DNP Phasing Out PAs?

[Gastrapathy]

Doctors should hire PAs instead of fake doctor nurses but we won't because Dark Helmet was right.

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[deleted6669]

nyc guy is right here. there are truly NP independent states and many excellent "brick and mortar" NP programs like U.WA, UCSF, Vanderbilt, etc.
it really depends what you want to do when done. some fields work better for NPs( women's health, psych, nicu), some better for PAs(surgery, em, ortho, critical care) and some it doesn't matter.
best of luck whatever you decide. for more info from the pa side of things see www.physicianassistantforum.com for the NP perspective try www.allnurses.com

 

[pamac]

The DNP's are backing themselves into a corner. They have created their own online doctorate programs. There are literally DNP programs that are only 9 credits of coursework. This is absolutely laughable. Currently every physician I am speaking with is saying they are not going to hire NP's because PA's are much better trained. As for the independent thing--that is a joke. EVERY state specifically requires that any NP at any level who wishes to prescribe medicine or perform any procedures MUST have a written signed agreement with a physician. Go read the nursing acts--the NP's are only independent for practicing "nursing." The NP"s have completely overblown their so-called independence. In reality their relationship with physicians is not different that the PA-physician relationship. What is more--look at the data. A PA with a Master's degree has more didactic hours of training AND more clinical rotation hours of training than most NP's with a doctorate. What is more the NP training is all online and their clinical rotations are very poorly managed and structured. There is a reason why PA school cannot be done online; the training is too intense and in-depth. I anything happens, the PA profession is going to benefit tremendously from the DNP move.

The 9 credit DNP you mention doesn't exist. I've seen programs that add an additional certification to post doctorate NPs that might come across to a casual observer like yourself as being a full DNP program, but that might be because you didn't scroll down. Sometimes you'll see an NP in an area like family practice that wants to move into an area like psyche, and they will do some additional coursework along with clinicals to match their desired area of specialty. Additional coursework would duplicate some of the areas they already covered in their previous work.

As far as independence, you are wrong. There are clear advantages to NP independence, and many PAs are open about them.

The ER group and hospitalist service where I work uses NPs vs PAs because of the regulatory supervisory burden that they feel accompany PAs. They prefer the providers to be independent providers. Of course, that's not universal, and many places want to utilize PAs more. It just goes to show there is diversity of thought. Until recently, ER and hospitalist groups here felt pressure to only put a physician in front of a patient due to image concerns. The public felt like anything less than a doctor or nurse standing in front of them was shorting them significantly, and different hospitals were advertising on their providers prowess as a way to try to one up each other.

PAs and NPs often do function interchangeably, but being able to not have the regulatory issues regarding finding an SP is important when things go sour. Just to to the PA forums and see what a lot if folks there have to say about some of the hoops they have to jump through that NPs don't. However, if the law doesn't address how NPs operate independently, insurance companies or facility regulations might put similar burdens on NPs as exist for PAs, so there might not be daylight between the two careers, even if practice acts allow for NPs to be unencumbered.

 

[68PGunner]

Considering the war that nurses are waging against physicians, I will always vouch for a PA over a DNP.

 

[deleted480308]

The DNP's are backing themselves into a corner. They have created their own online doctorate programs. There are literally DNP programs that are only 9 credits of coursework. This is absolutely laughable. Currently every physician I am speaking with is saying they are not going to hire NP's because PA's are much better trained. As for the independent thing--that is a joke. EVERY state specifically requires that any NP at any level who wishes to prescribe medicine or perform any procedures MUST have a written signed agreement with a physician. Go read the nursing acts--the NP's are only independent for practicing "nursing." The NP"s have completely overblown their so-called independence. In reality their relationship with physicians is not different that the PA-physician relationship. What is more--look at the data. A PA with a Master's degree has more didactic hours of training AND more clinical rotation hours of training than most NP's with a doctorate. What is more the NP training is all online and their clinical rotations are very poorly managed and structured. There is a reason why PA school cannot be done online; the training is too intense and in-depth. I anything happens, the PA profession is going to benefit tremendously from the DNP move.

you are factually incorrect. there are states that give NPs complete independence (even though they shouldn't)

Considering the war that nurses are waging against physicians, I will always vouch for a PA over a DNP.

every hiring decision I am involved in once I reach attending will lean hard to the PAs

 

[68PGunner]

you are factually incorrect. there are states that give NPs complete independence (even though they shouldn't)

every hiring decision I am involved in once I reach attending will lean hard to the PAs

Of course. Nurses will eventually face the consequences of trying to bite the hands that feed them down the road. Physicians in general are very generous human beings. However, when you invade people's feeding ground and threaten their jobs, physicians will react like any normal human being -- fight back with all their vested power and authority to protect their rights and jobs.

