a full 3yrs after your undergrad degree, and therefore unlikely to be looking for a spot in a PA school
 
sb247 said:
It's possible you are thinking of a PTA (physical therapist assistant) which is a 2 yr undergrad degree. A PT is a full 3yrs after your undergrad degree, and therefore unlikely to be looking for a spot in a PA school
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The poster I was responding acted insulted that I would suggest that a PT might got to PA school. I personally know of one, as well as a Ph.D., and have read of a couple of Pharm.D.'s that went to PA school. I also know of an MS prepared nutritionist and an MSW that quit their jobs to get a BSN, as well as a JD who did they same. Heck, if I'm not mistaken, I think there is an Au.D. on this going back to school to be a mid-level.
 
sarjasy said:
I think RN + PA (like you) is the absolute best path for a mid level.

Are you willing to say that a CNA with 1 year of HCE + PA school is superior to an RN with 5 years of ICU or ER experience + NP school?
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I'm willing to say you are comparing apples to oranges with that statement, and I'm also willing to say that neither of those are typical applicants to NP or PA school. The average PA applicant has 3.7 years experience last time I checked.

Secondly, that would depend on the specialty that NP went into, and we'll assume they became a ACNP. If it was ER or ICU, then of course the ER or ICU nurse is going to win for about the first 6 months to a year, then equal. Any other specialty, equal or even the PA ahead initially depending on the specialty and who did what elective.
 
Denatured said:
I'm willing to say you are comparing apples to oranges with that statement, and I'm also willing to say that neither of those are typical applicants to NP or PA school. The average PA applicant has 3.7 years experience last time I checked.
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No, it is completely valid question. If you were to say, "all bananas are yellow" all I must do is show you a banana of another color to disprove your claim. Some claim that PA's are inherently superior to NP's. Maybe you are not making such a blanket statement. If you are, you have three choices (1) bite the bullet and say that in the example I provided, the PA is superior, or (2) concede that any blanket statement saying PA's are inherently superior is false, or (3) dodge the question (which is what you are attempting). Which is it?

BTW, I believe you are an RN, but are you a PA?
 
sarjasy said:
No, it is completely valid question. If you were to say, "all bananas are yellow" all I must do is show you a banana of another color to disprove your claim. Some claim that PA's are inherently superior to NP's. Maybe you are not making such a blanket statement. If you are, you have three choices (1) bite the bullet and say that in the example I provided, the PA is superior, or (2) concede that any blanket statement saying PA's are inherently superior is false, or (3) dodge the question (which is what you are attempting). Which is it?

BTW, I believe you are an RN, but are you a PA?
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No, no. A straight comparison would be a direct entry NP to a no HCE PA grad, or a one year med-surg RN vs a one year CNA experience, or a 5 year paramedic to a 5 year ER RN. You are stacking your side. Also, it depends on specialty as a PA is a generalist and can do multiple specialties equally well, whereas a NP is a specialist with narrower training. This is a fact no one can deny. So a PA vs a FNP in a inpatient setting, the PA will win. A neonatal NP vs a PA in neonatology, yeah, the NP is going to win.

I agree with your premise that anyone stating a PA is inherently better at any job is false. We disagree in that I do believe PA training is better, which I believe I've discussed earlier. Does it really matter when you go into one specialty for the next 5-25 years? No, so it's really just an opinion and personal preference. Besides, the studies show they are both excellent providers, so my anecdote is just that.

Yes, I am both. PA is a more recent development. I don't have half as much PA experience as RN at this point. Beyond that I rather not say to preserve some sense of anonymity.
 
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