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PA vs. NP
Started by obgyny
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deleted6669
both programs are grad school programs and both produce a midlevel provider. neither "ranks higher".
the training methods are very different but both produce competent providers. np's have to work in a particular specialty(peds np, family np, etc) while pa is a broader based education allowing the pa to work in any field. for a peds np to work as a hospitalist with adults they have to go back to school. the pa legally can transition between specialties without additional certifications. all pa's have a legal ralationship with a physician who provides varying degrees of oversight from signing every chart in some states to just meeting with the pa twice yearly to discuss their practice in other states. 12 states allow np's to practice independently without any physician oversight and to write for controlled substances.both pa's and np's get their own dea #s to prescribe controlled substances but some states put conditions on which drugs can be written for while others do not.
check out the links in the sticky at the top of the clinicians forum for good info on both professions.
The N.P. is licensed and the P.A. is certified (but is licensed in one state, I believe... Louisiana?).
The P.A. must receive a certain amount of continuing medical education AND pass a recertification exam every 6 years. The physician and N.P. do not have to pass a recertification since they are licensed, although in most states must receive a certain amount of C.M.E. (Continuing Medical Education) to maintain their license.
As mentioned elsewhere on this site, 12 states allow N.P. completely independent practice, probably with more to come.
No state allows completely independent practice on the part of the P.A.
Now, I do not seek to equate either the N.P., or the P.A., with that of a physician.
P.A.s and N.P.s are not the equivalent of a physician. PERIOD.
However, in the form of a limited scope... and setting up a limited scope practice of one's own independent of a physician, the N.P. simply has the autonomy to do so.
So, one thing to consider is what you want do if you don't obtain admission to medical school. If you want launch your own mid-level practice, the N.P. degree/licensure may be of more interest.
I personally know several P.A.s that I would much prefer to treat me for midlevel (and actually some rather advanced level) medical conditions over some other well qualified, board certified physicians. No question about it, P.A.s can be that good. And I know N.P.s that have arrived at courses of treatment that have solved the medical issues/concerns of patients that have been dealing with physicians for years, without resolution.
A N.P. friend is currently receiving training in a relatively new technique of hair transplantation which does not require harvesting a strip of follicle bearing donor hair grafts. This is essentially a "scarless" form of hair transplantation. When he is finished with his training, he will be able to open his own office and provide fee for service care entirely under his own license. Another N.P. friend has her own office and provides fee for service BoTox treatment. But these are very limited practices dedicated to one specific issue and in these type of practices, this is where the N.P. can really excel, in both patient satisfaction as well as financially - and in the real world, financial issues matter. All N.P. degree program is a master's level program and most P.A. programs as well. A master level degree program is not inexpensive and this degree represents a significant level of dedication, education and professionalism.
In most cases, P.A.s simply can't practice like this so this is a significant difference between the N.P. and the P.A.
I have heard of some P.A.s, geographically removed from their supervising physician, who employee physicians to review their charts by fax. To me, this is an obvious conflict of interest and probably won't stand up to scutiny by a state BOMEX. The M.D./D.O. signs off thereby fulfills the letter of the law regarding "supervision" and receives a payment for the "supervision".
To my mind this is entirely improper. It would be just like a P.A. starting his own "Order Viagra Here" website, where the "patient" fills out form, the P.A. writes the script, sends it to the pharmacy for processing, faxes the "medical record" to the "supervising physician" who approves it and receives a payment for doing so. Like I said, entirely improper but I'll bet this is being done as I write this.
I wish I had an answer for you aside from this...
The N.P. has the autonomy to set up an independent limited scope practice. This is an inarguable fact. But in the emergency department setting where I work, the N.P. and P.A. are treated exactly the same (and both are very, very well paid). In my Level One Trauma Center, EVERY PATIENT treated by either the N.P. or the P.A. is, after the workup is completed, examined by an Emergency Medicine Board Certified M.D./D.O. ... as it should be.
I hope this helps.
The P.A. must receive a certain amount of continuing medical education AND pass a recertification exam every 6 years. The physician and N.P. do not have to pass a recertification since they are licensed, although in most states must receive a certain amount of C.M.E. (Continuing Medical Education) to maintain their license.
As mentioned elsewhere on this site, 12 states allow N.P. completely independent practice, probably with more to come.
No state allows completely independent practice on the part of the P.A.
Now, I do not seek to equate either the N.P., or the P.A., with that of a physician.
P.A.s and N.P.s are not the equivalent of a physician. PERIOD.
However, in the form of a limited scope... and setting up a limited scope practice of one's own independent of a physician, the N.P. simply has the autonomy to do so.
So, one thing to consider is what you want do if you don't obtain admission to medical school. If you want launch your own mid-level practice, the N.P. degree/licensure may be of more interest.
I personally know several P.A.s that I would much prefer to treat me for midlevel (and actually some rather advanced level) medical conditions over some other well qualified, board certified physicians. No question about it, P.A.s can be that good. And I know N.P.s that have arrived at courses of treatment that have solved the medical issues/concerns of patients that have been dealing with physicians for years, without resolution.
