nurse to physicans assistant

Discussion in 'Clinicians [ RN / NP / PA ]' started by ebeth, Nov 21, 2000.

  1. ebeth

    ebeth New Member

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    from everything i've heard from people, going from a nurse to a physicans assistant is not the way to go. usually, nursing students go from being a nurse into a masters program in the hopes of becoming a nurse practioner. i am currently in my junior year at a four year college with a bachelors level nursing program. i am very discouraged lately on my choice of going into nursing and i'm looking for alternatives to when i graduate. are there any extra requirements needed going into a physicans assistant program from a nursing program?
    thanks [​IMG]
     
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  3. Hey Ebeth...
    It's just me. I will find out as much info for you this weekend about the whole PA stuff...you can also post topics under everyone...I think "everyone" is checked more than the nurses...so, good luck to both of us! [​IMG]

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  4. ShannonB

    ShannonB Junior Member

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    I am curious about this also. I'll graduate in May with my BSN and am already thinking of grad school as a viable option. I've considered FNP or CNS within a few yrs. Do either of you have any info on these as well? [​IMG]
     
  5. tman

    tman Senior Member

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    ebeth,
    I've researched the physician (not physician's...they take offense to the 's)assistant career field pretty extensively. In fact I was accepted to PA school but I changed my mind and decided to persue medical school instead. I have a BS in Biology and do not have a nursing background. That being said here's some of what I learned about the subject:
    a) PAs and NP's end up doing essentially the same thing after school...they are both considered "mid-level" providers or physician extenders. There are some area's each are more predominant in, for instance, NP's are more often found in women's health than PAs...although this may change in the future. PAs have a strong presence in Surgery, some surgical PAs are given privileges to be First Assistants, cardiovascular surgery PAs actually perform the vein harvesting surgery autonomously during bypass surgery and often are responsible for closing incisions. If you want to go into surgery PA is definitely the way to go.

    b)Although in the end they do the same thing, their training is very different. NP's train based upon the "Nursing Model" and rely heavily on the training you receive during your BSN school. The training for NP's varies greatly also, for instance some schools have intensive 1-2 year full time schools, while others allow you to get the degree in a couple of years by going part time, often just a couple of weekends a month or a couple of nights a week (great if you want to work and go to school part time). Predominantly they rely on the A&P and micro and other prereq's to nursing school, with little or no more training in most of the basic sciences. They do usually require a semester of pathophys, and pharm, but that is usually about the extent of their basic science curriculum. Clinically, NP's require an average of 500 hours, while the average PA student will get over 2000 hours of clinical instruction(again NP's rely a lot on prior nursing experience).
    PAs on the other hand are trained on the "Medical Model" which basically means you get the Reader's Digest condensed version of medical school. The first year is mainly spent studying the basic sciences, such as gross anatomy with a cadaver, medical physiology, pathology, pharmacology...etc... the second year is similar to a third year med student's doing clerkships in a variety of specialties, including medicine, psych, EM, surgery, OB/GYN and FP. PA school is full bore, intense training similar to med school...in fact many PA schools are co-located with a med school and take some of the same classes as the med students. Just as you can't do med school part time you can't do PA school on a weekend a month like some NP programs allow you to. There is one PA school in the East that allows you to complete training in 3 years and you get summers off, and it's a little more spread out...
    The bottom line with training is that PAs win hands down with a couple of exceptions, one of the California schools, either Stanford or USC,I can't remember which, actually trains NPs and PAs identically, they attend the same classes, but only BSN's can get the NP degree, and all other students get the PA degree (even the BSN's if they want it which is not uncommon), they call it the Primary Care Associate program.

    c)The PA career field is fairly new (started in the late 60's/early 70's) and is still struggling with it's identity. In fact the very name Physician Assistant is the source a lot of debate within the career field, since the word "assistant" implies to many people an "unskilled helper" and is often confused with Medical Assistants who's duties are to take blood pressures and take people to their rooms. Most PAs work pretty much autonomously and see patients just as a doctor does. In fact many PAs work in rural areas where their supervising physician might be 100 miles away. Some patients who are uneducated about PAs training often are not comfortable being treated by "the doctor's assistant" and so PAs are always trying to educate the public about what their capabilities are. As a fairly new player in the healthcare industry many people don't know much about PAs. Another problem PAs face is that each state makes it's own laws governing PA practice guidlines and there are big differences from state to state on what PAs are allowed to do, nearly every state now allows PAs to prescribe meds, but some require a doctor to co sign for the prescription. Many states with a lot of rural areas allow PAs to prescribe schedule II-V drugs, while others only allow schedule V. Some states require that a physician review all of a PAs cases while others only require a small percentage of cases to be checked. PAs are also few in number compared to nurses and do not yet have a lot of political clout.
    NPs on the other hand have a lot of political clout since there are tons of nurses and the nursing profession (not necessarily the NP profession, but remember that all NPs are nurses first) has been around a long time. Because of their clout and general acceptance due to the public's familiarity of nurses, they do not have to face many of the hurdles the young PA profession deals with. Some states allow NPs to work very autonomously and they can even "hang a shingle" out and start their own practice (much to the disgust of many doctors). In fact there is a strong push by nurses to allow NPs everywhere to work autonomously...this really gets the doc's riled up and is one reason why doctors generally support PAs more than NPs. By their self definition PAs will never fight for complete autonomy, and really push the doctor-PA team concept.

