Hello everyone

[pacjeffery]

After using your forums for research I've decided to register. I'm Jeff, 38 years old with twin boys on the way in September. Currently, I'm a CNA at a local hospital taking EMT class in the Fall (with AEMT class to follow in the Spring). Simultaneously I am fulfilling prerequisites for PA school. Working as a CNA I wanted to become a mid-level. Being a NP would require becoming an RN first. No disrespect to the nurses, but I don't want that. I am interested in an ER Tech position, however. My goal is to be a PA in the ED.

I'm sure I'll have many questions later but I'm just introducing myself now.

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[Dynamo24]

Welcome. Good luck with your studies and congratulations on your commitment to a career in medicine.

 

[pacjeffery]

Thank you. It's not going to be easy but what good things are? I did want to be an RN at one time but I've grown disenchanted with the way I see some nurses treat patients. They seem bitter and hateful. Their main joy is knowing they can abuse patients and "their" CNA's.

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[Dynamo24]

RNs work extremely hard and catch a lot of flack from doctors, patients etc. They are a lot of the time the oil in the machine and don't get much respect. As an EMT I have an ocean of respect for MOST nurses. There are rude ones though, just like there are rude doctors, PAs, etc.

 

[pacjeffery]

Indeed there are. But for my goals, I believe the PA route is more beneficial.

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[deleted6669]

SEE www.physicianassistantforum.com for a better PA forum than here....

 

[pamac]

Thank you. It's not going to be easy but what good things are? I did want to be an RN at one time but I've grown disenchanted with the way I see some nurses treat patients. They seem bitter and hateful. Their main joy is knowing they can abuse patients and "their" CNA's.

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Meh.... Not buying that particular take from you. Theres absolutely nothing keeping you from not being the tool you insist that some nurses are acting like. And anyone with any brains knows a happy cna is way more effective than one struggling with an A hole nurse. I'm just thrilled when Im fortunate to have a CNA to help with patients, so I'm not going to abuse that by making them want to take off the first chance a supervisor gives them to move floors or cut their shift short for the day. Treat them bad and they find ways to pay it back to you. When there is an attitude issue among staff, I mostly see that kind of thing prevalent among folks that never worked as anything other than a nurse.... folks who stepped right into the nursing world and think the world revolves around them. Granted, there are times when Im slammed and don't feel like I can explain something in depth as much as I'd like, but being on a high horse (especially fairly new to the game) opens one up to look like a fool when the CNA catches a legit mistake you made, or brings up an important insight you overlooked (Of course, a nasty nurse just sees that the wrong way anyway and lashes out rather than looks inward to improve.)

So, yeah... Been around difficult coworkers a few times..... Not enough to write off a whole profession. I saw something on a floor I was tramsferring a patient to months ago where a young pa student didn't think that treating department clerks poorly would bring down preceptor and attending physician rage. The embarrassment of being immediately called out by a passing MD, and told in the presence of several hospital staff members to apologize right then and there made an impression on everyone who saw it go down. But whether it was a resident, a student PA, a student nurse or new orientee, or an experienced nurse, it comes down to the person in particular. I think this student was a good kid, just maybe was caught up in the newness of communicating to others. But in any event, it was all on this person, not their school or their profession.

And I can't imagine the hell to pay for getting caught treating a client poorly. I've seen folks get disciplined, or worse, for things that didnt even approach abusing a patient (or the accusation was in dispute).

 

[pacjeffery]

You don't have to buy it. Their hell they pay is being walked out of the facility. A nurse was caught "wasting" narcotics into her pocket and taking them home. Now her license is in jeopardy. The bad attitudes don't make my decision to do one thing over another. My personal pros and coins do.

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[pacjeffery]

And I'm not upset. No need to be. So if that came off that way it wasn't the intent. I really believe after all my considerations, becoming a PA is better for me and my family than RN-FNP.

