PA vs. NP

[jalmostpa]

Just wondering if anyone knows the difference(s) between PA's and nurse practicioners. The two professions look very similar from what I've read. Any info would be great but I would especially like to hear from someone in the PA field to find out your perspective on this. Thanks!

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[lizzied2003]

hi, are you looking for the difference in job roles (as they can be very similar or dissimilar depending upon what you are doing) or are you asking about requirments--PA's enter a formal program usually with a Bachelors Degree. From what i have seen PA programs are quite concentrated and 24 calender months to 36 months. The PA's I have worked with some new and some experienced seem to have strong surgical backgrounds but that just may be from experience. NP's have a Master's degree in some type of NP practice (family, midwife, pedi). They are required to have a BSN first and be licensed as a RN . They take a standardized credentialing exam and have to recert every 5 years. I believe both can prescribe but NP's are able to essentially 'hang their own shingle' if they are so motivated. I know that as an NP I am able to be sued independently of the doc's i work with , I am not sure how it is for PA's. Salaries are also very variable. I have met NP's who make barely 50,000 and some who are making about 100,000 based on productivity and reimbursement. I think the same might be said for PA's. I think most fall somewhere in between. Both NP and PA's have websites that are pretty extensive. try APA, AANP, hope this helps. good luck.

 

[themadmedic]

http://www.aapa.org/geninfo1.html

 

[DocWagner]

Having worked with both, I really don't see much difference...as they both have the same roles in the ED's where we are (both see fast track patients and check in each with the attending physician). NP's, as nurses, seem to be quite skilled with procedures, that I like (since I may be hiring at some point). Unfortunately, there is no standardization of education accross the board for either profession (I can only assume MS will be a requirement in the future)...and I certainly have seen a wide variety of skill levels. Overall, very very similar.

 

[deleted6669]

copied from prior post 12/02-hope this helps-
NP's start as nurses with a bs degree and attend 2 more years of school to get an ms degree. most of the time is classroom with 400-700 hrs on average of clinical time. np's have an independent license and can open up their own practice. most work in primary care.
pa's are former paramedics, resp. therapists, or nurses, most with a bs degree who attend school for 2 years and get an ms or bs degree, depending on the program. PA school is often compared to the 1st and 3rd years of med school. the first year is actually composed of some 1st year and some 2nd year med school classes. the 2nd year of pa school is the 3rd year of med school with 2200 hrs or so of clinical time and all the same required rotations and responsibilities. pa's work in all medical fields including surgery, inpatient services and emergency medicine. many also work in primary care. pa's must work in conjunction with an md/do but supervisory requirements vary widely. in most settings an md never sees pts seen by the pa. chart reveiew is the standard requirement for supervision and this varies from 10-100% of charts depending on setting. pa's in a recent national survey make about $5k/yr more than np's. this is likely due to the fact that more pa's work in specialties. a pa and an np in the same setting make the same salary.the range is probably $50-120k /yr or so based on setting. both pa's and np's can do h+p's, order xray and labs, write prescriptions, suture, reduce fractures, treat emergency patients, etc. the difference is basically one of focus. pa's practice from the medical model while np's practice from a nursing based model .hope that helps.-e

 

[PACtoDOC]

Nurse Practitioner programs have very little clinical hours compared to PA programs. It is about 500 hours minimum for clinical hours for NP's in their 2nd year and about 2000 minimum for PA students. Every NP I have ever worked with was lacking in their education out of school, particularly in reading EKG's, differential diagnosis, and confidence. With time, I think NP's and PA's alike level out and become rather equally proficient. If you look at the military as a model of healthcare utilization, you will see the true heirarchy in medicine.

The military holds in highest regards its MD's and DO's, followed closely and only by the PA's. The military rarely uses NP's to the degree to which they use PA's. It is simply because as a new graduate the military knows PA's are more proficient. Then even further down the food chain in the military are the podiatrists and chiropractors. PA's make a significant amount more annually than NP's as well. I hear that stupid argument about how an NP can "hang out their own shingle", but I have never seen this happen. Hell, its rare enough to see a physician hang out their own shingle these days. It would be virtually impossible for an NP to open up shop and survive, because they cannot get credentialled on most insurance plans without a collaborating physician. And most NP's are smart enough to know that it is simply past the point of arrogant to think that they can provide excellent healthcare to the level of a physician, off on their own. There is just way too much they don't know. Thats why PA's are smart enough to always keep their relationship with physicians, and this is why physicians do not hold PA's in contempt quite as much as they do NP's. NP's have their use however, but I will never hire one personally.

