PA school?

[Knowledgecraving]

Hey everyone!
I'm looking for some insight and advice from PA's/NP's/MD/DO's.
I graduated with my BSN in August and have been working as an RN since December (not very long!). I've realized that nursing is not for me, and that I should have stuck to pre-med instead of changing majors in college. I crave so much more knowledge. I find myself wanting to be on the opposite end, ordering tests and interpreting results to figure out what's going on with my patients, instead of being the one to take orders. Nursing is challenging in it's own ways, but there's so much "fluff." I spend less time figuring out what's going on clinically with patients and more time adjusting pillows, delivering pudding, scratching backs, cleaning poop, and being called into rooms to do things like "move this tray, hand me my phone, empty my urinal." Don't get me wrong, there are definitely moments that make me love my job, and I do love to do these things for people who cannot do it for themselves. However, a lot of the time it's by those who are fully capable, yet think it's your job to be their maid/waitress/personal assistant. I want to help people in emergency situations and actually save their life, I want to travel to other countries and do mission trips with surgical teams, I want to help people who don't have access to health care. I want to be the person who FINALLY figures out what's wrong with someone and changes their life. I want to help in a different way.

I want to go back to school ASAP! I considered going the MD/DO route, but it will take me 3 years just for pre-reqs, and even longer in school and residency. I've ruled that one out as I'm already 23 and would like to eventually have a family.
PA schools draw me in the most. The intense curriculum in the medical model is so attractive to me, I crave it! The hands on skills, being in a classroom, and being fully prepared with 2,000+ hours of clinical in exciting rotations all draw me in. However, it would take me about 2 years to get my pre-reqs done due to being in a contract with my hospital where I have to work full time as an RN for 2 years (unless I want to pay 4k). The only PA school in state is a private one that costs about 40k a year, not to mention I wouldn't be able to work and would have to take out extra for living expenses, car, etc. The thought of having over 100k in debt once I graduate scares the crap out of me!
Then, I look at NP. I've met plenty of NP's who are incredibly knowledgable and amazing providers. Some of my professors were NP's who taught at medical school! I would need (at the minimum) 1 year of nursing experience to apply. It would take me about a semester or two to complete the pre-reqs. Once accepted, I could work during the online program and still make money and even come out debt free. This would be the easier way to go. I just don't know if it will be enough for me, to take online classes and feel ready to care for someones life after. Can someone give me insight on how NP programs are? Would it be dumb to go to NP school if I don't even like nursing?! I feel like the NP route is better for those who have been nurses for MANY years and love nursing, however I can't decide.
Would I just be taking the long road to eventually get to the same destination as a PA? Should I just take the easier route and do NP? Please help me decide!!

I graduated with a 3.7 cumulative undergrad GPA and a 3.9 science GPA. However, I haven't taken a lot of the pre-reqs for PA. How competitive is PA school and would I even be considered as a BSN and not with a bio degree?

Thank you in advance to anyone who read this and would like to respond with some advice. It's much needed!!!

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[pamac]

Hey everyone!
I'm looking for some insight and advice from PA's/NP's/MD/DO's.
I graduated with my BSN in August and have been working as an RN since December (not very long!). I've realized that nursing is not for me, and that I should have stuck to pre-med instead of changing majors in college. I crave so much more knowledge. I find myself wanting to be on the opposite end, ordering tests and interpreting results to figure out what's going on with my patients, instead of being the one to take orders. Nursing is challenging in it's own ways, but there's so much "fluff." I spend less time figuring out what's going on clinically with patients and more time adjusting pillows, delivering pudding, scratching backs, cleaning poop, and being called into rooms to do things like "move this tray, hand me my phone, empty my urinal." Don't get me wrong, there are definitely moments that make me love my job, and I do love to do these things for people who cannot do it for themselves. However, a lot of the time it's by those who are fully capable, yet think it's your job to be their maid/waitress/personal assistant. I want to help people in emergency situations and actually save their life, I want to travel to other countries and do mission trips with surgical teams, I want to help people who don't have access to health care. I want to be the person who FINALLY figures out what's wrong with someone and changes their life. I want to help in a different way.