I find it personally refreshing that our young and future physicians are aware of the current situation, unlike the baby boomers who have let this situation out of control by allowing the crisis to manifest to today conditions.

To answer the OP question, PAs will always be the preferred choice given the nurse's current stance against physician and the pa's current understanding of their symbiotic relationship with physicians. If the reverse is true, DNP will be the preferred choice.

 

[pamac]

There is more than enough work to go around, and that's a big part of what is driving the mid level provider boom, along with the steady expansion of NP independence. If physicians actually have entrenched opinions like yours (even though it sounds like you are still a physician in embryo), they seem unable to stop the movement. Maybe once you are out in practice, you'll change your mind due to oversight and liability issues that don't follow NPs. Or maybe you will meet some NPs that impress you vs the newly minted PA working in their first real job. By the time I'm finished with my NP, I will have run dozens of codes, seen countless patients (both sick and not sick) spent thousands of hours managing their care, had thousands of conversations under difficult circumstances, etc.... And that's if I only worked for a few years as an RN. Your brand new 23 year old PA won't have that behind them, but you can bask in the magnanimity of sticking to your guns just for the sake of it. But hiring decisions might not even be in your hands, as you are likely to be a physician employee, as the trend is to move away from small practices as big entities buy them out. Right now that model means that 50% of you guys work as employees, and that is projected to grow. Those same entities hiring you will be the ones deciding who you work with, and they might want independent providers to man the guns vs PAs you guys have to "supervise". That's been the case in my hospital with our hospitalist group.

If you do happen to run your own practice, you might not want to worry about the lawyers that will chase after you because of a decision your PA made. Had you hired an NP that was independent of oversight, you wouldn't have attorneys salivating about the direct link between you and the mistake. When lawsuits go down, the ambulance chasers don't bother with the nurses, they go straight for the facility and the physicians because they are seen as the fat cats. They show the jury pictures of you pulling up to work in a an exotic import while their client drives a beater and now wears a C collar. The nurse might (or might not) be cut loose from their job, but they rarely get sued. That's why it costs $114 dollars a year to insure me, and a couple thousand to insure an NP, while it costs a PA 3 times that, and costs physicians exponentially more.

You don't sound like you know enough about the landscape to understand that NPs aren't threatening your job. The changes that are coming are being driven by cost and government.... And to an extent, your peers. Your refreshing young future physicians who you think give a hoot are deciding they don't want to run a practice, and deal with the headaches that come with it. They want to travel, go home without the pager on, go drink with friends at the drop of a hat, not have to worry about hiring someone who won't rip them off or forget to fill out a form that Medicaid audits every year, etc. They will pass on the wealth to go work for Kaiser, and Kaiser will decide who carries the pager and when. You'll get your check and do what kaiser human resources tells you to do, and you'll probably like it because you won't sit there hoping your practice you built will be ready for you to sell so you can retire asap because you hate the stress you would have built up around you. You'll ask yourself what use you have for money if you don't have time to spend it. That, along with declining reimbursement headed our way from government funding is what is driving NP independence. Facilities might want independent providers to fill the gaps while you are out visiting the pacific coast on vacay every other month. But they will decide... Not you. A CFO accountant and a CEO with an MBA will be the boss, and probably a CNO who they meet with every day to cover nuts and bolts issues. You might get to put your 2 cents in if you decide to send an email or manage to have time to take a walk to the corner office and leave a suggestion in the suggestion box, but you better be polite. If you aren't churning out results yourself, you might be asked to move on to a place that's a "better fit". That.... Is the future for you and your refreshing young, future physicians, and you guys are driving this as much as NPs are stepping up to fill the void. Gosh, how many tens of thousands of physicians are we running short of, and medical students like yourselves are freaking out about what the future holds? You probably aren't even interested in being doc Hollywood and making 7 figures.

When o care collapses and socialization is the next big thing, they will be lucky to get bright people such as yourselves to sacrifice your prime years to a society that takes you for granted and wants to treat you like they are in front of an ihop server. When Americans pay nothing for their care, we will be the ones bearing the brunt of the entitlement they feel. You'll welcome the NPs that provide you quality of life benefits, because you definitely won't be taking home high six figure salaries. Look to physicians in Europe and abroad to see your future. Or look to the Public Health Service corp or the military medical corp.