 

[themadmedic]

As for the NPs "hanging a shingle"...what some don't also realize in discussing this is that in some states NPs are required to have a collaborative agreement with a physician in order to write scripts...

As for military medicine...I have only worked with one NP during my time in the Army...PAs however are used extensively in all healthcare settings in the military and exercise a large amount of autonomy and are highly respected...

 

[mophine]

EMEDPA,

I am currently an applicant to both PA and Medical school and, based on your posted credentials, was wondering what made you take the dive and go back to med school? Which DO school are you attending?

Also, just out of curiosity, what PA school did you attend?

I apologize for the "20 questions", but faced with these career decisions, I am trying to gather as much info as possible.

Thanks in advance,

Mo

 

[deleted6669]

1. BETTER SCOPE OF PRACTICE AND AUTONOMY
2.STILL TAKING PREREQS, BUT PLANNING ON TUCOM
3.HAHNEMANN, NOW DREXEL

If you are thinking at all about med school do not "settle" for pa school. it should not be an either/or decision. if you want to be a doc, go to med school. if you want to be a pa, go to pa school. it sucks if you figure out later that you really wanted md/do while already working as a pa. lots of classes to repeat, loans to arrange,MCATS to study for, etc.

 

[EHallberg]

Indo, this points out something I've noticed, as a non-trad with a BA in a totally non-science field. In terms of pre-requisites -- for me anyway -- a BSN, PA school, or med school are fairly similar. 16 semesters or so of basic sciences.

Emedpa, thanks for underlining the importance of shooting for one's chosen target. Once I've spent the time to get the prereqs and contact hours for any of the above programs, we mentally fast-forward to my 40th birthday (and assume the best)... and then, I can either be working as an RN, finishing PA school, or starting residency.

I gotta say, PA or MD/DO sounds a lot more like where I want to end up, no matter what might look like a better thing to do right now. And I do believe that's the key.

 

[ckplay]

The NPs I have worked with have been more skilled and knowledgeable in the clinical setting than PAs, which is expected since most NPs are seasoned nurses. I think too much is being made of the difference in education. The difference in hours-requirement makes sense because nurses already have a lot of clinical experience, where as most PAs do not. As far as understanding pathophysiology, in my experience PAs have not shown to be better than NPs.

 

[PACtoDOC]

Then my guess is that your experience is pretty limited. Perhaps you could elaborate on it. NP education is simply not even close to the rigor involved with PA education across the board. I would challenge any NP to take our board exam. A PA education is diverse and across the board a medical education (mini medical education). And in medical school, we have PA's doing a lot of the clinical education of us, whereas there are no NP's. You can probably equally compare a PA and an NP 5 years out of training, but there is no comparison at graduation.

 

[MacGyver]

And in medical school, we have PA's doing a lot of the clinical education of us,

Are you freaking serious? What med school allows PAs to train med students?

All PAs have to be supervised anyways, so they have an MD above them checking all their work which involves chekcing the work of the med students.

Why do that and have 2 layers of review on top of the med students when you can work more efficiently just working under an MD and have 1 layer of review.

Its not like having a PA train med students frees the attendings up, because they will still have to hang around and supervise the PA.

PA and MD training is different. MDs should train MDs and PAs should train PAs.

 

[deleted6669]

there is no chart review for things like teaching physical diagnosis so no chart review or supervision is needed. most pa's are only supervised indirectly so the chief resident or attending just has to sign a few charts/ week(my doc signs 10% of mine within 1 month-that is the state minimum requirement). as far as basic procedures, it only makes sense to have a pa teach them because at most facilities they do more of them. I used to work at a family practice residency and all the interns had to spend a month with the pa's in urgent care. we taught them how to remove ingrown toenails, suture, remove fb's in the eye,reduce minor fractures and dislocations, etc. your statement that
"PA and MD training is different. MDs should train MDs and PAs should train PAs." is incorrect . we do procedures and h+p's the same way the docs do. that's why many good pa programs are taught at medical schools by the same faculty with many classes/rotations taken with med students.
the pa's at that hospital did far more of those types of procedures than the docs on a day to day basis so we were better at it than they were. would you prefer to be taught a procedure by someone who does it 10 times a day or once a month. think about it...and macgyver what's up with your pa paranoia? there are plenty of patients to go around.

 

[PACtoDOC]

I refuse to even grace your reply MacGyver with a response. You simply talk out your lower squamocolumnar juntion, or shall I say dentate line.