I want to go back to school ASAP! I considered going the MD/DO route, but it will take me 3 years just for pre-reqs, and even longer in school and residency. I've ruled that one out as I'm already 23 and would like to eventually have a family.
PA schools draw me in the most. The intense curriculum in the medical model is so attractive to me, I crave it! The hands on skills, being in a classroom, and being fully prepared with 2,000+ hours of clinical in exciting rotations all draw me in. However, it would take me about 2 years to get my pre-reqs done due to being in a contract with my hospital where I have to work full time as an RN for 2 years (unless I want to pay 4k). The only PA school in state is a private one that costs about 40k a year, not to mention I wouldn't be able to work and would have to take out extra for living expenses, car, etc. The thought of having over 100k in debt once I graduate scares the crap out of me!
Then, I look at NP. I've met plenty of NP's who are incredibly knowledgable and amazing providers. Some of my professors were NP's who taught at medical school! I would need (at the minimum) 1 year of nursing experience to apply. It would take me about a semester or two to complete the pre-reqs. Once accepted, I could work during the online program and still make money and even come out debt free. This would be the easier way to go. I just don't know if it will be enough for me, to take online classes and feel ready to care for someones life after. Can someone give me insight on how NP programs are? Would it be dumb to go to NP school if I don't even like nursing?! I feel like the NP route is better for those who have been nurses for MANY years and love nursing, however I can't decide.
Would I just be taking the long road to eventually get to the same destination as a PA? Should I just take the easier route and do NP? Please help me decide!!

I graduated with a 3.7 cumulative undergrad GPA and a 3.9 science GPA. However, I haven't taken a lot of the pre-reqs for PA. How competitive is PA school and would I even be considered as a BSN and not with a bio degree?

Thank you in advance to anyone who read this and would like to respond with some advice. It's much needed!!!

PA/pre med prereqs are a different beast than the ones you've probably taken for your pre RN courses, but there's no reason for me to doubt you would do as well in them as you did for the RN prereqs if you are willing to put in the time to do well. They are upper division courses. Expect to have to take two semesters of upper division general chemistry, and two semesters of organic, and one semester of bio chemistry. You'll also have to take two semesters of upper division biology, and upper division anatomy and physiology (generally these aren't the ones you've taken as prereqs for nursing... in fact, rarely will you have already taken these by accident on the way to getting into RN school). If you want to do Med school, you probably are looking at two semesters of physics (upper division, not intro courses). Not having a bio degree won't hold you back, but not having taken the appropriate prereq courses will. So you probably have at least four semesters in front of you involving some very busy courses, along with work at your job. You probably will have to take O chem after you've done your Gen chem because Gen chem is frequently a pre-req for O chem. Then you have to fit Bio chem in there somewhere. And you might want to have taken other electives like Genetics, Neuroscience, etc to round out your knowledge base in the sciences.

The things I mentioned above isn't gospel, and there is variety out there as far as how to approach getting into PA or Med school. But generally, you would have a hard time retooling yourself to get into PA school from where you are now unless you were one of the folks who had a biology degree prior to your BSN or something like that. Prior to mine, I had a couple biology oriented degrees. I've taken all the biology and chem courses needed for med school and then some, but rarely do I run into a fellow nurse who can say the same, and they aren't familiar with the difference between the chemistry classes I took, and the ones they took as pre-RN's. They are a whole different animal, and although its possible to do a semester where you take advanced anat and phys, general chem, and labs, and a course like Genetics or Immunology, that's a tremendous amount of work.