    d)From what I gather (and this of course is a hotly debated subject) doctors prefer PAs generally for a couple of reasons. First, PAs are trained the same way doctors are with a strong foundation in basic sciences followed by diverse clinical rotations where they are generally treated as third year med student clerks and thus pick up a strong background in clinical skills as well. They speak the same language as docs do and have the scientific background to discuss the nity-grity of complex pathophysiological processes. They also readily embrace the fact that they are ultimately subordinate to their supervising physician no matter how much autonomy they have...and they usually have plenty. As stated above many NPs are fighting for complete autonomy from doctors, which understandably doesn't sit well with docs. Because of NPs relience on pre-nursing science classes, NPs often struggle with the nity-grity science stuff...but this apparently doesn't really affect their effectiveness as providers. In fact one of NPs strong selling points is their effectiveness as providers, the nursing model of training and just nursing in general relies on compassion and understanding of their patients since a nurse is largely a patient advocate by trade, many patients appreciate the down to earth approach that NPs generally bring with them.

    Anyway, as you can see it is a pretty complicated subject. I didn't set out to write a novel on the subject, but there are a lot of factors to consider. The bottom line is that each career field has its strong points, and you should carefully consider several things before you make a decision. Consider things such as how much time and energy do you want to commit to your education, if you are willing to commit yourself for two years of intensive training and want a strong background in science and clinicals PA is the way to go. Also consider where you plan on practicing and look into what PAs vs NPs are allowed to do in the state you want to practice. And of course the list goes on and on..(kind of like this reply..lol). One last thing...compensation...PAs are generally compensated better than NPs, the average NP starts out making 38-45k/year while PAs average $55K + starting out. Anyway good luck whatever choice you make!
     
  6. rdennisjr

    rdennisjr SDN Super Moderator
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    tman, after looking into the PA/NP program over the last year and a half, I think your 'novel' is by far the best synopsis of the difference between these two related professions. Big Thumbs up for you on making a clear distinction between two fuzzy subjects.

    For those that are interested, the military (all branches) participate in a PA training program. Both active duty and National Guard/Reserve soldiers can apply, and you attend two years of training to national standards. After completion (w/ a bachelors currently, soon to be a masters...) you owe the branch you are in 6 years - active duty time or national guard time depending on how you applied. While a tough program to get into, it does have the added benifit of the little fact that you get active duty wages while you attend, rather than paying for the privlage. The one hitch of course is that you must be part of the military. However, then you get to serve your country as well as learn a new skill. I've just been accepted to the program so while I don't have a lot of knowledge about the day to day activities there I can discuss the application program if you have questions. Feel free to email if you have questions, or check out their web site:
    http://www.cs.amedd.army.mil/ipap/
     
  7. tman

    tman Senior Member

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    Thanks, congrat's on your acceptance to ipap..incidentally I am AD AF and it was the IPAP that I was accepted to also. I decided to forgo matriculation so I could apply to USUHS school of med...should be hearing any time now....Good luck and enjoy Ft. Sam!
     
  8. Pilot

    Pilot Senior Member

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    Tman,

    You response to the topic was great. I wish you luck in your medical school endeavors.
     
  9. Nurse2Doc

    Nurse2Doc Senior Member

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    I am a RN/BSN, specialize in trauma & TICU~~TMan said it very well~we in fact had an entire seminar on the subject in nursing school that TMan could have given. Another fact to consider (and this point has been made by BOTH professionals~Nurses have the support of the ANA, a strong and powerful organization. PAs on the other hand, do not have the support of a strong organization. How is this important? When it comes down to the advancment of the profession (and I assume this is relevant to you, or you would not be working for your BSN and would not be posting here otherwise~~we all know wayyyy too many nurses who are wayyyy too content to do their 8 or 12 hours and go home), and to autonomy and to demanding respect for the knowledge that we implement in our profession, there is strength in numbers. The AMA is a strong and powerful organization, and yet the ANA has garnered their respect and attention. PAs stand alone, and it is difficult to affect change solely. I got my BSN specifically to go on to med school, but did lots of checking in the meantime. I almost went PA, except that it went from a bachelor's program to a master's program about the time I was making major decisions. When it came right down to it, if nursing is your life then go NP and teach and be a strong nurse and a leader. If you don't quite feel like nursing is your calling, PA is a strong option. Consider where you are going~if your current degree is a stepping stone, ie if your ultimate goal is to be a doctor, then take the shortest, most effective route (both will satisfy the experience and educational goals of a premed). If your current career path is a rung on the ladder to be the best you can be in your profession, nursing offers a multitude of options~~limitless, while PA offers its own rewards. Bottom line~do you want to be a nurse? Do you want to be a doctor? (we know the philosophy differences~they are real.) Or do you want a career in medicine that does not involve the expense and sacrifice that med school demands? Choose what is right for you. I have experiences as a nurse that I would NEVER have gotten as a doc or a PA, that I would not trade for anything. I also have experiences as a nurse that make me mad, and there are changes that I choose to affect that will be better instigated as a physician. My BSN was a stepping stone to my long term career as a physician~had the PA degree been a 4 yr program I probably would have gone that route. Bottom line~~what do you want to be when you grow up? A great nurse is not unlike a great teacher, underpaid, under respected, both with the potential to affect many lives. A great PA is also is also underpaid, under respected, but is more like a Leiutenant in the military~both strong and effective.
    All in my humble opinion~~Good Luck!

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    Some people look better with their clothes on!
     