 

[ckplay]

Originally posted by PACtoDOC
Then my guess is that your experience is pretty limited. Perhaps you could elaborate on it. NP education is simply not even close to the rigor involved with PA education across the board. I would challenge any NP to take our board exam. A PA education is diverse and across the board a medical education (mini medical education). And in medical school, we have PA's doing a lot of the clinical education of us, whereas there are no NP's. You can probably equally compare a PA and an NP 5 years out of training, but there is no comparison at graduation.

I did a four week clerkship in a renal clinic with 3 NPs and 2 PAs. The NPs were more comfortable with patient interaction and presenting to the attendings than the PAs. This may just be a difference in clinical experience. As a future physician, I would hire experience over a "mini medical education" any day.

 

[lloydchristmas]

Originally posted by ckplay
I did a four week clerkship in a renal clinic with 3 NPs and 2 PAs. The NPs were more comfortable with patient interaction and presenting to the attendings than the PAs. This may just be a difference in clinical experience. As a future physician, I would hire experience over a "mini medical education" any day.

Finally. Someone who makes sense.

 

[patriot_missile]

hey,
i read on duke.edu site that you need 1000hours of experience such as Paramedic to apply for the PA programs (i don't think my lifeguard-emt experience will count... or some hospital volunteer bull****). And i also plan to major in math in undergrad, so how would i go about getting the clinical experience and getting into the PA school?
And i understand if i don't major in nursing in undergrad, then i should forget about NP?

Also you mentioned that PA's can work in rural areas in ER's at $40/hr. Can they have flexible shifts, i.e. only day shifts or only 3days/wk or take a several months long vacations? What states are the most friendly for these? I.e. are places such as Maine and Colorado good? How will the market for PA's go in the next 5-10 years, as opposed to NP's?

Also NP's can make more money if they specialize in CRNA, do the PA's have a similar program in anesthesia? and if you complete surgery residensy as a PA, can you work under a surgeon in a rural setting and do things such as appendicitis? And if you can't, then is there a purpose in getting the 12months residensy? And can you work in an office of a family practioner and take a % of the profit?
thanks

 

[lloydchristmas]

Originally posted by patriot_missile
hey,
i read on duke.edu site that you need 1000hours of experience such as Paramedic to apply for the PA programs (i don't think my lifeguard-emt experience will count... or some hospital volunteer bull****). And i also plan to major in math in undergrad, so how would i go about getting the clinical experience and getting into the PA school?
And i understand if i don't major in nursing in undergrad, then i should forget about NP?

Also you mentioned that PA's can work in rural areas in ER's at $40/hr. Can they have flexible shifts, i.e. only day shifts or only 3days/wk or take a several months long vacations? What states are the most friendly for these? I.e. are places such as Maine and Colorado good? How will the market for PA's go in the next 5-10 years, as opposed to NP's?

Also NP's can make more money if they specialize in CRNA, do the PA's have a similar program in anesthesia? and if you complete surgery residensy as a PA, can you work under a surgeon in a rural setting and do things such as appendicitis? And if you can't, then is there a purpose in getting the 12months residensy? And can you work in an office of a family practioner and take a % of the profit?
thanks

Usually, you can work out a schedule that you want if you work as a PA/NP in a rural ER. This includes 3 days/week, whatever shift you want, time off, etc. Depends on who is employing you. Small ERs are usually staffed by larger hospitals who contract providers to cover the shifts at the small places. To find the friendly states for these... you need to check the laws for those states. You won't find many NP/PAs in states that don't let them prescribe controlled substances (as of now, there are only 8 states left that don't let them prescribe controlleds). You can also see what states are friendly towards using mid levels in ERs by searching job search engines on the net to find where they are needing PA/NPs in ERs. This will lead you where the market is.

As far as the market is concerned... I believe NP market is better, simply because the lobby power lies with nurses. It's too bad it's not about training, but it's not. It's about you can line the pockets of the lawmakers. There is power in numbers when it comes to lobbying, and unfortunately, PAs don't have the numbers that nurses do.

PAs don't have the anesthesia programs available that nurses do. CRNA is a totally different field than NP or PA. You shouldn't confuse the two. There are anesthesia assistants coming around, which pose a threat to CRNAs. However, again, it's the lobby power that will save the CRNAs because they are first nurses, and will be strongly supported by nursing lobby.

I don't know much about PA residencies; didn't know there were such things. Any PAs out there care to elaborate on this question regarding surgical PA residencies etc?

Hope the rest helps...

 

[deleted6669]

CHECK OUT WWW.APPAP.ORG FOR INFO ON DOING A PA RESIDENCY IN ANY SPECIALTY.

 

[patriot_missile]

Thanks!