I sat in an ER the other day with a physician who was pretty blunt about how miserable a decent hospital residency was, and how little glory there was to the job that person was in, but you already work around physicians and can see a little window into what they do. That physician spoke of the cost of school (granted one of the more expensive ones out there), the fact that in residency you miss everything in life from weddings to holidays to funerals, the low pay of residency, the uncertainty of where you will live due to where you get into school and where you match for residency. This physician was underwhelmed as to the glory involved in being a provider. They also mentioned how frustrating the interactions were among physicians, and how they still had to deal with specialists who didn't respect their assessments, etc. Then there are the patients that don't think you know what you are doing, because they are comparing you against another physician they are familiar with. As a PA, expect some patients to say something akin to wondering why there isn't a doctor around especially if they read up on their condition on Web MD and think you don't know anything since you aren't a physician. They didn't read about their antidepressant on Web PA or Web NP after all.

I agree with all the things you said about nursing, and certainly recommend you gear up to move on to something else. If you feel it now, it will only get stronger with time. But realize that retooling to do PA school will involve a tremendous amount of effort, and I'm not sure you are quite familiar with the path ahead of you. You will graduate as a PA to do things that you probably can just as easily do as an NP (except for probably surgery unless you cast yourself as a surgical first assist or something atypical). You will likely make the same amount as a PA, and obtain it sooner and at a significant savings, as I've found NP schools to be considerably cheaper.

But you are 23. You really aren't very old. If you think you want to be a physician, you certainly can do it. You also could go back to school for a few years and then go to PA school if you think it offers you more bang for your buck. I honestly don't think it will. I talked to a PA the other day who was jealous of what NP's had going for them, but that person who didn't have an RN degree, so the logical choice was to do PA school. It cost well over $100k for school alone, and then that person couldn't work for 2 years, and then went to work alongside NP's who paid less and didn't have to work under a physicians supervision (which in all reality wasn't very onerous at all, but that person chaffed at the idea behind it). So decide if the thirst for knowledge that you insist you have is worth the extra time and treasure to obtain. For me, the time crunch involved in doing PA school would be the biggest sting if I were in your position.

As an NP, you might one day be insulted online by PA's, PA students, and med students alike. If that disturbs you, I don't know what to tell you. Most of those folks wouldn't tell you those things to your face, and of the three, few would have been involved in as many codes as you have as an RN anyway. You probably will have patient's who know less than you take issue with you being just a fancy nurse and not a doctor. You might also have RN's like me wonder why you don't seem to know as much about science as a PA (I've found that new and even some semi experienced NP's around me are lacking).

PA school is indeed more hard science based than NP school, but only you can weigh what you are willing to give up for that.

I'll mention one more thing, and in reality it is very subjective, and very much based on geography and job market, but financially, last year I easily made as much as a new PA or NP makes in my town, and I did it by working very little overtime. I did it doing all the things you spoke of, and then some, but I also had no debt from school, and not carrying that debt is a huge relief. Start from there and do the thing that gives you the most bang for your buck. I'm not saying to keep doing all the unpleasant things you mentioned by staying as an RN (and oh dear... the unpleasantness at times). Certainly move on to bigger things. But there will come a day when you return home and won't care at all what your title is or who salutes you, you'll take solace in your paycheck and what it can do for you. As long as there isn't a tremendously poor work environment, you'll probably enjoy whatever role you find yourself in as a PA or NP vs what you are familiar with as a floor RN. I decided the best thing for me was to consider wages, debt, freedom, work environment, etc, and that lead me to NP school. As for respect, you earn that by how well you perform. If someone doesn't like me, I'm not going to be able to command any respect from them that I haven't earned.

 

[Knowledgecraving]

PA/pre med prereqs are a different beast than the ones you've probably taken for your pre RN courses, but there's no reason for me to doubt you would do as well in them as you did for the RN prereqs if you are willing to put in the time to do well. They are upper division courses. Expect to have to take two semesters of upper division general chemistry, and two semesters of organic, and one semester of bio chemistry. You'll also have to take two semesters of upper division biology, and upper division anatomy and physiology (generally these aren't the ones you've taken as prereqs for nursing... in fact, rarely will you have already taken these by accident on the way to getting into RN school). If you want to do Med school, you probably are looking at two semesters of physics (upper division, not intro courses). Not having a bio degree won't hold you back, but not having taken the appropriate prereq courses will. So you probably have at least four semesters in front of you involving some very busy courses, along with work at your job. You probably will have to take O chem after you've done your Gen chem because Gen chem is frequently a pre-req for O chem. Then you have to fit Bio chem in there somewhere. And you might want to have taken other electives like Genetics, Neuroscience, etc to round out your knowledge base in the sciences.