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[pamac]

You don't have to buy it. Their hell they pay is being walked out of the facility. A nurse was caught "wasting" narcotics into her pocket and taking them home. Now her license is in jeopardy. The bad attitudes don't make my decision to do one thing over another. My personal pros and coins do.

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Ok. I responded based on this statement you made:" I did want to be an RN at one time but I've grown disenchanted with the way I see some nurses treat patients. They seem bitter and hateful. Their main joy is knowing they can abuse patients and "their" CNA's. "
That conflicts with your new take, which is "Their bad attitudes don't make my decision to do one thing over another."

So while I can respect your revised take on wanting to become a PA based on personal circumstances, your former take based on seeing all the bad apples being grumpy pants and poor characters needed some explanation, given that there are PAs out there with similar misdeeds to their credit.
There are some real pros to the PA field... Ones that appealed to me at one time as well. But like you, personal preferences have drawn me towards a specific path.

 

[Dynamo24]

Ok. I responded based on this statement you made:" I did want to be an RN at one time but I've grown disenchanted with the way I see some nurses treat patients. They seem bitter and hateful. Their main joy is knowing they can abuse patients and "their" CNA's. "
That conflicts with your new take, which is "Their bad attitudes don't make my decision to do one thing over another."

So while I can respect your revised take on wanting to become a PA based on personal circumstances, your former take based on seeing all the bad apples being grumpy pants and poor characters needed some explanation, given that there are PAs out there with similar misdeeds to their credit.
There are some real pros to the PA field... Ones that appealed to me at one time as well. But like you, personal preferences have drawn me towards a specific path.

Yeah I think at the end of the day you choose what makes you happy. A LOT of people get into medicine for the cash and "glory" and realize that there isn't a lot of glory and the cash isn't worth the amount of work that goes into it. I think that is where you see bitter and rude physicians, PAs, NPs, RNs, RTs, CNAs. etc etc. If you don't have a love for the field and just want cash, get out...because most people won't want to deal with you and you'll hate your job. pamac has laid out his decision process on going RN and its reasonable and makes a lot of sense for him. You may want to do PA but don't make your motivation because of "crappy" nurses or whatever. You'll end up treating them like garbage when you can delegate to them and you'll have good nurses like pamac hating you. Not that you will do that, but its just good advice. Just focus on crushing your school work, learning all you can in your current field and training, and get into PA school and be a good source for your peers and a relief to your preceptors.

 

[pamac]

You may want to do PA but don't make your motivation because of "crappy" nurses or whatever. You'll end up treating them like garbage when you can delegate to them and you'll have good nurses like pamac hating you.

Nope... Many nurses won't be delegated to or treated like garbage by a grumpy PA. They don't work for them. As for me, I won't "hate" them... I'll call them out just like any other colleague with bad behavior. When that nonsense starts, theres a chance that a PA or NP will get responses like "is that what your supervising physician wants you to do?" or "I'm not sure Im allowed to take those kinds of instructions from an assistant....Makes me a bit uncomfortable. We better check on the policy first". The lack of respect can fly right back if you come across a nurse that chooses to return the favor (which to me would be contrary to a professional demeanor, so that wouldnt be my way of operating). But go read posts on PA forums where nurses don't give PAs the respect they think they are entitled to. Some of that comes out if the blue without a PA doing something to precipitate it, but other times the precursor is a PA or NP being rude. But each day, you pick your battles, and I tend to give folks slack..... Grouchy docs that received 5 admits at the same time when they have been awake 20 hours and have something going on the next day they can't miss.... Nurses that just lost a patient and have a husband at home who is unemployed and drinks too much... PA student that just started clinicals and hasn't ever touched a patient before and is scared out of his mind.... I'll take a little crap from all of them.

