NP or PA?

[Cody30]

Hi there, looking for some additonal information to make a choice.

I was in a PA program but took a leave of absence after the first semester. And Signed up for a FNP program. I am trying to decide the best route. I know they are similar but different theroy. The PA gets a lot of clinical in many specialties and is ready for most practice environments. the NP program I signed up for in a family program and has minimal elective options for surgery, er etc. I work in the OR now and some have told me that coming from that background I would not need the first assist course. Surgery or Ed are my interests.These are the closest programs to me and I can't really move. The PA program does carry a high debt, but since the NP program requries only part time work and more semesters the debt is close.
Liked the PA route but do need to get that debt paid off in a timely manner. Have heard some NPs over years state they dont make much more then regular RN, that does not make since to me since now your a provider and have a MSN.

Just wondering what others expierences are in their areas of the country. Thanks

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[guetzow]

You are correct. PA's have, for a much longer period of time, been practicing in significantly more specialties than NPs. This is changing, however, so you must make a personal decision (That being, Medical Model vs a smattering of nursing theory and practice guidelines. For me, making an independent medical decision was more desireable.). As far as pay, they are also basically the same. There was a time when the remark was that NPs did the same/similar job for less pay. But that has really been changing too; likely because of head hunters (And younger Docs) who really don't know the difference between mid-levels and have driven the market in that direction. Lastly, PA is a 2-year program which may be a faster track for you if you aren't already a nurse. Some say PAs are less hamstrung by protocols than NPs and are free to perform more procedure$, as by it's very definition, "The PA scope of practice follows that of his/her SP, and with a reasonable amount of training, may perform any procedures he/she is capable of doing with such training". But who really knows? It's a personal decision

 

[deleted6669]

Hi there, looking for some additonal information to make a choice.

I was in a PA program but took a leave of absence after the first semester. And Signed up for a FNP program. I am trying to decide the best route. I know they are similar but different theroy. The PA gets a lot of clinical in many specialties and is ready for most practice environments. the NP program I signed up for in a family program and has minimal elective options for surgery, er etc. I work in the OR now and some have told me that coming from that background I would not need the first assist course. Surgery or Ed are my interests.These are the closest programs to me and I can't really move. The PA program does carry a high debt, but since the NP program requries only part time work and more semesters the debt is close.
Liked the PA route but do need to get that debt paid off in a timely manner. Have heard some NPs over years state they dont make much more then regular RN, that does not make since to me since now your a provider and have a MSN.

Just wondering what others expierences are in their areas of the country. Thanks

for surgery or em you will have more opportunities with the pa. you also have the option of doing a pa residency in one of these areas if you like(see www.appap.org)
for primary care(fp/im/peds/obgyn) either the np or pa would be fine.
overall you have more options with the pa because of the extra 1500 hrs+ of clinical training in a variety of specialties- typical pa= 2200 hrs of clinicals while typical np=500-800 hrs......
best of luck whatever you decide.

 

[guetzow]

Diplomatic answer, but same theme

 

[FNP2B]

for surgery or em you will have more opportunities with the pa. you also have the option of doing a pa residency in one of these areas if you like(see www.appap.org)
for primary care(fp/im/peds/obgyn) either the np or pa would be fine.
overall you have more options with the pa because of the extra 1500 hrs+ of clinical training in a variety of specialties- typical pa= 2200 hrs of clinicals while typical np=500-800 hrs......
best of luck whatever you decide.

EMEDPA, I have to say I always enjoy reading your post and responses...but I always notice your same response to the NP vs. PA clinical hours and I have a question for you regarding just that.

I have seen your take on the clinical hours NP vs. PA
Here is mine and if you see anything off please correct me.

ERNP(emergency med NP)= 700-900hrs dedicated to emergency med
PA(emergency med)= maybe 100hrs dedicated to emergency med

PNP(pediatric NP)= 700-900 hrs dedicated to pediatrics
PA(pediatric)= maybe 100 hrs dedicated to pediatrics

CNM(nurse midwife)= 700-900 hrs dedicated to ob/gyn
PA(ob/gyn)= maybe 100 hrs dedicated to ob/gyn

NNP(neonatal NP)= 700-900 hrs dedicated to neonatology
PA(neonatal)= maybe 100hrs dedicated to neonatology

So would it be correct to say if some one wanted to specialize they would receive a more in-depth and comprehensive training from an NP program. I am only speaking of school clinical hrs, nothing past the actual program.
FYI
I myself am also stuck in the valley of decision regarding which field to pursue.

 

[Monika]

Just to give you an idea here are the approx. hours I spent in each rotation for my clinical year.