The things I mentioned above isn't gospel, and there is variety out there as far as how to approach getting into PA or Med school. But generally, you would have a hard time retooling yourself to get into PA school from where you are now unless you were one of the folks who had a biology degree prior to your BSN or something like that. Prior to mine, I had a couple biology oriented degrees. I've taken all the biology and chem courses needed for med school and then some, but rarely do I run into a fellow nurse who can say the same, and they aren't familiar with the difference between the chemistry classes I took, and the ones they took as pre-RN's. They are a whole different animal, and although its possible to do a semester where you take advanced anat and phys, general chem, and labs, and a course like Genetics or Immunology, that's a tremendous amount of work.

I sat in an ER the other day with a physician who was pretty blunt about how miserable a decent hospital residency was, and how little glory there was to the job that person was in, but you already work around physicians and can see a little window into what they do. That physician spoke of the cost of school (granted one of the more expensive ones out there), the fact that in residency you miss everything in life from weddings to holidays to funerals, the low pay of residency, the uncertainty of where you will live due to where you get into school and where you match for residency. This physician was underwhelmed as to the glory involved in being a provider. They also mentioned how frustrating the interactions were among physicians, and how they still had to deal with specialists who didn't respect their assessments, etc. Then there are the patients that don't think you know what you are doing, because they are comparing you against another physician they are familiar with. As a PA, expect some patients to say something akin to wondering why there isn't a doctor around especially if they read up on their condition on Web MD and think you don't know anything since you aren't a physician. They didn't read about their antidepressant on Web PA or Web NP after all.

I agree with all the things you said about nursing, and certainly recommend you gear up to move on to something else. If you feel it now, it will only get stronger with time. But realize that retooling to do PA school will involve a tremendous amount of effort, and I'm not sure you are quite familiar with the path ahead of you. You will graduate as a PA to do things that you probably can just as easily do as an NP (except for probably surgery unless you cast yourself as a surgical first assist or something atypical). You will likely make the same amount as a PA, and obtain it sooner and at a significant savings, as I've found NP schools to be considerably cheaper.

But you are 23. You really aren't very old. If you think you want to be a physician, you certainly can do it. You also could go back to school for a few years and then go to PA school if you think it offers you more bang for your buck. I honestly don't think it will. I talked to a PA the other day who was jealous of what NP's had going for them, but that person who didn't have an RN degree, so the logical choice was to do PA school. It cost well over $100k for school alone, and then that person couldn't work for 2 years, and then went to work alongside NP's who paid less and didn't have to work under a physicians supervision (which in all reality wasn't very onerous at all, but that person chaffed at the idea behind it). So decide if the thirst for knowledge that you insist you have is worth the extra time and treasure to obtain. For me, the time crunch involved in doing PA school would be the biggest sting if I were in your position.

As an NP, you might one day be insulted online by PA's, PA students, and med students alike. If that disturbs you, I don't know what to tell you. Most of those folks wouldn't tell you those things to your face, and of the three, few would have been involved in as many codes as you have as an RN anyway. You probably will have patient's who know less than you take issue with you being just a fancy nurse and not a doctor. You might also have RN's like me wonder why you don't seem to know as much about science as a PA (I've found that new and even some semi experienced NP's around me are lacking).

PA school is indeed more hard science based than NP school, but only you can weigh what you are willing to give up for that.

