PA vs DNP/NP

[Sunflowerising]

Hi, I'm currently an undergrad and wish to enter the medical field. I am considering becoming a DO, but have been intrigued by other options that are less of a time sink and soul-committing process.

Consequently, for the past few weeks I've been glancing at the PA and DNP/NP pursuits. They appear rather similar, but one thing google cannot provide accurate measure on is how they are respected and viewed in the average hospital setting (It may seem shallow, I think the desire to be respected is especially prevalent among the members of this forum). Which would you prefer to work alongside/practice beneath you? Which is held in higher esteem, what stereotypes and controversies surround each? Are there differences in expectations and treatment, functions and duties? While I'd like honesty, please do not respond with what might be considered insulting or dismissive - in short please maintain respect in what might prove a sensitive topic.

It would be absolutely wonderful if residents or doctors who've direct experience would comment.

Thank you.

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[236116]

(So, jsyk, everyone gets touchy on this subject. 😳)

PA/NP- straight-up, no BS midlevel? Awesome. Take the paperwork and wound-checking, please. (Yes, oversimplfying.)

Everyone and their brother being a Doctor of Something? Not so much. The public isn't intelligent enough to know the difference. The huge problem with the DNP is that the woman who is pushing it, besides being a bit of a quack, is trying to say that DNP's will be exactly like MD's. (don't know her position on DO's, though.) Not accurate, not in the slightest.

A great PA/NP is a god-send. A sucky one... well... makes kittens cry. I get confused on the nurse continuum, but IIRC, PA/NP's are there to *help*, not take over, and I think a lot forget that. There are a lot of differences in scope. I'm sure there's a chart around here somewhere. And PA's are under the BOM, NP's are under the BON (they're nurses. so kind of obvious). CRNA's and AA's I don't know.

Have some links- didn't read them all the way through, sorry:
http://medinfo.ufl.edu/pa/program/faq.htm
http://jaapa.com/issues/j20061001/articles/guesteditorial.html

 

[justtesting]

from my experience having worked in a hospital for the past 4-5 years i can tell you both NP's and PA's get tons of respect and appreciation from both the people above them (physicians) and the people below them (nurses, techs, cna's etc). you will rarely find anyone who looks down on them for 'only' being a PA or NP. if you want to know which gets more respect, it just depends on how specialized you go. i work with one PA who is in cardiothoracic surgury and has been doing that for over 20 years and he gets as much or more respect as any other dr in the hospital. thats because he knows his shiz and has proven himself. on the flip side, there are some NP's working in the anesthesiology dept who have been around for a while and are also very respected. but if you take an average NP and an average PA and they will get the same respect. i see nothing wrong with the DNP unless you go around advertising yourself as a Dr. that just gets too confusing. if it is just a goal in your life to earn a doctorate degree (as a personal acheivement) then the DNP is a great way to do it. In the workplace though, the DNPs and MNPs will do the exact same thing and get paid the same- kinda the way an associates degree nurse does the same and gets paid the same as a bachelors degree nurse. no real advantage (besides personal achievement) despite the higher degree.

 

[Handyman73]

I can't speak a ton about DNPs, as I have had fairly limited contact with them. Soon ALL nurse practitioners will have doctoral degrees. I actually saw somewhere in writing that they should all be doctors, since their "clinical training is equivalent to that of other clinical doctorates, such as doctors of medicine, osteopathy, podiatry, etc..." If they believe it, it is a little scary.

The PA profession had a few founders, but the fellow getting top billing was an MD named Eugene Stead. He had experience (I think at Emory?) in training docs for a full MD degree in three years during World War II. He subsequently went to Duke and founded the first PA program, which is roughly modeled on a med school curriculum. The major difference is that it is lower on theory, and possibly higher on practical, hands-on stuff.

Right out of school, PAs will tend to have better basic science knowledge and technical skills, NPs will have more focus on holistic medicine and prevention. All things being equal, after a couple years of practice they all wind up at around the same place.

I think PA school will likely get you in practice faster, as I believe that you have to have some clinical experience as an RN to proceed to an NP program.

 

[deleted6669]

I think PA school will likely get you in practice faster, as I believe that you have to have some clinical experience as an RN to proceed to an NP program.

a typical pa student also has prior medical experience. many of us are medics, rn's, rt's, etc
there are direct entry programs now for both professions for folks with a bs without prior experience. the np is 3 yrs( yr 1 to get bsn and yr 2/3 to get np). the pa is 2 yrs but has around 2 yrs of prereqs that vary by program. do yourself a favor. for either pa or np don't do direct entry. there is a difference in quality of these grads vs standard program grads with experience.

