I agree with essentially everything emedpa posted. A couple clarification points: much of it depends on your state regulatory boards what you can and cannot do as a PA or NP, so look at that. As an NP student you cannot "work" as an NP, not until you are licensed as an NP. You can always work as an RN, which is your pre-requisite profession. The NP certification is a rider on top of the RN license. Gives you flexibility for an extra "RN" day here and there for the nice agency ICU cash, but I don't advise it since you are always held to the highest level of your education for liability purposes, but you cannot function as an NP when you are picking up an RN shift. So same liability without the ability to write any orders, only alert the main medical provider... you see it can get sticky.
You have to watch this. Depending on the state you may be held to the standard of an NP and there are a number of NP's that have been sued over this. Some of the hospitals are reacting to the increased liability.
I fully agree the PA training is better. I guess the theory is that the NP training is supposed to be in addition to your RN experience already held. But a year or two out and you can't see the difference in PA vs NP in the same arena, my experience. A lot of docs give us a good deal of respect in our role (we are NOT trying to be physicians), and value in the team, but some don't. Anyway, emedpa is also right in the specialties. If you want surg then go PA. Though emedpa is not entirely correct in the setting. Our ACNPs are trained specifically for an acute care role, in the hospital and ICU. The FNP or ANP or even GNP, PNP, and PsyNP can see patients in the hospital or clinic. It is not the setting that determines scope, it is the situation being treated, and the type of patient (age, gender, ailment, acuity, complexity). Just like a Family Physician can see their hospitalized patients, even though they are not specifically Internal Medicine or whathaveyou. The shape of our scope practice is the same as that of a physician in the same field, only our scope is not as broad or as deep.
Once again it depends on the state and hospital. One thing that you have to remember is that you are limited by your NP certification to what you can see. FNP can see everyone but ANP cannot see peds and vice versa. In my area we are seeing new FNP's denied hospital credentials since they have no training in inpatient medicine as NP's. You also have to watch out for certification issues. For example state law may allow ACNP's to see FP patients, but ACNP certification only applies to urgent care or inpatient. Also certification requires an ACNP to work within their certification (see the circular logic here). Overall outside the FNP, NP degrees are more limiting than PA degrees which are essentially tied to their physician.
I don't know how a PA feels just out of school, but I tell you I felt grossly undertrained and undereducated. It sucked. I had to rise to the challenge in a major way, and read my butt off on every diagnosis when I came across it, even if it was simple stuff, just so I had it down cold the next time around before I started writing for a bunch of labs and meds. As an FNP I have been working as a hospitalist for a year and a half. I work in acute care, ICU, LTACs, take pager-call... I was an employee for a bit but after developing a good reputation with physicians who saw that I do a thorough job, am conscientious, caring, can handle complex patients, always keep them in the loop and ask clinical questions/guidance, and set firm boundaries on my scope limits of what I will see or not see and who I expect them to see in addition to my visit, and when I will just defer the entire case over to them and back out. After gaining a good rep then I became an independent contractor, and now I will see a docs patients for him/her a day or two each week for a fee. That gives them the weekend off, or nights free of pages, or a weekday off. I either charge per pt/progress note, or a flat rate for a day. I submit my billing to them, and they submit the billing to insurance. They have to cosign my notes and briefly visualize the patient in a certain period of time, for facility policy and billing at the doc rate reasons.
Umm you realize that this billing arrangement is probably not kosher. You cannot have an MD bill for you for medicare. For them to bill they have to see the patient the same day and partipate in care. They also have to be in the same practice. I actually haven't looked at the independent contractor rules. I guess it would depend on the state.
Anyway sorry for the digression, my point is that your decision depends on how you view your career structure. All that being said, I had to go back to pre-med stuff since I need to know more, and want to do more clinically. My RN/NP pre-reqs are not conducive to medschool, but PA pre-reqs are a bit closer to those required. So a big step back for me to go forward... if MD/DO might still be a future for you, then go PA.