  10. BD

    BD Member

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    They're(NP and PA's) both "rip-off's" to the american public. Hey ,lets play doctor even though we haven't gone to medical school and we "don't understand the nity-grity of complex pathophysiological processes". That's o.k. ,we can learn as we go. I think that sums up the PA and NP professions. You wonder why docs get pissed- there is your reason.These people are out there treating pt's with only 1/4 of the education a Dr. has and yet they have the audacity to want autonomy.They go to school for 2yrs and then are practicing( don't count college!)meanwhile the DR's are going for 7-10 yrs before practicing; do the math. The problem is not what NP's and PA's know ,it's what they don't know that can kill someone if unsupervised.It really is sad to see the public getting screwed by people who just want the quick bucks w/out having to actually earn them.
     
  11. BoonDoc

    BoonDoc Member

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    BD,
    Do your research. NP and PA have MANDATORY hands on health care experience before they are even considered for their respective schools.
    Second. I have been seen by far more PAs than MDs. I have ALWAYS found them to be competant professionals.
    Get off your rocker.

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    Walking is man's best medicine.
    -Hippocrates
     
  12. BD

    BD Member

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    to boondoc, you need to do your homework.PA's do one yr of didactic work and one yr of clinical rotations.You cannot count that one yr of clinical rotations as "true" clinical experience; only a moron would do that.One more thing ,you say that you have seen more PA's than doctors and that they're competent.You missed my point, these PA's and NP's are using "you" to "learn as they go".2yrs of schooling is not ,nearly, enough to be out there practicing medicine;particularly when they didn't attend medical school. How do I know this , because I'm a 4th yr med student and although my ego would say "I'm ready now" , I know that I'm not. There is still,after 4yrs, much to learn in residency. Again, these people have 2yrs and no residency and yet they see pt's as though they were doctors.That is ,my friend, practicing medicine without a medical degree and is fraud to the american public.I do believe there is a place for PA's and NP's but it should always be under the supervision of a doctor and I also think they need more training before they actually treat pt's .Now you may feel they are competent but just "do the math"( 2yrs vs 7-10 yrs), it does add up. and by the way ,you have been lucky that the PA's ,you have seen, have been "competent".
     
  13. BoonDoc

    BoonDoc Member

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    BD,
    Yet again you missed the point.
    PAs and NPs have YEARS and YEARS of health care experience before they start the two year program.

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    Walking is man's best medicine.
    -Hippocrates
     
  14. Neurogirl

    Neurogirl Resident Extraordinaire

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    BoonDoc

    BD is correct. I too am a 4th year med student and have had the opportunity to work with a number of PAs and PA students. While the majority have been very skilled and knowledgeable, their knowledge base IS limited and pales in comparison to even 3rd and 4th yr med students. Also, most DO NOT have years and years of health care experience before they started their training and even if they did, it wouldn't have been the kind of experience useful in the practice of medicine.

    The problem is, "PAs and NPs don't know what they don't know". During recent senate hearings on pending legislation regarding prescribing rights for non-physicians, a physician (previously a NP) testified for the AMA. She (sorry, I don't remember her name) stated that prior to med school she truly believed that she was knowledgeable enough to prescribe independently. After med school the felt differently. She said she had NO IDEA how deficient her knowledge base had been. In short, as a NP, she "didn't know what she didn't know".

    While the professions do have their place, there is a reason why they are and should always be supervised by a physician. Just what do you think we're doing during those extra 6-8 yrs...twiddling our thumbs and drinking coffee?!?!?!? No! We're learning how to distinguish the benign from the malignant. Although your experiences with PAs have been positive, I doubt you've ever presented with unusual or complex pathology.

    Like BD, I know that even as a 4th yr, I am FAR from ready to actually function independently. At this point I realize just how complex the practice of medicine can be and am grateful that I have another 4-6 years to become a competent physician.

    Please do not misunderstand. I DO NOT believe that PAs and NPs are a "rip off" and think that BD was being a little harsh. However, those who believe they are equal to physicians are deluding themselves. No matter how you slice it you CANNOT cram 8-10 years of education into 2. When physicians get upset about prescribing rights for non-physicians, PAs and NPs automatically assume it's a turf issue. They don't realize that physicians are just trying to protect patients.



    [This message has been edited by Neurogirl (edited 12-17-2000).]
     
  15. BoonDoc

    BoonDoc Member

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    Neurogirl

    Thanks for the insight. My experience with PAs has been in the Army. I can honestly say that they are very competant with thier knowledge of medicine.
    On the civilian side, I can understand how a PA with only 2 years of training could be dangerous prescribing drugs.

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    Walking is man's best medicine.
    -Hippocrates
     
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  17. BD

    BD Member

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    thanks neurogirl. Yes, I was a "tad" harsh when I said that "they" were a "rip-off" but I was trying to make a point. My point was when patients go to the doctors ofc., and the key word is doctor, they expect to see a doctor. I've seen NP's and PA's wear long white coats ,stethoscopes around the neck and they were letting pt's call them doctor without correcting the pt. . These same professionals were also giving some bad Dx's and misinformation to these pt's
    and the pt's were ,completely,unaware because they were feeling secure with the "doctor's" Dx.; thank God we picked up on these mistakes.This is a dangerous trend that is going to continue as long as NP's and PA's push for and try to win, their independence. Let me reiterate, I believe there is a place for these professionals, and this place is under the supervision of a "real" doctor.Forgive me if I was harsh.