ER (adult and peds): 180 hrs
Urgent Care: 160 hrs
General Surgery: 200 hrs
Surgery elective: 220 hrs
Community/Underserved Medicine: 180 hrs
Peds (neonatal, general): 280 hrs
OB/Gyn: 260 hrs
Inpatient Geriatrics: 200 hrs
Hospitalist: 160 hrs
Endo: 160 hrs

There are PA residencies that offer even more training, for those interested in gaining more competency in a particular area of medicine.
APPAP

 

[FNP2B]

Just to give you an idea here are the approx. hours I spent in each rotation for my clinical year.

ER (adult and peds): 180 hrs
Urgent Care: 160 hrs
General Surgery: 200 hrs
Surgery elective: 220 hrs
Community/Underserved Medicine: 180 hrs
Peds (neonatal, general): 280 hrs
OB/Gyn: 260 hrs
Inpatient Geriatrics: 200 hrs
Hospitalist: 160 hrs
Endo: 160 hrs

There are PA residencies that offer even more training, for those interested in gaining more competency in a particular area of medicine.
APPAP

Thank you monika for correcting my clinical hrs for PA's and also verifying the fact that if I wanted to work as a midlevel provider lets say in the NICU the best program would be an NNP(neonatal NP) program because you receive almost triple the amount of clinical hrs than you would in a PA program (strictly dedicated to neonates). I understand the residence options once one finishes a PA program but I am looking more towards what each program offers while one is in school. Now on the other hand PA is definitely the right choice if some one wanted to chose primary care because you get a taste of everything adding up to over 2000 clinical hrs, whereas an FNP(family NP) also gets a taste of everything but with about half the clinical hrs. Thank you again monika for giving me a personal break down of your clinical hrs.

 

[guetzow]

Having worked years in NICUs as an RT, using every type of concievable ventillator, many transports, and being intimately familiar with the most common types of cardiopulmonary neonatal pathologies (An integral part of RT training), I, or any other PA who had previously been an RT (And there are many), would make a great neonatal PA. This fact, is why PAs with relevant clinical experience, are every bit as competant as an NP. How many RNs have this experience? (In the RT example). This is also why so many PAs have excelled in specialties.

 

[Monika]

Having worked years in NICUs as an RT, using very type of concievable ventillator, many transports, and being intimately familiar with the most common types of cardiopulmonary neonatal pathologies (An integral part of RT training), I, or any other PA who had previously been an RT (And there are many), would make a great neonatal PA. This fact, is why PAs with relevant clinical experience, are every bit as competant as an NP. How many RNs have this experience? (In the RT example). This is also why so many PAs have excelled in specialties.

Very true, good point.

There is also a dedicated post-graduate neonatal PA residency at the University of Kentucky now.

 

[FNP2B]

Having worked years in NICUs as an RT, using every type of concievable ventillator, many transports, and being intimately familiar with the most common types of cardiopulmonary neonatal pathologies (An integral part of RT training), I, or any other PA who had previously been an RT (And there are many), would make a great neonatal PA. This fact, is why PAs with relevant clinical experience, are every bit as competant as an NP. How many RNs have this experience? (In the RT example). This is also why so many PAs have excelled in specialties.

Again I am not speaking of previous or post grad education....I am simply referring to the comparison of clinical hrs always brought up when one is comparing NP clinical hrs to PA clinical hrs and I believe it is safe to say that an NNP student will receive more hrs dedicated to the specialty he/she is wanting to work as a midlevel provider compared to a PA student wanting to work in the NICU. But in reference to previous experience, NNP programs, most if not all require that an RN have at list two years experience in the NICU and their bachelors (BSN) before applying.

 

[guetzow]

"Again I am not speaking of previous or post grad education"...... Huh? I beg to differ...(Is that nursing theory logic?)

 

[FNP2B]

Very true, good point.

There is also a dedicated post-graduate neonatal PA residency at the University of Kentucky now.

Let me rephrase "I am not referring to previous experience or as monika stated above “post-grad education”.....I was simply comparing the clinical hrs an NNP student would receive versus a PA student in the NICU (which hypothetically speaking is the place that both students want to work coming out of their programs). Again I believe NP=PA I am just reference the usual comprising of NP and PA clinical hrs.

 

[deleted6669]

EMEDPA, I have to say I always enjoy reading your post and responses...but I always notice your same response to the NP vs. PA clinical hours and I have a question for you regarding just that.

I have seen your take on the clinical hours NP vs. PA
Here is mine and if you see anything off please correct me.