 

[deleted480308]

There is more than enough work to go around, and that's a big part of what is driving the mid level provider boom, along with the steady expansion of NP independence. If physicians actually have entrenched opinions like yours (even though it sounds like you are still a physician in embryo), they seem unable to stop the movement. Maybe once you are out in practice, you'll change your mind due to oversight and liability issues that don't follow NPs. Or maybe you will meet some NPs that impress you vs the newly minted PA working in their first real job. By the time I'm finished with my NP, I will have run dozens of codes, seen countless patients (both sick and not sick) spent thousands of hours managing their care, had thousands of conversations under difficult circumstances, etc.... And that's if I only worked for a few years as an RN. Your brand new 23 year old PA won't have that behind them, but you can bask in the magnanimity of sticking to your guns just for the sake of it. But hiring decisions might not even be in your hands, as you are likely to be a physician employee, as the trend is to move away from small practices as big entities buy them out. Right now that model means that 50% of you guys work as employees, and that is projected to grow. Those same entities hiring you will be the ones deciding who you work with, and they might want independent providers to man the guns vs PAs you guys have to "supervise". That's been the case in my hospital with our hospitalist group.

You don't sound like you know enough about the landscape to understand that NPs aren't threatening your job. The changes that are coming are being driven by cost and government.... And to an extent, your peers. Your refreshing young future physicians who you think give a hoot are deciding they don't want to run a practice, and deal with the headaches that come with it. They want to travel, go home without the pager on, go drink with friends at the drop of a hat, not have to worry about hiring someone who won't rip them off for forget to fill out a form that Medicaid audits every year, etc. They will pass on the wealth to go work for Kaiser, and Kaiser will decide who carries the pager and when. You'll get your check and do what kaiser human resources tells you to do, and you'll probably like it because you won't sit there hoping your practice you built will be ready for you to sell so you can retire asap because you hate the stress you would have built up around you. You'll ask yourself what use you have for money if you don't have time to spend it. That, along with declining reimbursement headed our way from government funding is what is driving NP independence. Facilities might want independent providers to fill the gaps while you are out visiting the pacific coast on vacay every other month. But they will decide... Not you. A CFO accountant and a CEO with an MBA will be the boss, and probably a CNO who they meet with every day to cover nuts and bolts issues. You might get to put your 2 cents in if you decide to send an email or manage to have time to take a walk to the corner office and leave a suggestion in the suggestion box, but you better be polite. If you aren't churning out results yourself, you might be asked to move on to a place that's a "better fit". That.... Is the future for you and your refreshing young, future physicians, and you guys are driving this as much as NPs are stepping up to fill the void. Gosh, how many tens of thousands of physicians are we running short of, and medical students like yourselves are freaking out about what the future holds? You probably aren't even interested in being doc Hollywood and making 7 figures.

When o care collapses and socialization is the next big thing, they will be lucky to get bright people such as yourselves to sacrifice your prime years to a society that takes you for granted and wants to treat you like they are in front of an ihop server. When Americans pay nothing for their care, we will be the ones bearing the brunt of the entitlement they feel. You'll welcome the NPs that provide you quality of life benefits, because you definitely won't be taking home high six figure salaries. Look to physicians in Europe and abroad to see your future. Or look to the Public Health Service corp or the military medical corp.

If patients getting highest quality care is the goal, there is no defense for midlevel independence.

 

[pamac]

Then under your logic, anything less than a physician doing full patient care and changing bed pans is the gold standard. Get over yourself, mid level providers have been providing high quality care for decades with studies to back it up.

Medical....student.

 

[pamac]

Fact is, nobody gets the highest quality of care, because treatments are dictated by patient compliance levels, insurance, hospital policy, availability of equipment, resources of all types. Your ideal world doesn't exist. The question is whether patients get adequate care, and what that consists of. In a world such as ours where resource limitations exist (and always have) doesn't it make sense for an attending such as yourself to handle mostly the big stuff? You haven't even supervised any PAs yet, so how do you even know how independence for even them would affect the landscape. I've never argued that PAs should be satisfied with what they have right now, because in today's practice environment, at least apart from specialties where the physician can't be substituted for (surgery, etc), PAs operate with barely an ounce of micromanagement. But why not even give them independence so they don't have to be joined at the hip to you guys who want to treat them like they are the squires, and you are the knights, all while they are spending 99% of their time fighting the battle just like you. I'm not saying that we need to get paid as much as you guys do, because you guys bring hard earned expertise that you sacrificed to obtain. But administratively, it makes sense to cut PAs loose, because increasingly, they don't work for you guys, they work for the facility and operate autonomously without you looking over their shoulder. Their status should reflect that. It protects you too. But in any event, it's happening whether you think it should or not. And it's not even being driven primarily by nurses, it's coming from stakeholders who don't share your idealism about what constitutes what is in a patient's best interest.Medical students with bold online stances will make the folks making decisions give not a whiff. We live in a world with resources and trade offs.