I'll mention one more thing, and in reality it is very subjective, and very much based on geography and job market, but financially, last year I easily made as much as a new PA or NP makes in my town, and I did it by working very little overtime. I did it doing all the things you spoke of, and then some, but I also had no debt from school, and not carrying that debt is a huge relief. Start from there and do the thing that gives you the most bang for your buck. I'm not saying to keep doing all the unpleasant things you mentioned by staying as an RN (and oh dear... the unpleasantness at times). Certainly move on to bigger things. But there will come a day when you return home and won't care at all what your title is or who salutes you, you'll take solace in your paycheck and what it can do for you. As long as there isn't a tremendously poor work environment, you'll probably enjoy whatever role you find yourself in as a PA or NP vs what you are familiar with as a floor RN. I decided the best thing for me was to consider wages, debt, freedom, work environment, etc, and that lead me to NP school. As for respect, you earn that by how well you perform. If someone doesn't like me, I'm not going to be able to command any respect from them that I haven't earned.

Wow, I can't thank you enough for writing such a thorough and informational response. Your input has helped me tremendously.

I've definitely ruled out becoming a physician. I don't think I'm devoted enough to medicine to start from scratch now and miss everything in life until I'm in my mid 30's. That's not what I see for myself, as much as I wish I could obtain the knowledge physicians have.

I agree about PA school. It will take me 2 years to do my bios, gen chem, o chem, and upper division math to get into o chem, and bio chem. It will be a long and difficult ride. Although I feel that I can tackle those courses with determination, I'm just not sure if it's the right move for me financially. I already have 50k in debt from nursing school that I'm paying off, and to add on another 100+k would be very overwhelming at my age. Especially when I want to have a car, a place, and eventually a family.

I will admit, part of not wanting to go to NP school is what you said about people not respecting NP's because they are lacking when it comes to the sciences. I want to be the best provider I can be, and I want people to actually take me seriously and not think I'm just "a nurse." But you're right, that all comes from how well I perform. The last thing you wrote really stuck with me. About doing everything you ever wanted, but also being debt free and not worrying about the title in the end. Having debt has really been stressing me out, and I work 4 12 hour shifts a week just to be able to pay it off. I think I'm really starting to lean more towards NP now.

Working as an RN is just so different from what I thought it would be. Having 7 patients and barely having a CNA to help is just miserable. It's a wonderful learning experience and I do think that I will be able to handle a lot more once I'm through with this experience, but I am just dying to get out as soon as I can, and the PA route will definitely prolong that.

Can I ask you, how long were you a nurse before you went back to NP school? Also, did you feel adequately prepared after completing the online NP program? And did you have in person skills days like PA's where you learn to suture, staple, cast, insert chest tubes, etc?

 

[pamac]

I haven't completed my NP program yet, so I'm not the best person to answer questions about feeling prepared. I will say this, I've seen PA new grads ready to roll the first day on the job, and have been impressed with what I saw from the standpoint of working alongside them as an ER nurse. The NPs were a bit slower to catch on, and those were NPs with some decent background. There are also some NPs I know in another venue that seemed to have a learning curve as well. A year in they roll pretty well, but I'm not going to insist that NP>PA blindly. Those are just my observations, which certainly are subjective. I think that all could be due to a lack of those NPs having a solid footing in hard sciences. My biology degrees help me quite a bit as a nurse when I'm trying to visualize a pathology. Interestingly, for the nuts and bolts of everyday nursing, my bio knowledge isn't critical to what I do, and I get shown up on quite a few skills if I don't put in a lot of effort.

So I could have started on my NP immediately upon getting my RN. I didn't do that because I didn't know I could have. I wish I had started on my NP as soon as I could have.

You probably will get the most crap about the title thing when on the Internet. Like I say, in real life, nobody will likely troll you to your face unless you make yourself a target by being brash, pushy, wrong but outspoken, arrogant, prideful, etc. if you want to be around the kind of people who would call you out for their own ego's sake, then you are a glutton for punishment. I might be spoiled because the providers I'm around are 99% class acts, and I'm around a lot of different providers in different venues. I have rarely seen a provider being difficult, and certainly not anywhere near the kind of malice I've seen among nurses and nurse management (and for the most part even they are 90% decent). The PAs and NPs are collegial to each other, and the docs seem to treat everyone well (sometimes more than the RNs deserve). I really don't have any horror stories of arrogant providers. I've run into one NP that drove me nuts, but that person was a know it all super nurse in their own mind, and was wrong about what they were criticizing me about. A PA wouldn't have tried to tell me how to be a better nurse.

