Difference between NP & PA....

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Not liking it sounds like a personal problem. 'People' are the same no matter where you go. It's all about how 'you' deal with them. You can't run away from yourself.
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yalepa99 said:
this thread arguing and bitching about how PA's are better than NP's and how NP's are better than PA's is EXACTLY the reason I am getting out of the human medicine field. Its so petty. I am a Yale PA graduate as of 1999, and I'm so tired of this kind of thing. Ego's amoung midlevels is outrageous!
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Yea, kinda reminds me of debakey and cooley...now that was some high level egos.
 
I find the Self-Loathers, constantly degrading others, to be more annoying.
 
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mariedoreen said:
Of course not... we're all much too busy bashing NPs to distract ourselves with that right now.
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I am so sad that you are making uneducated comments about NP's, pure ignorance...so sad...please read and do your research...
 
hospPA said:
Matt,
That is a great question! I really wonder what they will say.

My take: NP's and PA's basically compete for the same jobs, unless the physician has a personal preference to one or the other (Like, "prefers medical training" or "will work for cheaper because there are more of them"). Both professions practice medicine under the supervision of a physician. NP's "call" this supervision "collaboration". Do not fool yourself however, it IS supervision. It should be. How can you be independent with a couple years nursing experience and two years of part-time schooling? I have no idea.

The other issue is that one who practices medicine should be trained in medicine, right? That is not the case for NP's.

Let me qualify this by saying that I work with many great NP's. They are great because of course they are smart and they have abandoned the independent practice crap that is fed to students in NP school. They realize that they are indeed practicing medicine and therefore took the time to learn it.

Pat, RN, PA-C, MPAS
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I have been reading your replies but you seem to be a well-educated person but your replies belongs to an ignorant person who makes wrong comments about NP's...please if you make a comment, it better be the right one without confusing the readers.
Thank you
 
Oh and yeah, NP's can work independently without the supervision of the physician. So please....the important thing is that we work for patients not bashing other professionals...and keep that in mind....okey..ciao
 
ThreadResurrection.jpg




So you dig up a 2+ year old thread to make your only three posts to b*tch about random people's comments about NP's?


Uber Lame.
 
The bottom line is this:

You have two categories of practitioners.

A) Autonomous Doctorate Level Practitioners



1) Unlimited Doctorate Level Practitioners
  • Have an unlimited practice medical license assuming 100% liability
  • Have unlimited prescribing ability regarding medications
a) Doctors of Medicine (M.D.'s)---Medical Doctors
b) Doctors of Osteopathic Medicine (D.O.'s)--Osteopathic Doctors



2) Limited Independent Doctorate Level Practioners
  • Practice independently within a specialty area assuming 100% liability.
  • Independently (100% autonomy) Prescribe medications that are germane to their scope of practice (ie, dental, eyes, lower extremity)
a) Doctors of Dental Surgery/Medicine (D.D.S's/D.M.D.'s)--Dentists
b) Doctors of Optometry (O.D.'s)--Optometrists
c) Doctors of Podiatric Medciine (D.P.M.'s)--Podiatrists
___________________________________________________________________________________________________________


B) Supervised Mid-level Practitioners
  • Practice under the supervision of a physician.
  • Supervision can be direct, indirect, on-site, off site
  • Do not assume 100% liability becauase the supervising physician is 100% liable for the actions of the midlevel practitioner.
  • Are Supervised Prescribers of Medicine functioning as physician extenders (not to be confused with MD's, DO's, DDS's, DMD's, OD's and DPM's).
a) Physician Assistants (P.A.'s)
b) Nurse Practitioners (N.P.'s, A.R.N.P's, etc.....)---side note: in 11 states nurse practitioners have independent limited practice (ie no physician supervision is required for practice or the prescription of drugs in the nurse practitioner's scope of practice. 40 states are not like this though.)
c) R.N.'s (less autonomy and delegation by a) and b) above)
d) all other mid-level providers.

---I can provide references (state code) for all of the listings above.....


the point is P.A.'s and N.P.'s are both supervised mid-level providers so what is the huge argument about?
 
Akoito

What kind of "health student" are you? At least have the balls to let us know. You could be an EMT student for all we know. At least if we know your background you might have A LITTLE credibility - as it is, you're simply a pain in the ass, nothing more.

And if all you're going to do here is resurrect old threads for a personal agenda, do us all a favor and take a hike.
 
