HOW DO ONLINE NP PROGRAMS OPERATE?

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Jamessremos

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I am seeking information about the clinical aspects of online NP programs, specifically ACNP and RNFA like the program at UAB... How are clinical sites and preceptors obtained and is this the University responsibility or the NP student?

Personal experiences with these programs or situations would be great!

Thanks,
JAMES

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From what I have seen, they operate very poorly for the students (and their future patients) but make the universities a great deal of money.

The ones I am familiar with put the onus on the student to find their preceptor sites for their 500 clinical hours.
 
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From what I have seen, they operate very poorly for the students (and their future patients) but make the universities a great deal of money.

The ones I am familiar with put the onus on the student to find their preceptor sites for their 500 clinical hours.

This right here.
 
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I just received word from UAB that I would be required to arrange my own clinical which is not what I was hoping to hear. I like the RNFA option they offer, however, I'm thinking I could simply stay in my BSN home university and continue from there to the FNP program offered and then do my own RNFA certification without all of the online hassle and having to arrange my own clinicals.

Being able to be in a classroom is so much more applealing, but I thought, "if they already have established clinical partners then that would be okay..." NOT!

Oh, well
 
what is your end goal? (practice setting/role)
My end goal is to work in surgery doing, possibly, cardiothoracic first assisting with vein harvest and everything. PAs often get these jobs but many will hire either PAs or NPs, provided the NP also has their RNFA cert.

If not in surgery I believe I would also enjoy Emergency Dept... ACNP programs tend to target the ED but many people point out that EDs treat pediatrics that ACNPs are technically not licensed for. There seems to be some gap in the whole "which NP specialty program do I choose?" HOwever, the FNP appears to be the most versatile option if you have several interests in mind as possibilities.

I'm thinking FNP and gain my RNFA on top of that...then I can do surgery, or ED, or primary, urgent care clinic, whatever...and I won't have any age restrictions on who I can treat. I would like to stay flexible since there's no guarantee of getting my dream job right out of the gate :)
 
I went to RUSH (post-masters) and although they had clinical settings arranged they let me set up my own which I did at a Navy hospital on Okinawa and a VA clinic in Texas. I looked up the hospital commander's background and saw that he had been in Hawaii and was from Tennessee. By the time we got though with our backgrounds in Hawaii and TN, he ordered an NP to precept me. Unfortunately, the NP left the day before I arrived and I was assigned to a Navy psychiatrist. We had a great time and still keep in touch. My housing (free) was set up by the hospital chief nurse which turned out to be the hospital chaplain's house about 20 yards from the ocean and 200 yards from the best sushi I've ever eaten. For the VA clinic I just called up the closest one to my dad's house, met with the NP there, and went after it. I lived with my dad for free, other than treating him to a steak every now and then. If you do consider the VA start months in advance as they are agonizingly slow. I'm currently in an embedded behavioral heath team and love my job. Working for the Army is much better than being in the Army, btw. Keep in mind you may have to show up on campus for parts of your training, testing, etc.. We had to do several days of supervised physical exams and patient psych interviews. This was after sending in videos of doing physicals and interviews with family, friends, or anybody you could drag off the streets. I already had a masters in psych nursing and an MBA , both brick and mortar schools so had knowledge of educational process and the military. Starting off fresh might make it more difficult but my case shows that you can work it to your advantage also. I did my coursework at Rush while living in Bangladesh and Thailand.
 
if your top 2 specialty areas of consideration are em and surgery I would strongly recommend that you consider PA>NP as PAs dominate in both of these areas. If you wanted psych, nicu, or women's health I would say go NP. good luck whatever you decide.
 
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While it's possible that you could do NP school and hobble together the certifications you'd need to offer you the flexibility to go to surgery, and turn around and do something like ED (there are about 3700 NPs in ERs vs 7000 PAs), it's more of a convoluted process than just going to PA school and walking out of school with the ability to jump in to just about any specialty. Additionally, all but a couple PA schools are taught live in class, which you indicated a preference for. The vast majority of NP programs are not direct entry, and would require you to obtain at least an associates degree in nursing, if not require a bachelors degree. Many NP programs are transitioning to offering a DNP, complicating things for you further. With PA, it's 2 years and you are done and practicing. NP is most feasible for folks who are already nurses. I know 1 NP that's also an RNFA. He seems to do pretty well, although I've never talked to him about money matters.

Most of us on the nursing side jump to NP after we've seen at least a portion of bedside work, and I don't hear a lot of desire to twist in knots to diversify specialties. Most folks talk about the value of getting an FNP, but it seems like people settle into what they want to do. If you want to do general clinic work, you do FNP, and anesthesia wouldn't do for that kind of person. Same for anesthesia providers... You are doing what you want, and the desire to obtain an FNP is far from a priority. You gravitate to what you think you want to do and as a nurse you generally have an idea of what you are getting into. I used to want to do ER, and couldn't imagine not being in that realm, at least on occasion. It was like a badge to wear around. Then I go to work in one, and look forward to when I can spend my day in less hectic surroundings. It's like "been there, done that, give me a career with less drama". The thought of getting into a more specialized state of mind has its appeal.

So do PA. Even as a PA, you'll probably see the merits of settling into a specialty. Most of your appeal to whomever employs you may even rest on you putting all your eggs in one basket. The days of jumping around to different specialties is going away, not because it's impossible, but mostly because it's unfeasable to being as efficient as you can.
 
Just as an FYI, there are now more than 10,000 PAs working in EM.
 
The stats I saw were a few years old.
 
One of the big PA vs. NP issues for me is the inability to work during PA school...I have a family making that very difficult to do. NP track doesn't demand you not work....and if you have to stop for whatever reason at least there's a BSN to fall back on which is still an awesome degree for getting a good job

There appears to be plenty of jobs for NP-RNFA just like PA... I find no shortage of good jobs out there for either.
 