    [This message has been edited by BD (edited 12-18-2000).]
     
  18. rdennisjr

    rdennisjr SDN Super Moderator
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    BD: Please Please Please research a topic before you spout off with unprovable, unrealistic, and clearly uninformed rhetoric. Now, before you get to upset, let me agree with you on one thing. Anyone (physician, PA, NP, EMT, Architect, secretary, garbage collector...) who attempts to either a: pass themselves off as something they are not, or b: believes that their title gives them the authority to speak inteligently about any other subject is just plain wrong. Any PA/NP (two completly seperate professions, and both mid-level providers, not low-level,) who pretends to be a physician is in the wrong career and does not represent the vast majority of the members of that career field. I don't think any practicing and intelegent mid-level provide would argue with you over that.

    Now, first, only a small portion (as in a few individuals, not the vast majority as you imply) of PA's wish autonomy. Those folks are probably in the wrong career. The role of the PA is to provide competent care within their perscribed limitations within their relation with a physician. Rx's, image analysis, histories, advanced procedures, suturing, etc. They are also highly trained to know when to say when. The critical decision within every patient contact for them is whether they can treat that patient or whether they should be forwarded to the attending. Doesn't sound to me like the way to search for autonomy. Do the PA's get autonomy. Sure - the doc doesn't hang over their shoulder on every patient. That's not the point. The point is that this makes for a strong, efficient, and quality team. If the point is who gets to make decisions, does that mean as a doctor you will supervise every injection, every action, every comment that gets made to every patient you ever see. Of course not. What about if you decide your patient needs some advanced surgical procedure - hmmm, just 'cause your the doc I guess you can do any type of surgery you wish - no need for specialists. Okay - key point - PA's and Physicians work as a team - if not, then they aren't PA's. They are doc wanna be's, and I don't know of any PA's that will gladly claim that title.

    Next point - apparently you believe that the only way to learn any medical skills is med-school. Guess what bud - wrong. Or do you honestly believe that all of the paramedics, EMT's and other pre-hospital care providers are just stretcher haulers? If so, I think a bit of real-world experience will do you wonders. That or go get your MD and volunteer to ride around doing street work for the rest of your career. Speaking of pre-hospital folks. A very high percentage of PA/NP are experienced pre-hospital care folks. So since you seem to think that PA rotations are of no value (not sure why - can you explain what your argument is by the way?) that isn't going to be that PA's first IV start. Let's see now - new doc, first rotation - hmmm...oh yes, gee, first IV start ever, huh? Oh no, did some in Med-school. This is number 15 now. Well tell you what - the PA/Ex-paramedic who has done around 5000 of them will do this one since it's a bit tricky. Okay - 'nough harping on that one.

    One last comment that I don't understand. You criticize the PA/NP for 'practicing on a patient'. Tell me - how do you do your training? Practice on dogs? What do you think training hospitals are for. Clearly not the training of physicians I guess.

    Anyhow - the point is. PA's don't want to be docs. If they do they should go to med school. Doc's don't want to be PA's. If they do they should go to PA school. In fact many PA/Physicians train with the same instructors at the same schools to the same standards. In anycase, I realize I won't be changing your mind here. Just remember the next time a head nurse comes up and says, hey doc - I'd recomend....whatever. You might want to listen. It's a health care team and you are going to have the most training - and the least real world experience. So work and listen well.
     
  19. BD

    BD Member

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    to rdennisjr, I don't know where you have the nerve to criticize me,saying that I'm unrealistic .Everyday ,BOZO ,I go to work at a hospital( you know what a hospital is ,right?)so i don't have to research anything; I see it every day. If I were you I'd do my homework. NP's and PA's have been trying to lobby for legislation to be passed so they can have more practice priviledges and advance their scopes of practice so it is you ,my condescending friend, who should get their head out of thy ass!.
    pt. 2 you also have a nerve comparing a resident doctor to a PA. let me explain something to you, one is a doctor the other is someone who is not ..and as far as your idiotic examples ( I love that one about the surgery-get real )As for the" I'm just a supid intern ,let me move out of the way so the PA can save the day by putting in an IV again- get serious.
    pt. 3 Yes I did say NP's and PA's are "learning as they go" .2yrs of schooling and they're out practicing "so-called" medicine and most are not practicing at training hospitals..like residents who hold medical degrees- you see the key is the medical degree( you keep missing that key point). let me also inform you of something that you said " PA's don't want to be docs, if they do they should go to med school" You don't just go to med school , you are given the priviledge to go so try not to trivialize that process. I ,also ,do not think that the only place to get medical training is in med school and I did say there was a place for NP's and PA's .Let me also explain to you that contrary to what you might think ,not all PA's have medical experience before going to PA school and as far as rotations are concerned ,they are only there to get a student's "feet wet".One last thing, before you go spouting off about real world experience let me let you in on a little secret ... in medical school ,you do 2yrs of rotations in hospitals and private offices so I have a liitle experience as to how things work and in 5mos I will have a medical degree, what will you have Mr Experienced one who is telling me how it is?

    [This message has been edited by BD (edited 12-18-2000).]
     
  20. BoonDoc

    BoonDoc Member

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    I want to reiterate Dennis' point.
    As army medics, we go through ATLS and ACLS certification bi annually. When it comes to actual hands on procedures, the "medical school" training that the doctors have, do little or nothing to help them through the ATLS testing. In fact the visiting docs usually get pissed off when a couple of NCOs are able to run circles around them in a trauma setting.

