Experience for PA School - no name clinic or fancy hospital?

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PA2784

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Hey guys. I'm new to this forum so I have no idea if I'm posting this correctly. For those of you who have already gone through or are going through PA school applications I have a dilemma...

I recently got an offer as an MA for let's say a very prestigious ivy league hospital. The position is for cardiology where I'll be doing half paperwork stuff and the other half diagnosing, holter monitors, etc. Honestly I don't fully know what I'll be doing but I get the feeling that this isn't much direct hands on experience. The doctor however is the best in his field and went to John Hopkins and Harvard and gives very good recommendations. He's had several other hires get into PA school.

Now skip to job offer number 2 and its for an orthopedic surgeon who also does primary care work. I'll get tons of experience basically short of performing surgery myself but the doctor is a no name guy at a no name clinic. I will however do everything including injections, blood draws, diagnosing, surgical assistance, etc.

Which one will get me into PA school?

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I would gravitate to whatever job fits in best with what you want to do your whole shift, as well as the one that will not get into the way of you getting good grades, because that will be the single biggest factor behind you getting into PA school. It really won't matter much where you work as an MA, because you'll just be an MA. Name dropping might not help you as much as you want it to on your application. However, consider who can give you the best letter of recommendation, because that will be helpful. The person that can give you the best recommendation will be the one that knows you well enough to refer to specific things about you... it won't have much to do with reputation. You can work at the best facility, but if your reference can't include specific anecdotes about why you would be a great pick for a PA school to choose, then you are missing out.
 
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speaking as an "old school PA", I would say position #2 unless you have a strong interest in practicing cardiology after you become a PA. The best preparation to become an awesome PA (as opposed to getting into a PA program) isn't your schoolwork, it's your health care experience. my recommendation is always get as much hands-on HCE as you can, preferably in the field you see yourself eventually working in.
see the PA forum for a much wider PA-related audience than you will get here at sdn.
www.physicianassistantforum.com
 
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I've never heard that EMEDPA owns a piece of that website he refers to. It does have an owner, but I don't believe it is him. He is a moderator there. After a spat he had on another thread with some physicians, he hasn't been back, and he said on the PA forums that he wouldn't be back here. It seems as if he is keeping to that statement, and I haven't seen him post here since then. If that's the case, then he won't be replying to defend himself. I feel like EMEDPA redirects folks to the PA forums simply because, as he frequently would say, many more PA's read and post on there than here. I think that's clearly true. For that simple reason, it would make more sense for someone seeking to be a PA and wanting advice from one to go where they hang out, which is the PA forums.

I don't agree with everything EMEDPA says, but I think his voice was worthwhile. He tends to be dogged in his insistence that PA's dominate emergency medicine, as well as a few other specialties, and I tend to think that his opinion on that is mostly resting in either how he wants it to be, or how it is in the locales he works. But regardless, I don't think he gets any financial benefit from anything he says. Mostly he's a fan of the PA profession. I would be too, but overall, I see the a lot of weakness in the requirement that they be tied to a physician in order to practice. At the time that I was interested in becoming a PA and commenting on the PA forums, too many folks there were not remotely interested in spinning the PA field off into something like what NP's have. Its changed gradually with time, but its too late for them to make that jump. I mostly am a fan of independence from the standpoint of non physician providers having the ability to be in more control of thier employment terms more than anything else. I don't like the idea of them being like dental hygienists are to dentists, or paralegals are to lawyers. As it stands, that's what PA's are to physicians. So becoming a PA was not for me.

As for the PA profession's demise.... its hard for me to say. Since I decided to become an NP, that decision colors how I feel about the future of the PA's. It didn't seem bright enough for me to choose it for myself, so that's basically my take on it. I think that the expenses for going to PA school have gotten completely out of hand, and schools look at them as cash cows. NP schools have tended to be getting cheaper over time with the competition, but its hard to find a PA program that isn't at least $80,000. I feel like the instruction they give is generally top notch, but that is to be expected when you have a lot of ground to cover for someone with no healthcare experience. But I don't think PA schools are scamming folks. I think its starting to look like what happened to law schools over the past few years, where the market is tightening in strange ways. But for PA's, its difficult because they aren't thier own men, they are tied to physicians, and that means they have less freedom in their employment. However, as more PAs and NPs are churned out, NP's are going to be affected by what additional PA's have brought to the landscape.
 