 

[dragonfly99]

I think either one is fine. If you are good at your job people will end up respecting you. Some won't but there are jerks everywhere...some people don't respect physicians either, I can tell you for damn sure.

I think PA education is more in the physician mold so perhaps we physicians have an easier time relating to them and their thought processes. NP's come from more of a nursing philosophy and out of nursing education. I think there is more emphasis on patient education and care coordination, but perhaps less on hard science. If you feel you need a doctorate then NP is the way to go, but I don't think a doctorate is necessary. You can end up doing similar stuff with either pathway (PA or NP). I don't think one is more "respected". There are some NP's and PA's who try to say they have equivalent training to a MD or DO, which I don't think is accurate...the reason is because medical residency is a heinous number of hours and we just end up seeing more stuff. Also the med school curriculum...it just crams a lot of stuff in our heads. Most of it we don't necessarily use all the time, but it helps with the weird cases and difficult diagnoses, which in my experience sometimes the NP's or PA's miss if they don't know when to ask for help. However, ALL folks in medicine - including MD's and DO's - can and will at times be out of our depth when trying to diagnose stuff, or just do stuff/procedures. So knowing when to ask for help is important for all. And for a lot of stuff, there are NP's and PA's who can do certain things better than me of course...I mean someone who sews up cuts every day in the ER is going to be a lot better than me, who just learned how in med school and residency but doesn't do it on a regular basis.

I do think there is sometimes more conflict between NP's and physicians as professions, a lot of that coming from the fact that some of the NP leaders @the national level want to say that an NP coming out of training has equal or better training to a family physician type who did 3 years of residency at 80 hours/week or sometimes more. I don't really think that's accurate.

 

[NPEMTIV]

from my experience having worked in a hospital for the past 4-5 years i can tell you both NP's and PA's get tons of respect and appreciation from both the people above them (physicians) and the people below them (nurses, techs, cna's etc). you will rarely find anyone who looks down on them for 'only' being a PA or NP. if you want to know which gets more respect, it just depends on how specialized you go. i work with one PA who is in cardiothoracic surgury and has been doing that for over 20 years and he gets as much or more respect as any other dr in the hospital. thats because he knows his shiz and has proven himself. on the flip side, there are some NP's working in the anesthesiology dept who have been around for a while and are also very respected. but if you take an average NP and an average PA and they will get the same respect. i see nothing wrong with the DNP unless you go around advertising yourself as a Dr. that just gets too confusing. if it is just a goal in your life to earn a doctorate degree (as a personal acheivement) then the DNP is a great way to do it. In the workplace though, the DNPs and MNPs will do the exact same thing and get paid the same- kinda the way an associates degree nurse does the same and gets paid the same as a bachelors degree nurse. no real advantage (besides personal achievement) despite the higher degree.

I definitely agree with this post. I was in your situation a few years ago myself. I wasn't sure if I wanted to be a physician or a PA. I can't say I pursued NP, but the midlevel practitioner arrangement intrigued me. I see no reason you wouldn't be respected as either an NP or PA. I personally plan on having several of either working with me in my clinic. They provide an invaluable service. They are not physicians and I believe most know that (Except for one PA I saw who had DOC on his custom license plates), but I do foresee some potential future problems with the DNP. While the official statement regarding the transition to DNP states its to reach a higher standard of research/teaching ability it seems to me a convenient cover for a future push into expanded practice rights. The problem here is that if you wanted to be a doctor go be one. Don't try to sneak in. Physician groups will adamantly oppose this and tension will result. Of course most NPs don't want to be doctors in my experience and the future DNP is being pushed by a select group so who knows.

In the end I think it comes down to what you want. PA & NP have very similar practice rights (some exceptions/differences based on individual states). NPs are trained in a nursing model and PAs are trained in a physician model. This is the biggest difference I know of. Both have similar educational requirements for licensure and from the knowledge I have both are typically paid in a similar fashion based on where you work and what field you're in. Both are capable of doing a fine job in their respective tasks and I don't see you having any trouble either way. Best of luck.

 

[Sunflowerising]

Thank you all very much! I'm not quite sure how to close this thread, but I think I get the general idea. 🙂 Certainly though, if you feel there's anything that's worth mentioning, reply on.

 

[dragonfly99]

sunflower,
it might end up being more important which school you go to than which degree you get. I mean, if you go to a kick-butt PA school (or NP school, for example) you might come out with better training than if you just say you are going to pick one field over the other. Or one school might have a particularly good reputation in its local area and/or have a great career placement office and be better at helping you find a job. Just a thought.