 

[deleted6669]

. But go read posts on PA forums where nurses don't give PAs the respect they think they are entitled to. Some of that comes out if the blue without a PA doing something to precipitate it, but other times the precursor is a PA or NP being rude..

sometimes it's just because the nurses hate PAs for existing....I worked at a facility for a while where all nurses were rude and insulting to ALL pas ALL the time. many of them were in np programs and wanted jobs there. it worked for a while. we all quit after they refused our legitimate orders for tylenol on febrile kids, etc. without real time md cosignature. after a while no pa would work there so they hired np's. finally an e.d. medical director with some balls became chief of staff of the hospital and made it known that PAs would work in the er again and any nurse who refused a reasonable order would be fired. several were. most of the np's eventually quit and were replaced by pas. it's now a pa dominated dept again with a few nps although they still post jobs as PA/NP.

 

[NYCGuy86]

sometimes it's just because the nurses want to be working with nps instead of PAs....I worked at a facility for a while where all nurses were rude and insulting to ALL pas ALL the time. many of them were in np programs and wanted jobs there. it worked for a while. we all quit after they refused our orders for tylenol on febrile kids, etc. without real time md cosignature. after a while no pa would work there so they hired np's. finally an e.d. medical director with some balls became chief of staff of the hospital and made it known that PAs would work in the er again and any nurse who refused a reasonable order would be fired. several were. most of the np's eventually quit and were replaced by pas. it's now a pa dominated dept again with a few nps although they still post jobs as PA/NP.

As a tech (ER and med/surg), I've worked with many of those nurses that have an anti-PA complex, and indeed, many were and are enrolled in NP programs, extolling the superiority of NPs over PAs.

 

[pamac]

sometimes it's just because the nurses hate PAs for existing....I worked at a facility for a while where all nurses were rude and insulting to ALL pas ALL the time. many of them were in np programs and wanted jobs there. it worked for a while. we all quit after they refused our legitimate orders for tylenol on febrile kids, etc. without real time md cosignature. after a while no pa would work there so they hired np's. finally an e.d. medical director with some balls became chief of staff of the hospital and made it known that PAs would work in the er again and any nurse who refused a reasonable order would be fired. several were. most of the np's eventually quit and were replaced by pas. it's now a pa dominated dept again with a few nps although they still post jobs as PA/NP.

Doesn't surprise me that someone would get canned for delaying patient care to make a political point. Talk about taking one for the team. I've never seen that kind of thing go on because PAs and nursing staff where I'm at interact well on the occasion where there halpens to be any interaction at all (mostly its docs rounding). Besides, I can't see anyone even having a deep interest in all the nitty gritty policy wonk stuff like what folks talk about in forums... It's just a matter of working and going home at the end of a shift. If a PA is calling the shots, then oh well... It's work that needs to be done.

Have to wonder about NPs working the floor when they could theoretically be a provider... Unless they are in management and therefore probably guaranteed to make at least what a PA does. Outside of that, I'm never sure about that practice, even though I know floor nurses that make near what a new PA does with better bennefits. Why wouldn't they practice as an NP if they could, and why take it to the point where they are and not use it? Probably because they aren't getting picked up for provider jobs.

PAs are becoming a rare sight around ERs here because they arent independent providers like physicians or NPs, and ER groups want less red tape. Even NPs arent often found. Board certified ER docs are what everyone wants to see when they hit an ER, unless its fast track (where a "nurse with benefits" can slip under the radar because folks expect them there). The places that didn't roll that way with the BC docs were forced that direction to keep up image. Any facility not having ER docs gets a billboard from the competition down the street touting the opposing hospital's quality of staff... To the point of seeming like a taunt to those in the know. That trend is spreading out through the region and I don't see it changing much, even in the face of the efficiency of utilizing nonphysician providers. It's image, and it is everything. Emergency is like a hospital's mascot, so they work that angle hard.

 

[NYCGuy86]

Here in the NYC area, there are PAs in most EDs, including the hospital I work at. No NPs. PAs are in both fast track and the main ED. There are certain things that they can diagnose, treat, and discharge without running by the physician (though the MD/DO still has to review the chart within 48 hours), usually the primary care stuff, while everything else they have to present to the MD/DO prior to discharge or admission order.