I've never heard that EMEDPA owns a piece of that website he refers to. It does have an owner, but I don't believe it is him. He is a moderator there. After a spat he had on another thread with some physicians, he hasn't been back, and he said on the PA forums that he wouldn't be back here. It seems as if he is keeping to that statement, and I haven't seen him post here since then. If that's the case, then he won't be replying to defend himself. I feel like EMEDPA redirects folks to the PA forums simply because, as he frequently would say, many more PA's read and post on there than here. I think that's clearly true. For that simple reason, it would make more sense for someone seeking to be a PA and wanting advice from one to go where they hang out, which is the PA forums.

I don't agree with everything EMEDPA says, but I think his voice was worthwhile. He tends to be dogged in his insistence that PA's dominate emergency medicine, as well as a few other specialties, and I tend to think that his opinion on that is mostly resting in either how he wants it to be, or how it is in the locales he works. But regardless, I don't think he gets any financial benefit from anything he says. Mostly he's a fan of the PA profession. I would be too, but overall, I see the a lot of weakness in the requirement that they be tied to a physician in order to practice. At the time that I was interested in becoming a PA and commenting on the PA forums, too many folks there were not remotely interested in spinning the PA field off into something like what NP's have. Its changed gradually with time, but its too late for them to make that jump. I mostly am a fan of independence from the standpoint of non physician providers having the ability to be in more control of thier employment terms more than anything else. I don't like the idea of them being like dental hygienists are to dentists, or paralegals are to lawyers. As it stands, that's what PA's are to physicians. So becoming a PA was not for me.

As for the PA profession's demise.... its hard for me to say. Since I decided to become an NP, that decision colors how I feel about the future of the PA's. It didn't seem bright enough for me to choose it for myself, so that's basically my take on it. I think that the expenses for going to PA school have gotten completely out of hand, and schools look at them as cash cows. NP schools have tended to be getting cheaper over time with the competition, but its hard to find a PA program that isn't at least $80,000. I feel like the instruction they give is generally top notch, but that is to be expected when you have a lot of ground to cover for someone with no healthcare experience. But I don't think PA schools are scamming folks. I think its starting to look like what happened to law schools over the past few years, where the market is tightening in strange ways. But for PA's, its difficult because they aren't thier own men, they are tied to physicians, and that means they have less freedom in their employment. However, as more PAs and NPs are churned out, NP's are going to be affected by what additional PA's have brought to the landscape.

The perception that we are dependent and tied to physicians is a little bit off. We may be associated on paper to a physician but that doesn't really mean much in most situations. I've never even met said physician I'm "dependent too". I'm also mostly an ER PA and I'll tell you that I've run into 4 NPs in ER during my decade in practice. So, yes I agree that PA have a much stronger presence in ER then NPs.

Now, how about those independent NP states. Does being in an independent state actually mean the NP is allowed to practice without any oversight. Nope, it does not. I worked in Hawaii side by side 2 NPs in the ER. They had to follow the exact same rules as myself and the other 10 PAs in regard to staffing certain acuity patients with an attending. A compare and contrast of the professions can be healthy and informative. Then there are those that post inaccurate information and seem to have unresolved grudges against the profession or their own personal life choices.
 
I know more than 4 NPs that work in my ER alone. Areas can vary as to whom they prefer. Overall, there are a bit less than half the number of NP's working in ER nationally as there are PA's, but that's still a significant number, especially considering there aren't a tremendous amount of PA's in ERs nationally. I saw one instance of the hospital getting rid of all inpatient PA's in favor of NP's due to the independence factor, and that was also the case for a season in the ER, but did eventually change there, and there is relative parity for now. But having plenty of NP's in an ER environment isn't a rare thing. Less than PA's, but certainly not out of the question. The region I live is isn't an anomaly. The fact is that physicians comprise the lion share by far of ED providers. Locally, hospitals were even starting to market their ED's citing the fact that every patient would "see a doctor", implying that anything else would be a compromise.