 

[deleted480308]

Then under your logic, anything less than a physician doing full patient care and changing bed pans is the gold standard. Get over yourself, mid level providers have been providing high quality care for decades with studies to back it up.

Medical....student.

A midlevel isn't as qualified to diagnose and determine treatment as a physician. We all know that and getting legislature to lie abour doesn't change the truth.

And no, you don't have any quality study showing midlevels provide similar outcomes when operating independently with identical patient populations

 

[pamac]

We would all love to have astronauts fly our passenger planes for safety sake, but apparently you would go a step further and demand it.

Much of the problem we are trying to tackle in healthcare isn't the quality of the provider, it's access. We can play dueling studies if you want, but why don't you show me all the studies lamenting the awful outcomes non physician providers are responsible for in identical patient populations. You are ignoring most of what I said previously anyway. Provider shortage doesn't even compute for you because you are playing in the theoretical universe where you think it's moral to ignore something that can often be fixed in the name of the person providing it not have the right pedigree. An MD delivered my kids, not a midwife. But if I had to choose between a midwife and nothing, of course... midwife. I can appreciate the difference between an MD and a midwife, and was extremely interested in paying for the MD so that in a bad situation I would have her knowledge and training to tap into. It's not hard to see that the gold standard is a physician. But physicians themselves have decided that a very large portion of medicine can be covered by midlevels effectively. The fact is (and you are completely and purposely ignoring this because it defeats your mantra) non physician providers have been performing roles independently and effectively for decades. You've never even supervised a PA or an NP, so what do you know about the practical aspects of the environment working with a midlevel? You are regurgitating a statement that sounds good to you as a med student, but ignores facts on the ground.

Every once in a while there's a nut that advocates hard that NPs are equivalent to physicians, and they are easy to shut down. I'm saying that the employment and supervision structure should favor employees careers not being inextricably linked to the physician. As a nurse, I don't work for any doctor, but I'm evaluated by separate entities regarding my individual work and effectiveness in being a nurse, including the parts where I follow doctors orders. When the physician leaves to work at some other place, I don't have to go snuggle up to another to be able to do my work. A PA who's doc goes to work for the big guys has to go find a doc who is willing to take them on in order to do any work at all. The independent NP doesn't. They go get hired (or ever so rarely start their own practice 1% of the time). They can work the next day if they have privlages. That's how they functioned as a nurse, so it's a natural extension of what they are used to. You guys are fixated on the few NPs that go out on their own like they are going to pull any revenue away from you. Go create some revenue and see how that works, then jealously protect it. Soon you'll be hiring a midlevel to maximize it, and you won't be out in the streets lamenting the fact that your practice isn't putting a physician in front of patients at each visit. The next step is you doing your own thing in your office while they do theirs, then you complain over beers to your colleagues about how "your" PA or NP interrupts you to ask a question you think everyone should know the answer to.

SB247 in ten years at a bar with physician colleague:

"Why can't they just use their head and not have to have me hold their have all the time...what do they teach in PA/NP school? Anyway, I'm so busy I'm thinking of hiring another one so I can deal with all the referrals coming in... And I'm freaking sick of taking call every 3rd weekend, so the midlevels all better be ready for that bomb to drop, because it's not going to be me doing it anymore." Good standard medicine be damned. And heaven help "your" PA that doesn't act independent enough to keep from bugging you with their questions. You'll want them independent enough to leave you alone at work, but not independent enough to hold back a bigger slice of the pie you want them to have.

More depressingly, your work, and mine as well, will be dictated even more than it is now by the cost curve. So don't get high horse about what is best, especially at this stage of life. You are bound to be disappointed by what you see when you get out and have to deal with preauthorizations, patient compliance, family interference, facility limitations....and most terrifying of all: the fact that midlevel providers will be *gasp* diagnosing and determining treatment for patients that you probably will never even see or hear about (!). And you might even pay them out of your own pocket to do that for you.

 

[TheEarDoc]

No, I mean anyone who knows how multiple tests are constructed can take one in almost any subject and pass it. This should be very clear.

Nurses especially since the exams are usually 2-3 right answers, but only 1 correct answer.