Researching the job market for mid levels I've seen no preference for NP or PA as long as you have proper credentials and training for the position or can be taught which seems to often be the case that many are being taught on the job after school to do the things NP and PA school didn't really cover....PAs don't walk out of school knowing how to do EVH for example. ..they either do an additional residency which are few or more often have to be on job trained by others or a surgeon to do it. That is why residencies are multiplying for mid levels. ..there's virtually no specialty training in the basic programs to prepare graduates for the real world. Many site the time following graduation feeling like unprepared idiots and that's PA or NP...

As for jumping around, I just want fallback options....I might enjoy surgery for a while but want to do something less time consuming as I get older
 
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One of the big PA vs. NP issues for me is the inability to work during PA school...I have a family making that very difficult to do. NP track doesn't demand you not work....and if you have to stop for whatever reason at least there's a BSN to fall back on which is still an awesome degree for getting a good job
QUOTE]
just as an fyi- there are a handful of part time pa programs that split the first year into 2 years and allow work during those years. the 3 rd yr is the same as the normal second year(full time clinicals). I attended such a program and worked 24-30 hrs/week as a medic the first 2 years and did concert standbys the 3rd yr. traditional PA students do have careers to fall back on as well as they are already medics, nurses, and resp. therapists.
 
If you want to do surgery go to PA school...they pretty much own that world. Yes, there are RNFAs but the majority of mid-levels in surgery are PAs. You may get a little pigeon-holed in surgery after a while...but that's true of anyone spending a number of years in a specialty.

To your original question, my program is hybrid so I do a lot of lectures and exams at home and go to campus several times each semester for on-campus intensives. My program also has a clinical coordinator that works with me to find clinical sites.
 
I'm not really concerned about being able to get a surgical job....I have 20 years of surgery experience under my belt as a tech. All I need is the credential which is easy enough. I already have myour prerequisites for nursing plus a great scholarship awarded so I'm not passing on that

Plus I plan on working hearts as a tech while in nursing school so I will have surgeon contacts for hearts in case I want to go that route as an np. While in np school I'll be working as a nurse and plan on an ER job so I can have those connections going as well. I've been thinking surgery or ER once I get my FNP so all that will give me options and connections to work with. And I'll get some experience in something other than surgery at the same time.

Again, surgeons will hire those who are qualified. My experience and research tells me that the NP vs PA debate isn't really important to them. It's more about qualifications and credentials. Either mid-level provider is fine to them. They just want you to be able to do your job well and have the ability to bill for your services.

However one caveat would be on the student side: PAS do have the advantage of a more generalized program while NPs are increasingly specialized which means you really better research the degree before joining a program...your credentials might be limited like ACNP which can only treat adults vs FNPS that can treat anyone. It's a limitation that can have pros and cons. PA don't have that issue to contend with.

As far as owning surgery as a PA, I shadowed a heart group and their new PA was having to go through training within the group before they would let her do anything. After a year she was still training....being a PA didn't make her more capable of being trained. Heck, as a tech I've sutured plenty of total knees and total hips already. You just have to be trainable.

Surgeons want capable, qualified, and credentials.

As one surgeon put it, I can train a monkey to do this stuff. But unfortunately you can't bill for his services
 
I'm not really concerned about being able to get a surgical job....I have 20 years of surgery experience under my belt as a tech. All I need is the credential which is easy enough. I already have myour prerequisites for nursing plus a great scholarship awarded so I'm not passing on that

Plus I plan on working hearts as a tech while in nursing school so I will have surgeon contacts for hearts in case I want to go that route as an np. While in np school I'll be working as a nurse and plan on an ER job so I can have those connections going as well. I've been thinking surgery or ER once I get my FNP so all that will give me options and connections to work with. And I'll get some experience in something other than surgery at the same time.

Again, surgeons will hire those who are qualified. My experience and research tells me that the NP vs PA debate isn't really important to them. It's more about qualifications and credentials. Either mid-level provider is fine to them. They just want you to be able to do your job well and have the ability to bill for your services.

However one caveat would be on the student side: PAS do have the advantage of a more generalized program while NPs are increasingly specialized which means you really better research the degree before joining a program...your credentials might be limited like ACNP which can only treat adults vs FNPS that can treat anyone. It's a limitation that can have pros and cons. PA don't have that issue to contend with.

As far as owning surgery as a PA, I shadowed a heart group and their new PA was having to go through training within the group before they would let her do anything. After a year she was still training....being a PA didn't make her more capable of being trained. Heck, as a tech I've sutured plenty of total knees and total hips already. You just have to be trainable.

Surgeons want capable, qualified, and credentials.

As one surgeon put it, I can train a monkey to do this stuff. But unfortunately you can't bill for his services


As a CT surgery PA there is a strong preference for PAs in the field. While taking vein isn't an overly difficult skill (in some places STs shuck vein - which is a travesty), the knowledge and training advantage a PA has is noticeable.

A PA is far more versatile and I do things in the OR that are far beyond the realm of a RNFA.

The fact that NP is an easier road should concern you. It did me. That's why, as a nurse, I chose the PA route though it was more costly and difficult. I don't look for shortcuts.
 
As a CT surgery PA there is a strong preference for PAs in the field. While taking vein isn't an overly difficult skill (in some places STs shuck vein - which is a travesty), the knowledge and training advantage a PA has is noticeable.

A PA is far more versatile and I do things in the OR that are far beyond the realm of a RNFA.

The fact that NP is an easier road should concern you. It did me. That's why, as a nurse, I chose the PA route though it was more costly and difficult. I don't look for shortcuts.