    But, wait, how can that be? We didn't go to medical school. We only have one year of medical training.

    My point is this. Don't put so much weight in medical school. You become doctors with experience, not by putting a MD after your name.


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    Walking is man's best medicine.
    -Hippocrates
     
  21. rdennisjr

    rdennisjr SDN Super Moderator
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    BD: As stated, I obviously am not going to change your opinion. However, just as a sugestion, remember you are a part of a health-care team. Team - not individual. Life will go much easier for you if you learn to work with your team-mates. Use your partners to your benifit. As it is, you appear (not saying you do, just that it is coming across as you do.) to have the God complex running out of control. Ask any physician after they have spent a few years being a doctor - and no, rotations don't count - you are not the final decision maker during that time which appears to be one of your key points. They will tell you that some of their best learning came from nurses, PA's, techs, and perhaps most importantly - patients. A majority of what you went through med school for is essentially trivia. Nice to have but not really related to your real-world work.

    Perhaps the biggest lesson you can learn from re-reading your post is your need for anger/agression therapy. Name calling and searching for ways to build yourself up or put-down the person you have a disagreement will do you no good in the real world. Just because someone doesn't go to med school doesn't mean they can't. I have no fear that I could attend med-school anytime I wished. I will stack my GPA, MCAT, GED, masters degree and my medical experience (you asked - 7 years in the medevac business - that's in the streets, in 2 different combat zones, fire departments, and yes even hospitals doing real-world, hands on assesment and treatment. Never claimed to be a doc - only a team-mate of one.) I chose not to go to med school to allow me to spend a bit more time with my family rather than yet another 7 years in school. Does that make me different than a doc - yes of course. Do I understand that I'm not a doc. Of course. Am I less than a doc in any way. Nope. Just not a doc. I have several friends that are docs. I know what it entails.

    Point is: grow up. Work with your team-mates - your not god. If not, well I feel for your patients and co-workers.
     
  22. BD

    BD Member

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    To boondoc and rdennisjr,once again I have to explain for you (since you missed the pt AGAIN!).Yes, PA's and NP's are part of the healthcare team but when they ,themselves, decide that they should become independent(which has been the whole pt to this argument)that's is when people like myself and others say enough is enough .Don't tell me that this is a minority movement amongst PA's and NPs. It is going on all over the country and they have been to ,not only ,state capitals but also washington fighting for their "cause".And let me reiterate something neurogirl said, "NP's and PA's don't know what they don't know" ;This is the essence of the argument.And let address some of the things you have brought up: 1. you didn't choose not to go to med school, you chose not to apply- there is a diff. .2. med school is where you lay your knowledge foundation and is not , as you say,"trivia"; You really trivialize the medical degree but only those who haven't a clue ,would say something like that( again NP's and PA's don't know what they don't know!)3.Let me explain something to boondoc,There is a hell of a lot of training than just trauma in med school(any monkey can start a lidocaine drip) and contrary to what you stated ,my school does teach ACLS throughout all 4 yrs of med school so any time you want to discuss algorhythms and TX for MI ,V-tach or VEA..etc.. I'd be happy to and if you want, we can even discuss ecg's or pathologies and physiologies of CHF,ARDS,liver failure,ARF,strokes,TIA's, lateral medullary syndrome etc...oh wait, you don't know anything about the path and phys.; so come down off that cloud( again -you don't know what you don't know). pt 4. Medicine is much like (to use something you guys can relate to )the military.In order for a unit to be combat effective ,every soldier, from the generals and CO's down to the NCO's and privates, have to perform their jobs to function as a "team". Yes ,they work as a team towards the common goal but there is a chain of command.In the end , it is the generals and CO's who make the final orders and battle plans not privates and NCO's( and yes, they do work as a team).Medicine is the same way. Do I think that I'm better than you? no . Am I ,as a DR. ,going to be above you ? yes. It is not that I think I'm God and it is not my ego . I think it is your ego that is the problem here- you can't handle the fact that someone is "outranking"you . Truth, sometimes, hurts but it still is the truth. So when you say you are not a DR. but you're not less than a doctor- you are wrong, you are less than a DR. but not in terms of who is better than whom, just in terms of education and knowledge.

    [This message has been edited by BD (edited 12-19-2000).]
     
  23. rdennisjr

    rdennisjr SDN Super Moderator
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    OKay, I can't believe I'm even trying this again, but after carefull review of all of the posts I think I need to.

    1. Your right - PA's and NP's aren't docs.

    2. Your opinion and mine vary on how many of the mid-level folks want autonomy. I think few, you think most or all. I agree - complete autonomy isn't the right thing. NP's do have autonomy in many states already however.

    3. I'll admit what I said about trivia could be interpreted wrong. Obviously what you learn in med school is important. However, please admit that a large majority of what you have learned will never come into play again and in fact will be poorly remembered. Will you remember every step of every process of everything. Of course not.

    4. Another poster made the good point - PA/NP's don't know what they don't know. Good point. Not complete however. Add MD/DO to that list also. How can you even begin to tell a PA that they don't know something - if you haven't been through there program yourself? Perhaps you may not know everything you think you do.

    5. Leadership - since you use the military anology - a good leader knows the abilities and limitations of not only themselves, but their soldiers. So far in this discussion, you have seemed to only view the limitations of others - not their abilities, or perhaps your own.

    6. You claim pa/np know nothing about patho/phys? I think this again falls under - MD's don't know what they don't know. Hmmm...