I'm not against the PA track, it just is that for a current RN, it just doesn't make any sense to do it if you aren't one of the folks that already has prerequisite stacked up...ESPECIALLY.... If you have considerable debt from. Nursing school. Just don't do it. You'll get just as much professional respect as an NP as you would as a PA, maybe more because you don't have the word assistant in your title (I wish they would change that).

I'm certain you could go to medical school if you wanted to. I could have. But I think for me, I wouldn't have been happy with the sacrifices I would have had to make, and the fruits wouldn't have made up for it for me. It's a choice. The med school choice is a very satisfying one for plenty of people, and you may want to ask around to make sure you really have your head in the right place on that, because attitudes change over time, and you could really do well as a physician. But I don't think PA makes sense. The effort you would have to put in to get into PA school is just a bit less than what you'd have to do to get into med school. Doing all that just to do PA and not MD or DO school would be the real waste, I think.

I have friends that are practicing NPs. They do very well and lots of folks envy their success and freedom. I wouldn't hesitate to go that route. I think in your mind you are comparing NP to PA like one would compare a chiropractor to a physical therapist. That's not how it is. You'll be joining a well respected profession as an NP.

 

[AnnoyedByFreud]

Current NP here and I'd like to chime in and echo pamac's thoughts. Do not let the perceived hatred of NPs on online forums stop you from making what is obviously the best career choice for you, OP (assuming you don't want to work in a surgical setting). Go to NP school. I decided to go to NP school at age 23 and do not regret it for one second. Sure, I considered med school and PA school, but in the end becoming an NP was clearly the best "bang for my buck", if you will. Just make sure you are excellent at what you do, and on one will doubt you (well, fewer people will). It is true that NP school is not as rigorous as med school or PA school. This does not mean you can't make it more rigorous. Study using Pathoma, First Aid, other resources that med students/residents use, etc. Always ask questions in clinic and find the best providers you can who are willing to mentor/teach you. I bargained hard for my first NP job and basically got them to set up several hours of supervision for me weekly - kind of like a mini residency. My point is, you can always become a better clinician, learning does not stop when you get out of school and your clinical abilities are not limited by the initials after your name. The flexibility/power that comes with an NP degree (which is significant, though it can depend on the state) is a wonderful thing and you have your entire career to develop your clinical skills. Don't let a bunch of noise on the internet (mostly from non-NPs and people who haven't even graduated from school yet, heck some of them are pre-health) stop you from considering NP school. Best of luck.

 

[Boatswain2PA]

I sat in an ER the other day with a physician who was pretty blunt about how miserable a decent hospital residency was, and how little glory there was to the job that person was in, but you already work around physicians and can see a little window into what they do. That physician spoke of the cost of school (granted one of the more expensive ones out there), the fact that in residency you miss everything in life from weddings to holidays to funerals, the low pay of residency, the uncertainty of where you will live due to where you get into school and where you match for residency. This physician was underwhelmed as to the glory involved in being a provider. They also mentioned how frustrating the interactions were among physicians, and how they still had to deal with specialists who didn't respect their assessments, etc. Then there are the patients that don't think you know what you are doing, because they are comparing you against another physician they are familiar with.

Assuming that physician is a resident, he will likely change his tune in a few more years when he is making $300+ an HOUR working as an attending in an ED. Versus $60-$80/hour that a PA/NP makes working in an ED.

Nobody hates NPs, online or in person. However there are some items of discontent between NPs and other clinicians.

1: MD/DO education >>>>>PA education >>>> NP education. That's factual, and nobody in their right mind can disagree with that (although some people do)

2: That does not mean an experienced PA > an experienced NP. After a few years out of school, the quality of the provider is strictly dependent upon how much work that provider puts into learning their job.

