PA or NP?

[JakeSill]

Which job out of the two can make me the most money? Short-term? What about in the long run?

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[deleted6669]

if $ is your only criteria, the answer is CRNA or AA

 

[Boatswain2PA]

If money is your goal, then become an investment banker, or hospital administrator.

 

[762513]

Electrician. Don't do it for the money.

 

[Panteleimon & Nightingale]

No, no, and no. Just no. You have to be a nurse for several years before applying to NP school, and sometimes that entails at least 2 years of critical care experience for a solid knowledge base. A PA can come from any background with the right grades and science courses under their belt, but they are problem solvers with a passion for helping people. But, it is not keen to go into a field just for the money. We're dealing with lives here. You have to want to help improve the quality of life for people just as much as you want a sustainable income. If you're doing it for the income alone, you may want to pick a more selfish route, like administration, or an investment banker, as stated above by the previous responder.

I've chosen NP because while I want a little bit more compensation, --I also have the hope of improving healthcare for the people I serve. If I did it solely for the money, --I would have chosen another job with less stress.

 

[762513]

Unfortunately there are a direct entry programs out there that don't require any RN experience. It's unfortunate, but its there.

 

[W19]

No, no, and no. Just no. You have to be a nurse for several years before applying to NP school, and sometimes that entails at least 2 years of critical care experience for a solid knowledge base. A PA can come from any background with the right grades and science courses under their belt, but they are problem solvers with a passion for helping people. But, it is not keen to go into a field just for the money. We're dealing with lives here. You have to want to help improve the quality of life for people just as much as you want a sustainable income. If you're doing it for the income alone, you may want to pick a more selfish route, like administration, or an investment banker, as stated above by the previous responder.

I've chosen NP because while I want a little bit more compensation, --I also have the hope of improving healthcare for the people I serve. If I did it solely for the money, --I would have chosen another job with less stress.

Not remotely true

 

[Sgàile]

Unfortunately there are a direct entry programs out there that don't require any RN experience. It's unfortunate, but its there.

Exactly. How can one be advanced practice in a profession they've never practiced?

 

[pamac]

PA programs and medical schools also churn out grads who have little or no previous HCE. In the case of physicians, they have huge knowledge base and residencies, but I'd have an easier time finding a PA school that has no requirements for healthcare experience than one that has even 2 years of required RN level professional HCE.

Direct entry NP programs are rare, and very expensive. Most of them offer the RN up first and encourage work in that field while you do the next phase, which is better than nothing, though still not ideal. I think NP school can be a lot better, but I don't think that answering call lights and passing meds directly applies to being a great provider, but that's the majority of what a typical med surg nurse does. But ideally, NP school would be more robust so folks didn't have to hope that a new grad NP would have to rely on RN experience to make them more competant to be an NP. I'm in NP school, and I'm not interested in taking more fluff classes, but here I am writing papers and citing poor quality "nursing research" because my professors require it.

 

[W19]

Below is the curriculum of Nova Southeastern PA program. This is close t0 med school without residency IMO. I rotate with PA students and I think they are capable and smart students. I don't get why people think PA and NP are interchangeable. Their education is superior to that of NP.

Didactic Phase
Anatomy (5)
Microbiology (3)
Clinical Behavioral Medicine (3)
Life Support Procedures & Skills (3)
Physiology (3)
Legal & Ethical Issues in Health Care (2)
Interpretation & Evaluation of Medical Literature (2)
Clinical Procedures & Surgical Skills (5)
Clinical Pathophysiology (3)
Pharmacology I (2)
Pharmacology II (4)
Health Promotion & Disease Prevention (2)
Physical Diagnosis I (3)
Physical Diagnosis II (3)
Physical Diagnosis III (3)
Core Competencies (2)
Medical Terminology (1)
Clinical Medicine & Surgery I (7)
Clinical Medicine & Surgery II (8)
Clinical Pharmacology (4)
Biomedical Principles (1)
Clinical Laboratory Medicine I (1)
Clinical Medicine & Surgery III (7)
Clinical Genetics (2)
Introduction to the PA Profession (1)
Electrocardiography (2)
Clinical Laboratory Medicine II (2)
Complementary Medicine & Nutrition (2)