ERNP(emergency med NP)= 700-900hrs dedicated to emergency med
PA(emergency med)= maybe 100hrs dedicated to emergency med

PNP(pediatric NP)= 700-900 hrs dedicated to pediatrics
PA(pediatric)= maybe 100 hrs dedicated to pediatrics

CNM(nurse midwife)= 700-900 hrs dedicated to ob/gyn
PA(ob/gyn)= maybe 100 hrs dedicated to ob/gyn

NNP(neonatal NP)= 700-900 hrs dedicated to neonatology
PA(neonatal)= maybe 100hrs dedicated to neonatology

So would it be correct to say if some one wanted to specialize they would receive a more in-depth and comprehensive training from an NP program. I am only speaking of school clinical hrs, nothing past the actual program.
FYI
I myself am also stuck in the valley of decision regarding which field to pursue.

many generalist pa programs allow you to create a specialty focus by tweaking your rotations a bit to get more emphasis on an area of interest. for instance as a prior paramedic I knew I wanted to do em so I did this:
trauma surgery(for surgery instead of general) 5 weeks (24 hr shifts every other day, with 12 hr shift on "off" days. total = 612 hrs
inpt internal medicine(instead of outpt) 5 weeks
hospital inner city obgyn(instead of clinic) 5 weeks
trauma ctr em 5 weeks x 50 hrs/week=250 hrs
psych(inner city lockdown instead of clinic) 5 weeks
peds em at peds hospital(instead of outpt clinic) 5 weeks x 50hrs/week=250 hrs
fp 12 weeks
community hospital em elective 12 weeks x 50 hrs/week=600 hrs

so my hrs for em+trauma= 1712 in addition I had another 1100 hrs of ob/psych/im/fp so 2800 hrs over 54 weeks with 27 weeks directly related to em or trauma.
folks who had an interest in other fields did similar things(peds surgery instead of general, etc) so it is possible to specialize and still meet all the generalist requirements for the pa degree.
for those interested in peds or neonatology there is also a peds focus pa program in colorado that takes 3 yrs and meets all the generalist requirements while also having significant time in peds and neonatology. I agree that a peds/neonatal np would have more exposure than most pa graduates however grads from the colorado program probably end up with more peds/neonatology hrs than most nnp programs just because it is longer and more intense. see http://www.uchsc.edu/chapa/pro_overv/index.htm

 

[FNP2B]

Always enjoy reading your post and responses EMEDPA.
Like I said I am currently wrapping up my RN program and I am still weighing out my options, both NP and PA are attractive, but I must hand it to the PA profession it has some awesome programs. These are my fields of interest.......Emed PA, FNP, CRNA. The medical field is such an awesome field to go into, because there are so many options for one to pursue. This RN degree is going to open a lot of doors for me and I am just trying to decide which one to step through.
Thanks again EMEDPA

 

[deleted6669]

Always enjoy reading your post and responses EMEDPA.
Like I said I am currently wrapping up my RN program and I am still weighing out my options, both NP and PA are attractive, but I must hand it to the PA profession it has some awesome programs. These are my fields of interest.......Emed PA, FNP, CRNA. The medical field is such an awesome field to go into, because there are so many options for one to pursue. This RN degree is going to open a lot of doors for me and I am just trying to decide which one to step through.
Thanks again EMEDPA

those are fairly different areas of concentration...
emed : a little bit of everything, great hrs, higher acuity overall, work lots of nights weekends
fnp- mostly fp clinic type work. some variety but low acuity for the most part. good hrs generally with a fairly predictable schedule
crna: gotta love the o.r......no clinic time, some preop anesthesia consults but mostly all anesthesia all the time which means 95 % boredom and 5% panic.
shadow 1 of each of these folks around for a week or 2 to see which fits your style best.
good luck whatever you decide.

 

[Cody30]

Thank you everyone for your replies for far.

 

[dqbanrn]

I frequently read these threads comparing NP to PA. One of the difficulties I notice in the comparison is that the educational model is different. PA education seems focused on producing a competant generalist healthcare provider by the end of the program, and even though they prefer their applicants have healthcare expierience, their backround may not have anything to do with their PA practice. Thus, they must make sure the student learn what they need to know during the program. NP education assumes you are a competant healthcare provider from the start since you must be an RN before begining any NP program (even the direct entry programs require this). The graduate level work is designed to build off of what the RN should have learned while earning their lisence. Further, NP education specializes while in school, hence the various np degrees, Acute Care, pediactric, FNP ect.. this means moving between specialties is usually easier for a PA (generalist). Though the fine print defines differences in scope with protocols and other legal jargin, reality and experience have shown me the two are used interchangeably.
this is my perspective of the two, but is possible other people have had different expierences.