A N.P. friend is currently receiving training in a relatively new technique of hair transplantation which does not require harvesting a strip of follicle bearing donor hair grafts. This is essentially a "scarless" form of hair transplantation. When he is finished with his training, he will be able to open his own office and provide fee for service care entirely under his own license. Another N.P. friend has her own office and provides fee for service BoTox treatment. But these are very limited practices dedicated to one specific issue and in these type of practices, this is where the N.P. can really excel, in both patient satisfaction as well as financially - and in the real world, financial issues matter. All N.P. degree program is a master's level program and most P.A. programs as well. A master level degree program is not inexpensive and this degree represents a significant level of dedication, education and professionalism.
In most cases, P.A.s simply can't practice like this so this is a significant difference between the N.P. and the P.A.
I have heard of some P.A.s, geographically removed from their supervising physician, who employee physicians to review their charts by fax. To me, this is an obvious conflict of interest and probably won't stand up to scutiny by a state BOMEX. The M.D./D.O. signs off thereby fulfills the letter of the law regarding "supervision" and receives a payment for the "supervision".
To my mind this is entirely improper. It would be just like a P.A. starting his own "Order Viagra Here" website, where the "patient" fills out form, the P.A. writes the script, sends it to the pharmacy for processing, faxes the "medical record" to the "supervising physician" who approves it and receives a payment for doing so. Like I said, entirely improper but I'll bet this is being done as I write this.
I wish I had an answer for you aside from this...
The N.P. has the autonomy to set up an independent limited scope practice. This is an inarguable fact. But in the emergency department setting where I work, the N.P. and P.A. are treated exactly the same (and both are very, very well paid). In my Level One Trauma Center, EVERY PATIENT treated by either the N.P. or the P.A. is, after the workup is completed, examined by an Emergency Medicine Board Certified M.D./D.O. ... as it should be.
I hope this helps.
One thing when you should also consider is that the NP will be limited by what the state BON says is the scope of practice for the NP and what the certication says the scope of practice is. The PA practice is limited by what the physician can do and what the physician allows the PA to do. This makes the PA a much more flexible provider.
David Carpenter, PA-C
Thank you David. This was just another one of qwerty1's misguided, biased posts. I thought someone would eventually chime in to correct her.
An observation I have about my medical training is that my superiors constantly demand precision and accuracy from me. If I don't know it for sure, I say I don't know and I go look it up so I don't give wrong information. Any provider who just pulls information out of the air or relies on hearsay as evidence is a dangerous one.
An observation I have about my medical training is that my superiors constantly demand precision and accuracy from me. If I don't know it for sure, I say I don't know and I go look it up so I don't give wrong information. Any provider who just pulls information out of the air or relies on hearsay as evidence is a dangerous one.
what type of medical training are u in?
another things about PAs is that they can assist in surgery, while NPs don't. at least i've never heard of a surgical NP. i wonder how much surgical PAs really get to do though. i was watching a med documentary (ResidentLife I think) where a PA got to go retrieve a donated heart and assist in a heart transplant if i remember correctly. that would be pretty cool!
As previously stated there are only 2 states that do not require PA's to have a license.
In Texas, I am licensed and certified. I renew my license every year, re-cert every six, have to maintain malpractice, DEA and Texas drug licenses, ACLS, BLS, recredential every year at the two hospitals where I work and have to have 40 hours CME every year from the state and 100 hours CME every two years from my national organization to maintain my certification.
Just wanted to clear up any misinformation.
-Mike
In Texas, I am licensed and certified. I renew my license every year, re-cert every six, have to maintain malpractice, DEA and Texas drug licenses, ACLS, BLS, recredential every year at the two hospitals where I work and have to have 40 hours CME every year from the state and 100 hours CME every two years from my national organization to maintain my certification.
Just wanted to clear up any misinformation.
-Mike
This is simply not true. I have seen NPs do all the vein harvesting in cabgs and first assist. In fact an RN and even a tech can first assist.
Actually, as a former surgical technologist and current surgical PA I can tell you that I don't think an NP can do those things under their NP license, they get no training in the OR and I do not believe that there is even a recongnized track for that in any NP program that I have heard of. Although, I could be wrong.
However, there are many folks who can assist at surgery and if they have those other credentials on top of their NP than their is no problem. i.e. RN first assist, Surgical technologist first assist or PA. The other thing is that to do some of those things may have to go to the credentialing committee before they are allowed to do them.
So, you are correct in the fact that they may do those things, but not because they are an NP, its due to the fact that they have training to first assist.
-Mike
The surgical PA's scope of practice is limited by the supervising/sponsoring physician (surgeon), and the restrictions of the facility (which are variable).
CTS PAs go from skin to getting the pt on bypass, surgeon does grafts/valve, and then the PAs get the pt off, close, and to the ICU. Pretty good scope if you ask me.
Yep just hard to get paid. The only people that can bill medicare for assists beside physicians are PAs and NPs. The issue with NPs is credentialing. Since the domain of surgery is the RNFA most hospitals are now requiring NPs to get their RNFA which requires two years of perioperative experience to get. There are programs that will waive that for NPs but you still need your CNOR which again require two years of perioperative experience. There are nurses that have done NP school after being an RNFA and there are some nurse that have been grandfathered in. Of course in the hinterlands the credentialling standards may vary.
