Is there a different between PA and NP in terms of employment opportunities?

[contemplating2005]

In terms of employment opportunities do you see much of a difference? I work in one location, one hospital I noticed has much more job opportunities for NP and then another hospital has a lot of job opportunities for PA. All of this in the same city might I add. I find this fairly interesting. In the future which profession do you think will essentially have better opportunities?

My current thoughts are:
PA - has standardized medical curriculum, so employers I feel would prefer PA compared to NP as a new grad. PA however are always controlled by the medical boards and physicians.

NP - better lobby, but lots of online NP programs and non standardized curriculum.

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[pamac]

NP education is more standardized than it gets credit for, but I do agree that PA education is very robust in its fundamentals. Outside of FNP education, other NP avenues tend to be specialized in focus, but I still think PAs can show up and function very well in short order in a specialty. They are trained as generalists, and they rotate through a broad spectrum of specialties. That gives tremendous insight, I believe.

It used to be that NPs and PAs both tended to be folks with quite a bit of experience. These days, you are seeing most PA programs taking students with minimal experience. You are seeing plenty of newer nurses making the jump to NP as well, but aside from the handful of direct entry NP programs (programs that take someone with no experience like PA schools, and make them RN's then NP's), most of the NP's out there have a fair amount of actual, robust experience in a position of high stakes. And to their credit, there are many PA programs that have stuck to their roots, and require significant amounts of high level health care experience to be competitive for admission into their programs. But the many new programs popping up in the last 5 years haven't had that emphasis. But regardless, research and anecdotal evidence seems to indicate that NP's and PA's produce similar levels of quality with their work. For everyone, there is a learning curve. A lot of nurses cite previous RN experience as a strength, but I know plenty of RNs that don't have very significantly broad work history as an RN for that to be as compelling as some would like it to be. I think a lot of PA schools are turning away from being centered on health care experience because they feel like they want to also have standardized educational experience, rather than rely on whether a patchwork of candidates won't have similar sets of skills prior to showing up to their first day of class. From there, it comes down to grades, and ability to absorb the academic rigor.

I think the main difference between the two pathways that you need to look at are factors like what kind of specialty you want to practice in, what kind of relationship you want to have required of you with a physician, what state you are in (and the rights afforded to NPs there), what kind of education you have in hand right now, and what kind of training you feel you need to have. Time is another factor. If you have a bachelors degree in biology, and good grades, then in 3 years (counting the application and selection year), you could be a new PA. If you want to help out in surgery and round on surgeons patients, then there are typically more PA's doing that. If you want to work in behavioral health, a psyche NP would be what you want to do if you want the most options. General practice is a wash between PA's and NP's. I've noticed hospitalists are often also evenly distributed. Where I live is like where you are, and different facilities have certain preferences.

I've noticed something interesting as of late, and this could be indicative of some significant changes to the landscape. Several health care systems exist in my region. And my nurse friends working in other health systems from myself, as well as the nurses in my health system, have reported that the facilities are starting to be more active in supporting the RN's currently working there that are pursuing their NP degrees. They are offering more generous tuition reimbursement, and bending over backwards to provide clinical preceptorships at their facilities and clinics. Additionally, they are upfront with them that they will want to hire them at the conclusion of their training. No formal offers or agreements are inked until they graduate, but these conversations are out in the open. And make no mistake, these decisions are nurse driven because nurses not only have a lobby, but they are in positions in hospitals to make those decisions. They are the administration of hospitals. They run the departments, they control almost every aspect of healthcare at the hospital level, and the hospital systems control the satellite clinics. They literally drive the initiatives that everyone adheres to. And nurses are choosing their own. So once these NP student nurses graduate, they have done their clinicals at the hospital and the hospital clinics, they know everyone, and they are competing against PA's that are showing up for the first time. Often, the same folks that coordinate the RN employee clinicals are the folks in HR that are driving the hiring. At my health system they are. And from there it works that way in other venues. I've been cultivating relationships with other providers for several years. I'm not disappearing to an out of state PA school for two years and hoping to return to ask for a job. In fact, I'm doing clinicals in other places so that I maximize my exposure to potential employers.

So I think the question you ask needs to be considered alongside what you already have going for you. NP typically will take a bit longer as a rule. Direct entry NP can be short, but you are jumping through two hoops there, and those programs are on campus programs, so you relocate to the few locations in the country that offer them. And they are expensive. I was fine doing the NP route because overall it was a considerable savings vs PA school or even direct entry.

 

[DizzyJon]

A lot of this has to do with the administration. If admin is RN top heavy, then often they want to employ more NPs. Also have seen it dependent on resident's being in-house or not. One hospital had all their surgery resident's pulled out and in return hired a ton of PAs and this broke ground to PAs given preference in other specialties. There are 3 systems in my area and one seems pro PA, another is a good mix, and the third is pro NP. I don't think it really has to do much with the standardization of either program.