Clinical Phase
Family Medicine (6)
Emergency Medicine (6)
Clinical Elective-I (6)
Internal Medicine (6)
Surgery (6)
Clinical Elective-II (6)
Prenatal Care & Gynecology (6)
Pediatrics (6)
Clinical Elective-III (4)
Graduate Project (3)

*Clinical rotations vary in sequence

 

[pamac]

87 credit hours in 3 semesters of study durring the didactic phase. Unless they are inflating some of that, PAs are taking more credits than medical students I guess.

 

[762513]

87 credit hours in 3 semesters of study durring the didactic phase. Unless they are inflating some of that, PAs are taking more credits than medical students I guess.

29 credits a semester. I'm sure there's nothing wrong with this picture.

 

[Boatswain2PA]

87 credit hours in 3 semesters of study durring the didactic phase. Unless they are inflating some of that, PAs are taking more credits than medical students I guess.

We both know that = credit hours does not mean = education.

Standardized MD/DO education >> Standardized PA education >> unstandardized NP education. Doesn't matter if it's a Doctor Nurse or an associates trained PA, or if the PA program gave more credit hours than the MD program.

 

[762513]

We both know that = credit hours does not mean = education.

Standardized MD/DO education >> Standardized PA education >> unstandardized NP education. Doesn't matter if it's a Doctor Nurse or an associates trained PA, or if the PA program gave more credit hours than the MD program.

Prove that all PA programs are "standardized" and there is no standardization in NP programs.

 

[pamac]

We both know that = credit hours does not mean = education.

Standardized MD/DO education >> Standardized PA education >> unstandardized NP education. Doesn't matter if it's a Doctor Nurse or an associates trained PA, or if the PA program gave more credit hours than the MD program.

The reason why this caught my eye is because I looked over my progression plan at my NP school, and noted that my courses covered much of the same ground only under a different course title, and less segmented than the approach that PA program had. Then you get into things like "health promotion", "medical terminology"(every nurse I know took it as a pre nurse), "legal and ethical concerns in healthcare", "into to the PA profession", "interpretation of medical literature", "life support procedures and skills" (is that ACLS, PALS, NRP, and BLS?), "biomedical principles".

Then you break up courses into pieces and credit the heck out of them and that makes for an impressive visual at first glance, but that doesn't impress me as much anymore.

Now, the skills lab, the broader exposure of some of the clinicals (mostly the surgical ones that your surgeon will require you to have), and the rotations (provided they are decent and not a few of the ones I've seen at my facility where the PA students dink around and play scribe for a few weeks).... That part is appealing, but not overwhelming. Surgical skills are nice to have, but parients are there for the surgeon, not the PA, and if I wanted to first assist, I'd go the RNFA route.

So back to the credit issue, I'm starting to think that when I've been deferential to PA training as >>>>>>>>>>>> than NP, I might have been off a bit. I see a bit of fluff like NP school has, and quite a bit of segmentation and throwing tons of credits down in the course catalog, and then some broad exposure to different realms to further the generalist approach that the PA field is based on (which is actually the commendable part of the training). Take the last part out and it seems closer to NP training.

My revised opinion of the training heirarchy is MD>>>>>>>> PA>NP.

 

[AnnoyedByFreud]

Clinical Phase
Family Medicine (6)
Emergency Medicine (6)
Clinical Elective-I (6)
Internal Medicine (6)
Surgery (6)
Clinical Elective-II (6)
Prenatal Care & Gynecology (6)
Pediatrics (6)
Clinical Elective-III (4)
Graduate Project (3)

*Clinical rotations vary in sequence

It concerns me that PA programs do not apparently require a psychiatry rotation (it is often just an elective). I have actually met some PAs who did not do a psych rotation. This seems like a massive oversight to me. This is kind of beside the point of this post, but I do think it's a significant weakness of PA training. I have met some PAs who felt extremely uncomfortable treating basic MDD or GAD, though without the training I can see why...