3: NPs have legal ability to practice independently. However this isn't because they are "better" than PAs, and certainly not equal to physicians, it is strictly because they have enormous political lobbying power.

4. Any non-physician provider who refers to themselves as "Doctor" to their patients is a self-aggrandizing idiot. If you have a DNP, you are a nurse practitioner, so don't confuse your patient even more by referring to yourself as "Doctor". If you are a PA with a Doctorate in whatever, don't confuse your patient even more by referring to yourself as "Doctor."

 

[pamac]

Physicians kill themselves at twice the rate as the population at large.

That was an attending talking to me, but I still don't know many ER docs pulling in $600k. Most of them here make $250K-$320k per year. If money makes up for the important things in life you give up to get it, then becoming a doctor is worth it. Depends how you want to look at it. The physicians I personally know don't seem to be any happier than the average person. I was on track to make as much money as an ER doc in my mid 20's working in the family business, but it wasn't my preferred job or location (although its a great place to live, and everyone else wants to live there). I think I hit the peak contentment with money. If I had more, I'd probably just have nicer versions of the nice things I have right now... rolex vs what I wear, bigger house than the one I don't even clean right now because its decent sized and I'm lazy at that, Range Rover vs. the vehicle I drive now. Basically, I would live like my brother.

The discontent you speak of between NPs and "other clinicians" seems to imply that "other clinicians" are MD's, DO's, and PA's... as if PA's are part of the cool kids click. They aren't. For one, plenty of MD's and DO's have a preference for NP's, and plenty more don't care either way. Then there are others who have a preference for PA's and have heartfelt reasons behind that, and still others who like the fiduciary relationship required of PA's. I don't think its even on most physicians radar. So what if some clinicians have a problem with NP's and their drive for increased independence?... not offending physicians is what folks in the AAPA leadership lay awake at night concerned about while NPs add another state where NP's can practice independently. There are physicians who will talk down a PA as quick as those that would talk down an NP. If you guys were as rabid about gaining independence as NP advocacy groups, you'd see a side of physicians groups that you've never seen before.

To address point 1...nobody said anything contrary to what you said there. I think I've mentioned as much at length in almost any post I've made. However, I think some folks in something like psyche might argue that their emphasis in their programs could mean that psyche NP> PA practicing in psyche. I don't really have an opinion on that particular front because I know psyche NP's that would be eager and well served receiving more robust pharmacology or the ability to manage medical comorbidities along with psyche issues. I don't have an interest in taking a side on that.

Point 3... I agree. The nursing lobby is powerful. I was unimpressed with the American Association of Physician Assistants and the attitude I witnessed among various leaders, and their unwillingness to advocate for PA's the way I would have preferred them to. This progressed to the point where I did not finish attending PA program interviews I had been invited to, and jumped at the chance to go to a very well priced RN program in my neighborhood and go the NP route. I didn't want to be a dependent provider. That's it. I consider training for PA's to be superb. If you guys had a stronger position, I would have joined you. I'm all for signing on for a scope of practice, but I don't want to sign on for a scope of practice and a requirement to go find a boss... forever.

On point 4.... I don't know a single NP introducing him or herself as "Doctor" in any setting, let alone a clinical one and in front of patients.

I don't get excited about being called sir by retail staff, I don't yearn to be a physician when a patient assumes that I'm a doctor rather than an RN when I walk into the room... etc. I do get a little jealous at the sweet spread of goodies that I hear is in the physicians lounge, but leverage that perk with the fact that the best free cold cuts at work will never taste as good as a meal at home that I get to eat because I'm not performing an emergency appy instead. NP's and PA's are welcome in the "providers lounge" anyway, so if I still work here as an NP, I'll try to act professional and not squeal with delight when I load up on complimentary Red Bull and day old prepackaged salads. You can't tempt me with 8 years in what would feel like to me like prison with the reward of 400,000 dollars a year (cut in half after taxes, and cut down even more by student debt).