Not to seem insulting, but there are probably NPs doing your same job who would disagree with your assessment. After all, while PAs do tend to get more initial OR time during their training, that training is still rudimentary as many PAs will honestly attest....the reason why there are so many PA residencies. Still, that initial OR time would give PAS an advantage when hiring into an OR. As I mentioned, I shadowed the PAs in a local busy heart group and one year after graduation their new PA was still training to do EVH. She could close on the chest well enough but I could have done the same with my own experience closing hips and knees.

I don't doubt your clinical prowess, but I'd hedge my bets that you didn't get that training and experience only from your PA program since OR time is still limited and only one program is known to really focus a lot on OR experience (UAB) and even then now of them are known to give students EVH time in school. Most likely you were trained by the surgeons who hired you, maybe you did one of the four heart residencies in the country for PAs. But it's extremely unlikely you got it from your PA program.

Since you appear to believe PAS to be the superior clinicians, I wonder why hospitals and physicians so readily hire both PAs and NPS to do the same jobs out in the real world? Why are both considered to be mid-level Healthcare providers? I imagine it is because, the two are really not so different in the real world beyond the endless "who is better" debate found on every chat board.

I find it extremely difficult to imagine that me becoming an NP over PA would keep me from getting a job doing what I want in surgery. Another factor, and a valid point made by many NPs, is the tendency for NPS to have vastly more real world Healthcare experience by the time they graduate than your average PA grad who had any bachelor's degree and went to PA school with the minimum of patient care experience. While those NPS were nurses for many years.

There are so many scenarios that the argument loses its validity....if you've got the required education and the right credentials and a surgeon can train you to do what they want you to do and thus bill for your services then that likely counts more to most than whether you are a PA vs NP.

Otherwise, there wouldn't be any debate...everyone would automatically know that one was better. There would be no NPS doing the same job you do now. But that's not the case is it? There are many NPs doing your same job already and I would hazard a guess that their supervising surgeons are very happy with the job they are doing

No offense but the debate just doesn't hold much water out in real world practice. Everyone has their own opinion.
 
You forget that The NP degree adds nothing to the role in the OR. And you can get a RNFA cert from a 3 day class and OJT hours.

I went to UAB. Cornell and Duke both offer more of a surgical focus than most PA programs. I had 6 months of surgical rotations and 6 months of medicine rotations.

I'm not sure why you keep bringing up the PA that's been training EVH for a year. While EVH isn't an overly difficult skill, it can take time to learn. And then there are people who just will never be deft at it, regardless of title/degree. It's pretty easy for you to judge without even knowing how to shuck vein. I would never let a student attempt to harvest conduit, it's not even appropriate.

As far as RNFAs being my equal in the OR? Find a RNFA that cannulates, deairs, decannulates, and takes down IMAs. Then we can have that discussion.

I get that you've been a scrub tech and you've shadowed a few PAs, but the education disparity between the two (especially surgically) is huge. The gross anatomy alone makes a PA more qualified to be in the OR.
 
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You forget that The NP degree adds nothing to the role in the OR. And you can get a RNFA cert from a 3 day class and OJT hours.

I went to UAB. Cornell and Duke both offer more of a surgical focus than most PA programs. I had 6 months of surgical rotations and 6 months of medicine rotations.

I'm not sure why you keep bringing up the PA that's been training EVH for a year. While EVH isn't an overly difficult skill, it can take time to learn. And then there are people who just will never be deft at it, regardless of title/degree. It's pretty easy for you to judge without even knowing how to shuck vein. I would never let a student attempt to harvest conduit, it's not even appropriate.

As far as RNFAs being my equal in the OR? Find a RNFA that cannulates, deairs, decannulates, and takes down IMAs. Then we can have that discussion.

I get that you've been a scrub tech and you've shadowed a few PAs, but the education disparity between the two (especially surgically) is huge. The gross anatomy alone makes a PA more qualified to be in the OR.


...and yet, I can go online (just did) and find plenty of cardiothoracic surgery jobs for either a PA or NP. many are willing to train either one. My point on the recent Grad PA was that a PA education doesn't necessarily equate to PA superiority. Perhaps you are a top-flight individual, but just being a PA doesn't make you that. You were saying PAs own the OR and I had better become one in order to get into cardiothoracic surgery....I'm just saying that I don't find any evidence to support that claim. I'm not even sayino that EVH is overly difficult to learn....in do think it's cool having part of the operation to yourself (entrusted to you). Very cool in my humble opinion.

I am simply trying to argue the point that, based on all the evidence out there, that surgeons are perfectly comfortable with hiring and training either PAS or NPs...that is not difficult to find those kinds of positions. I've even found cardiothoracic surgery jobs that were only for NPs including sign on bonuses even.

You seemed to be of the opinion that such things don't exist, or that those opportunities are so rare that I shouldn't even bother. But that is only your opinion because I see those job ads regularly all over the country.

Obviously I'm at a disadvantage talking about your skills in the OR...I'm not a mid-level provider yet. I'm sure you're very good at what you do, but I'm only saying that a surgeon can train an NP to do the job and do it well. I may never be a cardiothoracic rock star like you claim to be, but I'm sure that I can be trained and I already have a plan for getting a foot in the door through my current scrub tech status...basically to get good at hearts on a local heart team while I'm doing my BSN and then use those connections to help find a position once I become a NP.
Standing side by side with heart surgeons day in and day out gives one an opportunity to show one's ability. Then, if they like you, appreciate what you bring to the table and understand your goals, many physicians are willing to give you a shot.
You're right, being a PA doesn't mean you're going to automatically be good at a particular skill....it is the individual that makes the difference as you stated and that's all I'm hoping for...the opportunity to prove myself when the time comes. Fortunately, surgeons are willing to give plenty of NPs that opportunity just like they do for PAs.
 