 

[pamac]

That’s a good example of how getting a foot in the door makes a difference for a profession.

What is going to make you most satisfied with your career is deciding if it fits you. When I was choosing between continuing on toward a PA program or veering off to become an NP, I asked myself what I valued in a profession where I functioned as a medical provider, and I feel like I found it in the NP realm. I never felt comfortable with the regulatory requirement for PAs to be affiliated with physicians for their livelihood, even if it still seems like a formality to a lot of them. To become an NP or PA is too hard, too expensive, and they take on too much responsibility to need to have a dependent relationship to draw a paycheck and be managed like a dental hygienist. There’s nothing wrong with dental hygiene by the way, but thats just not a role I could see myself driven towards. It’s just not me. I’m not saying I need to be the boss, or run the show, but I don’t want my ability to practice in my career tied directly to my ability to get someone else to perpetually “supervise” me statutorially. But that’s not to say that PAs actually have that thought hanging over their heads every day, but if I were one, it would hang over me in my own mind. I don’t want to be the apprentice for my whole career. For me, the parchment that I earn means that I can get my license and step out and go to work, and see a patient of my own, and prescribe a medication as I see fit. I’m accountable to me and the law, not the whim of someone who can tell me how to wield my accomplishment. A PA can be told “I don’t like you, so since I don’t want to sponsor you, you can’t even prescribe until you find another keeper”. You are nothing without your master. As an NP, you can’t go out and perform outside of your scope, but inside your scope, you can work according to your comfort level, and what you are accountable to. If you want to volunteer as medical staff for a fun run, you can do so without a physician boss telling you no. In over 25 states, NPs have bosses, but they don’t have bosses that have as profound of an impact over them as a supervising physician has over “their” PA.

 

[Boatswain2PA]

PAMAC is right in many accounts, but few things I disagree with him about.

NP education - CRNA is great, ACNP might be good, but the rest is terribly unstandardized. Online FNP programs are popping up everywhere and many are absolutely terrible. I work with several nurses who are going through them and they know their programs are just terrible, but it's the easiest route to check the box to become a provider. Lots of threads here about it, so won't belabor the point beyond saying this: Post baccalaureate education for a physician = 4 years medical school, 3-7 years residency, and 20000+ clinical hours. Post baccalaureate education for a PA = 2.5 years of INTENSE standardized training (where if you're extremely gifted you might be able to work a few hours a month to pay your bills, but almost nobody can do this), including 2000+ clinical hours. Post baccalaureate education for a NP is 2 years of (frequently) online classes (that many people, possibly even MOST people do while working full time) and only 500 clinical hours. Yes, some NP programs exceed this, but many do not.

Do you want to learn how to practice medicine? Or do you want to take some classes so you can write prescriptions??

PAMAC is also right about the growing independence of NPs. Some mega-organizations prefer this because there is reduced administrative oversight (which is scary!). And in some places NPs are able to open up their own clinic right after graduation (even scarier). However most organizations, even in states requiring zero oversight of NPs, still lump us all together to ensure adequate physician oversight, so there is usually virtually no difference clinically between a PA or NP.

He is absolutely right about the concern for many PAs regarding being tied to a physician. Lots of stories about a supervising physician dieing, going to jail, or suddenly retiring and the PA is up $chitts creek sans paddle. However there are some similar NP stories as well (I personally know of a case like this happened to a NP last month).

Then there is the whole "doctorate" thing. NPs are continuing to push for a mandatory Doctorate, which means more cost (would bring closer to cost of PA programs) and more time, but rarely increased clinicallly significant training (more nursing theory/management papers). And if you are a DNP, don't refer to yourself as a doctor in the hospital or clinic, because everyone will be laughing at you because of it.

Bottom line though is you can get to (mostly) the same place professionally, so the path usually depends on where you are starting at. If you already have a RN/BSN, then it just makes sense to do the NP route. If you have another BA/BS degree, then PA may be a better path for you.

Lastly, important to realize how freaking hard it is to get accepted to PA program. Much greater academic pre-requisites (Chemistry for majors (ie: not "Chemistry for nursing" that many schools offer), organic chemistry, biochem, statistics, etc). Many schools have scores or HUNDREDS of qualified applicants for every seat. The financial cost is much higher (and remember, you effectively CANNOT work during PA school). Most PA applicants are not selected.

Meanwhile, if you are a BSN/RN, as long as you have a checkbook then you will be able to find a program to get into somewhere.

 

[contemplating2005]

I have looked into the UC davis program for FNP and the curriculum is exactly like the PA. I might consider doing the pa/np dual sounds like a good option

 

[pamac]

I think UC Davis is the one program you could have mentioned that actually was a hybrid PA/NP program, where everyone attended class together whether they wanted to be a PA, or an NP. The curriculum matches there, but it wouldn’t be that way with any other programs you compared. You found a needle in a haystack.