Andromeda1 said:
The bottom line is this:

You have two categories of practitioners.

A) Autonomous Doctorate Level Practitioners








1) Unlimited Doctorate Level Practitioners
  • Have an unlimited practice medical license assuming 100% liability
  • Have unlimited prescribing ability regarding medications
a) Doctors of Medicine (M.D.'s)---Medical Doctors

b) Doctors of Osteopathic Medicine (D.O.'s)--Osteopathic Doctors








2) Limited Independent Doctorate Level Practioners
  • Practice independently within a specialty area assuming 100% liability.
  • Independently (100% autonomy) Prescribe medications that are germane to their scope of practice (ie, dental, eyes, lower extremity)
a) Doctors of Dental Surgery/Medicine (D.D.S's/D.M.D.'s)--Dentists

b) Doctors of Optometry (O.D.'s)--Optometrists
c) Doctors of Podiatric Medciine (D.P.M.'s)--Podiatrists
___________________________________________________________________________________________________________







B) Supervised Mid-level Practitioners
  • Practice under the supervision of a physician.
  • Supervision can be direct, indirect, on-site, off site
  • Do not assume 100% liability becauase the supervising physician is 100% liable for the actions of the midlevel practitioner.
  • Are Supervised Prescribers of Medicine functioning as physician extenders (not to be confused with MD's, DO's, DDS's, DMD's, OD's and DPM's).
a) Physician Assistants (P.A.'s)

b) Nurse Practitioners (N.P.'s, A.R.N.P's, etc.....)---side note: in 11 states nurse practitioners have independent limited practice (ie no physician supervision is required for practice or the prescription of drugs in the nurse practitioner's scope of practice. 40 states are not like this though.)
c) R.N.'s (less autonomy and delegation by a) and b) above)
d) all other mid-level providers.

---I can provide references (state code) for all of the listings above.....


the point is P.A.'s and N.P.'s are both supervised mid-level providers so what is the huge argument about?
Click to expand...


First of all, general practitioners threatened by the scope of a PA don't have to work with a PA. PAs are greater demand parters in subspecialties practice than either general practice / primary care specialty.
 
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AmosStollMD said:
First of all, general practitioners threatened by the scope of a PA don't have to work with a PA. PAs are greater demand parters in subspecialties practice than either general practice / primary care specialty.
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There is no real data on demand for specialty PAs vs. Primary care. You could argue given the unfilled positions in primary care that there is more demand for PAs there.

PAs largely choose to work in specialty practice because the money is better. Specialty practices can pay PAs more in specialty practice either because their income is high enough to offset the lifestyle gains or because they can make more money off the PA than primary care can.

Essentially the same reasons that US physicians are not going into primary care.

David Carpenter, PA-C
 
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DrMed2009 said:
I am German and completed medical school in Germany. And we do not have NP's, PA's. And nurses are NOT allowed to prescribe any form of medication. What you maybe mean are the rural nurses. They drive to patients that aren't able to go to the doctor on a regular basis and they provide basic medical care like a nurse in a hospital does (giving shots, medicine (but prescribed always by a doctor), measuring blood pressure etc. But they always work under a doctor and only she/he is allowed to prescribe medication.
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Stands to reason that Germany, the country with the Notarzwagen (ambulance with ER doc on board, not a paramedic) would not let nurses perform as extenders. 7 years of being stationed there in the Air Force and loved every minute of it!
 
I know that PA's can still work for ambulance companies as the medical director and I have heard some PA's still go on calls with the medics. What is the rules on this? Or is it true? Just curious :)
 
Narnian said:
I know that PA's can still work for ambulance companies as the medical director and I have heard some PA's still go on calls with the medics. What is the rules on this? Or is it true? Just curious :)
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Yup I personally know several medics turned pa who still do regular medic shifts. one classmate of mine does 2 twelve hr shifts/week as a medic and 3 ten hr shifts/week as an em pa. he is also the disaster coordinator for his hospital(he got a postgrad masters in disaster management).
I also know 3 pa's who are ems medical directors or associate ems medical directors.
a pa working as a medic needs to either stick to medic protocols and be a field medic on his medic days or get malpractice coverage from their group as a prehospital pa.
 
