PA vs NP

[Boatswain2PA]

Outstanding post Journey. That is why MLPs should ALWAYS work for (real) Doctors.

---

Members don't see this ad.

 

[dudestheman90]

[

 

[JourneyAgent]

I do see what your saying Journey agent. It's a slippery slope. DNP's do not go through the same training as MD's, I understand that. But you have to understand that at least in my state, the term collaboration is used and defined differently than the term supervision which is a term coined for the PA profession. I, as a future NP, would have no problem working alongside or in collaboration with a Physician. I don't see a problem in this. However the key term there is collaboration, An NP is an independently licensed practitioner, I do not work underneath anyone, but i work alongside a physician. They key term their is alongside, not underneath, A PA is a doctors assistant or second hand man, an NP is not. This is actually good for the physician, working alongside and asking questions if need be. An NP will generate more patients, thus more business for the practice thus more money. But you have to realize nurses operate under a different board and different model of training. The NP is liable for care admitted, not the physician, even if the NP works with a physician. However, An MD, is liable for the treatment given by a PA since the PA profession falls under the medical board and same model of training as a physician. So that's the hole point, an NP works alongside a physician, not underneath. There's some sort of an agreement between the NP and the MD, it's called a joint protocol and the MD can give the lighter case loads to the NP since the MD would likely be comfortable with the tougher cases. The whole point of this debate is that an MD has to see an NP as an independent practitioner that works alongside them, they are not doctors assistants (PA's).

Also the whole thing with primary care, i personally dont plan on working in primary care, i plan to go into a specialty. The best part is we get to pick our own specialty, regardless of the competition, we get w/e specialty we want to do. I know in MD, you have to match and you may not get that residency you want like radiology for instance and may end up doing primary care instead. I know primary care docs make around 150k per year, i also know car mechanics that make almost the same amount only difference is they dont have any debt since they dont have any schooling besides maybe 1 year at a CC. I always tell people if u want to make money ur in the wrong field, laywers, business ceo's, politicians, actors, ect... make a ton more money than healthcare providers, so why not just do that instead.

A lot of words there. Very circumspect. Liability either extends beyond your license to mine for your actions or it doesn't. That's why I'd never take one of those chart reviewing gigs where a doc is supporting the independent practice of np's. I'm not sharing responsibility without seeing the patient. This kind of thing is highly variable. What you're describing is your feelings and declarations on the matter. That means exactly nothing to me if you and I are going to be entering into some kind work arrangement. I can talk about a case with my colleagues but its my license I'm using to sign for diagnoses and treatments.

If you're along side me by our shared employer, then you'll be doing it independently or I'll go somewhere else. If I or my group hires you and we can build enough trust where your practicing as I would. And you're giving some of your potential costs as a nonphysician back to us then.....maybe. I still don't like the idea. Especially with all of your profession's rhetoric currently.

I'd be much more comfortable establishing a collaboration with PA to manage medical issues or a close long term relationship where I can trust s/he practices with the same intentions and understanding of my responsibility for their decisions than someone who enjoys the freedom to f@ck up with my co-signature blithely.

Alongside....together....shared....collaborative. Whatever, do it yourself then. I think I'd enjoy the competition. It's always fun to go against a flippant adversary when you've paid your dues.

 

[Boatswain2PA]

Dude - you have a lot to learn when you get out in real world.

 

[JourneyAgent]

Dude - you have a lot to learn when you get out in real world.

Dude? Me dude? Been around. Been living in the world. There is some talk amongst theoretical physicists that the world is possibly a simulation. But I'll act if it isn't and keep livin. Not sure what I'd do differently if it was. So real is my acting assumption. Both in my decades before medical school, during, and after.

My only point is that if we are to carry this experiment through we should really commit and stop f'n around halfsies with it. NP's might have a stronger more customer oriented approach to medicine. So let's find out. Cut them loose. No more hiding behind us. Let's give the public a clear option. DNP clinics-- completely autonomous, free to be holistic or whatever is unique about there perspective. And we block them from working in physician run operations.

Of course there's too many of us on the take. Hiring them and skimming off their wages. But still. I think it's a good thought experiment to cut the fat out of the major league BS their propagandists are selling to their students.

Ok. Back to anticipating this real world you speak of. Rosy cheeked. Bright eyed.

Tell me a story about what's really out their pops.