 

[contemplating2005]

I think UC Davis is the one program you could have mentioned that actually was a hybrid PA/NP program, where everyone attended class together whether they wanted to be a PA, or an NP. The curriculum matches there, but it wouldn’t be that way with any other programs you compared. You found a needle in a haystack.

It seems like a good option. If just np, you get the medical education that PA provides and the lobbying power that np provides. You can always go the dual route np/pa route. Not sure about cost but it is the exact same length.

 

[pamac]

Psyche NPs, ACNPs, CrNAs... they more than hold their own because they are specialists with a specialist focus for their clinicals and training. FNPs can come out of school with learning curves. Generalist folks have a lot of ground to cover, and PAs do it right.

Most of the Pa programs I’ve looked at aren’t 2.5 years, and the average program is 26.4 months, not 30, so I don’t know where that came from. Most of the Np programs I know of are the ones that are 2.5. And I don’t know of many NP programs with less than 700 hours of clinical requirement. Mine is very typical with a requirement for at least 800. I’ll probably end up with 1200, all psyche focused. Some folks tend to always cite the low end statistics and suggest they are the norm. The same kind of exaggeration goes into acting like direct entry Np programs are far more common than they are.... when there are actually only a handful of the programs out there to choose from.

PA school is hard to get into because you have literally tons of folks applying that are folks who read in clickbait articles about PA being one of the top ten graduate degrees for wages, and they see that you can get in most places with none or minimal healthcare experience and just a few prerequisites (which they are actually incorrect about because they don’t know that some of those prerequisites have their own prerequisites). But these days, I’d much rather be a 22 year old with good grades applying to Pa school than a 31 year old paramedic, because my odds are better as the 22 year old (as long as I did some token healthcare experience like a mission trip to South America). So you have tons of applicants applying to PA school, and the average applicant applying to Pa school usually applies to more than 8 programs. Most folks I know personally applied to around 10. If you apply to 12, you statistically have a 50% chance of getting in. So each PA school turns away plenty of folks, but overall, decent applicants find their way in somewhere. I applied to one NP school. There is literally no Pa program with “hundreds of qualified applicants for each seat”. It’s not The NASA astronaut corp, nor even medical school as far as competitiveness. I’ve been impressed to see a few programs with 10 applicants for each seat, but realistically, around one third of PA applicants really have no business applying. And again... with most applicants applying to tons of schools to increase their chances of getting in somewhere, that skews everyone’s approach to applying. Around 6500 new PAs are minted every year out of an applicant pool of around twice that. By comparison, 20,000 NPs graduate each year, but I haven’t seen any data on how many are in the total applicant pool vs how many get in. Honestly, I’m sure that most everyone could get in to some Np school if they really wanted. The ones that don’t get in in a given cycle have their hearts set on a particular program.

Many facilities have similar physician oversight of PAs and NPs as a matter of policy (mine does for the hospitalists NPs... and we don’t hire PAs for that role anymore) but it relates to patient care, not the things I addressed. The NPs arrangement in those situations is that they essentially have a physician manager, but not someone that they are statutorily required to be the apprentice to. A physician collaborator that NPs have to run a few cases by per quarter is a different thing than being a physician that has someone’s name attached to them for the PAs ability to do their job. And many physicians aren’t interested in that anymore, and want an independent provider like an NP so they don’t get sued.

There are NO stories of Nps having PA style trouble with losing a supervising physician unless they are on one of the 24 states where they aren’t independent (and every year that number gets smaller... Virginia just barely changed their law to allow fully independent practice by NPs). It’s just not as big of a deal for NPs that aren’t restricted to working under a physician. But in no states does a PA even get away from having that threat lifted from above their heads.

The Np doctorate is optional, and will be basically forever. Sure, some schools push it. But the schools that still offer masters options will always have plenty of business. I’m finishing up my masters right now, and supposedly 2015 was the goal that someone set to have the DNP be the standard. The doctorate is doing what it was designed to do... put NPs at the decision making table in hospital administrations. And PAs all over the PA forums are talking amongst themselves about how to get something going of their own like that. For years they were saying “it doesn’t make you any more prepared to practice to have a DNP”, and I always told them it was to get them ahead in the board room and not the exam room. Now they all wish they had something similar to advocate for them in the boardroom, and wish they also individually had an avenue to get away from patientcare due to burnout.

 

[pamac]

I’m not saying that one shouldn’t become a PA, though. It’s probably the fastest route from start to finish to becoming a prescriber. Most NPs won’t run their own clinic, and many will have a work environment similar to PAs, so those technical aspects that were hang ups for me probably wouldn’t make a bit of difference for many folks out there, even among the PAs. The PAs that seem to complain about dependence most are folks that are some of the gunners out there in the PA community who are using their skills, ability, and ambition to high degrees, and many probably could have gone to medical school of the circumstances were slightly different for them. Otherwise, dependent practice isn’t a significant burden. I don’t suggest that the PAs I’ve heard griping about dependent status don’t have legitimate concerns, just that they probably don’t register as a dealbreaker for most people, especially if you are making the kind of money that PAs tend to make after just 2 years of school.