I worked on credentialing in my facility for a few projects, and ED PAs are in their own class as far as how their supervisory relationship tends to affect them. PA's in an ED will generally have a ton of supervising physicians. Because of that, there's really nobody who ends up taking charge, and they don't feel the tug of the supervisory requirement. Can be the same for large practices. However, for risk averse physicians (which ends up being a lot of them), some groups don't want to place trust in anyone but themselves. That's why there was a push to make the switch at my facility to using NP's. They spoke openly of wanting providers to all have their work attached to the provider, and not leave another provider on the hood for decisions that were made. I think that profit margin issues brought the ER group back around, and they decided it was better to make more money than stick to their paranoia. Hospital system marketing departments also moved on to other issues to harp on.

As far as independent states, how a PA or NP practices in a facility depends on facility policy. If the facility wants all PAs and NPs to have oversight at that facility, then those are the rules. But walking out of that facility, one type of provider can walk across the street and set up shop immediately, and the other can't. One type of provider can go to another facility and work independently if that other facility doesn't have a policy in place directing otherwise, the other can't. I'm not saying it should be this way, and would be fine with PAs having independence like NPs, but its not in place for them, and it can be a big deal. All one has to do is go to the PA forums to read the gripes they have about it. One thread there was a horror show of folks who had their lives turned upside down due to the relationship they were required to have with physicians.
 
Independence in coming...I'm bet in the next 5-10 years we will start with a handful of states and then go from there...just as the NPs did. In the three states and one commonwealth I've worked, I have never had a physician state they preferred NPs because of independence. I've met just as many NPs as PAs that own their own practice.
 
All I can say is that's what I've heard in the course of my work with the folks making the decisions at the administrative level, as well as what I have read at the PA forums from PAs. Overall, I really don't think physicians have PAs or NPs on their radar typically. Most of them seem to look at them as essentially interchangable.

PAs will never be independent for a number of reasons. For one, NPs will fight it tooth and nail, and they have so much more clout. Physicians will also fight it because there's nothing in it for them whatsoever. Why would they be so benevololent as to allow them to spin off?

I've never personally encountered a PA that own their own practice. The ones I've heard of on forums that do this all report that they have an extra, well paid employee physician who they rely on to do nothing but allow the physician to use their name to function as their supervising physician, and that the overall process is difficult to maintain. I know several NPs that run their own practice.
 
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A good example of where having no strings attached to another provider is helpful. Psyche NP's are often hired by groups composed entirely of clinical therapists so that there is a provider in house that can perform med management for the patients. This is a very valuable service, and NP's are well paid very well for it (often, they are the ones making the most money of all the providers there). But the income they bring in allows the company to bring in more revenue, so its a good arrangement. PA's can't do it without involving their supervising physician, which means it rarely if ever happens. Tele med services are also very lucrative, especially in the psyche field. Its easier to operate across state lines as a single NP than as a PA that needs to deal with a supervising physician as far as credentialing.

If I felt like PA would end up independent providers, I would have become one. Nurses add a couple of states per year to the fold of independent practice states, and that's with considerable effort with a significant lobby behind them. Sometimes they face pushback from physicians that must be overcome. Physicians will not allow another provider the opportunity to make those kinds of gains. And it won't be something that gains momentum and just happens, as the NP's have shown. Its a knock down drag out effort. If there was a code to unlocking independence, the NP's would have cracked it already. Its taken over 50 years for NP's to expand complete independence to half the states.

If independence catches fire for PA's, NP's would benefit too, and be that much farther ahead. I'd honestly be fine advocating for PA's to be independent, because I think it would float all boats, especially NP's. Having two separate providers out there would be that much more evidence that allowing providers to be independent is worthwhile. I just don't see it happening. For one, any change would truly require a name change for PA's, and gaining a name change and independence would both be monumental tasks on their own.