    9. At least once the dreaded - the PA was doing the worst possible thing and thank-god the doctor was there to save the day - speach was brought up. Guess what - it might even be true - PA's ddo make mistakes. Guess what else - doc's make mistakes also - on a regular basis. Why? Because both are humans.

    8. Next time you have a disagreement with someone - on a professional level, which is the level I would imagine you would prefer to discuss at, I would recomend you refrain from name calling. It really does make you look childish.


    Key point since I'm rambling again. I think actually we agree on the key point - complete autonomy is not what the NP/PA role is about. They are there to act as part of the physician-lead health care team. The disagreaments have been on attitude, intent, and childish behavior. Perhaps this can still be turned to a more interesting discussion - such as - how can the public be educated about the now-common PA/MD relationship.

    [This message has been edited by rdennisjr (edited 12-19-2000).]
     
  24. BD
    I have to tell you, you really have embarrassed yourself here. You clearly feel threatened by something you need not fear.
    First-- I was a paramedic for 10 years.
    second-- I am a NYS lic. PT
    Third -- with all of my education, including a masters in PA. I have been in school for 6 years.
    fourth --I am now applying for a surgical residency.
    As a PA, my service is to the patient. Having a TRAINED professional to lighten the workload around a hospital and assist in surgery is as valuable, if not more so, than having another MD on staff. (and not just because of money). No one is calling for the lines between PA`s and MD`s to be blurred. That is all in your head. You have embarrassed yourself into looking as foolish as some activist with an uninformed opinion. I would also submit to you, without the use of names like Bozo, that dispite where you sit in your training, that I would provide a higher level of care to a patient. I feel that it is people like you in the health care field that are the true threat to the patient. If they are getting ripped off by anybody pal--it is your attitude. I suspect that if you made it this far, you are only a few years away from maturity. When you get there, let us know so then we might forget this nonsense and have an adult conversation.
     
  25. skullcrusher

    skullcrusher Junior Member

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    I think PAs are valuable for what they are used to do...which is lighten the load for the docs by taking the less complex cases and increase efficiency towards patient care. However, make no mistake about it, whether you like it or not, you're underneath the physician...isn't that why they call you guys assistants?? oh I'm sorry associate..give me a break i'm lmao!!!! I'm looking forward to seeing all you army PAs...because you're gonna have to salute...there's an officer in the room..hahah

    [This message has been edited by skullcrusher (edited 12-23-2000).]
     
  26. skull
    Clearly you are not getting it. Only a the intellect of a child would contribute to this conversation with a reference to hierarchy. You would comprimise human dignity for a fleeting power feeling? I really feel badly for you. Once you grow up, and I am certain you will, please contribute with something more than rhetoric.
     
  27. tman

    tman Senior Member

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  28. Nurse2Doc

    Nurse2Doc Senior Member

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    EBETH~I was responding to your post and your questions, unlike some of the other posters who take every opportunity available to them to rant and rave. These boards never cease to amaze me. Feel free to email me if I can help you in any way. Guys~~GROW UP!(preferably sometime BEFORE you graduate from med school and become a doctor)
     
  29. goingback

    goingback Member

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    Alright already guys! Are you forgetting something here; the fact that both jobs of PA and physician are very important and the people who pursue those careers should be very compassionate, easy to get along with and have the ability to work well with a team. Please stop commenting like you know what each positions are all about because they are different. I am a mother of two and I just love it when all the people who tell me what I am doing wrong or how I should raise my children that don't even have children! And when they assume that I am home most of the time with my children I sit and watch the tube all day. They should try having two children 17 months apart and I bet they wouldn't be sitting down for too long. Actually, I know they wouldn't. They don't have a clue what it is all about and the same goes here.

    Boy, I have been debating on this issue of PA or going to med-school. You guys are putting a damper on both career choices. I hope that when I become one or the other one of these days I will have a wonderful team to work with. AND if I decide to go the PA route I don't want to be labeled a doc wannabe because I will have gone the PA route because of personal decisions (like going to school yet still being the best mother and wife I can be). I just want to help people and that is why I am looking into both of these careers.

    I am just wondering; if I decide to become a PA are the physicians going to label me a doc wannabe? What a shame if so because all I will be trying to do is help others. I don't have to have the MD after my name to accomplish that.

    On the other hand, yes I do have another one, if I decide to go the med school route it is because I am a leader and have been most of my life. Yet, I would never ever make someone that is on my team feel inferior in any kind of way. And if they ever offered there advice you better believe I would listen.

    Finally, I admire both of these professions and they deserve much respect and gratitude. But so does the rest of the team from the nurse, nurse assistant, EMT, and so on. Soooo, please stop the argueing. Thanks and God bless you all who are pursuing these careers!
     
  30. goingback

    goingback Member

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    Alright already guys! Are you forgetting something here; the fact that both jobs of PA and physician are very important and the people who pursue those careers should be very compassionate, easy to get along with and have the ability to work well with a team. Please stop commenting like you know what each positions are all about because they are different. I am a mother of two and I just love it when all the people who tell me what I am doing wrong or how I should raise my children that don't even have children! And when they assume that I am home most of the time with my children I sit and watch the tube all day. They should try having two children 17 months apart and I bet they wouldn't be sitting down for too long. Actually, I know they wouldn't. They don't have a clue what it is all about and the same goes here.