 

[contemplating2005]

I’m not saying that one shouldn’t become a PA, though. It’s probably the fastest route from start to finish to becoming a prescriber. Most NPs won’t run their own clinic, and many will have a work environment similar to PAs, so those technical aspects that were hang ups for me probably wouldn’t make a bit of difference for many folks out there, even among the PAs. The PAs that seem to complain about dependence most are folks that are some of the gunners out there in the PA community who are using their skills, ability, and ambition to high degrees, and many probably could have gone to medical school of the circumstances were slightly different for them. Otherwise, dependent practice isn’t a significant burden. I don’t suggest that the PAs I’ve heard griping about dependent status don’t have legitimate concerns, just that they probably don’t register as a dealbreaker for most people, especially if you are making the kind of money that PAs tend to make after just 2 years of school.

Have you noticed much of a difference salary wise between the two? is Cali more pa or np friendly? So by this logic wouldn’t it be best to be a np at this program because you get the same curriculum as a pa and also the lobbying power that np provides?

 

[pamac]

The quirk with UC Davis is that the only way to become dual certified is if you are an RN. If you apply to their PA program and get in, you only can work as a PA. If an RN applies and gets into the UC Davis' NP program (which is separate from the PA program), then IF there is available space, they can take a semester of the NP program, and then apply to get into the PA program. When they graduate, these RN's can take the exam for the NP and PA licenses if they would want to. The main benefit that I see for an RN through this program would be to get the excellent education and training that PA programs provide. If they also wanted to work in an area where there is an extremely high preference for PA's, I guess this might be useful as well, but I have my doubts as to how much farther they could go as a PA vs an NP. Maybe work as a surgical PA helping surgeons. I think they wouldn't even need to get licensed and certified as a PA either, just show up and tell the physician that they are trained as a PA, but are an NP. That would probably be enough for any PA fanboy physician, if any of them even care. Malpractice insurance alone as a PA is at least 6 times what NP malpractice is, so that's reason enough to not go through the hassle of getting any license besides the NP. I guess it would be kind of cool to be able to say you are both, which for me would be appealing. To be honest, I don't know if in an independent state like mine, whether a dual certified and licensed NP/PA would have to function as a PA with a supervising physician, or could just work independently like NP's can. If I were limited to the scope of a PA, I certainly would forgo going through licensure as a PA, and opt for NP.

But like i said, if you aren't already an RN and go to the UC Davis PA program, you don't get the benefit of being able to sit for the NP exam and become an NP. Its just a PA program with extra stuff that PA's complain that count as nursing fluff courses (which is accurate to some degree).

And like Boatswain said, getting into PA school is incredibly hard. UC Davis is likely to be one of the harder programs in the nation to get into because of the fact that there are nurses gunning for positions there as well. There's a reason why so many folks applying to PA school apply to 8-12 of them.

I can only speculate on how the market is in California, but from what I've heard, it seems to be good for both PA's and NP's. NP's there aren't independent, but the California Nurses Association is the most powerful nurses union in the country, and makes sure NP's are taken care of. I've not heard horror stories, except in terms of the high cost of living areas and the tightened job markets in places where folks seem to want to live. Outside of the main drags, I've heard there are great opportunities where cost of living is lower, and the pay is quite good. I don't pay much attention to California, because I wouldn't live there even if it paid double, and cost of living came down significantly.

I think the future of being a PA or NP is as bright as a future can be for just about any career, but I think one must have expectations that things will just be more complicated. Folks need to temper their expectations in a lot of regards. Take being an RN for example... I don't think anyone can name a career that one can walk into where you can have as many options about where you live, how much you want to work, or what schedule you want to work, compared to what an RN has. For the most part, you can get plenty of overtime, and the harder you work, the more you get paid. In most places, its not unheard of to make $100k if you are willing to work more. Even at that, you wouldn't have to work even an extra shift every week to make $100k. There was a time when my hospital was frustrated when I quit working overtime, even after they would literally throw money at me. But I was burned out at the job. You know you are burned out when they are offering you 2.5 times your base rate with your differentials added if you come in, and you turn them down. Some of the "complications" I'm referring to that might have to be considered as an NP or PA surround wages. Overall, I see that with 20,000 new NP's coming out every year from school (which is actually close to the 23,000 physicians that are churned out of medical schools), and the 6500 PA's as being something that will usher out the era of being able to name your price in whatever location you want, in whatever specialty, and have you dictate what the terms are for hours and call. And I think folks should expect to start to network and compete for jobs, as well as have employers drive more of a hard bargain. NP's and PA's will be reminded that they are employees, and will start to be treated increasingly more like the rest of the employees, albeit among the best paid employees. I'm already seeing this with physicians. These kinds of things are happening in many industries, not just medicine.