How can a PA be a medical director? The medics are practicing under the medical directors license. A PA doesn't have a license to practice medicine. I understand how a PA could decide what protocols the medics could do, what drugs they carry, but I don't understand legally how a PA could be the final medical authority for an ambulance service.
 
jbar said:
How can a PA be a medical director? The medics are practicing under the medical directors license. A PA doesn't have a license to practice medicine. I understand how a PA could decide what protocols the medics could do, what drugs they carry, but I don't understand legally how a PA could be the final medical authority for an ambulance service.
Click to expand...

PAs DO have a license to practice medicine in most states. Check this out:

http://wwwapps.ncmedboard.org/Clients/NCBOM/Public/LicenseeInformationSearch.aspx
 
Is that license the same as an MD's license? And can someone else practice under that?

My understanding was that in most places a PA has to be affiliated with an MD/DO.
Whether or not that physician has to be in the same building or not is another matter, but that in most states a PA legally needs that oversight to be available. I don't understand how that would work with EMS medical direction.

I wouldn't be surprised if the PA medical directors had some formal relationship with a physician to cover themselves in a legal/malpractice sense, but do the protocol decision making themselves.

If I was a PA I don't know that I'd want to take on the full liability of being a medical director knowing that the vast majority of med directors are MD/DO. It certainly would be ugly in court when the other side brings in some board certified emergency medicine physician medical director who would have done something different and then they start comparing your training.

Also I wonder if it changes one's insurance. There is a big difference between a company saying "we'll insure you for your actions" and "we'll insure you in case you are personally named in a suit because one of your 300 paramedics decided to do something crazy."

Not saying that a PA couldn't be a good medical director, but I'm not quite sure I understand how it works legally.
 
meathooks said:
No, PAs are also licensed by the board of medicine. Your link is to a search site for the board of medicine. That is why NPs are on a different site (they are licensed by the board of nursing).

It is usually a good idea to know what you're talking about before you say things.
Click to expand...


Excuse me? I linked that on purpose, in answer to an erronous post stating PAs are not licensed. I am a PA, and very well know we are licensed by the medical board.

to quote yourself "it is a good idea to know what you're talking about before you say things". You would think you could read.....
 
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jbar said:
Is that license the same as an MD's license? And can someone else practice under that?
Click to expand...

Definitely not the same, in that my license is a dependent license requiring MD supervision. That said, if a EMED physician delegates you the authority, there is no reason you can't be medical director.
 
bradt9881 said:
Definitely not the same, in that my license is a dependent license requiring MD supervision. That said, if a EMED physician delegates you the authority, there is no reason you can't be medical director.
Click to expand...

agree- while I have never been an ems medical director I have given direction to medics in the field as part of my delegated scope of practice.
my state license by the way says:
"emedpa, pa-c is hereby granted this license to practice medicine in the state of xyz".

I do have a sponsoring physician of record but I legally am engaged in the practice of medicine.
 
Hello everyone,

I'm a critical care RN with 3.5 years of ICU experience (was lucky enough to start in the ICU, good grades mean something :D). In undergrad I was initially doing the chemistry route. I did that for 3.5 years, and I think I'm something like a foreign language and Pchem from getting the degree. It was at this point that it dawned on me: I don't want to be a chemist if I don't get in/go to medical school. It was at this point that I chose nursing, and decided that CRNA was for me. Much less to give up time-wise, my brother is an ER MD and I saw what he and his family went through, while still getting mostly the same benefits.

At some point in the past 2 years I decided that being a CRNA might be a bit boring for me. CRNAs don't chop my head off here, I'm just saying this: You're either really stressed, or really bored... based on my shadowing/personal friend experience. I think it's a really healthy profession, and that it helps a lot of people, but I just don't think I want to do it for 30 years. Most CRNAs I talk to, and ask "do you like your job", respond with something along the lines "I like the money". With that said.... I want to enjoy my job.

Then I had this great idea! I was going to go to law school, and I'm still considering this, as you can probably tell by my name. The only other thing that pops in my head is NP/PA. So I am doing some research on the two. My brother instantly says "PA!", and obviously most co-workers say NP, especially with the dawn of the CCNP. While I understand the major differences, and the reasons some prefer one over the other, I wanted to voice what I understand as the differences, and have someone with a bit more knowledge let me know if I'm correct.