    Boy, I have been debating on this issue of PA or going to med-school. You guys are putting a damper on both career choices. I hope that when I become one or the other one of these days I will have a wonderful team to work with. AND if I decide to go the PA route I don't want to be labeled a doc wannabe because I will have gone the PA route because of personal decisions (like going to school yet still being the best mother and wife I can be). I just want to help people and that is why I am looking into both of these careers.

    I am just wondering; if I decide to become a PA are the physicians going to label me a doc wannabe? What a shame if so because all I will be trying to do is help others. I don't have to have the MD after my name to accomplish that.

    On the other hand, yes I do have another one, if I decide to go the med school route it is because I am a leader and have been most of my life. Yet, I would never ever make someone that is on my team feel inferior in any kind of way. And if they ever offered there advice you better believe I would listen.

    Finally, I admire both of these professions and they deserve much respect and gratitude. But so does the rest of the team from the nurse, nurse assistant, EMT, and so on. Soooo, please stop the argueing. Thanks and God bless you all who are pursuing these careers!
     
  31. jdaasbo

    jdaasbo Senior Member

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    wow,

    This is a lot of emotional stuff here.

    Let say that I am a third year medical student. Our school also has a PA program. Our PA program pretty much has separate classes from the medical program. I know for a fact that the duration, content, and depth of the PA program is less than that of the medical. This is ok, is not meant as an insult, just the truth.

    I have mixed feelings about PAs and NPs, to tell the truth (ie some good and some bad).

    Here is what I see in the health care market:

    1)As the healthcare pie is shrinking, people, HMOs, politicians, etc are searching for cheaper ways to provide healthcare. In many instances NPs and PAs are being used (or actively seeking) to fill the financial gaps by providing healthcare at a lesser cost: they have lower salaries, cost medicare less to train because they have no residencies (for the most part), and have much lower malpractice insurance costs (which in the end are rolled over to the customer(read patient)). This last point is due to the fact that these midlevel providers are under the "supervising physician's" malpractice insurance. (something that physicians are starting to realize is that these providers increase the doctors liability-there was a neat article on this in Medical Economics a few months back).

    2) As the Healthcare cost is shrinking, PAs and NPs are competing for the same healthcare dollar with physicians more and more. This is most evident in the primary care field, but it is also evident in specialty fields too. More about this later.

    3) In some cases, Managed Care is purposely trying to blur the lines between physician providers and non-physician providers. A case in point: Kaiser in San Diego (or perhaps some other West Coast city) two years ago started having all their docs, NPs, and PAs in the primary care setting wear the same name tag which read "Health Care Provider Smith (or Johnson)." It is in managed care's interest to decieve the public as to who is a physician and who is a PA, NP as the latter cost less to employ.

    4) In some cases, the nursing profession is certainly trying to lobby for complete autonomy (ie no physician supervision). There are two very good examples of this that come to mind: 1) Bill Clinton this past thursday signed a bill which effectively allows CRNAs (nurses who specialize in providing anesthesia, traditionaly under the supervision of physician gas passers) to practice anesthesia unsupervised for Medicare patients. This law allows CRNAs to provide anesthesia completely autonomously (ie no surgeon supervision, no anesthesiologist supervision, no anybody supervision). The American Society of Anesthesiologist has been fighting this tooth and nail with the ANA, and has lost. The future of the specialy of anesthesiology is seriously in question as the nurses cost less to train, are cheaper to employ, etc. University of Pennsylvania published a study in which they compared nursing anesthesia to dr. anesthesia and found a 28% higher on the table mortality and a 21% higher 60 day mortality for the nursing group for medicare patients. Hmmm. 2) another good example of this is Columbia school of Nursing in NYC has two health clinics which are entirely staffed by NPs and has NO physicians. They are practicing autonomousy TODAY. These clinics are part of a Columbia HCA study underway.

    So here is what I see: while in the clinical day to day setting, PAs/NPs and Physicians get along great together and are effective as a team, both groups are spending millions and millions of dollars battling eachother over practice rights and priveleges. The AMA is fighting the same battle with chiropracters, psychologists, and optometrists by the way. Lots of money is being spent on this and it is all over the newspapers.

    So not to be too long winded here, here is my opinion on the whole thing:

    1) a little knowledge is a dangerous thing. It is hard for anyone to asses what you don't know. And when you mess up, it is to the patient's detriment. If you were having surgery, wouldn't you want the person with the most experience and most training at your side?

    2) Fully trained physicians (at the attending level) definately have much more training than PAs and NPs (who have completed all of their training). If you disagree, you just need to look at the math and don't forget to look at the hours per week invested in each year of training.

    3) NPs and PAs that want to practice independantly, then they should have their own DEA numbers, their own medical licenses, and their own malpracice insurance instead of piggy backing on the supervising doc.

    4) In my opinion it is a reality that many PAs and NPs do practice autonomously.

    To end this diatribe, let me say that I do not think midlevel providers should be independant. I think that they should practice under close supervision only (ie the doc in the office, NOT 40 miles away at another clinic). I also think that anesthesia should be practiced only by anesthesiologists and that the difference between NPs, PAs, physicians and all others in the healtcare field should be emphasized rather than purposely blurred.


    Phew

     
  32. TheWizard

    TheWizard Junior Member

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    BD:

    As an attending physician of 4-years who was a mid-level practitioner for 6-years, I am here to state unequivocally that you are so far out in left field that I am embarrassed for you and our profession. You are mistaken on so many levels I can't even begin to address them, nor do I wish to.