 

[pamac]

Maybe they could pick up a rotation in psyche as an elective.

 

[AnnoyedByFreud]

Maybe they could pick up a rotation in psyche as an elective.

I'm sure they can. My point is that psych rotations should not be electives for full scope providers who can waltz out of PA school and into any kind of medical setting the next day. It should be a required rotation. I know some physicians who think PAs get superior psychiatry training... turns out some get next to none!

 

[Boatswain2PA]

The reason why this caught my eye is because I looked over my progression plan at my NP school, and noted that my courses covered much of the same ground only under a different course title, and less segmented than the approach that PA program had. Then you get into things like "health promotion", "medical terminology"(every nurse I know took it as a pre nurse), "legal and ethical concerns in healthcare", "into to the PA profession", "interpretation of medical literature", "life support procedures and skills" (is that ACLS, PALS, NRP, and BLS?), "biomedical principles".

Then you break up courses into pieces and credit the heck out of them and that makes for an impressive visual at first glance, but that doesn't impress me as much anymore.

Now, the skills lab, the broader exposure of some of the clinicals (mostly the surgical ones that your surgeon will require you to have), and the rotations (provided they are decent and not a few of the ones I've seen at my facility where the PA students dink around and play scribe for a few weeks).... That part is appealing, but not overwhelming. Surgical skills are nice to have, but parients are there for the surgeon, not the PA, and if I wanted to first assist, I'd go the RNFA route.

So back to the credit issue, I'm starting to think that when I've been deferential to PA training as >>>>>>>>>>>> than NP, I might have been off a bit. I see a bit of fluff like NP school has, and quite a bit of segmentation and throwing tons of credits down in the course catalog, and then some broad exposure to different realms to further the generalist approach that the PA field is based on (which is actually the commendable part of the training). Take the last part out and it seems closer to NP training.

My revised opinion of the training heirarchy is MD>>>>>>>> PA>NP.

PA program "legal & ethical concerns in healthcare" = few lectures.
NP program "legal and ethical concerns in healthcare" = one lecture, three papers, and then a group project that takes three days for each team to give their hour-long presentation to the class over the internet.

The surgical skills I learned on my (multiple) surgery rotations don't help me in the OR. It DOES help me understand the pathology of diseases, what my post-surgical patients have just been through, and what my pre-surgical patients are going to go through. It's not about being a first assist, it's understanding surgery's role in the medical care of your patient.

One of the fatal flaws of NP education is the vast differences between NP programs. You may be in a terrific one that approaches the educational level of a PA program...but most don't come anywhere close. The "minimum" PA rotations include full rotations in FP, EM, surgery, cards, ICU, hospital, womens health, (and I'm sure others). This is for every single PA program. Meanwhile, the "minimum" clinical rotations for many NP programs is 500 hours of part-time at your friend's clinic.

 

[Boatswain2PA]

No need for a full psych rotation, just like there is no need for a specific rotation in urology, derm, optho, or pick your sub-specialty.

PAs learn psych (and urology, derm, optho, and everything else), and they are tested on it with the PANCE.

 

[pamac]

I'm sure they can. My point is that psych rotations should not be electives for full scope providers who can waltz out of PA school and into any kind of medical setting the next day. It should be a required rotation. I know some physicians who think PAs get superior psychiatry training... turns out some get next to none!

I think that many programs have psyche as one of the set rotations.

 

[762513]

PA program "legal & ethical concerns in healthcare" = few lectures.
NP program "legal and ethical concerns in healthcare" = one lecture, three papers, and then a group project that takes three days for each team to give their hour-long presentation to the class over the internet.

The surgical skills I learned on my (multiple) surgery rotations don't help me in the OR. It DOES help me understand the pathology of diseases, what my post-surgical patients have just been through, and what my pre-surgical patients are going to go through. It's not about being a first assist, it's understanding surgery's role in the medical care of your patient.