What I believe will happen is PA's will keep becoming fixtures of specialties and move away from generalist practice. They will likely keep getting paid well (maybe even better for a while) as they become more valuable and take certification exams to be even more invested in the specialties. This will make lateral moves to other specialties more difficult. If a PA chooses to jump specialty, you'll see them negotiated down to start from the bottom as far as value until they get their new certifications and experience. That won't be good overall for them to lose that mobility because it will hand more power over to employers to make demands on them.
 
Independence in coming...I'm bet in the next 5-10 years we will start with a handful of states and then go from there...just as the NPs did. In the three states and one commonwealth I've worked, I have never had a physician state they preferred NPs because of independence. I've met just as many NPs as PAs that own their own practice.

I hope it doesn't. If you want independence there is a PA to DO bridge for that.


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I hope it doesn't. If you want independence there is a PA to DO bridge for that.


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but why? What is really the difference or harm of PAs being independent vs NPs? There just isn't. The AAPA has just a month ago supported optimal team practice (separation from supervision/independence). There are states like Michigan that have already changed practice laws and Tennessee which is looking at legislation to get PAs to independent practice. So, it is coming whether you agree or not...because it has already started.
 
Michigan doesn't represent independence. PA's there still require a formulated and signed physician agreement with delineated responsibilities and a signed plan on how to reach a physician if the original physician is unavailable. That's something that is similar to what NP's have to go through in some of the more restricted states they practice in. So at its best, what Michigan has now for PAs is something that NP's wouldn't even be satisfied with. With the new law there physicians can have agreements with as many PA's as they like (seems like a great deal for physicians), and lawyers aren't even sure if it absolves physicians of their liability over their PA's actions.

Having a bill in consideration in Tennessee just means its got to get through the gauntlet to become a law, and that's a huge lift. When physicians and nurses associations feel that's a possibility, they will halt it. In Tennessee, there is an undersupply of primary care physicians, but an oversupply of PA's and a larger oversupply of NP's (Tennessee is home to some NP school powerhouses). Without that need driving the cause for independence, PA's won't be granted it, and PA's definitely won't leapfrog to anything better than the nursing lobby has obtained for NP's. Tennessee is one of the states that is considered restricted as far as NP independence... Michigan is too. All those examples show is that PA's best level of autonomy in the country is what NP's already have in their worst states for provider autonomy. PA's are excited about circumstances that no NP would call being independent.

Its that kind of excitement that to me is concerning... PA's celebrating victories that aren't really victories. Over at the PA forums, everyone was excited about Michigan until they actually looked at what they got from it. Then the talk of victory changes to talk of it being a moral victory. I want my professions advocates to push for real victories that open up doors. PA's should have those kinds of victories, because I think they deserve them.
 
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As far as the bridge that isn't really much of a bridge. LECOM shaves a year off of medical school for PA's. There are quite a few medical schools that are already doing this by instituting a fast track option that is 3 years (Texas Tech and NYU come to mind)... so essentially any NP that wants to go to one of those can do it and call it a bridge.
 
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Michigan doesn't represent independence. PA's there still require a formulated and signed physician agreement with delineated responsibilities and a signed plan on how to reach a physician if the original physician is unavailable. That's something that is similar to what NP's have to go through in some of the more restricted states they practice in. So at its best, what Michigan has now for PAs is something that NP's wouldn't even be satisfied with. With the new law there physicians can have agreements with as many PA's as they like (seems like a great deal for physicians), and lawyers aren't even sure if it absolves physicians of their liability over their PA's actions.

Having a bill in consideration in Tennessee just means its got to get through the gauntlet to become a law, and that's a huge lift. When physicians and nurses associations feel that's a possibility, they will halt it. In Tennessee, there is an undersupply of primary care physicians, but an oversupply of PA's and a larger oversupply of NP's (Tennessee is home to some NP school powerhouses). Without that need driving the cause for independence, PA's won't be granted it, and PA's definitely won't leapfrog to anything better than the nursing lobby has obtained for NP's. Tennessee is one of the states that is considered restricted as far as NP independence... Michigan is too. All those examples show is that PA's best level of autonomy in the country is what NP's already have in their worst states for provider autonomy. PA's are excited about circumstances that no NP would call being independent.