 

[Boatswain2PA]

Dude? Me dude? Been around. Been living in the world. There is some talk amongst theoretical physicists that the world is possibly a simulation. But I'll act if it isn't and keep livin. Not sure what I'd do differently if it was. So real is my acting assumption. Both in my decades before medical school, during, and after.

My only point is that if we are to carry this experiment through we should really commit and stop f'n around halfsies with it. NP's might have a stronger more customer oriented approach to medicine. So let's find out. Cut them loose. No more hiding behind us. Let's give the public a clear option. DNP clinics-- completely autonomous, free to be holistic or whatever is unique about there perspective. And we block them from working in physician run operations.

Of course there's too many of us on the take. Hiring them and skimming off their wages. But still. I think it's a good thought experiment to cut the fat out of the major league BS their propagandists are selling to their students.

Ok. Back to anticipating this real world you speak of. Rosy cheeked. Bright eyed.

Tell me a story about what's really out their pops.

Ummmm....no. Not you Journey-dude, I was referring to Dudestheman-dude. Nice rant though! Lol

 

[JourneyAgent]

Ummmm....no. Not you Journey-dude, I was referring to Dudestheman-dude. Nice rant though! Lol

guns drawn. Lead flying everywhere. Whoops friendly fire.

But my acceptance of the dude moniker actually caused to wonder if I was being naive in some sense. And it occurred to me that flying fast and loose with these arrangements, ie. some semi-retired specialist md glancing over NP charting and taking a fee, might be some kind of new normal. And that resistance to that management structure may very well be naive and futile.

I remember a natural tension and caution in the new attendings I worked with that seemed to fade in the more experienced docs. Could be that just as my infantile clinical systems are coming on line, fear of f'ing up or worse having to be responsible for the f'ups of others is distorted in my perception. Maybe it's just hard to f'up most things that badly if your general intentions toward the patient are good and sincere.

Maybe my position will change as I understand better how to manipulate situations and still maintain conscientious patient care. But looking forward on how to get out from under all this debt the thought of risking what I've worked for by spreading myself too thin supervising someone who doesn't respect my training....seems unbearable. For now I'm anti-collaboration with NP's. Cynical of a NP new grad independence, but not opposed to letting the public decide for itself. And very anti obfuscation of the differences between the 2 models that NP's have been so deft at subverting.

 

[group_theory]

The term "collaborate" is a murky legal term.

In New York, Quirk v. Zuckerman (196 Misc 2d 496 (Sup. Ct. Nassau Co. 2003), the plaintiff injured his elbow and went to the ED, was sent to fast track, and was seen by an NP who diagnosed him with epicondylitis. Was never seen by an attending physician in the ED, but apparently the case was discussed ... plaintiff came back with compartment syndrome. Plaintiff sued, and Dr Zuckerman's lawyers argued that there was no physician-patient relationship to form the basis of the lawsuit. The NY Supreme Court of Nassau County (trial court) wrote:

Therefore, it is important that the Court examine the relationship between the attending physician and the nurse practitioner.   The practice of a registered nurse practitioner as defined in the Education Law § 6902(3)(a) includes diagnosis of illness and physical conditions and the performance of therapeutic and corrective measures in "collaboration" with a licensed physician qualified to collaborate in the specialty involved.   While the word "collaborate" is not legally defined by statute, the Court can certainly apply its common ordinary meaning as defined in Webster's Dictionary, which is as follows:  "cooperate, join (forces), work together, team up."   The nature of the relationship which constitutes collaboration is rather left to the proviso that all services be performed in accordance with a written practice agreement and written practice protocols which shall contain explicit provisions for the resolution of disputes between the nurse practitioner and the collaborating physician (8 NYCRR 64.5).   However, the statute is clear that if the written agreement does not so provide, then the collaborating physician's diagnosis or treatment shall prevail if there be any conflict in diagnosis (Education Law § 6902[3] [a]&#820.   Therefore, the ultimate responsibility for diagnosis and treatment rests with the physician if the written agreement is silent.

So definitely know your hospital's policy with regards to working with NPs/CRNAs/PAs, or your group's policy, when it comes to working with NPs/CRNAs/PAs, especially in regards to roles of supervisors or "collaborators", and your obligation under your hospital/group policy. If your group's policy or your hospital policy have a more restricted policy in place with additional supervisory requirement compare to what the state requires, that policy prevails when it comes to vicarious liability and respondant superior.