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Obviously I'm at a disadvantage talking about your skills in the OR...I'm not a mid-level provider yet. I'm sure you're very good at what you do, but I'm only saying that a surgeon can train an NP to do the job and do it well. I may never be a cardiothoracic rock star like you claim to be, but I'm sure that I can be trained and I already have a plan for getting a foot in the door through my current scrub tech status...basically to get good at hearts on a local heart team while I'm doing my BSN and then use those connections to help find a position once I become a NP..

You are very defensive. Seriously. Let it go. PAs are trained the medical model, so are often preferred (not always - depends on state and physician) to NPs. NPs get lots of research education that takes the place of much of the pathophysiology and advanced anatomy that PAs get. The advanced anatomy is helpful for surgery. I'm a PA. My husband has almost completed his online NP degree, so I've seen both. (He went NP so he could keep working, but acknowledges that he'd prefer to be a PA because the education is stronger.) The education he receives is far inferior in most medical aspects than what I received as a PA. (He did get more education on nursing theory and how to read nursing research.) We both went to well known and reputable programs.

Does that mean as a NP you won't be able to get a job? Of course not, people do. Those suggesting PA over NP were trying to help you have the most opportunity in your preferred fields. No one is saying you won't get a job going the direction you've already decided on.

Your question was online NP programs and clinical rotations. Depends on the program and where you are in relation to that program. For example, there's an online NP will provide you with rotations if you live in their state, but if you live outside of that state you will have to find your own. I know of other programs that make you find your own rotations no matter what. You'll have to research the programs you want to consider.
 
From what I have seen, they operate very poorly for the students (and their future patients) but make the universities a great deal of money.

The ones I am familiar with put the onus on the student to find their preceptor sites for their 500 clinical hours.

This.

Also, there's no good substitute for face-to-face instruction, in my humble opinion.
 
This.

Also, there's no good substitute for face-to-face instruction, in my humble opinion.

That's right because after you graduate most of your education will be online or looking stuff up yourself, and your old professors will love to have you call them day or night for answers.
 
That's right because after you graduate most of your education will be online or looking stuff up yourself, and your old professors will love to have you call them day or night for answers.

Or better yet, not being able to pay off any of those school loans because you realize after you graduate that you still have no idea what it is that NPs do.

Moral of the story OP: don't cheap yourself out of a good NP program i.e. Face-to-face instruction.

Besides, do you really want to find and set up all of your preceptor sites yourself? If you're going to pay money for it anyway, might as well pick a program where they're willing to do their job, too.
 
You can get your baseline knowledge like BSN2014 recommends - by absorbing knowledge imparted upon you by someone who (should) know the subject and have some skill in teaching others.

Or you can get your baseline knowledge in a Zen-like way, by self-inflection on the mystical nature of disease processes and it's impact on the human condition. This method is best performed online, or, in true Zen-manner, simply by staring at goats.
 
You can get your baseline knowledge like BSN2014 recommends - by absorbing knowledge imparted upon you by someone who (should) know the subject and have some skill in teaching others.

Or you can get your baseline knowledge in a Zen-like way, by self-inflection on the mystical nature of disease processes and it's impact on the human condition. This method is best performed online, or, in true Zen-manner, simply by staring at goats.

:lol:
 
Anyone here familiar with the Carilion Emergency Medicine Fellowship for PA/NP?
 
You can get your baseline knowledge like BSN2014 recommends - by absorbing knowledge imparted upon you by someone who (should) know the subject and have some skill in teaching others.

Or you can get your baseline knowledge in a Zen-like way, by self-inflection on the mystical nature of disease processes and it's impact on the human condition. This method is best performed online, or, in true Zen-manner, simply by staring at goats.

And you could be the NP that has the highest patient satisfaction rate, brings in the most revenue 2nd only to the highest revenue producing physician in all of Army behavioral health, obtain multiple master's degrees in both brick and mortar universities and online, making you much smarter than idiots who just flap their jaws and are wannabes, and do it all without having a personality disorder.
 
And you could be the NP that has the highest patient satisfaction rate, brings in the most revenue 2nd only to the highest revenue producing physician in all of Army behavioral health, obtain multiple master's degrees in both brick and mortar universities and online, making you much smarter than idiots who just flap their jaws and are wannabes, and do it all without having a personality disorder.

Yayyyy you! You are such a super educated TIGER!!
 
I am simply trying to argue the point that, based on all the evidence out there, that surgeons are perfectly comfortable with hiring and training either PAS or NPs...that is not difficult to find those kinds of positions. I've even found cardiothoracic surgery jobs that were only for NPs including sign on bonuses even.

The argument on this board ad nauseam is that PA > NP, no matter what. It seems that many here think that the 500 hours you get in a PA program straining your neck from a corner in the OR trying to observe a gallbladder somehow makes you greatly more qualified than you would be otherwise.

Your 40,000 hours in the OR + NP is "slam dunk" greater than the PA's you would be competing against for a job on graduation, many of whom may have only scribed in the ER or took vital signs with automated blood pressure cuffs for 6 months prior to PA school. You'd be competing against PA grads who have just figured out how to scrub in, and who may not yet grasp what a 4-0 nylon even means, and certainly not the difference between running and interrupted sutures and when to use them, and much less the difference in feel between different tissues, vascular supply, infection control, etc.

From an experience perspective, you'd have your pick of jobs as an NP. Do what works best for you and ignore the irrational and nonsensical arguments of PA > NP here, which are largely made by those who don't understand NP training and/or are bitter that NP's are more autonomous on average. If you don't believe me, re-read this thread.
 
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You can get your baseline knowledge like BSN2014 recommends - by absorbing knowledge imparted upon you by someone who (should) know the subject and have some skill in teaching others.

Or you can get your baseline knowledge in a Zen-like way, by self-inflection on the mystical nature of disease processes and it's impact on the human condition. This method is best performed online, or, in true Zen-manner, simply by staring at goats.