Its that kind of excitement that to me is concerning... PA's celebrating victories that aren't really victories. Over at the PA forums, everyone was excited about Michigan until they actually looked at what they got from it. Then the talk of victory changes to talk of it being a moral victory. I want my professions advocates to push for real victories that open up doors. PA's should have those kinds of victories, because I think they deserve them.

Well aren't you just a ball of positivity. I'm not sure of the exact timeline NPs took to independence. Did they go from being supervised to full practice authority overnight in the first state? Was there maybe a couple small steps before getting full practice authority?
 
As far as the bridge that isn't really much of a bridge. LECOM shaves a year off of medical school for PA's. There are quite a few medical schools that are already doing this by instituting a fast track option that is 3 years (Texas Tech and NYU come to mind)... so essentially any NP that wants to go to one of those can do it and call it a bridge.

That's very true. But it was pointed more so at the PAs that get their doctorates. I've never figured out the point in them, even in academics. Waste of time and $


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Well aren't you just a ball of positivity. I'm not sure of the exact timeline NPs took to independence. Did they go from being supervised to full practice authority overnight in the first state? Was there maybe a couple small steps before getting full practice authority?

He's not trying to rain on your parade... he's just being honest. Let's just say I know one of those states well, and I've heard the legislature state they didn't want to do anything to make the Nursing body upset(they hold a LOT of clout) and granting PAs independence would definitely do so.


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He's not trying to rain on your parade... he's just being honest. Let's just say I know one of those states well, and I've heard the legislature state they didn't want to do anything to make the Nursing body upset(they hold a LOT of clout) and granting PAs independence would definitely do so.


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I'm just being honest too. Are either of you actually a PA? why do you spend so much time consumed with PA practice and posting in PA forums if you think the worst of the profession. How many NP independent states did they go up against physicians opposing them? So much doubt in your minds as if you are trying to state facts when they are just opinion. I'll send you a list of possible gifts to send me when PAs get their first independent state ;-) It may be next year or in 5 years, but it is going to happen.
 
That's very true. But it was pointed more so at the PAs that get their doctorates. I've never figured out the point in them, even in academics. Waste of time and $


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Well, as a PA with a doctorate degree, I disagree. In academics you often need a degree higher then what you are teaching. PAs with doctorates are able to be considered for higher academic rank, get paid higher if working for the government, and can stand out to employers when applying for administrative jobs. Does one need a doctorate to work as a PA, go into academics, or administration? NO they do not, but it can help.
 
I'm just being honest too. Are either of you actually a PA? why do you spend so much time consumed with PA practice and posting in PA forums if you think the worst of the profession. How many NP independent states did they go up against physicians opposing them? So much doubt in your minds as if you are trying to state facts when they are just opinion. I'll send you a list of possible gifts to send me when PAs get their first independent state ;-) It may be next year or in 5 years, but it is going to happen.

IIRC, Makati was a PA before going to med school.
 
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why do you spend so much time consumed with PA practice and posting in PA forums if you think the worst of the profession. How many NP independent states did they go up against physicians opposing them? So much doubt in your minds as if you are trying to state facts when they are just opinion. I'll send you a list of possible gifts to send me when PAs get their first independent state ;-) It may be next year or in 5 years, but it is going to happen.

I'm not creating the threads about PA's. I'll give advice to pre-PA's any time someone asks, as well as comment on the landscape that I know pretty well. Most of that advice consists of "your grades aren't great, and you are asking if you should spend a lot of time and money chasing something that probably won't pan out because PA school is extremely competitive." A lot of times they don't know there is any other way out of the tough situation they are in.