In addition, state laws and court cases differ in each states so what applies to one state may not apply to another.

 

[JourneyAgent]

The term "collaborate" is a murky legal term.

In New York, Quirk v. Zuckerman (196 Misc 2d 496 (Sup. Ct. Nassau Co. 2003), the plaintiff injured his elbow and went to the ED, was sent to fast track, and was seen by an NP who diagnosed him with epicondylitis. Was never seen by an attending physician in the ED, but apparently the case was discussed ... plaintiff came back with compartment syndrome. Plaintiff sued, and Dr Zuckerman's lawyers argued that there was no physician-patient relationship to form the basis of the lawsuit. The NY Supreme Court of Nassau County (trial court) wrote:



So definitely know your hospital's policy with regards to working with NPs/CRNAs/PAs, or your group's policy, when it comes to working with NPs/CRNAs/PAs, especially in regards to roles of supervisors or "collaborators", and your obligation under your hospital/group policy. If your group's policy or your hospital policy have a more restricted policy in place with additional supervisory requirement compare to what the state requires, that policy prevails when it comes to vicarious liability and respondant superior.

In addition, state laws and court cases differ in each states so what applies to one state may not apply to another.

Awesome post, thanks. The vagueness of that term bothers me, but I can now see, why I need to pay attention when looking for a job and signing contracts.

 

[Makati2008]

Wtf are you talking about. I'm half way through my 3rd year. And of course if your a PA you'd have been further ahead than me. I was talking about a PA student who will enter practice before I graduate.

And annoyedbyfreud....I don't need to convince you of anything. What I can say emphatically is I can't believe someone with my approximate level of experience considers themselves fit for Independent practice. If you feel dandy about it. Thanks. And I won't be referring or asking your input on my patients. Just because anyone who thinks that is scary to me. Yeah...pretty much that's it.

Clinically I was ahead of med students then especially when it came to coming up with a ddx. You wouldn't understand PA education unless you have done it

 

[JourneyAgent]

Clinically I was ahead of med students then especially when it came to coming up with a ddx. You wouldn't understand PA education unless you have done it

And you were so enthusiastic about it that you went to medical school. Look, 3rd year clinical rotations is a mind bending expansionary period in both of our training. If I'm 2 months ahead of you I might think your dense. If you're a month ahead of me you might think I'm slow. So I realized in making these individual comparisons that such an undertaking is misguided.

The difference between me and PA is that that vertical trajectory persists. While s/he stops and goes to work where they will from that point forward only get trained to be useful in whatever area they're working in.

The breadth and the depth of mine persists. So that when I arrive at practice in psychiatry I have the depth in my field to treat their complaint but also the breadth to be able to recognize, treat, or refer appropriately for their medical issues.

What's specific to PA curriculum I take your word for. The endpoint, or that which matters, doesn't seem to be a matter of dispute. I was making the point that that endpoint comes too quickly for all of us. But for mid levels at an alarming rate.

 

[Makati2008]

And you were so enthusiastic about it that you went to medical school. Look, 3rd year clinical rotations is a mind bending expansionary period in both of our training. If I'm 2 months ahead of you I might think your dense. If you're a month ahead of me you might think I'm slow. So I realized in making these individual comparisons that such an undertaking is misguided.

The difference between me and PA is that that vertical trajectory persists. While s/he stops and goes to work where they will from that point forward only get trained to be useful in whatever area they're working in.

The breadth and the depth of mine persists. So that when I arrive at practice in psychiatry I have the depth in my field to treat their complaint but also the breadth to be able to recognize, treat, or refer appropriately for their medical issues.

What's specific to PA curriculum I take your word for. The endpoint, or that which matters, doesn't seem to be a matter of dispute. I was making the point that that endpoint comes too quickly for all of us. But for mid levels at an alarming rate.

I agree with the general points you make. But as far as my excitement about being a PA wasnt the reason I went back(had plenty of EM excitement and made plenty of money with no overhead).

These reasons-> I have someone footing the bill, I wanted a challenge and I was sick of playing the get the SP game with sick folks in the ER when all the SP did was read my note to an attending. So if I don't match EM and instead FM then it's a wash for me salary wise.