 

[Boatswain2PA]

That was an attending talking to me, but I still don't know many ER docs pulling in $600k. Most of them here make $250K-$320k per year. If money makes up for the important things in life you give up to get it, then becoming a doctor is worth it.

Agree, but these ED docs are making $250-$350K a year while only working 100-120 hours a month. I'm making huge money for a PA (grossed $165K last year) but I'm working almost twice as many hours.

Money isn't what it's about, but money is a good measurement about what it's about. If time = money, then money = time. If you're making $350 an hour, you only have to work 2 shifts to make what I make in two weeks.

 

[pamac]

My ER docs work 3 /12's. Is it a given that many ER docs work 30 hours a week or less? I've read this from you and EMEDPA.

 

[Boatswain2PA]

My ER docs work 3 /12's. Is it a given that many ER docs work 30 hours a week or less? I've read this from you and EMEDPA.

Some do, some don't. When you are at the top of the food chain, and make that much money, you can do what you want. If a BC EP wants to make $600K a year they CAN working at $350/hr, but it's a recipe for burnout.

Are your "ER docs" BC EPs? Or FP/IM docs who work in the ED??

 

[pamac]

Board certified... That's all this region will allow. A facility can't afford the hit to their reputation if they don't have board certified when everyone else does. The next advertisements you'd see would be a billboard saying something to the tune of "come see us, we are board certified, unlike the other guys".

To be honest, I haven't asked around the physicians much to find out what their group requires, or if they are gluttons for punishment while saving up for a new Porsche. Could be that the guys I see all the time while I work my 3 and then the occasional overtime shift are like you say...heart attack men.

The way patients are treating everyone these days, I can't imagine how fun it is to be even an ED physician. I'm starting to see more people (and not just the ones you'd expect) being all sorts of nasty. The other day I had a patient live commenting on Facebook telling everyone how much they hated us, trying to take pictures of staff to post. Telling everyone there was nothing they could do about it (the staff really didn't care, but you can imagine how lame that was to do that). It seems like every shift a patient or family member goes bannanas and insists at that moment in the middle of the night that they want to talk to "the exective in charge". I'd be the first person on their side if they were right about the care they were being given, but in the cases where I've been an outsider watching all these things go down, I've been really surprised at the battles these patients choose to fight. They want McMedicine so they can be diagnosed, cured, and back home to pig out in 2 hours. It's almost like the physicians are getting some of the worst of it over time. Most of it is Medicaid or self pay folks who never intend to pay, and almost always for complaints that really aren't the important issue at stake ("I know you want to see if the reason my mom vomited all over your gurney is because of a blockage, but you gave her something for the nausea and pain and now she wants a sandwich... She hasn't eaten since this morning, so just have the doctor come in so we can ask him again ourselves?"). Before too long, it's going to take $350 per hour to get anyone to do anything for some of these people, not to mention the poor guy who trained 10+ years just to have someone tell them their pharmacology knowledge is deficient when it comes to essential oils.

 

[Boatswain2PA]

You sound like you are "feeling the burn" taking care of too many people who "feel the Bern."

I live and work in a much better place than you do. I certainly see patients like, this, but they are relatively rare, and are of little consequence.

 

[W19]

Some do, some don't. When you are at the top of the food chain, and make that much money, you can do what you want. If a BC EP wants to make $600K a year they CAN working at $350/hr, but it's a recipe for burnout.

Are your "ER docs" BC EPs? Or FP/IM docs who work in the ED??

You do it for 7+ years only, and then go enjoy your time at the golf course... I actually know a FM doc who made a ton of $$$ working for 1o years at rural ER after residency... He semi retired in his early 40s since he has been working only 2 days/week and use the rest of his time to do things he enjoys.

 

[pamac]

I asked around. It's pretty standard for ER docs in my metro area to work 3/12's, and adding on time to chart. A doc told me about another doc that works an insane number of shifts (I literally don't know anyone in ANY industry that works that much... Nobody.) Using your math Boat, he's literally looking at over a million and a half dollars gross if he does that for a year.