You forgot another option. Become a psych MD, DO, or PA and peddle psych meds (even to kids whose CNS isn't fully developed) that are at best slightly better than placebo, and then practice according to an instruction manual (just updated to version 5.0 - get it on your iPhone NOW!) whose users and writers/"experts" (see above) can't seem to decide what is abnormal or not. That's real medicine and real science and really evidence based, right? If it's PO, it's science!!! Right? Don't leave such things to NP's! Leave it to medicine, as placebo is far superior to "staring at goats."
 
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The argument on this board ad nauseam is that PA > NP, no matter what. It seems that many here think that the 500 hours you get in a PA program straining your neck from a corner in the OR trying to observe a gallbladder somehow makes you greatly more qualified than you would be otherwise.

Your 40,000 hours in the OR + NP is "slam dunk" greater than the PA's you would be competing against for a job on graduation, many of whom may have only scribed in the ER or took vital signs with automated blood pressure cuffs for 6 months prior to PA school. You'd be competing against PA grads who have just figured out how to scrub in, and who may not yet grasp what a 4-0 nylon even means, and certainly not the difference between running and interrupted sutures and when to use them, and much less the difference in feel between different tissues, vascular supply, infection control, etc.

From an experience perspective, you'd have your pick of jobs as an NP. Do what works best for you and ignore the irrational and nonsensical arguments of PA > NP here, which are largely made by those who don't understand NP training and/or are bitter that NP's are more autonomous on average. If you don't believe me, re-read this thread.

First, I don't think anybody has said PA > NP. If you are already a nurse it makes no sense to take yourself out of the job force for 2-3 years while you go to school full time PA school when you can get much the same job as a NP after going to school part time for 2 years.

However any reasonable metric shows that MD education >>>>> PA education >>>>>> NP education. That being said, xx years out of school/residency, the quality of the provider is strictly dependent upon that individual provider.

Second, PA school surgery experience is a bit more than you suggest. My PA school surgery experience, which is NOT atypical, started on the first day of my family practice rotation (2nd rotation) where I scrubbed in and acted as first assistant on a C-section. My cardiology rotation included scrubbing in on caths and stents, open and closed pericardiocentesis, and pacemaker placements. In my trauma rotation I put in chest tubes, intubated, learned the art of throwing figure eights around bleeding arteries, drilled holes and put in ICP bolts, etc.

And ON TOP OF ALL OF THAT, I had my surgery rotation, which was well over 800 hours, with much of it acting as first assistant doing everything inside the belly/pelvis including hysterectomies, breasts, nodes, and glands. Then went for a week in ortho surgery where, once again, I was acting as first assistant for shoulder and knee repairs.

Big difference between that and "PA grads who have just figured out how to scrub in"

That being said, I agree that 40,000 hours in the OR + NP gives this particular person a huge leg up for surgical jobs.

You forgot another option. Become a psych MD, DO, or PA and peddle psych meds (even to kids whose CNS isn't fully developed) that are at best slightly better than placebo, and then practice according to an instruction manual (just updated to version 5.0 - get it on your iPhone NOW!) whose users and writers/"experts" (see above) can't seem to decide what is abnormal or not. That's real medicine and real science and really evidence based, right? If it's PO, it's science!!! Right? Don't leave such things to NP's! Leave it to medicine, as placebo is far superior to "staring at goats."

Great points. Which may indicate why NPs own the market on the "mid-level" psych jobs. I think the Zen-ster is a great example of this, just look at how much money he makes!
 
The amusing thing that I always see on PA forums is how they rage on the autonomy and independence of NPs while citing training as the metric, and yet in the same breath complain that MDs don't give them, as PAs, their due. How convenient that PA training has met a magic threshold for training competence that NPs haven't. Many outspoken physicians don't think PAs are trained as rigorous as they need to be, and when they write an editorial, there is a rallying cry for a letter writing campaign from PAs.
 
And you could be the NP that has the highest patient satisfaction rate, brings in the most revenue 2nd only to the highest revenue producing physician in all of Army behavioral health, obtain multiple master's degrees in both brick and mortar universities and online, making you much smarter than idiots who just flap their jaws and are wannabes, and do it all without having a personality disorder.

Let me be clear: I wasn't laughing at you. I was laughing at the last part of your previous comment. I sincerely hope you're not serious when you suggest that a solid educational background can really be obtained by staring at goats. Because it can't, regardless of how you phrase it. I doubt that a bunch of farm animals can tell you more than the adequately prepared nursing instructors at a solid brick and mortal NP program.

Second of all, that's a huge chip you're carrying around on your shoulder. Obviously it's contributed to an ego as well. Take it from someone who is a regular patient in the healthcare system: you might want to rethink how you perceive yourself in relation to your practice as an NP. There's nothing wrong with a good dose of humility.
 
Researching the job market for mid levels I've seen no preference for NP or PA as long as you have proper credentials and training for the position or can be taught which seems to often be the case that many are being taught on the job after school to do the things NP and PA school didn't really cover....PAs don't walk out of school knowing how to do EVH for example. ..they either do an additional residency which are few or more often have to be on job trained by others or a surgeon to do it. That is why residencies are multiplying for mid levels. ..there's virtually no specialty training in the basic programs to prepare graduates for the real world. Many site the time following graduation feeling like unprepared idiots and that's PA or NP...

As for jumping around, I just want fallback options....I might enjoy surgery for a while but want to do something less time consuming as I get older
Most surgeons I know only hire PAs. RNFAs have scope of practice issues in many states that don't let them do things like vein harvesting independently, whereas a PA has a scope of practice that is basically whatever their supervising physician deems them competent to do (with some limits that vary state-by-state). This, combined with the greater quality control and consistency of PA clinical training (they have the same core clinical rotations as medical students, for the most part, and a very similar curriculum in regard to preclinical that is simply an abbreviated and slightly watered down version of what we learn), makes most surgeons in ortho, CT, and the other specialty surgical fields have a strong preference for PAs. General surgery is more RNFA friendly, but the pay tends to not be as good.
 