For Chronicstudent (so I can save a post)
There is one program at UAB that is a ACNP/RNFA program.
http://main.uab.edu/sites/nursing/98239/
The issue that I would have is that the scope is more limited than the PA (since it is based on the ACNP you can't see peds) and is longer than the UAB surgical PA program which is well regarded. Also considering that less that 1% of NPs work in a surgical setting vs. 25% of PAs one would assume that surgeons are more knowledgeable about PAs.
David Carpenter, PA-C
Thank you for edumacating me.
-Mike
-Mike
You are correct, Mike. I'm an NP and assisting in surgery is definitely outside my scope of practice. Simply being an NP does not qualify one to assist in surgery. (And that's quite all right with me!)
Kim
If you want to get the most bang for your buck and get the most out of your training, the PA route is the way to go. PA's are trained using the medical model, which is the best model in the health care system to use (pathophys, differential dx, etc.). NPs are trained to use the nursing model, which while more wholistic, is not a complete medical model and is lacking in evidence-based medicine.
In other words, if you're debating about NP vs. PA, go the PA route; you'll fine more opportunity and you'll learn more clinical medicine along the way.
Nothing wrong with NPs, but PA's have a better grasp on pure medicine, whereas NPs are...well, they are still nurses. There is a difference.
In other words, if you're debating about NP vs. PA, go the PA route; you'll fine more opportunity and you'll learn more clinical medicine along the way.
Nothing wrong with NPs, but PA's have a better grasp on pure medicine, whereas NPs are...well, they are still nurses. There is a difference.
D
deleted6669
wow! talk about an "about face". a pa recently save your life or something zack?.....🙂
There are differences, but the only ones that will really matter differ between states. Check with the laws in your state regarding both NPs and PAs. It's true the training is far and away better for PA (and I'm NP). But, I've found that you can and will learn what you want to in time. I routinely have patients call me to see them in the ED because they don't want to see the docs we have. And I routinely see them fall below the standard of care both in ED and office (good example from yesterday: I saw a refill for coumadin signed for 4 months... no INR for 4 months!)
That is not because I was trained so well as NP. It was awful, and I got lucky enough to be taught medicine by a good MD for 6 yrs while I was in college and grad school.
If you can realize the insufficiencies of NP training and you get more autonomy in your state that way, I'd go NP. If you feel you really need good medical training, go PA.
That is not because I was trained so well as NP. It was awful, and I got lucky enough to be taught medicine by a good MD for 6 yrs while I was in college and grad school.
If you can realize the insufficiencies of NP training and you get more autonomy in your state that way, I'd go NP. If you feel you really need good medical training, go PA.
thanks for all the input. i think the PA route sounds more for me (as a backup). i'm definitely going to give applying to med school my all (i would actually like to perform the surgeries...i'm also considering some physician specialties such as oncology and neurology as well), but if years & years pass by and nothing works out, then I need something else to work on.
Don't forget that PA School is, in many cases just as hard (if not harder) to get into than Med School!!! The PA profession is one of the fastest-growing in the nation--even more so than other medical professions--and schools haven't quite expanded to meet that need just yet. In a few years, who knows, but right now it's quite difficult to get accepted to PA School if you're not lucky enough to have a public school in your state of residence.
There are also different prerequisits for PA School that you may not have covered in your premed route-- the Anatomy & Physiology series, the GRE, and many hours of paid direct patient care experience, for instance.
Med school is certainly longer and more comprenensive than PA School, but be careful when considering it as a "backup" to med school. You might also want to consider the fact that, though there are many surgical PAs (about 30% of all PAs), there are very few in other specialties such as oncology & neurology. Most PAs are in general practice or internal medicine.
Actually PAs are well represented in Oncology and Neurology with over 1000 PAs in Heme/Onc and about 600 in Neurology. PA practice has shifted in the last 10 years and about 40% are in Primary care. 35% are in specialty care and 25% are in surgery.
I will second the comment on back up. One is that PA programs want someone who want to be there as a PA not as a back up. The other is that while over all PA school is not as competitive as medical school, individual programs can be as or more competitive than a given medical school. If you have trouble getting into any medical school, you are probably going to have trouble getting into PA school.
David Carpenter, PA-C
I'll be part of the admissions interviews at my program -- and I guarantee that anyone who hints to me that they would rather be in 4-year med school will get a big fat "Do Not Recommend" on the little form I fill out for the faculty to consider. My radar is pretty good, and my faculty advisor's is scary good.
We are a great program, and we're justifiably proud of our instructors and our graduates. What's nice about the current climate is we have so many applicants I don't have to think twice about working to find the ones who really want to be PAs. They're definitely in there.
We are a great program, and we're justifiably proud of our instructors and our graduates. What's nice about the current climate is we have so many applicants I don't have to think twice about working to find the ones who really want to be PAs. They're definitely in there.