 

[JourneyAgent]

I agree with the general points you make. But as far as my excitement about being a PA wasnt the reason I went back(had plenty of EM excitement and made plenty of money with no overhead).

These reasons-> I have someone footing the bill, I wanted a challenge and I was sick of playing the get the SP game with sick folks in the ER when all the SP did was read my note to an attending. So if I don't match EM and instead FM then it's a wash for me salary wise.

Yeah there's a definite artificiality to the way professions get parsed and frozen. I propose we work for some kind of fluid synthesis with the ability for NP/PA's to bridge to MD/DO and likewise for a 2nd year orthopedist to tap out and work as a PA or something along those lines. The only ones who benefit from the frozen immobility is people trying to exploit others. A greedy physician, a malignant PD, and the money changers who can play us against one another.

 

[dudestheman90]

l

 

[Makati2008]

If there was coursework or some sort of bridge program that allowed NP's to take classes felt necessary by MD's, so we can practice with the medical knowledge that you feel nurses currently lack than I would be more than happy to enroll in that sort of program. However these type of programs don't exist b/c of greed by you know who, ect...Not my fault. RN's and NP's need to be respected and allowed to practice within their scope and governing state laws. Nothing more and nothing less.

They do exist bro but only for PAs(PA to DO) but NPs were not involved due to their education being in the nursing model as well as other variances in curriculum.

 

[dudestheman90]

l

 

[Makati2008]

lol theirs only 1 PA to DO program which is 3 years in length, only 1 year less than a regular 4-Yr medical school program.

What's the lol about? More Are in the works(one being discussed at my school for down the line). With that program comes three things a dNP can never give: respect, the ability to practice independently in all the states, and tons more clinical exposure that that little doctorate doesn't

 

[JourneyAgent]

They do exist bro but only for PAs(PA to DO) but NPs were not involved due to their education being in the nursing model as well as other variances in curriculum.

Yeah. The PA model is basically ours, truncated and streamlined for quicker endgame. So a bridge program into a prep course, step1 step 2 and then residency makes sense.

For NP's I think a short general residency and some sort of exam equivalency could allow us and the public the benefit of a different philosophy. So that maybe residents could work as PA's if they wanted to take a break in training for family reasons etc. but not NP's since their base is nursing.

 

[Makati2008]

Yeah. The PA model is basically ours, truncated and streamlined for quicker endgame. So a bridge program into a prep course, step1 step 2 and then residency makes sense.

For NP's I think a short general residency and some sort of exam equivalency could allow us and the public the benefit of a different philosophy. So that maybe residents could work as PA's if they wanted to take a break in training for family reasons etc. but not NP's since their base is nursing.

Why would a resident want to work as a PA? If they are AMG they can get a license with passage of step three and 1 year of training?

 

[JourneyAgent]

Why would a resident want to work as a PA? If they are AMG they can get a license with passage of step three and 1 year of training?

I've heard that argument but the problem is that there are so few opportunities to practice as a doc without completing residency that I'm skeptical it is a real option. Whereas opportunities for PA's are everywhere. Litigation dictates this scenario. As a PA your under the license of a doc. But nobody wants the liability of a partially trained doc.

idk. i'm not hip to the specific reasons, i just read here and sense the word on the street. I could be wrong. But given the feared consequence of getting your contract in residency cancelled or not renewed it seems like the situation must not be good.

 

[dudestheman90]

l

 

[JourneyAgent]

Well its clear to me you guys don't have respect for the nursing profession. Although were trying to help physicians meet the demand for primary care and the implementation of the 2014 ACA. I'm surprised at the hatred. Just realize nurses compromise the largest sector in healthcare, 3 million strong, We sustain the healthcare system and are the patient's advocate. We go through both medical and nurse training. I prefer the holistic approach to care b/c i feel that i will be a better healthcare provider. The nursing profession has and will continue to advance. There are now clinical doctoral programs for nurses, many sub-specialities to choose from and postgraduate residency programs as well. I do plan to pick a specialty and subspecialty b/c I want to be extremely competent in a specific area of medicine. I also plan to conduct research, publish and possibly teach later on in my career. And if the opportunity presents, go into politics and public health, nursing presents many opportunities for this as well. Also I'll graduate with no debt from school and i'll be making bank right from the start. Good luck drowning in debt. While your stuck in residency for 3-8 years making 40k ill be making 2-4 times your salary. Oh and i get to go home after an 8hr shift, and i wont have to work 60-80 hours per week and ill still be making more money than you. I'll get to go to work nice and fresh with my beauty sleep. Just keep that in the back of your mind when your a resident, that insignificant NP that you see, with less responsibility, yet making more $$. Why do you'aall think i chose nursing. The perks are just to delicious. Employers will even give nurses a sign-on bonus just to recruit you and even want you to further your education, hell they'll even pay you to become an NP. I absolutely love nursing! The most trusted profession in medicine!