Either way, I don't think that someone can go wrong with either PA or NP, but I personally would rather join the group that has more members. Think of it this way... just in new grads alone, NP's dominate. Year one: 20,000 NP's, 6500 PAs. Year Two: 40,000 NP's, 13,000 PAs. Year 3: 60,000 NP's, 19,500 PA's. So it takes PA's 3 years to match how many NP's graduate every year (and new NP programs are popping up as quickly as new PA programs). That disparity will take its toll on PA's if there ever is a severe tightening of the workforce, although I don't see that happening... we will actually be behind on how many providers we need, unless the landscape changes due to the influence of artificial intelligence.

 

[contemplating2005]

The quirk with UC Davis is that the only way to become dual certified is if you are an RN. If you apply to their PA program and get in, you only can work as a PA. If an RN applies and gets into the UC Davis' NP program (which is separate from the PA program), then IF there is available space, they can take a semester of the NP program, and then apply to get into the PA program. When they graduate, these RN's can take the exam for the NP and PA licenses if they would want to. The main benefit that I see for an RN through this program would be to get the excellent education and training that PA programs provide. If they also wanted to work in an area where there is an extremely high preference for PA's, I guess this might be useful as well, but I have my doubts as to how much farther they could go as a PA vs an NP. Maybe work as a surgical PA helping surgeons. I think they wouldn't even need to get licensed and certified as a PA either, just show up and tell the physician that they are trained as a PA, but are an NP. That would probably be enough for any PA fanboy physician, if any of them even care. Malpractice insurance alone as a PA is at least 6 times what NP malpractice is, so that's reason enough to not go through the hassle of getting any license besides the NP. I guess it would be kind of cool to be able to say you are both, which for me would be appealing. To be honest, I don't know if in an independent state like mine, whether a dual certified and licensed NP/PA would have to function as a PA with a supervising physician, or could just work independently like NP's can. If I were limited to the scope of a PA, I certainly would forgo going through licensure as a PA, and opt for NP.

But like i said, if you aren't already an RN and go to the UC Davis PA program, you don't get the benefit of being able to sit for the NP exam and become an NP. Its just a PA program with extra stuff that PA's complain that count as nursing fluff courses (which is accurate to some degree).

And like Boatswain said, getting into PA school is incredibly hard. UC Davis is likely to be one of the harder programs in the nation to get into because of the fact that there are nurses gunning for positions there as well. There's a reason why so many folks applying to PA school apply to 8-12 of them.

I can only speculate on how the market is in California, but from what I've heard, it seems to be good for both PA's and NP's. NP's there aren't independent, but the California Nurses Association is the most powerful nurses union in the country, and makes sure NP's are taken care of. I've not heard horror stories, except in terms of the high cost of living areas and the tightened job markets in places where folks seem to want to live. Outside of the main drags, I've heard there are great opportunities where cost of living is lower, and the pay is quite good. I don't pay much attention to California, because I wouldn't live there even if it paid double, and cost of living came down significantly.

I think the future of being a PA or NP is as bright as a future can be for just about any career, but I think one must have expectations that things will just be more complicated. Folks need to temper their expectations in a lot of regards. Take being an RN for example... I don't think anyone can name a career that one can walk into where you can have as many options about where you live, how much you want to work, or what schedule you want to work, compared to what an RN has. For the most part, you can get plenty of overtime, and the harder you work, the more you get paid. In most places, its not unheard of to make $100k if you are willing to work more. Even at that, you wouldn't have to work even an extra shift every week to make $100k. There was a time when my hospital was frustrated when I quit working overtime, even after they would literally throw money at me. But I was burned out at the job. You know you are burned out when they are offering you 2.5 times your base rate with your differentials added if you come in, and you turn them down. Some of the "complications" I'm referring to that might have to be considered as an NP or PA surround wages. Overall, I see that with 20,000 new NP's coming out every year from school (which is actually close to the 23,000 physicians that are churned out of medical schools), and the 6500 PA's as being something that will usher out the era of being able to name your price in whatever location you want, in whatever specialty, and have you dictate what the terms are for hours and call. And I think folks should expect to start to network and compete for jobs, as well as have employers drive more of a hard bargain. NP's and PA's will be reminded that they are employees, and will start to be treated increasingly more like the rest of the employees, albeit among the best paid employees. I'm already seeing this with physicians. These kinds of things are happening in many industries, not just medicine.

Either way, I don't think that someone can go wrong with either PA or NP, but I personally would rather join the group that has more members. Think of it this way... just in new grads alone, NP's dominate. Year one: 20,000 NP's, 6500 PAs. Year Two: 40,000 NP's, 13,000 PAs. Year 3: 60,000 NP's, 19,500 PA's. So it takes PA's 3 years to match how many NP's graduate every year (and new NP programs are popping up as quickly as new PA programs). That disparity will take its toll on PA's if there ever is a severe tightening of the workforce, although I don't see that happening... we will actually be behind on how many providers we need, unless the landscape changes due to the influence of artificial intelligence.

very informative reply as always, thank you. Out of curiosity, why does having a large occupational disparity advantageous for NP? I would assume more graduates equals more competition for jobs/ reduce pay.