So here goes:


NP
  • Has prescriptive and diagnostic authority as dictated by state nursing board (this seems odd to me, honestly)
  • Generally works alongside a physician, but can operate independently depending on the state of residence.
  • Focuses less on traditional medicine and more on the holistic approach.
  • Education is less clinical and scientific based, and more theory based.
  • Needs to be proactive in doing self-education regarding pharm, path, and anatomy (I don't like saying is "less educated in", simply because I wouldn't allow myself to be)
  • Is more specialized and generally focuses on one aspect of practice.
PA
  • Has prescriptive and diagnostic authority as dictated by the medical board. (makes more sense to me)
  • Cannot work independently of a physician
  • Education is based more in the sciences and clinicals, and less on the theory that is prevalent in nursing educations.
  • Can be specialized, but has the ability to change specializations depending on who will hire them.
So from that the basic differences I get are this: Education is slightly different with one concentrating more on theory and the other on science, NPs have the ability to do their own thing, to an extent, and PAs MUST be overseen by an MD. From what I can tell, outside of a few subtle differences, these are the main differences..... Am I correct, or is there something I'm missing.

Also, I'm curious whether the salaries are comparable, and which one has an easier time finding a job (if they're not the same).

I'm still not convinced that either is what I'll do, hell, part of me still wants to apply to medical school. I'm just trying to be as well-informed about these professions as possible, so that I can weigh all my options.

I appreciate the feedback in advance
and I apologize for the lengthy post.
 
Dude, I cannot believe you think being a CRNA id boring....I have the best job on the planet. That being said it takes all kinds for the world to work.

For PA VS NP
Salaries are equal for the most part but as an NP and independent the earning potential can be significantly higher usually it is not gotta be entrepreneurial in the right place and right time.

Ability to be hired once again time and place, but if willing to move you will find work foe either profession.

If you want to go to med school go for it you will never regret at least trying but you may well regret NOT trying.

Good luck hope I helped.
 
Like I said, I can only go on what I've been exposed to (which is about 80 hours of shadowing). I've followed the CRNAs that do the cool **** like Open hearts, also I've followed the ones that do OB, and stuff like removing toes, ports, etc. The ones doing the later all seemed very bored. They pushed a few drugs, and sat back and did nothing. Rinsed and repeated. Seemed very tedious to me.

It probably comes down to what type of environment you work in (as with all professions). I'm making a general, blanket statement based on what I've witnessed. I'm not knocking it, and have never heard anyone say they didn't like their job. You are, however, the first person I've encountered that said it's the best job on the planet (and still... part of me wonders if you say that r/t the paychecks, or the job itself, it is the third highest paid job in the country on average, anesthesiologist being number ;))

Thanks for the comment
hellothane said:
Dude, I cannot believe you think being a CRNA id boring....I have the best job on the planet. That being said it takes all kinds for the world to work.

For PA VS NP
Salaries are equal for the most part but as an NP and independent the earning potential can be significantly higher usually it is not gotta be entrepreneurial in the right place and right time.

Ability to be hired once again time and place, but if willing to move you will find work foe either profession.

If you want to go to med school go for it you will never regret at least trying but you may well regret NOT trying.

Good luck hope I helped.
Click to expand...
 
I work independantly so get to do my own regional, and the like and I like it, the pay is good, do not get me wrong but the autonmy is the best, good luck.

Oh was not trying to bust you out, just REALLY like anesthesia.
 
Rnbsnjd said:
Hello everyone,

I'm a critical care RN with 3.5 years of ICU experience (was lucky enough to start in the ICU, good grades mean something :D). In undergrad I was initially doing the chemistry route. I did that for 3.5 years, and I think I'm something like a foreign language and Pchem from getting the degree. It was at this point that it dawned on me: I don't want to be a chemist if I don't get in/go to medical school. It was at this point that I chose nursing, and decided that CRNA was for me. Much less to give up time-wise, my brother is an ER MD and I saw what he and his family went through, while still getting mostly the same benefits.

At some point in the past 2 years I decided that being a CRNA might be a bit boring for me. CRNAs don't chop my head off here, I'm just saying this: You're either really stressed, or really bored... based on my shadowing/personal friend experience. I think it's a really healthy profession, and that it helps a lot of people, but I just don't think I want to do it for 30 years. Most CRNAs I talk to, and ask "do you like your job", respond with something along the lines "I like the money". With that said.... I want to enjoy my job.