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You forgot another option. Become a psych MD, DO, or PA and peddle psych meds (even to kids whose CNS isn't fully developed) that are at best slightly better than placebo, and then practice according to an instruction manual (just updated to version 5.0 - get it on your iPhone NOW!) whose users and writers/"experts" (see above) can't seem to decide what is abnormal or not. That's real medicine and real science and really evidence based, right? If it's PO, it's science!!! Right? Don't leave such things to NP's! Leave it to medicine, as placebo is far superior to "staring at goats."
While psychiatry has its problems, there are certainly well studied medication therapies out there. I mean, look at schizophrenia- it used to be a disease that was completely untreatable, and now we've got people living functional lives again care of their meds. I think what many in medicine don't like about psych is that it is still in its infancy, care of the brain being the most complicated part of the human body by a long shot, and that leads to a lot of uncertainty and interpretation. It isn't cut and dry, there is no "remove the lesion and the patient is fixed" like most other specialties, and that isn't something that most of the Type A hyperperfectionists present in medicine can cope with. But the opportunity to improve quality of life- something that many other specialties can rarely do- is unparalleled in psychiatry, if practiced appropriately.

Psych is definitely more NP than PA friendly, largely care of NPs being fully independent in psych practice in many states. This makes them less of a headache to employ, and much more likely to self employ.
 
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While psychiatry has its problems, there are certainly well studied medication therapies out there. I mean, look at schizophrenia- it used to be a disease that was completely untreatable, and now we've got people living functional lives again care of their meds. I think what many in medicine don't like about psych is that it is still in its infancy, care of the brain being the most complicated part of the human body by a long shot, and that leads to a lot of uncertainty and interpretation. It isn't cut and dry, there is no "remove the lesion and the patient is fixed" like most other specialties, and that isn't something that most of the Type A hyperperfectionists present in medicine can cope with. But the opportunity to improve quality of life- something that many other specialties can rarely do- is unparalleled in psychiatry, if practiced appropriately.

Let me be clear in that I am not necessarily disagreeing with you. I manage the medical problems of many psych patients and treat depression, anxiety, etc. to a certain degree. My point is that psych, in many regards, is border-line pseudo science. You call it a discipline "in its infancy." So be it. But, my "complaints" about psych are the same voiced by many MD/DO psychiatrists. If I owned the world, there would be no psychiatrists, only neuro-psych. The APA has sold their souls to self-preservation, while kicking real science and evidence to the curb. The DSM-5, the supposed penultimate result of decades of psychiatric research, is exhibit A in not just pseudoscience, but pseudoscience at its worst.

Again, this isn't just some dumb, uneducated, political-axe-grinding FNP saying this, psychiatrists are saying this. Psychiatry at this point is nothing more than "academic" psychology combined with a medical degree, i.e. social scientists with a prescription pad. There is seemingly less interest in basic biology of the brain, neuronal molecular mechanisms and how they related to behavior, etc. and more interest in political agendas. A 16 year old female that thinks she is a cat trapped in a human body is a "normal variation of human behavior." As is the early 20's female who thinks she is a vampire, that is "due to an underlying anemia that medicine does not yet have the ability to fully appreciate." Meanwhile, a 7 year old boy who talks too much in class needs intensive meth therapy STAT! Not to call out an entire profession, of course, as there are many in the profession who agree with what I am saying.

In regard to the discussion at hand, I think Zen is an awesome dude with weird ideas. Let me emphasize awesome dude. Who seems super cool! And he probably has as much "evidence" to back him up as every other therapist/psychiatrist/faith healer/counselor/motivational speaker/whatever person does.
 
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I am seeking information about the clinical aspects of online NP programs, specifically ACNP and RNFA like the program at UAB... How are clinical sites and preceptors obtained and is this the University responsibility or the NP student?

Personal experiences with these programs or situations would be great!

Thanks,
JAMES

To the OP:

Who may very well be horrified at the responses given, and the hornet's nest you have touched upon. My apologies. Before continuing, let me add that I miss the responses of Blue Dog's biting commentary in this forum, who when I first started posting to this board, I considered almost an equal. :)

As for online courses and preceptors. Let me ask you this. When professors/instructors have been picked for you in the past, how well did that go? It was probably convenient, yes, but...How well did it workout? Were they the best instructors you could have gotten?

At UAB, you find your own. Is that a bad thing??? I got to pick my own preceptors, and I would have done it no other way -- it is the best way. My preceptors were chief residents, fellows, and former military who had practiced all over the world, etc. How is that worse than being assigned to someone who may be a horrible clinician that simply signed up to train students out of boredom, a need for cash, or out of some sense of duty? The great greek philosophers had students that came to them to be trained. Picking your preceptor is an opportunity, not an inconvenience.
 
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Let me be clear in that I am not necessarily disagreeing with you. I manage the medical problems of many psych patients and treat depression, anxiety, etc. to a certain degree. My point is that psych, in many regards, is border-line pseudo science. You call it a discipline "in its infancy." So be it. But, my "complaints" about psych are the same voiced by many MD/DO psychiatrists. If I owned the world, there would be no psychiatrists, only neuro-psych. The APA has sold their souls to self-preservation, while kicking real science and evidence to the curb. The DSM-5, the supposed penultimate result of decades of psychiatric research, is exhibit A in not just pseudoscience, but pseudoscience at its worst.