Also you mentioned about the NP vs PA malpractice insurance for the physician, sounds like there is potential negotiating power with that for the NP.

 

[Lanntis]

The quirk with UC Davis is that the only way to become dual certified is if you are an RN. If you apply to their PA program and get in, you only can work as a PA. If an RN applies and gets into the UC Davis' NP program (which is separate from the PA program), then IF there is available space, they can take a semester of the NP program, and then apply to get into the PA program. When they graduate, these RN's can take the exam for the NP and PA licenses if they would want to. The main benefit that I see for an RN through this program would be to get the excellent education and training that PA programs provide. If they also wanted to work in an area where there is an extremely high preference for PA's, I guess this might be useful as well, but I have my doubts as to how much farther they could go as a PA vs an NP. Maybe work as a surgical PA helping surgeons. I think they wouldn't even need to get licensed and certified as a PA either, just show up and tell the physician that they are trained as a PA, but are an NP. That would probably be enough for any PA fanboy physician, if any of them even care. Malpractice insurance alone as a PA is at least 6 times what NP malpractice is, so that's reason enough to not go through the hassle of getting any license besides the NP. I guess it would be kind of cool to be able to say you are both, which for me would be appealing. To be honest, I don't know if in an independent state like mine, whether a dual certified and licensed NP/PA would have to function as a PA with a supervising physician, or could just work independently like NP's can. If I were limited to the scope of a PA, I certainly would forgo going through licensure as a PA, and opt for NP.

But like i said, if you aren't already an RN and go to the UC Davis PA program, you don't get the benefit of being able to sit for the NP exam and become an NP. Its just a PA program with extra stuff that PA's complain that count as nursing fluff courses (which is accurate to some degree).

And like Boatswain said, getting into PA school is incredibly hard. UC Davis is likely to be one of the harder programs in the nation to get into because of the fact that there are nurses gunning for positions there as well. There's a reason why so many folks applying to PA school apply to 8-12 of them.

I can only speculate on how the market is in California, but from what I've heard, it seems to be good for both PA's and NP's. NP's there aren't independent, but the California Nurses Association is the most powerful nurses union in the country, and makes sure NP's are taken care of. I've not heard horror stories, except in terms of the high cost of living areas and the tightened job markets in places where folks seem to want to live. Outside of the main drags, I've heard there are great opportunities where cost of living is lower, and the pay is quite good. I don't pay much attention to California, because I wouldn't live there even if it paid double, and cost of living came down significantly.

I think the future of being a PA or NP is as bright as a future can be for just about any career, but I think one must have expectations that things will just be more complicated. Folks need to temper their expectations in a lot of regards. Take being an RN for example... I don't think anyone can name a career that one can walk into where you can have as many options about where you live, how much you want to work, or what schedule you want to work, compared to what an RN has. For the most part, you can get plenty of overtime, and the harder you work, the more you get paid. In most places, its not unheard of to make $100k if you are willing to work more. Even at that, you wouldn't have to work even an extra shift every week to make $100k. There was a time when my hospital was frustrated when I quit working overtime, even after they would literally throw money at me. But I was burned out at the job. You know you are burned out when they are offering you 2.5 times your base rate with your differentials added if you come in, and you turn them down. Some of the "complications" I'm referring to that might have to be considered as an NP or PA surround wages. Overall, I see that with 20,000 new NP's coming out every year from school (which is actually close to the 23,000 physicians that are churned out of medical schools), and the 6500 PA's as being something that will usher out the era of being able to name your price in whatever location you want, in whatever specialty, and have you dictate what the terms are for hours and call. And I think folks should expect to start to network and compete for jobs, as well as have employers drive more of a hard bargain. NP's and PA's will be reminded that they are employees, and will start to be treated increasingly more like the rest of the employees, albeit among the best paid employees. I'm already seeing this with physicians. These kinds of things are happening in many industries, not just medicine.

Either way, I don't think that someone can go wrong with either PA or NP, but I personally would rather join the group that has more members. Think of it this way... just in new grads alone, NP's dominate. Year one: 20,000 NP's, 6500 PAs. Year Two: 40,000 NP's, 13,000 PAs. Year 3: 60,000 NP's, 19,500 PA's. So it takes PA's 3 years to match how many NP's graduate every year (and new NP programs are popping up as quickly as new PA programs). That disparity will take its toll on PA's if there ever is a severe tightening of the workforce, although I don't see that happening... we will actually be behind on how many providers we need, unless the landscape changes due to the influence of artificial intelligence.

I do so thoroughly enjoy your posts, pamac!

 

[pamac]

very informative reply as always, thank you. Out of curiosity, why does having a large occupational disparity advantageous for NP? I would assume more graduates equals more competition for jobs/ reduce pay.