New York Presbyterian-Weill Cornell also recently started a PA Emergency Medicine residency program (in addition to all the other EM PA residencies around the country).

http://www.weillcornellparesidency.org/

Guess it depends on the area.

 

[pamac]

Here in the NYC area, there are PAs in most EDs, including the hospital I work at. No NPs. PAs are in both fast track and the main ED. There are certain things that they can diagnose, treat, and discharge without running by the physician (though the MD/DO still has to review the chart within 48 hours), usually the primary care stuff, while everything else they have to present to the MD/DO prior to discharge or admission order.

New York Presbyterian-Weill Cornell also recently started a PA Emergency Medicine residency program (in addition to all the other EM PA residencies around the country).

http://www.weillcornellparesidency.org/

Guess it depends on the area.

Yeah, there are regional nuances.... Like PAs in NYC having very low wages compared to where I am. I'd be ticked to do a residency and go work there for 75k.

Meanwhile, Nevada just became another independent practice state for NPs. And where I am, NPs have no chart review like PAs. They don't have SPs, they collaborate.

 

[NYCGuy86]

Yeah, there are regional nuances.... Like PAs in NYC having very low wages compared to where I am. I'd be ticked to do a residency and go work there for 75k.

I doubt residency trained EM PAs would be making 75K (and I know the SICU PA (completed the Montefiore surgical PA residency) a co-worker of mine shadowed at our hospital is making 6 figures).

Also, in browsing allnurses, I've seen new grad NPs talk about jobs they're considering with similar salaries. So yes, regional nuances.

Meanwhile, Nevada just became another independent practice state for NPs. And where I am, NPs have no chart review like PAs. They don't have SPs, they collaborate.

Sounds nice!

Meanwhile, other states have restrictive NP laws, some where PAs can do things NPs aren't able to, and have chart review, etc. Regional nuances...

 

[deleted6669]

there are pockets of np dominance in em but if you look at the nationwide picture, PAs own the EM market and are the non-physician provider of choice according to the american college of emergency physicians.
if you look for em jobs you will probably find 5 pa jobs for every np job.
SEMPA(The Soc. of EMPAs) has liaisons on multiple acep committees, advisory board members at high levels in acep, a rep from the emergency medicine residents assoc. as an advisor, etc.
The EM certificate of added qualifications exam was vetted by several members of the ACEP board as a valid tool to help show competence in em and a past president of that organization helped write the test.
there are a lot of good reasons to become an np. going into em is not one of them unless you live in one of those few areas that staffs nps in their er's. where I work the nps are not allowed to leave urgent care. they can't even get privileged for fast track.this has been true in all 3 states I have worked in as an em pa.

 

[deleted6669]

I doubt residency trained EM PAs would be making 75K .

any residency trained em pa working full time for less than 125k+ to start didn't get a good deal and should look elsewhere...

 

[pamac]

I doubt residency trained EM PAs would be making 75K (and I know the SICU PA (completed the Montefiore surgical PA residency) a co-worker of mine shadowed at our hospital is making 6 figures).

Also, in browsing allnurses, I've seen new grad NPs talk about jobs they're considering with similar salaries. So yes, regional nuances.



Sounds nice!

Meanwhile, other states have restrictive NP laws, some where PAs can do things NPs aren't able to, and have chart review, etc. Regional nuances...

Even with regional nuances, you'd have a hard time finding a state where NPs were more restricted than PAs, if at all. Regional nuances might account for what role is preferred in a given facility.