Again, this isn't just some dumb, uneducated, political-axe-grinding FNP saying this, psychiatrists are saying this. Psychiatry at this point is nothing more than "academic" psychology combined with a medical degree, e.g. social scientists with a prescription pad. There is seemingly less interest in basic biology of the brain, neuronal molecular mechanisms and how they related to behavior, etc. and more interest in political agendas. A 16 year old female that thinks she is a cat trapped in a human body is a "normal variation of human behavior." As is the early 20's female who thinks she is a vampire, that is "due to an underlying anemia that medicine does not yet have the ability to fully appreciate." Meanwhile, a 7 year old boy who talks too much in class needs intensive psychotropic therapy STAT, (i.e. legal meth).

In regard to the discussion at hand, I think Zen is an awesome dude with weird ideas. Let me emphasize awesome dude. Who seems super cool! And he probably has as much "evidence" to back him up as every other therapist/psychiatrist/faith healer/counselor/motivational speaker/whatever person does.
You have no idea what you're talking about in regard to psychiatry training- almost everything we learned was neuropsych in medical school. But you should also keep in mind that much of abnormal psychiatry does not occur on the receptor level- if you get tortured for months in a prison in Iraq, or you were raped theoughout childhood, or you watched your family burn to death in front of your eyes, as a few examples, that isn't a receptor problem- you've got events that have damaged your ability to function, not a problem with a neurological basis. I fully agree with you that kids are overmedicated, but that is more the fault of certain psychiatrists than it is of the profession itself. Regardless, you judge the field by how it is practiced (largely by FMGs and US MDs that settled for it because they could do no better) rather than how it is taught.

This is a great example of one of the big rifts between PA and NP education, and the one that most defines the way by which physicians see you. In PA school, you are trained by physicians in the same manner as a 3rd or 4th year medical student, and the first year is extremely similar to first and second year of medical school. This leaves you with a sound theoretical and practical basis of Ob/Gyn, surgery, IM, FM, peds, psych, and EM. It's a breadth that I really never appreciated until medical school. That common ground and breadth that MDs and PAs share, in addition to the scope of practice flexibility, are a big reason why some specialists are more apt to hiring PAs. NPs fare better in some fields do to the increased independence factor that they have in many states, but specialties have typically been both more PA friendly and paid PAs more (Advance for PAs and NPs has yearly surveys that bear this out). So, for the person considering what career path to take, your eventual specialty of interest into account, as well as how much you like to move about, as NPs are locked into a scope of practice, while PAs can jump from field to field.
 
You have no idea what you're talking about in regard to psychiatry training- almost everything we learned was neuropsych in medical school.

Then why does neuropsych exist as a specialty? I'm just a dumb NP, I need help with this. BTW, as I mentioned in my post, psychiatrists are leveling the same criticism that I am. Please address in your response.

But you should also keep in mind that much of abnormal psychiatry does not occur on the receptor level- if you get tortured for months in a prison in Iraq, or you were raped theoughout childhood, or you watched your family burn to death in front of your eyes, as a few examples, that isn't a receptor problem- you've got events that have damaged your ability to function, not a problem with a neurological basis.

You. Don't. Know. This. How tragic events alter neurochemical function is a COMPLETELY UNKNOWN, which is my point. That is why psych needs a heavier grounding/emphasis in neurobiology and less of an emphasis in toting the water for political agendas. Furthermore, a neurochemical alteration, if it could be shown based on social trauma, does NOT extricate one's responsibility for aberrant behavior.

I fully agree with you that kids are overmedicated, but that is more the fault of certain psychiatrists than it is of the profession itself.

Fine. Where is the outrage by psychiatrists? All I hear is crickets. The outrage is coming from family practice. Though "stressed" moms and teachers seem to love meth-for-kids.

Regardless, you judge the field by how it is practiced (largely by FMGs and US MDs that settled for it because they could do no better) rather than how it is taught.

Are you saying that psych is where the bottom-of-the-barrel med students end up?

This is a great example of one of the big rifts between PA and NP education, and the one that most defines the way by which physicians see you.

So are you saying that if I was an MD/DO/PA trained in the "medical model" that I too would be dispensing psychotropic meds at an alarming rate to kids whose CNS isn't fully developed? And to adults whose real problems aren't solved by drugs?

Do you know why "personality disorders" were ditched in the DSM-5? They don't respond to drugs (oral chemicals). But then again, most psych disorders don't' respond very well to drugs. Some people are just evil. Drugs can't fix that. But you can't get research dollars for saying such things, and saying such things certainly isn't politically correct. Evil people are just victims of society in one way or another, right?

People that have truly experienced horrific events are one thing. The veteran, extreme trauma, the survivor of sexual or physical child abuse, etc. are one thing. But the APA is all about concierge psychiatric medicine. That's all they have left after they have discredited themselves with their ever moving targets as to what constitutes psychiatric illness and what doesn't.

And your references to the various specialties have nothing to do with psych, BTW, though your appreciation for them is duly noted.

And you criticize NP's for some supposed lack of training. Really????

while PAs can jump from field to field.

Complete myth. Ask experienced PA's.
 
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Then why does neurpsych exist as a specialty? I'm just a dumb NP, I need help with this. BTW, as I mentioned in my post, psychiatrists are leveling the same criticism that I am. Please address in your response.



You. Don't. Know. This. How tragic events alter neurochemical function is a COMPLETELY UNKNOWN, which is my point. That is why psych needs a heavier grounding/emphasis in neurobiology and less of an emphasis in toting the water for political agendas. Furthermore, a neurochemical alteration, if it could be shown based on social trauma, does NOT extricate one's responsibility for aberrant behavior.



Fine. Where is the outrage by psychiatrists? All I hear is crickets. The outrage is coming from family practice. Though "stressed" moms and teachers seem to love meth-for-kids.
I'm not further derailing this thread on the psych issue, I'll simply leave it at "you are very incorrect."

As to PAs being able to jump around from speciality to specialty, I've talked with plenty of them. I've got a lot of PA friends that tried to convince me to go to PA school for precisely that reason, actually, because they know I get bored and one field might drive me nuts. I knew one that jumped EM to critical care to derm, another that went FP to EM to hospitalist. It's a pretty flexible career.
 