Also you mentioned about the NP vs PA malpractice insurance for the physician, sounds like there is potential negotiating power with that for the NP.

What it means is that as the landscape continues to fill with NPs, that will continue to be the provider that everyone thinks of when they think of non-phsysician providers. The more obscure a profession is, the more obscure a profession is. It’s like Apple.... Apple wants everyone to think of Apple when they think of smart phones. Or Amazon. When you think to order something online, what comes to mind first...eBay or Amazon? You think amazon. You know it’s easy to use, and you don’t have to think much about it. They are big and their name is out there. Yes, it is not awesome when a market is saturated. But people know what doctors are, and what nurses are, and “Nurse Practitioner” is a natural extension of nurses. But look at what comes with it. People think of your profession the moment they think of someone that can prescribe medicine that isn’t a doctor.

Here’s the best example. When you get anesthesia, who gives it to you? Anesthesiologists... MDs. Who else? Well, nurses, right? Why not? They are medical folks after all too... so Nurse Anesthetists make sense too. But what about Anesthesiologist Assistants? Yes, they exist and can practice in a handful of states. They make more than PAs, and have to work under an anesthesiologist like PAs, whereas most Nurse Anesthetists are independent like NPs. They make good money as well... around what CrNAs make in restrictive states. How come you’ve never heard of them? Because there are fewer than 6000 of them and they can’t practice outside of a few states. Guess who is going to make sure it stays that way? 44,000 CRNAs, and 2.2 million RNs.

So the nursing world has found that having numbers (even if it means a bit of saturation in the market for them) is preferable to obscurity. Nps are their own advertising. If they don’t get Np jobs right out of the gate, they make do with other RN jobs or roles such as management roles, or advocacy, or they go back to the bedside for a while. A few NPs don’t get jobs as NPs out of school, or have to fight hard to get one, but that’s ok by the ANA because they still end up working in the system and advancing the profession. There’s no huge downside for the nirsing world if there are tons of NPs out there as long as it’s NPs competing against NPs... because an Np will win. And they want to dominate any non NP competition.

 

[pamac]

NPs don’t have the benefit that other professions do as far as owning the market. Dentists can protect their income by limiting the number of new dentists they churn out, because they are the only providers in their realm. Physicians also are indispensable as the only providers at the top. Optometrists, physical therapists, even dental hygienists can control their value by squeezing supply. But if NPs don’t move bodies into the healthcare landscape, then they lose ground.

Amazon operated at a loss for many years. They would sell products at less than they paid because they felt it was in their best interest to gain market share. I remember thinking that their strategy would lead to them imploding. This is something that a lot of startups do, and it doesn’t always work, but the stakes for the NP community aren’t as precarious because at the end of the day, they aren’t out anything because education for a nurse is essentially fungible (able to be used for something else if not used for its original purpose). But a PA without a job is screwed. They can’t do anything else that utilizes their investment... nothing. Maybe someone who was a paramedic before Pa school can go back to doing that for $16 an hour, but they didn’t need to go to PA school if that’s the case.

So for me, that’s another thing I thought about when I chose nursing to become an NP. Hypothetically, if I graduated to a terrible market, I’d stay at my job making >$75,000 per year working 3 days per week, (or work 4 days and make $106,000) while I waited to find a job as a psyche NP that starts at $135,000. PAs and FNPs where I’m at start at $85,000 per year on average.

 

[Mad Jack]

NPs don’t have the benefit that other professions do as far as owning the market. Dentists can protect their income by limiting the number of new dentists they churn out, because they are the only providers in their realm. Physicians also are indispensable as the only providers at the top. Optometrists, physical therapists, even dental hygienists can control their value by squeezing supply. But if NPs don’t move bodies into the healthcare landscape, then they lose ground.

Amazon operated at a loss for many years. They would sell products at less than they paid because they felt it was in their best interest to gain market share. I remember thinking that their strategy would lead to them imploding. This is something that a lot of startups do, and it doesn’t always work, but the stakes for the NP community aren’t as precarious because at the end of the day, they aren’t out anything because education for a nurse is essentially fungible (able to be used for something else if not used for its original purpose). But a PA without a job is screwed. They can’t do anything else that utilizes their investment... nothing. Maybe someone who was a paramedic before Pa school can go back to doing that for $16 an hour, but they didn’t need to go to PA school if that’s the case.

So for me, that’s another thing I thought about when I chose nursing to become an NP. Hypothetically, if I graduated to a terrible market, I’d stay at my job making >$75,000 per year working 3 days per week, (or work 4 days and make $106,000) while I waited to find a job as a psyche NP that starts at $135,000. PAs and FNPs where I’m at start at $85,000 per year on average.

Psych NPs are generally more desirable, I've seen some clearing 200k

 

[pamac]

That would be nice, and I’ve heard it’s possible, but where I’m at, one would have to hustle considerably to manage that. More than I want to. I think psychiatrists make roughly $240k ish around these parts if they are doing well, but that’s just a guess.