Then I had this great idea! I was going to go to law school, and I'm still considering this, as you can probably tell by my name. The only other thing that pops in my head is NP/PA. So I am doing some research on the two. My brother instantly says "PA!", and obviously most co-workers say NP, especially with the dawn of the CCNP. While I understand the major differences, and the reasons some prefer one over the other, I wanted to voice what I understand as the differences, and have someone with a bit more knowledge let me know if I'm correct.

So here goes:


NP
  • Has prescriptive and diagnostic authority as dictated by state nursing board (this seems odd to me, honestly)
  • Generally works alongside a physician, but can operate independently depending on the state of residence.
  • Focuses less on traditional medicine and more on the holistic approach.
  • Education is less clinical and scientific based, and more theory based.
  • Needs to be proactive in doing self-education regarding pharm, path, and anatomy (I don't like saying is "less educated in", simply because I wouldn't allow myself to be)
  • Is more specialized and generally focuses on one aspect of practice.
PA
  • Has prescriptive and diagnostic authority as dictated by the medical board. (makes more sense to me)
  • Cannot work independently of a physician
  • Education is based more in the sciences and clinicals, and less on the theory that is prevalent in nursing educations.
  • Can be specialized, but has the ability to change specializations depending on who will hire them.
So from that the basic differences I get are this: Education is slightly different with one concentrating more on theory and the other on science, NPs have the ability to do their own thing, to an extent, and PAs MUST be overseen by an MD. From what I can tell, outside of a few subtle differences, these are the main differences..... Am I correct, or is there something I'm missing.

Also, I'm curious whether the salaries are comparable, and which one has an easier time finding a job (if they're not the same).

I'm still not convinced that either is what I'll do, hell, part of me still wants to apply to medical school. I'm just trying to be as well-informed about these professions as possible, so that I can weigh all my options.

I appreciate the feedback in advance
and I apologize for the lengthy post.
Click to expand...

I'll just comment on two things. Since you specifically spoke of the ACNP (not CCNP) understand that in the inpatient setting there is no such thing as working independently. Even if state law allows "independent" practice, hospital bylaws and Medicare require physician involvement in patient care. The degree of autonomy that you achieve will depend on your relationship with the physicians you work with (and the institution to some extent).

In the primary care world its different, but the amount of PAs and NPs that own their own practice is relatively equal at 2%. Even in states that have The vast majority of NPs and PAs will work for physician practices (although partnerships are becoming available in some areas).

Also look at what you want to do. Some areas are dominated by PAs such as surgery. Others may have more NPs working. In my institution the surgical services are all heavily PA, the ICUs 50/50 and the outpatient clinics more NP.

The way that NPs and PAs are used is going to depend on the the locality and state practice act.

David Carpenter, PA-C
 
I cannot believed the amount of ignorance regarding the NP profession. NP and PA must work hand in hand, it makes me sick when this kind of comments are posted.
 
JWK,
You have a very bitter personality my friend, all I'm saying is that health professionals must work together not saying all these "nasty comments". If you are an educated person you know what I am talking about. And what kind of health professional are you ?.... With the way you replied you need more education about the NP profession.
 
niko327 said:
Simply not true. The typical PA student either has substantial health care work experience, premedical type undergraduate coursework or both. Your post is misleading, there are many things people can do besides nursing that makes for outstanding clinical experience. I am NOT NP-bashing, NPs are a strong assett to the healthcare system as are PAs. But nursing is not the only thing one can do to prepare themselves for a career as a midlevel.
Click to expand...

No, they don't do a pre-med curriculum. I went from finishing PA school to doing a phD, and with wanting a much deeper understanding in the medical sciences, I went to med school. Many PA programs don't require organic chemistry, and physics. They don't require the MCAT either. MCAT is much much more challenging then the subject GRE that is required for PA school. The physics GRE and some specialty GRE exams are more challenging than the MCAT, but the GRE that is required for PA programs is not as hard as the MCAT. PA entrance reqs are quite a bit different than med school, vet school, etc. Again, I am familiar with it after finishing a PA program and going on to a Phd and an MD.

Going on for a PhD and an MD was really a humbling experience. When I reached the MD program I realized how much I didn't know about medicine, even after working as a PA-C for many years.
 
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To
Mike MacKinnon
Guest

I am currently trying to decide which path to take NP or PA and reading this blog made me ever more confused
Thanks for the links you posted, real helpful!
 
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