    Your arrogance and narrow-mindedness are only surpassed by your lack of true information. Unfortunately, this kind of elitist & know-it-all mentality is all too common amongst many medical students. Your generalizations and assumptions clearly demonstrate your lack of clarity on the topic of mid-level practitioners.

    The irony that rings out here is that you have quoted on numerous occasions that PAs & NPs do not know what they don't know, when the truth is that this statement applies to you more then them.

    Maybe after you are an attending for a few years you will get a grip. Until then, stay in the back seat where you belong with your eyes & ears open and your mouth shut.

     
  33. Heart-Nurse

    Heart-Nurse Junior Member

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    hey...hey...hey...the whole "dispute" about the PA/NP thing...i'm only an RN and i'm about to pass out 1.0 mg Xanax po q 4 hrs prn...oops...i guess i'm out of MY scope of practice...hehe...let's just lighten up a bit..everyone is entitled to their opinion. This is just MY opinion...i'm about to graduate w/ my BSN in May...I am not fulfilled w/ nursing. I want to go to medschool...maybe i've come to the conclusion that i would like to become a dr. instead of a FP...i'd rather spend the extra years doing something that I WANT instead of going on for a FP license and not being fulfilled. I do understand that being a FP or a PA is NOT the same as an MD...so i got the point!!
     
  34. jdaasbo

    jdaasbo Senior Member

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    What happened to having an intelligent discussion? One in which people used logic to back up their opinion instead of personal attacks.

    Mr. Wizzard, BD one day will be driving the car in which he is now backseat captive. Perhaps time would be better spent educating him rather than beating him up verbally. (That goes for you too BD).

    This is a profession so let us afford eachother at minimum cordiality.
     
  35. TheWizard

    TheWizard Junior Member

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    Listen guys, I realize that everyone just wants everyone else to get a long, and I strive for that too despite my last post to BD. Sometimes, however, people need to be slapped upside the head and told to wake up. I tried to do that in my last post to BD. I doubt that it will do any good just as I doubt it would have done any good for me to try to educate him. This is evident by BoonDoc's and rdennisjr's valiant attempts to educate.

    I apologize for the hostile words. I just can't stand to see that kind of "slamming" by someone who really doesn't know what they are talking about. And by the way, this is not about opinion, guys. He doesn't have any significant background to have formed an opinion that justify his generalizations and conclusions about the entire profession. What he is doing is pontificating. Maybe its because he's a med student and like many (not ALL) med students, he thinks he knows more than he does.



    [This message has been edited by TheWizard (edited 01-30-2001).]
     
  36. tuborg

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    I would like to get some feedback from people that are in practice or with experience.

    What is the most important factor between a PA and his physician supervisor and why ?

    How does a PA fit into the healthcare model?


    Can you tell me some of the issues PA's are/ will be facing in the future?


    Why did you chose PA over a physician or, NP?



    What are some of the limitations: prescribing medications/ or other limitations for PA's in NY state?


    What is the difference between Bachelors in PA to Master's in PA and how does that affect you when looking for a job after graduation?


    What do you think are the three most important aspects in evaluating a PA program?


    Thanks


     
  37. zenman

    zenman Senior Member

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    Just for the record, all health professionals "learn as they go." I have helped train residents and they have trained me. I've helped specialists track down a book so they could look something up. Last week, I was talking with a FP doc about heart blocks and she said she needed to pull out her EKG book and start studying again. She has been out of school about a year. Much of what you learn is forgotten and I've had a good laugh with some docs about what we all forget if you don't use it everyday. It's just a fact of life. It's all "learn as you go."
     
  38. zenman

    zenman Senior Member

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    I wish we all could do more since our healthcare system is now one of the leading causes of death.
     
  39. zenman

    zenman Senior Member

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    What's ARMY medic training like these days? I was a 91C back in..cough, cough...1972.
     
  40. chimichanga

    chimichanga misunderstood

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    wow, old thread...

    BD must be an attending by now...

    I'd like to see what his thoughts are now...
     
  41. guetzow

    guetzow Senior Member

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    1) Rapport (Remember: You are also interviewing Them). This speaks to working conditions, reimbursement (Hashing out a contract), and any and all future references.

    2) A PA Practices Medicine, and is a valuable Revenue Generator (Unlike ancillary staff and administrators)

    3) Reimbursement will always be an issue (Even with docs), and may or may not change in the future

    4) TONS of healthcare experience, coupled with a desire to write orders, but not spend six years to do it (NP considered too limited in regards to specialties, though that has been changing. Additionally, I was not a nurse. Hmmmmm...2 years vs 6 ~ No-brainer)

    5) AAPA has a list for that. Generally, I've found that folks in states with prescribing limitations tend to choose specialties heavier in procedure$ (It all balances out. For example:I make six figures in Tx, where I can't write for schedule I/II narcs, but do many procedure$. Previously, I worked in KS, where I 'Could' write for those schedules, but made much less in a less procedure-heavy specialty)

    6) NO difference between Masters and BS, though "Other" people, i.e.- recruiters, head hunters, and many Docs (Esp younger ones not familiar with PAs) do not know that. Hence, it may affect your marketability.

    7) Unless you are hell bent on attending one of the top few schools (i.e.- will uproot yourself and have tons of money to do it), in general, the three most important things are: Age of the School (> 20 years is good), Cost, and any post graduate job placement services they may have (Though, that is also related to Age of School, i.e.- capacity for good Networking)
     

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