For folks that don’t know, psyche is a strange market where physicians are near the low end of the physician pay scale, but at or near the very high end of the NP income scale. The specialty is not procedure rich, which makes it hard to have revenue pouring in... and there’s only so much that one can fill a day with as far as how many patients you can see. A lot of the billing is for interactions that bill low. But because there is so much demand, an NP can come along and fill a significant need that has got to be met, and can command decent money for their time and effort. There’s little overhead for facilities. A psyche NP ends up being able to bring in just about as much revenue as what a physician can, and they mostly can do about the same things within their scope. But overall, the revenue is lower than what someone like a surgeon can bring in. So that ends up bringing psychiatrists down, but bringing psyche NPs up.

 

[PreAAstudent]

That would be nice, and I’ve heard it’s possible, but where I’m at, one would have to hustle considerably to manage that. More than I want to. I think psychiatrists make roughly $240k ish around these parts if they are doing well, but that’s just a guess.

For folks that don’t know, psyche is a strange market where physicians are near the low end of the physician pay scale, but at or near the very high end of the NP income scale. The specialty is not procedure rich, which makes it hard to have revenue pouring in... and there’s only so much that one can fill a day with as far as how many patients you can see. A lot of the billing is for interactions that bill low. But because there is so much demand, an NP can come along and fill a significant need that has got to be met, and can command decent money for their time and effort. There’s little overhead for facilities. A psyche NP ends up being able to bring in just about as much revenue as what a physician can, and they mostly can do about the same things within their scope. But overall, the revenue is lower than what someone like a surgeon can bring in. So that ends up bringing psychiatrists down, but bringing psyche NPs up.

I think the acceptance rate to NP school is nearly 100% at this rate.. anyone with a bsn and a 2.0 gpa can get into university of phoenix...

 

[pamac]

Lol. Since you’ve never been to RN school, I’ll point out what you aren’t aware of. For one, a 2.0 definitely won’t get someone into RN school in the first place. It’s competitive. My ADN program had over 500 applicants for 30 spots, that’s PA school territory. Second, you don’t graduate RN school with a 2.0. Failing starts at 75 percent in every RN school I’ve heard of, and dancing around a 75 percent in a class consistently is actually harder than getting close to A’s because it’s like hanging around at a cliffs edge and trying not to fall off. But Maybe that’s true about being able to get into a school with a 2.0, I couldn’t say. I have a couple acquaintances that applied to my program that didn’t get in the first time they applied, and they had good stats. My GPA from my BSN was 4.0, so I can’t gauge what the low threshold is. Those folks I mentioned aren’t the kind of people who settle for a place like University if Phoenix, so they reapplied with some input from me on a few things, and they got in on the next application cycle.

I run across NPs from time to time that aren’t impressive to me, but I’d say that most of the folks that I know personally, or know of personally, are decent students with great heath care experience behind them from their RN work (but I am in an acute care environment, so I don’t know what’s going on elsewhere). These nurses are Nurses in the ER, ICU, or med surges. They run codes, are in charge of units, and make tough calls regularly. Contrast that with most of the PAs and almost all of the AAs coming out of school to their first real job ever, let alone the first job where they had someone’s life in their hands, and I think you see a difference. Hands on experience is more the norm for folks that are going into the NP field rather than the exception. I go to campus with my NP school cohort, and my peers are pretty much all nurses with that kind of quality experience. I met one gal that was a case worker currently, but she was in the post op ICU for 8 years before that. But we sit around and discuss scenarios and you just see the background all of us have emerge, and it’s impressive. The professors are teaching to a classroom full of folks that all “get it”. It blows away anything you see in a room full of novices. I’ve sat in on quite a few PA lectures, and it was all baby steps for them. You had some folks that were lucky enough to be CNAs before they got to PA school, so they kind of knew healthcare, but it was so limited. But overall, experienced folks like an RN in that environment would have been unequally yoked to the vast majority of the class that were novices to even basic things. They were blank slates. They don’t know the difference between sick people and healthy people that are just feeling unwell. They have never had to prioritize care based on acuity. The list goes on.

So maybe there are Np wannabees that have only ever been school nurses or are direct entry. The problem with that argument is that direct entry Np programs are fairly rare compared to AA and PA programs being pretty much entirely direct entry by nature (PA programs that require high HCE levels these days are fairly rare, and AA programs really don’t care much at all). Most cushy RN jobs aren’t suited well for brand new nurses, so most nurses that end up there get their start taking care of patients at the RN level before they move on and sit at a desk doing paperwork. Even your nursing home RN that you think does very little is someone who carries tremendous responsibility. So if an RN feels like University of Phoenix fits better into their career plan, it doesn’t concern me as much as a lot of other things they could be doing. An RN that is a really poor performer isn’t going to pass their boards or get/keep a job.