Everything I've noted are legitimate obstacles PA's face...this information isn't hard to find. Often it is gleaned from gripes from PA's themselves. I'm not interested in tearing down the profession, but I'm all for mapping out where the leadership needs improvement so PA's are best served. That doesn't happen when folks are jazzed up about advances that are meaningless.

I know how nurses obtained what they have because I'm in it, so its easy for me to see how they have a 50 year head start on the AAPA's efforts (especially when it seems most of the AAPA is content to be dependent providers). It takes a lot of effort for the nursing lobby to bring on a couple of states every year into independent practice... it doesn't just catch fire and gain momentum. Its critical that the PA lobby and PA proponents understand that if they are to have any real victories. Those victories don't just happen, and it makes sense for the AAPA to realize that other providers don't get swept in as well when the door opens for NP's, because the nursing posse makes it clear that they are only fighting for their own kind. PA's won't succeed by being passive and resting on the laurels of the ground NP's have paved.

Here are facts. PA's are fully independent in no states. NP's are independent in almost half of them now. In no states do PA's have more autonomy that NP's, and Michigan is a situation where all that has happened is that they now approach the same level of autonomy that NP's have there (which still sucks). And now physicians can supervise more PA's... big win for physicians.

I would have been a PA if not for what I saw going on (or not going on) in the profession. It has nothing to do with the great training they get in school, or the quality education standards they have for their candidates. It has everything to do with not wanting to have a dependent employment relationship foisted upon me where I have to be tethered to a physician, while still being expected to be responsible for my own work. PA's deserve the same kind of leverage over themselves that NP's have in 23 or more states. They won't get there without looking at the issue with clear eyes. I'm used to being an RN where we certainly are given our marching orders from plenty of people, including physicians, PA's and NP's. But we don't go into the work environment having a single person through which we derive our ability to practice. No boss is automatically built in to the circumstances. Even the physician writing the orders isn't my boss, and that's a healthy relationship that works well.
 
I'm just being honest too. Are either of you actually a PA? why do you spend so much time consumed with PA practice and posting in PA forums if you think the worst of the profession. How many NP independent states did they go up against physicians opposing them? So much doubt in your minds as if you are trying to state facts when they are just opinion. I'll send you a list of possible gifts to send me when PAs get their first independent state ;-) It may be next year or in 5 years, but it is going to happen.

I'm a PA turned Physician. PAs have a major hindrance that our NP counterparts don't....the attachment to the medical board and the term assistant in the title(which I don't agree with). Other PA-Physicians that I've talked to have voiced the concern that the profession may be harming itself trying to keep up with the NPs but it's not a big deal for us since we are insulated via our MD/DO degrees.


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Well, as a PA with a doctorate degree, I disagree. In academics you often need a degree higher then what you are teaching. PAs with doctorates are able to be considered for higher academic rank, get paid higher if working for the government, and can stand out to employers when applying for administrative jobs. Does one need a doctorate to work as a PA, go into academics, or administration? NO they do not, but it can help.

So why not pursue a MD/DO degree and be considered an expert in your respective field? A doctorate degree with more benefits.


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That's very true. But it was pointed more so at the PAs that get their doctorates. I've never figured out the point in them, even in academics. Waste of time and $


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It was rather brilliant for them to produce a bridge, although not for the reason that a lot of PA's are excited for it, and certainly not because specifically provides a greater opportunity for the individual PA pursing it (although its nice that it gets them out of the MCAT). A PA would be just as well served to just apply to NYU's 3 year program. But linking it to being a PA was a good thing that LECOM did for the profession.

What the bridge does is it gives the impression of a clear link between PA's and physicians, and provides clout to the PA profession by implying PA's are the same family. Unfortunately, this could serve to undermine the PA's severely if it catches on and reinforces a hierarchy... one of the best things that PA schools did is get rid of the idea that PA school was for med school wannabees. I don't think it'll become commonplace to see bridges in the face of new 3-year medical school offerings, though.