This series of sentiments is exactly why we prefer collaboration with PA's or at least why I will. Because while you say want collaboration you really want our job for a fraction of the effort and investment.

This is why even though I think it's important for us to be civil and not compromise patient care with cold hostilities, it is very natural for us to be competitors. And I think it can be beneficial to both of our training regimens and for the public to openly compete for their health care dollars.

I favor an open honorable competition. But will not tolerate cowardly passive aggressive behavior under my supervision. So I encourage you to reach for your best, declare yourself, and achieve independence. Because if you bring any doubt or subversion to my leadership of my team one us will be leaving. If we're separated in liability we can be friendly neighbors of course.

Please. Make your feeling known. You're better than us. So let's get it on.

 

[Makati2008]

Well its clear to me you guys don't have respect for the nursing profession. Although were trying to help physicians meet the demand for primary care and the implementation of the 2014 ACA. I'm surprised at the hatred. Just realize nurses compromise the largest sector in healthcare, 3 million strong, We sustain the healthcare system and are the patient's advocate. We go through both medical and nurse training. I prefer the holistic approach to care b/c i feel that i will be a better healthcare provider. The nursing profession has and will continue to advance. There are now clinical doctoral programs for nurses, many sub-specialities to choose from and postgraduate residency programs as well. I do plan to pick a specialty and subspecialty b/c I want to be extremely competent in a specific area of medicine. I also plan to conduct research, publish and possibly teach later on in my career. And if the opportunity presents, go into politics and public health, nursing presents many opportunities for this as well. Also I'll graduate with no debt from school and i'll be making bank right from the start. Good luck drowning in debt. While your stuck in residency for 3-8 years making 40k ill be making 2-4 times your salary. Oh and i get to go home after an 8hr shift, and i wont have to work 60-80 hours per week and ill still be making more money than you. I'll get to go to work nice and fresh with my beauty sleep. Just keep that in the back of your mind when your a resident, that insignificant NP that you see, with less responsibility, yet making more $$. Why do you'aall think i chose nursing. The perks are just to delicious. Employers will even give nurses a sign-on bonus just to recruit you and even want you to further your education, hell they'll even pay you to become an NP. I absolutely love nursing! The most trusted profession in medicine! Let's see zero debt vs 250-300k debt, yeah ill go with the latter.

Your obviously misinformed when I graduate I will make at minimum 170k doing rural FM(220 doing easy rural em shifts.)Also I am debt free(well ill owe 26k if that counts lol). In my opinion your a coward that couldn't hack in medical school and probably couldn't be a PA either.
Also your post prove that the mindset of newer NPs- to provide inferior care due to poor/limited scope training. I will be glad when the general public wakes up to this farce of medical training but if they don't so be it because my family won't be touched by a NP. Why not suck it up and be the head instead of the wannabe? Also didn't like half of the NPs fail a watered down USMLE step 3?

 

[dudestheman90]

;

 

[NYCGuy86]

Well its clear to me you guys don't have respect for the nursing profession. Although were trying to help physicians meet the demand for primary care and the implementation of the 2014 ACA. I'm surprised at the hatred. Just realize nurses compromise the largest sector in healthcare, 3 million strong, We sustain the healthcare system and are the patient's advocate. We go through both medical and nurse training. I prefer the holistic approach to care b/c i feel that i will be a better healthcare provider. The nursing profession has and will continue to advance. There are now clinical doctoral programs for nurses, many sub-specialities to choose from and postgraduate residency programs as well. I do plan to pick a specialty and subspecialty b/c I want to be extremely competent in a specific area of medicine. I also plan to conduct research, publish and possibly teach later on in my career. And if the opportunity presents, go into politics and public health, nursing presents many opportunities for this as well. Also I'll graduate with no debt from school and i'll be making bank right from the start. Good luck drowning in debt. While your stuck in residency for 3-8 years making 40k ill be making 2-4 times your salary. Oh and i get to go home after an 8hr shift, and i wont have to work 60-80 hours per week and ill still be making more money than you. I'll get to go to work nice and fresh with my beauty sleep. Just keep that in the back of your mind when your a resident, that insignificant NP that you see, with less responsibility, yet making more $$. Why do you'aall think i chose nursing. The perks are just to delicious. Employers will even give nurses a sign-on bonus just to recruit you and even want you to further your education, hell they'll even pay you to become an NP. I absolutely love nursing! The most trusted profession in medicine! Let's see zero debt vs 250-300k debt, yeah ill go with the latter.