 

[deleted6669]

Even with regional nuances, you'd have a hard time finding a state where NPs were more restricted than PAs, if at all. Regional nuances might account for what role is preferred in a given facility.

very true.
for anything outpt, np is likely the way to go in most areas. for most hospital based specialty practice PAs typically have the upper hand due to the nature of their training which focuses on this environment.
for example every pa has a surgical rotation while very few fnp's do.
to practice at the same level as a surgical pa an np would need ACNP to see hospitalized patients, RNFA to work in the er, and FNP to see patients outside the hospital in the follow up clinic.
several states(most notably TX) are getting really stringent about what different types of nps can do. fnps have been fired from hospital based jobs for example because their certification does not cover this type of pt.

 

[pamac]

there are pockets of np dominance in em but if you look at the nationwide picture, PAs own the EM market and are the non-physician provider of choice according to the american college of emergency physicians.
if you look for em jobs you will probably find 5 pa jobs for every np job.
SEMPA(The Soc. of EMPAs) has liaisons on multiple acep committees, advisory board members at high levels in acep, a rep from the emergency medicine residents assoc. as an advisor, etc.
The EM certificate of added qualifications exam was vetted by several members of the ACEP board as a valid tool to help show competence in em and a past president of that organization helped write the test.
there are a lot of good reasons to become an np. going into em is not one of them unless you live in one of those few areas that staffs nps in their er's. where I work the nps are not allowed to leave urgent care. they can't even get privileged for fast track.this has been true in all 3 states I have worked in as an em pa.

There are ER jobs for NPs posted all over the place, even in the states where you are and the surrounding areas. I keep tabs on them and get emails. And rural areas where you mention that a PA can fly solo easiest are plumb full of NP positions in ERs, especially in places where independent practice means an NP can fly solo pretty easy. If a PA gets privileges to more places in your facility by virtue of being extended their supervising physicians scope, then I think that says a lot about how they are given what the physician wants them to have. That might give insight into why a PA would be the provider of choice to certain physician groups as long as they don't try to venture out too far. You yourself mention how you has one locale out of the way that you prefer to work because it's the place where your hands are tied the least. Those ERs that won't let an NP set foot are probably also the places where PAs are practicing on a tight leash doing urgent care like duties.... Stuff that you'd probably hate anyway. To say PAs own the EM market ignores the fact that physicians own the EM market, and divy out to the NPPs whatever they want to.

 

[pamac]

very true.
for anything outpt, np is likely the way to go in most areas. for most hospital based specialty practice PAs typically have the upper hand due to the nature of their training which focuses on this environment.
for example every pa has a surgical rotation while very few fnp's do.
to practice at the same level as a surgical pa an np would need ACNP to see hospitalized patients, RNFA to work in the er, and FNP to see patients outside the hospital in the follow up clinic.
several states(most notably TX) are getting really stringent about what different types of nps can do. fnps have been fired from hospital based jobs for example because their certification does not cover this type of pt.

Yeah, but you would be the first to say that CAQ will lead to less mobility across the board from here on out... And talk about how facilities are refusing to allow you to perform
certain procedures without extensive, onerous documentation of the number of times youve performed them. So the future holds less mobility for PAs between specialties than in the past. They will look more like NPs.

 

[deleted6669]

Yeah, but you would be the first to say that CAQ will lead to less mobility across the board from here on out... And talk about how facilities are refusing to allow you to perform
certain procedures without extensive, onerous documentation of the number of times youve performed them. So the future holds less mobility for PAs between specialties than in the past. They will look more like NPs.

all true, but they will look more like nps with more training....

 

[deleted6669]

To say PAs own the EM market ignores the fact that physicians own the EM market, and divy out to the NPPs whatever they want to.

physicians own every market. my point is that in em they choose to use pas in far more settings than nps, especially those with high levels of autonomy(solo coverage for example).
there are over 10,000 PAs practicing in em nationwide(10% of all PAs).
I don't know the # of nps practicing in em but would guess its more like 2000 or so.

 

[pamac]

all true, but they will look more like nps with more training....

More training, and less hce...