One of the fatal flaws of NP education is the vast differences between NP programs. You may be in a terrific one that approaches the educational level of a PA program...but most don't come anywhere close. The "minimum" PA rotations include full rotations in FP, EM, surgery, cards, ICU, hospital, womens health, (and I'm sure others). This is for every single PA program. Meanwhile, the "minimum" clinical rotations for many NP programs is 500 hours of part-time at your friend's clinic.

You are so remarkably off-base about where the future of PA education, your own profession, is headed, it's hard to take you seriously when you claim to have such deep knowledge concerning NP and DNP training and education.

 

[AnnoyedByFreud]

No need for a full psych rotation, just like there is no need for a specific rotation in urology, derm, optho, or pick your sub-specialty.

PAs learn psych (and urology, derm, optho, and everything else), and they are tested on it with the PANCE.

That's ridiculous. Psych is not a subspecialty like derm or urology. There's a reason why all med students rotate through psych, it's a core component of health. I find the lack of legitimate psych training appalling, but it explains why several of the PAs I've worked with have had difficulties managing even basic psych cases that present in primary care.

 

[pamac]

If PA school is supposed to be a mini medical school, you would think that it would have a psyche rotation like they do. But I'll return to what I said about a lot of PA schools actually mandating a full rotation through psyche... schools like Yale and Medex, which are two of the best. It's not hard to find tons of programs that disagree with boatswain and feel there is a need to do a full psyche rotation. His comments fly in the face of whats is a pretty common occurrence.

 

[pamac]

There's truth to the notion that there is some inconsistency in NP programs, but my program is solid, so the fact that a few other programs don't have their act together doesn't mean much to me. That's my response to anyone who wants to lump me in with anyone else.

Yale is working on getting their online program accredited. Current students were completely up in arms over it and are terrified it will "water down" the reputation of their degrees. They are probably right in a way, but watch what everyone else does with their programs once they see Yale churning out PA classes of hundreds of students in a quest to send PAs to all corners of the US. Yale doesn't care because they figure they aren't in it for the money but for making an impact over public health. But things like that will lay waste to the notion of NP programs being illegitimate because they are delivered primarily online. Yale's program will have something like 3 immersion visits to campus (my NP program has more than that). They won't require an interview except in certain cases. They do require the GRE. They also want 1000 hours of HCE, and experience as low as CNA will qualify.

Online Physician Assistant Programs | Yale School of Medicine

 

[Boatswain2PA]

That's ridiculous. Psych is not a subspecialty like derm or urology. There's a reason why all med students rotate through psych, it's a core component of health. I find the lack of legitimate psych training appalling, but it explains why several of the PAs I've worked with have had difficulties managing even basic psych cases that present in primary care.

Fingers typed "SUB" specialty when mind simply said "specialty"

Yes, psych is a specialty like derm, urology, neuro, opthal, ortho, etc. There isn't time for a rotation in every specialty in PA school.

This is why MD/DOs are better trained....they have more time to do more of these specialty rotations.

This also highlights the weakness of (most) NP programs who offer virtually NO specialty rotations. How many FNP programs require a dedicated psych rotation?

If PA school is supposed to be a mini medical school, you would think that it would have a psyche rotation like they do. But I'll return to what I said about a lot of PA schools actually mandating a full rotation through psyche... schools like Yale and Medex, which are two of the best. It's not hard to find tons of programs that disagree with boatswain and feel there is a need to do a full psyche rotation. His comments fly in the face of whats is a pretty common occurrence.

Some schools add requirements to the PAEA/NCCPA requirements. My program required at least one "rural health" rotation. But I don't believe there is a big push for PA programs to add psych to the list of required rotations. I could be wrong though...

There's truth to the notion that there is some inconsistency in NP programs, but my program is solid, so the fact that a few other programs don't have their act together doesn't mean much to me. That's my response to anyone who wants to lump me in with anyone else.