I'm sorry, but this post is too amusing. Weren't you talking just a month ago about how you're applying to podiatry school, had an interview invite, were planning on taking the MCAT, etc.? Very interesting. What happened?

Also interesting that you're comparing a resident physician to an NP. The resident is still undergoing their medical education and training, while the NP is in their career already. So yes, the resident will be working 80 hour weeks, you'll be making more money than them as an NP, etc etc., yet those long weeks and pay are part of the educational experience that makes the attending physician that much more experienced and knowledgeable than the NP that goes home after 8 hours making "bank". It's also why that attending physician, after all those years of being "stuck" in residency (I doubt they would look at it as being stuck. Rather, they'd look at it as part of their graduate medical education, the sacrifice they make to be experts), will laugh at you claiming to be "extremely competent in a specific area of medicine". Sorry, the expert in that specific area of medicine will be the attending physician, not the NP.

Oh and btw, if you "go with the latter", that means that you would go with the 300K debt. You mean the former.

 

[Makati2008]

you didn't finish quoting me, see my post above (again). Also i was disrespected 1st. I
'm only returning the favor. I'm not even a nurse yet, but i'm stating the obvious. Of course you prefer PA's, so you can control and cap their salaries, smart!! That's why i decided not to go into PA. The Pa profession is requesting for their name change to associate, and are taking note of how far the nursing profession has advanced. It's only a matter of time b4 they start requesting for more authority. Google PA's for tomorrow! It seems as if the PA profession doesn't feel their being fairly treated.

I have a feeling your in for a rude awakening. You do know that the great majority of NPs are employees RIGHT lol. Also why is there a NP in the medical school class a year ahead of me if its so great....

 

[pamac]

Well its clear to me you guys don't have respect for the nursing profession. Although were trying to help physicians meet the demand for primary care and the implementation of the 2014 ACA. I'm surprised at the hatred. Just realize nurses compromise the largest sector in healthcare, 3 million strong, We sustain the healthcare system and are the patient's advocate. We go through both medical and nurse training. I prefer the holistic approach to care b/c i feel that i will be a better healthcare provider. The nursing profession has and will continue to advance. There are now clinical doctoral programs for nurses, many sub-specialities to choose from and postgraduate residency programs as well. I do plan to pick a specialty and subspecialty b/c I want to be extremely competent in a specific area of medicine. I also plan to conduct research, publish and possibly teach later on in my career. And if the opportunity presents, go into politics and public health, nursing presents many opportunities for this as well. Also I'll graduate with no debt from school and i'll be making bank right from the start. Good luck drowning in debt. While your stuck in residency for 3-8 years making 40k ill be making 2-4 times your salary. Oh and i get to go home after an 8hr shift, and i wont have to work 60-80 hours per week and ill still be making more money than you. I'll get to go to work nice and fresh with my beauty sleep. Just keep that in the back of your mind when your a resident, that insignificant NP that you see, with less responsibility, yet making more $$. Why do you'aall think i chose nursing. The perks are just to delicious. Employers will even give nurses a sign-on bonus just to recruit you and even want you to further your education, hell they'll even pay you to become an NP. I absolutely love nursing! The most trusted profession in medicine! Let's see zero debt vs 250-300k debt, yeah ill go with the latter.

That quote has a lot of truth in it, but look at how it comes across. As someone working towards becoming an NP myself, I cringe. No mention of the patient, nor what you'll do to specifically hone your skills towards excellence. A PA doesn't have the rich variety of avenues available that you listed, but they do at least have a singular focus on patient care as a provider. That's nice that you want to have eclectic career goals, but you are asking your patients to bear the risk of you not having all your attention invested in them. That feeds into the concerns these providers have.