 

[pamac]

physicians own every market. my point is that in em they choose to use pas in far more settings than nps, especially those with high levels of autonomy(solo coverage for example).
there are over 10,000 PAs practicing in em nationwide(10% of all PAs).
I don't know the # of nps practicing in em but would guess its more like 2000 or so.

I'm not interested in trying to make a case for solo DNP ERs or joining the NP>PA chorus mentioned here. I have been around NPs and nurses who are like that, and I think it's just as lame as someone saying they were turned off of nursing because of a few nurses that were poor characters. Its just like at the pa forums where you have folks extolling the virtues of PAs>NPs acoss the board that were themselves onlymarginally invested in healthcare prior to PA school, then move on to talk about how hardcore they are as brand new PAs, rolling solo with 30 patients a day in clinic and having bounced between 3 jobs in less than 18 months. And of course, they miss nothing.

 

[deleted6669]

More training, and less hce...

as you well know that depends on the program...also remember direct entry np.
so hypothetical: 2 twin sisters become rn's and both work for 5 yrs in the same dept. doing the same job, study the same amt as rn's, etc
one then becomes an np and one becomes a pa.
who is the more knowledgeable provider right out of school?
who should get the surgical job?

 

[deleted6669]

Its just like at the pa forums where you have folks extolling the virtues of PAs>NPs acoss the board that were themselves onlymarginally invested in healthcare prior to PA school.

as you know, I think there are some specialties where it really makes sense to pursue NP>PA.
FP, psych, women's health, nicu, and peds come to mind.

 

[NYCGuy86]

as you know, I think there are some specialties where it really makes sense to pursue NP>PA.
FP, psych, women's health, nicu, and peds come to mind.

I think generally speaking an NP can work in any of the specialties that a PA can, but with surgery, PA would make most sense, due to surgical rotations (including elective), surgical PA programs (i.e. Weill Cornell and UAB), and residencies in various surgical specialties. NPs could still do it, but it seems to require more hoops (i.e. RNFA). At my hospital, on the cardiac surgery team, the NPs do pre-op interview and teaching and post-discharge followup. The PA or RNFA assists intraoperatively. There is also an NP run step down unit (no residents, just NPs and the attending surgeons), and an NP run telemetry unit (in addition to the traditional resident team tele unit where I work, that gets the more complex patients).

At NYP, I see job openings for NPs in neonatal, palliative care consult, psychiatry, psychiatry-adolescent partial hospitalization, emergency (triage/pain resource/follow up calls), and ortho. For PAs, I see openings in pediatric general surgery, interventional cardiology, transplant, ortho, cardiothoracic surgery, internal medicine, critical care, CTICU, acute leukemia service, L&D, CCU, vascular surgery, OBGYN, neuro ICU, and hepatobiliary service.

 

[Makati2008]

I'm not interested in trying to make a case for solo DNP ERs or joining the NP>PA chorus mentioned here. I have been around NPs and nurses who are like that, and I think it's just as lame as someone saying they were turned off of nursing because of a few nurses that were poor characters. Its just like at the pa forums where you have folks extolling the virtues of PAs>NPs acoss the board that were themselves onlymarginally invested in healthcare prior to PA school, then move on to talk about how hardcore they are as brand new PAs, rolling solo with 30 patients a day in clinic and having bounced between 3 jobs in less than 18 months. And of course, they miss nothing.

Personally I would have the new grad PA over the DNP/NP(direct entry) more days than not. The direct entry folks tend to come out weaker and lack basic skills such as suturing, I&D, and coming up with a Ddx that falls outside of the algorithms they were taught.

Now a NP with 20 years of ER experience vs new PA I would go with the NP(already know of one that has agreed we will work together when I come back to my old site as a Physician)

I will agree with you on the point about the NYC EM PAs getting paid peanuts. I want to say I was offered between 75-85k and when I laughed in the docs face about the offer and said your headhunter said I would make 120k he told me he had PAs that had worked there 10+ yrs not making that. Also there was another hospital in new york(rural) that was offering PAs 20ish/hr and again I laughed.