Yale is working on getting their online program accredited. Current students were completely up in arms over it and are terrified it will "water down" the reputation of their degrees. They are probably right in a way, but watch what everyone else does with their programs once they see Yale churning out PA classes of hundreds of students in a quest to send PAs to all corners of the US. Yale doesn't care because they figure they aren't in it for the money but for making an impact over public health. But things like that will lay waste to the notion of NP programs being illegitimate because they are delivered primarily online. Yale's program will have something like 3 immersion visits to campus (my NP program has more than that). They won't require an interview except in certain cases. They do require the GRE. They also want 1000 hours of HCE, and experience as low as CNA will qualify.

Online Physician Assistant Programs | Yale School of Medicine

I agree with your (apparent) premise that Yale is risking watering down an excellent, proven curriculum in order to chase the all-mighty dollar. Just another example of how academia is failing us. I also agree with your comments about low-quality HCE...

BUT....and this is a HUGE BUTT....there will still be a full clinical year, with mandatory rotations, and a mandatory general medicine test (PANCE) that must be completed before these students are allowed to practice medicine. Those are the biggest things (but not only things) that set PA education well above NP education.

 

[762513]

Fingers typed "SUB" specialty when mind simply said "specialty"

Yes, psych is a specialty like derm, urology, neuro, opthal, ortho, etc. There isn't time for a rotation in every specialty in PA school.

This is why MD/DOs are better trained....they have more time to do more of these specialty rotations.

This also highlights the weakness of (most) NP programs who offer virtually NO specialty rotations. How many FNP programs require a dedicated psych rotation?



Some schools add requirements to the PAEA/NCCPA requirements. My program required at least one "rural health" rotation. But I don't believe there is a big push for PA programs to add psych to the list of required rotations. I could be wrong though...



I agree with your (apparent) premise that Yale is risking watering down an excellent, proven curriculum in order to chase the all-mighty dollar. Just another example of how academia is failing us. I also agree with your comments about low-quality HCE...

BUT....and this is a HUGE BUTT....there will still be a full clinical year, with mandatory rotations, and a mandatory general medicine test (PANCE) that must be completed before these students are allowed to practice medicine. Those are the biggest things (but not only things) that set PA education well above NP education.

My family practice NP program has so far placed me in primary care in an underserved clinic with high morbidities, (people walking around with A1C's of 16) pain management rotation, and pediatric rotation, with more to go. The NP's also take a board exam to become certified when we finish. I'm really failing to see Boatswains positions as valid.

 

[VA Hopeful Dr]

My family practice NP program has so far placed me in primary care in an underserved clinic with high morbidities, (people walking around with A1C's of 16) pain management rotation, and pediatric rotation, with more to go. The NP's also take a board exam to become certified when we finish. I'm really failing to see Boatswains positions as valid.

Good for you. You aren't the problem.

In the last 3 months I have had 14 NP students call my office asking if I would precept them. Their online programs offer essentially no help lining up preceptor sites. These types of places are the problem.

 

[W19]

Good for you. You aren't the problem.

In the last 3 months I have had 14 NP students call my office asking if I would precept them. Their online programs offer essentially no help lining up preceptor sites. These types of places are the problem.

You shouldn't precept these people...

 

[VA Hopeful Dr]

You shouldn't precept these people...

I don't

 

[d2305]

NP programs have no anatomy. There is nothing like the smell of formalin in the morning.

 

[deleted778763]

It concerns me that PA programs do not apparently require a psychiatry rotation (it is often just an elective). I have actually met some PAs who did not do a psych rotation. This seems like a massive oversight to me. This is kind of beside the point of this post, but I do think it's a significant weakness of PA training. I have met some PAs who felt extremely uncomfortable treating basic MDD or GAD, though without the training I can see why...

I attended George Washington university PA program and we had a required psych rotation . Just checked their website and they still do .

 

[DizzyJon]

My PA program had a 3cr behavioral health course and a clinical rotation.