At its core, its like a DNP is for nursing (which itself was never really about improving clinical prowess). The bridge makes so much more sense than a doctorate of physician assisting, which rightfully should be a tough sell. But for NP's it made sense to allow for a doctorate to gain clout and find a way to insert themselves into the practice environment more than they were when they were just being seen as providers.
 
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I'm not creating the threads about PA's. I'll give advice to pre-PA's any time someone asks, as well as comment on the landscape that I know pretty well. Most of that advice consists of "your grades aren't great, and you are asking if you should spend a lot of time and money chasing something that probably won't pan out because PA school is extremely competitive." A lot of times they don't know there is any other way out of the tough situation they are in.

Everything I've noted are legitimate obstacles PA's face...this information isn't hard to find. Often it is gleaned from gripes from PA's themselves. I'm not interested in tearing down the profession, but I'm all for mapping out where the leadership needs improvement so PA's are best served. That doesn't happen when folks are jazzed up about advances that are meaningless.

I know how nurses obtained what they have because I'm in it, so its easy for me to see how they have a 50 year head start on the AAPA's efforts (especially when it seems most of the AAPA is content to be dependent providers). It takes a lot of effort for the nursing lobby to bring on a couple of states every year into independent practice... it doesn't just catch fire and gain momentum. Its critical that the PA lobby and PA proponents understand that if they are to have any real victories. Those victories don't just happen, and it makes sense for the AAPA to realize that other providers don't get swept in as well when the door opens for NP's, because the nursing posse makes it clear that they are only fighting for their own kind. PA's won't succeed by being passive and resting on the laurels of the ground NP's have paved.

Here are facts. PA's are fully independent in no states. NP's are independent in almost half of them now. In no states do PA's have more autonomy that NP's, and Michigan is a situation where all that has happened is that they now approach the same level of autonomy that NP's have there (which still sucks). And now physicians can supervise more PA's... big win for physicians.

I would have been a PA if not for what I saw going on (or not going on) in the profession. It has nothing to do with the great training they get in school, or the quality education standards they have for their candidates. It has everything to do with not wanting to have a dependent employment relationship foisted upon me where I have to be tethered to a physician, while still being expected to be responsible for my own work. PA's deserve the same kind of leverage over themselves that NP's have in 23 or more states. They won't get there without looking at the issue with clear eyes. I'm used to being an RN where we certainly are given our marching orders from plenty of people, including physicians, PA's and NP's. But we don't go into the work environment having a single person through which we derive our ability to practice. No boss is automatically built in to the circumstances. Even the physician writing the orders isn't my boss, and that's a healthy relationship that works well.

So, what are you doing to join in the fight and help then? You've identified problems areas in the profession and keep pointing them out. We already know what they are. You seem very passionate about the profession and should get involved then at the national level and let your voice be heard and offer productive ideas/suggestions. Or you can continue to point out our obstacles and what we are doing wrong without any real reason other then to be the opposition.
 
So why not pursue a MD/DO degree and be considered an expert in your respective field? A doctorate degree with more benefits.


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I have no desire to go back to school and become an MD/DO as I am not planning on being in full-time clinical practice for even another 5 years. I obtained a doctorate to get into admin/academics. I want to help educate and give back to my profession. I can do this without being and MD/DO. If I wanted to be the best clinician I could be and practice clinically another several decades, then going to med school would be the route for me. It is just not what I wanted to do.
 
So, what are you doing to join in the fight and help then? You've identified problems areas in the profession and keep pointing them out. We already know what they are. You seem very passionate about the profession and should get involved then at the national level and let your voice be heard and offer productive ideas/suggestions. Or you can continue to point out our obstacles and what we are doing wrong without any real reason other then to be the opposition.

I voted with my feet and decided to be an NP so that I'd have more of a stake in my own future. If I gave the impression that I'm passionate about the PA field, that is mistaken. I couldn't be as passionatee as I would have like to be about that field because of the structural impediments you folks face. Too many people there have their own divergent views and interests at stake, and they can't be corralled. The revolution to change that can only come from within. Some folks feel the future requires PA's relying on the good will of physicians, some folks want to focus on PA's becoming the go to midlevel provider for specialties, others want name change and independence, etc. With the demographic of PA students changing from being former professional healthcare workers to being young folks whose first career will be PA, I don't see things changing like they would need to.

