MD/DO vs. PA vs. NP

[mvenus929]

Of MD/DOs and PA/NP, it's clear who has the most autonomy.

But today at work, we were discussing the various professions. One was saying how bad of an idea it was to become a doctor, because they really don't make that much money, with insurance reimbursements so low and insurance and whatnot so high. One of my coworkers had wanted to be an NP, until she found out she had to be an RN first, and she didn't want to go that route. One of my other coworkers chimed in and said that she could be a PA, but she wouldn't get to do as much as an NP, because NPs could do everything a doctor could do, except surgical procedures, without physician supervision. PAs, on the other hand, work under the supervision of a doctor.

I had done research on the clinics that were popping up in Walmart and other places a few years ago, and remember reading that though nurses staffed them, they had to be under the supervision of a physician. I had thought that NPs would be the ones staffing such clinics. Am I wrong in my assumption? Do NPs really have that much autonomy?

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[Perrotfish]

I had done research on the clinics that were popping up in Walmart and other places a few years ago, and remember reading that though nurses staffed them, they had to be under the supervision of a physician. I had thought that NPs would be the ones staffing such clinics. Am I wrong in my assumption? Do NPs really have that much autonomy?

NPs still practice under the lisence of a physician, but it is significant that they report to nurses. As I understand it nurses, at least in a hospital setting, have their own chain of command, so the physician can't directly repromand or fire them. PAs, as I understand, are in the same CoC as physicians and therefore report direclty to them or at least directly to the chief of medicine. So no, neither on can practice completely on their own. But yes, nurses are further removed from the physicians they practice under than PAs.

What exactly NPs, PAs, and all other midlevels are allowed to do, exactly, varies not just year to year but also state to state. So there's no clear rule there.

 

[kikiu]

From what I know, in my experience, it may be wrong, NPs and PAs are pretty much on the same level as autonomy. Both normally work under the doctor, or SP. NPs have a bit of an edge due to some legislation working in their favor for autonomy, but I would say the majority of NPs and PAs are in the same situation with autonomy---ultimately under the doc, but still given a great deal of "freedom" and responsibility to practice medicine !

However, I would say that a larger % of NPs have autonomy (still a very very very small #) than the % of PA, due to the nature of legislature. There may be a tiny bit of truth in the statement that NPs have more autonomy than PAs, but I don't think that there is a huge difference between the two.

 

[njbmd]

NPs and PAs do not practice under the license of a physician but under the supervision of a physician. In many cases, this supervision is minimal. There are duties that only a physician may perform (with vary from state to state). If you don't mind always being at the level of a PGY-2 resident for the rest of your career, the perhaps being a midlevel would appeal to you.

Do be aware that there are differences in the training of NP and PA in that PAs are trained on the medical model and NPs are not because they are nurses. If you are trying to get as close as possible to being a physician without going to medical school, then PA is going to be your best bet.

Being a midlevel may be quite appealing to many folks because of the shorter educational process but the physician will always lead the healthcare team. Being a midlevel isn't about autonomy as a CNA (certified nursing assistant) has autonomy to do their job, but being a midlevel is more about doing your job within the settings that you work. If you are satisfied with the scope of practice of midlevels then go for it.

For me, it wasn't enough and wasn't even close to being a physician.

 

[mvenus929]

If you don't mind always being at the level of a PGY-2 resident for the rest of your career, the perhaps being a midlevel would appeal to you.

I understand that you are probably talking generalities here, but I'm not planning on being either a PA or an NP. I'm the only one in my department at the hospital aspiring to be an actual doctor. There are others who want to be... most of the people in my department are still in school, either to be a RN or a med tech.