Nurses(at least the EM ones and I know it's anecdotal ) seem to be very jealous of medical students, Pa students, np student, etc... I don't know why it's that way but it is pretty blatant. I can tell you that I had an episode here lately with a nurse that was down right ugly to medical students on my EM audition for truly no reason and even the attendings got mad and mentioned to get admin involved and they backed off. I wonder if its nurses like these that kind of make SOME docs( not all by any stretch) treat RNs poorly when they become attendings.

 

[pamac]

I think generally speaking an NP can work in any of the specialties that a PA can, but with surgery, PA would make most sense, due to surgical rotations (including elective), surgical PA programs (i.e. Weill Cornell and UAB), and residencies in various surgical specialties. NPs could still do it, but it seems to require more hoops (i.e. RNFA). At my hospital, on the cardiac surgery team, the NPs do pre-op interview and teaching and post-discharge followup. The PA or RNFA assists intraoperatively. There is also an NP run step down unit (no residents, just NPs and the attending surgeons), and an NP run telemetry unit (in addition to the traditional resident team tele unit where I work, that gets the more complex patients).

At NYP, I see job openings for NPs in neonatal, palliative care consult, psychiatry, psychiatry-adolescent partial hospitalization, emergency (triage/pain resource/follow up calls), and ortho. For PAs, I see openings in pediatric general surgery, interventional cardiology, transplant, ortho, cardiothoracic surgery, internal medicine, critical care, CTICU, acute leukemia service, L&D, CCU, vascular surgery, OBGYN, neuro ICU, and hepatobiliary service.

L&d, obgyn where I'm at are dominated by NPs, and ortho is dominated by PAs. Surgery is also mostly a PA thing with not so many RNFAs. A surgery PA seems to make more sense to a lot of physicians because of their ability to function outside of the surgical suite in a broader capacity. They would be the ones doing preop interview and stepdown.

I looked around for areas that would be closed off to me completely if i were to choose to be an NP. I really didn't find any. I've come across NPs in the surgical environment (albeit with added on first assist credentials), as well as in other areas where you usually find PAs. It was encouraging to at least know that with some ambition and effort, I'd be likely to be able to settle in to a niche that i enjoyed. With my science background, I'm not even a traditional nurse. It's important to be realistic about where you are likely to find the jobs, but I lean toward a mindset that says "if it's not completely closed off, then there's no reason you can't do your best to make it work". It may mean you don't have as broad of an appeal as a potential hire, but it's not an impossible task. Even though physicians are the ER provider of choice, with NPs doing NPP stuff (not even many of them around), Ive seen a few PAs names on documents, indicating its not a total wash. One thing that seems to be winding down is PAs jumping specialties all the time, unless it's stints in urgent care. Practices here seem to be interested in continuity with thier NPPs, at least the ones I've seen around me for the last few years.

 

[deleted6669]

One thing that seems to be winding down is PAs jumping specialties all the time, unless it's stints in urgent care. Practices here seem to be interested in continuity with thier NPPs, at least the ones I've seen around me for the last few years.

lateral mobility for PAs is going away. hospital credentialing committees, the joint commission, and govt regulations are seeing to that. the future for PAs is going to be specialty residencies, CAQ/specialty boards, and staying in one specialty for the majority of one's career or the occasional jump to primary care or urgent care. docs went through the same pattern. it used to be that anyone who graduated medschool could do anything. then residencies and specialty boards became the norm.
I have worked with older "er docs" who only did a single year of general internship as well as folks who trained in fp who grandfathered into the specialty due to time spent in the trenches. today all the em jobs in urban areas go to those trained and boarded in em.

 

[pamac]

Personally I would have the new grad PA over the DNP/NP(direct entry) more days than not. The direct entry folks tend to come out weaker and lack basic skills such as suturing, I&D, and coming up with a Ddx that falls outside of the algorithms they were taught.