But I do have a very favorable view of PA's, their training, and their potential.
 
Additionally, since this is a forum, I just comment in a way that the conversation merits it. I'm not coming up with threads to offer advice unsolicited to PA's that already have their own refined opinions. I think they already have opinions to spare that are probably more informed than mine. If a topic comes up, it comes up.

The person that commented at the beginning of this thread seems to have deleted their comment to the OP, which is a bit frustrating. Context for a lot of what followed was based on that.
 
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I voted with my feet and decided to be an NP so that I'd have more of a stake in my own future. If I gave the impression that I'm passionate about the PA field, that is mistaken. I couldn't be as passionatee as I would have like to be about that field because of the structural impediments you folks face. Too many people there have their own divergent views and interests at stake, and they can't be corralled. The revolution to change that can only come from within. Some folks feel the future requires PA's relying on the good will of physicians, some folks want to focus on PA's becoming the go to midlevel provider for specialties, others want name change and independence, etc. With the demographic of PA students changing from being former professional healthcare workers to being young folks whose first career will be PA, I don't see things changing like they would need to.

But I do have a very favorable view of PA's, their training, and their potential.

I'm not sure one can have a favorable view of a profession while running away from the profession and discouraging others from entering into the profession. You are not an NP yet nor a PA. You can be a very educated person about becoming one or the other, but have no personal experience. I just don't understand why an individual would review in depth so much information about a profession they are not part of. That seems like something someone passionate would do. You can be passionate about taking putting down a profession or building it up. You have chosen to put down the PA profession and continue to point out downfalls we have without any desire to fix them. So, why do you do what you do? You can provide your personal reasons for becoming an NP without bashing PAs.

FYI...NPs used to be former professional healthcare workers to. Remember when an NP had to actually be an RN before "advancing"? No need to answer that question.
 
I'm not putting down the PA profession. You shouldn't equate laying out accurate information to putting them down. When you have a chronic illness, your provider isn't putting you down by pointing out your disease. I'm fine parsing my opinion of the PA profession into "things I think are great" and "things I think are a major roadblocks".

One reviews in depth the profession so that you know what you are getting into. I don't have to be a PA to know that I don't want to arrange for and have a supervising physician. I don't have to be an NP to know that I want to be an independent provider. I'd only have myself to blame if I didn't do my homework. How would you like to show up to a career you spent over a hundred thousand dollars into pursuing and find out you didn't know the downside, and didn't know your options?

The vast majority of NP's are in fact nurses who were experienced RNs. In fact, having an RN is a requirement. You are referring to some of the direct entry NP programs, which aren't really that common, and none of them are online. Most NPs coming to the workforce are not brand new nurses with no experience. Even the newest nurse will have 2 years experience before they can even finish NP school.
 
I'll throw out some things about NP education that significantly concern me....
lack of standardization and uniformity, less rigor than I think should exist, less biological science emphasis in both NP school and pre NP coursework (ie RN coursework). Those are big things overall. Not for me, because I'm steeped in sciences from a biology degree and more. If I didn't have that foundation, yes, I would be concerned for me personally. But since I have that, I tend to overlook that because its in my blindspot.

I've gone back and looked at all the things I've written, and I really can't see where not being a PA and having that particular experience takes away from my observations or my take on it. Its not just my opinion that PA school costs significantly more than NP school, or that where I work there are as many NP's in EDs as PA's, or that NYU offers a 3 year medical program that is similar to what PA's have for a bridge. I guess you would have a point if I were saying things specific to PA practice, like "being an NP is more fun than being a PA". I wouldn't know that. Neither would you, though... your take might be better from the PA's perspective, but it would still leave you to speculate as to the NP's POV as well.

But I do know that PA's recertify periodically, which NP's don't... so in a case like that, I point out what I see, and leave it to the reader to decide merit.
 
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