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The amusing thing that I always see on PA forums is how they rage on the autonomy and independence of NPs while citing training as the metric, and yet in the same breath complain that MDs don't give them, as PAs, their due.

This ^^^.
 
How many of those folks who jumped around were compensated at a level commensurate to their years of experience as a PA in total? The ones I know making the big money are folks that stay in a specialty where they get more valuable with each year of experience. Or the ones that make a jump to a role that mimics the one they came from... EM to family practice, or surgery A to surgery B. An experienced PA might have a shorter learning curve than a new grad, I guess. But are they going to pay the PA as much as the guy who worked in the same specialty as theirs the next town over, and did it for their whole career? Everyone in the PA world is coming to terms that jumping around is becoming less feasible. Most of the new folks will be locking in early in their career and staying there if they are smart. Opportunities won't rest on them being flexible, but investing in a single skill set through residencies and immersion. So if PA's are indeed the darlings of specialists, which I don't deny (but don't see it as cut and dry as was suggested), then they will need to be specialists in their own right. That means no more application essays mentioning how they chose to go PA because they like variety.
 
Great points. Which may indicate why NPs own the market on the "mid-level" psych jobs. I think the Zen-ster is a great example of this, just look at how much money he makes!

I could make more but I prefer working for the DoD taking care of Soldiers, who as most know have suffered a lot...and I listen to their stories all day long...either from combat or having to deal with the Army.
 
Let me be clear: I wasn't laughing at you. I was laughing at the last part of your previous comment. I sincerely hope you're not serious when you suggest that a solid educational background can really be obtained by staring at goats. Because it can't, regardless of how you phrase it. I doubt that a bunch of farm animals can tell you more than the adequately prepared nursing instructors at a solid brick and mortal NP program.

Second of all, that's a huge chip you're carrying around on your shoulder. Obviously it's contributed to an ego as well. Take it from someone who is a regular patient in the healthcare system: you might want to rethink how you perceive yourself in relation to your practice as an NP. There's nothing wrong with a good dose of humility.

Fellow you really need some help. That last comment about staring at goats was from Boatswamy, a PA who has yet to reach adulthood. Now, if you were really smart you would realize that gazing at goats, especially the kids, is really funny. Are you aware of what laughter does for you? If you can't find a farm near you with a few goats, I'd suggest looking on youtube. I bet there are plenty of baby goats to get you laughing.

Now, your comment about a huge chip on my shoulder is the most ridiculous thing I've heard. How did you dream that up? I've been in healthcare 45 years. Do you understand 45 years?? That's longer than you have been alive. You have yet to dream the experiences I've been through. Yes, I have a healthy ego (which you better have in this business) but when you have been in the business as long as I have do you seriously think I don't have a "good dose of humility?" When I make a comment that I bring in the 2nd highest amount of $$ for the department and have the highest patient satisfaction it means just that...period. Now, as the patient that you are do you want to chose me or is your selection process to pick someone lower on the totem pole with less relationship skills? I'm also probably the only person in the Army, and maybe the entire military, to be teaching Tai chi to Soldiers and successfully billing insurance for it. That surely must mean I must really be smart too!
 
Let me be clear in that I am not necessarily disagreeing with you. I manage the medical problems of many psych patients and treat depression, anxiety, etc. to a certain degree. My point is that psych, in many regards, is border-line pseudo science. You call it a discipline "in its infancy." So be it. But, my "complaints" about psych are the same voiced by many MD/DO psychiatrists. If I owned the world, there would be no psychiatrists, only neuro-psych. The APA has sold their souls to self-preservation, while kicking real science and evidence to the curb. The DSM-5, the supposed penultimate result of decades of psychiatric research, is exhibit A in not just pseudoscience, but pseudoscience at its worst.

Again, this isn't just some dumb, uneducated, political-axe-grinding FNP saying this, psychiatrists are saying this. Psychiatry at this point is nothing more than "academic" psychology combined with a medical degree, i.e. social scientists with a prescription pad. There is seemingly less interest in basic biology of the brain, neuronal molecular mechanisms and how they related to behavior, etc. and more interest in political agendas. A 16 year old female that thinks she is a cat trapped in a human body is a "normal variation of human behavior." As is the early 20's female who thinks she is a vampire, that is "due to an underlying anemia that medicine does not yet have the ability to fully appreciate." Meanwhile, a 7 year old boy who talks too much in class needs intensive meth therapy STAT! Not to call out an entire profession, of course, as there are many in the profession who agree with what I am saying.

In regard to the discussion at hand, I think Zen is an awesome dude with weird ideas. Let me emphasize awesome dude. Who seems super cool! And he probably has as much "evidence" to back him up as every other therapist/psychiatrist/faith healer/counselor/motivational speaker/whatever person does.

True, there are those swearing by the bio model but I think you also need to consider brain plasticity and how just talking or doing something (without meds) can affect change, many times equal to meds. Which is exactly why I studied other modalities, including ancient ones.
 
I'm not further derailing this thread on the psych issue, I'll simply leave it at "you are very incorrect."

As to PAs being able to jump around from speciality to specialty, I've talked with plenty of them. I've got a lot of PA friends that tried to convince me to go to PA school for precisely that reason, actually, because they know I get bored and one field might drive me nuts. I knew one that jumped EM to critical care to derm, another that went FP to EM to hospitalist. It's a pretty flexible career.

Have you ever considered therapy for your inability to chose a satisfying field?
 
Have you ever considered therapy for your inability to chose a satisfying field?
I don't need therapy for a personality trait that I've found to be quite beneficial. Stability, contentment, and predictability have never really been things that I have enjoyed, and that malcontentedness has pushed me to always be doing new things with my life. I don't view it as a problem, I view it as an engine for growth and change.
 
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