Now a NP with 20 years of ER experience vs new PA I would go with the NP(already know of one that has agreed we will work together when I come back to my old site as a Physician)

I will agree with you on the point about the NYC EM PAs getting paid peanuts. I want to say I was offered between 75-85k and when I laughed in the docs face about the offer and said your headhunter said I would make 120k he told me he had PAs that had worked there 10+ yrs not making that. Also there was another hospital in new york(rural) that was offering PAs 20ish/hr and again I laughed.

Nurses(at least the EM ones and I know it's anecdotal ) seem to be very jealous of medical students, Pa students, np student, etc... I don't know why it's that way but it is pretty blatant. I can tell you that I had an episode here lately with a nurse that was down right ugly to medical students on my EM audition for truly no reason and even the attendings got mad and mentioned to get admin involved and they backed off. I wonder if its nurses like these that kind of make SOME docs( not all by any stretch) treat RNs poorly when they become attendings.

Sounds like supply and demand... Lots of folks want to live in NYC, and lots of schools out east. A PA school near me is doing something similar to PAs and NPs here, but things are still pretty good.

It's clear PA education is better. It's frustrating that they seem to lack a national force with the determination to position them at least as well as NPs seem to be, if only to enable them to act in their own interest in the workforce (I'm not really caught up on the notion of complete practice autonomy and turf battles). The weak position of the aapa forms the bulk of my decision to go NP. As each new state allows NPs more perks, and as new laws seem to include carrots directed towards NPs and neglect PAs, i just feel like in the long haul, NPs are at the table, and PAs are fighting an uphill battle every step of the way. Folks kind of expect a bunch of determined nurses to show up and demand to be heard, but when PAs do it, they get hit from all sides.

Maybe I'm fortunate to be around nurses that are smart enough to realize that being jealous of a physician would mean also bein jealous of the tremendous effort they put into getting there. Most nurses around me have figured out that going to school for as little as 4 semesters, to work a job 3 days a week that pays decent money is a better return for their particular work ethic than attempting 10+years of training before they would even start to make good money. And I've yet to see anyone treat a nurse as bad as another nurse, so it doesn't surprise me that even NPs (who you would assume should logically be treated better by virtue of being part of the "sisterhood") would manage to draw ire from a nurse with a personality disorder. the docs around me have a remarkable level of decency towards staff. There are a few that come off as brash, but it's mostly surrounding thier loyalty to their patients, and that's the kind of intensity that I can respect, especially if I'm looking at it from a patient's perspective.

So I know why there are nurses that act out against providers... It's because they (the nurses in question) are a holes. Their peers, spouses, children, supervisors, subordinates... Possibly patients... Get similar treatment. They feel insulated from providers because the management structure makes any direct run at them have to be funneled through admin vs being held to account by the provider right then and there.

 

[sarjasy]

RNFA to work in the er,.

Dang, RNFA for ER? That's hardcore.

 

[sarjasy]

2 twin sisters become rn's and both work for 5 yrs in the same dept. who should get the surgical job?

Identical twins? The better looking one should get the job.

 

[pamac]

Identical twins? The better looking one should get the job.

I see what you did there!

 

[deleted6669]

dang, rnfa for er? That's hardcore.

sorry, typo. Rnfa to work in the o.r.

 

[Dynamo24]

any residency trained em pa working full time for less than 125k+ to start didn't get a good deal and should look elsewhere...

Do you think that salary should be a baseline in every region?

 

[deleted6669]

Do you think that salary should be a baseline in every region?

should be? yes.
Is? no.
some places don't pay more for residency trained folks. simple answer? don't work there.
I didn't do a residency but there are places I would never work and salaries I would never accept.
Know what you are worth. Know what is important to you. only take less than you think you are worth if the situation is otherwise ideal in every way.
if I could name my place, design my schedule and benefits package and get every perk I asked for (sabbatical, etc) I would take a 20,000 dollar/yr pay cut.