 

[NYCGuy86]

I'm not even a nurse yet,

Yes, we can tell.

but i'm stating the obvious. Of course you prefer PA's, so you can control and cap their salaries, smart!! That's why i decided not to go into PA. The Pa profession is requesting for their name change to associate, and are taking note of how far the nursing profession has advanced. It's only a matter of time b4 they start requesting for more authority. Google PA's for tomorrow! It seems as if the PA profession doesn't feel their being fairly treated.

The PAs that support the name change back to physician associate (you do realize that was the original name, and a few programs still carry that name) is because they believe that "assistant" does not fully reflect the roles that they play as autonomous (but not independent) clinicians. Your own posts, with the many mistakes and assumptions you make about PA vs NP practice, betrays why they are advocating for that name reversion.

One of the reasons many physicians prefer PAs over NPs is simply because they have more consistent educational training, based on the medical model, with a lot more clinical experience within the program.

 

[JourneyAgent]

Let's not attack without realizing that this is rhetoric s/he is probably just mouthing at this point. Perhaps that's more disturbing though. I've worked under nurses for many years. And I recognize this element of their culture. It's as fundamental to their instincts as eating a zebra's @ss is to a lion. It's how they're reared. And maybe we deserve it. We've been curtly telling them to do our b!tch work since their profession emerged. Really I can't imagine being a nurse for decades. If I did it for even a couple of years I would be one of these independence or death type NP's.

I want to ask the PA's if it is possible for human beings to not mind being in a truly collaborative relationship where the product of their moves is always the inherited responsibility of someone else?

I wonder if the true state of a capable human mind is rather to always reach for mastery of the task in front of them. And thus if some animosity is inevitable. What's the timeframe of a PA career before you start to think...I'm doin the same job as this guy but making a fraction of the salary?

I don't mean to be cynical but I know nurses to well to even entertain the possibility of no chip on the shoulder. Even when they're RN's they know better than us. Oddly I respect them as adversaries. Maybe because I was clothed and fed by nurses. My whole family is nurses. They're upbringing is steeped in a lore of subjugation. To their own narrative imagination they are the irish of the medical community and we the english. They're playing for all the marbles. I laugh when they play sheep like. There's nothing they enjoy more than eating our lunch.

Don't be fooled. We're natural enemies. And I say this as someone who always says please, sir, and ma'am to them. Not once letting on that I know what makes them tick.

 

[pamac]

you didn't finish quoting me, see my post above (again). Also i was disrespected 1st. I
'm only returning the favor. I'm not even a nurse yet, but i'm stating the obvious. Of course you prefer PA's, so you can control and cap their salaries, smart!! That's why i decided not to go into PA. The Pa profession is requesting for their name change to associate, and are taking note of how far the nursing profession has advanced. It's only a matter of time b4 they start requesting for more authority. Google PA's for tomorrow! It seems as if the PA profession doesn't feel their being fairly treated.

Deal with patients and gain some respect for what it's like to have thier welfare depend on your skills and knowledge before you dismiss what these folks are saying about the importance of training. You might not be excited about the shortcuts NPs can take to reach all that gold if you experienced the pucker factor you get when your knowledge isn't adequate to fix a problem and you can't pass the buck.

 

[NYCGuy86]

Let's not attack without realizing that this is rhetoric s/he is probably just mouthing at this point. Perhaps that's more disturbing though. I've worked under nurses for many years. And I recognize this element of their culture. It's as fundamental to their instincts as eating a zebra's @ss is to a lion. It's how they're reared. And maybe we deserve it. We've been curtly telling them to do our b!tch work since their profession emerged. Really I can't imagine being a nurse for decades. If I did it for even a couple of years I would be one of these independence or death type NP's.

I agree, you're right. I've worked as an ER tech and currently part-time as a clinical tech, and this is definitely part of the culture. I experience this sort of rhetoric every day I'm at work (interestingly most of the young nurses are planning on NP/are in NP school. They can't think of years and years of RN practice).

 

[Boatswain2PA]

Well its clear to me you guys don't have respect for the nursing profession. Although were trying to help physicians meet the demand for primary care and the implementation of the 2014 ACA. I'm surprised at the hatred. Just realize nurses compromise the largest sector in healthcare, 3 million strong, We sustain the healthcare system and are the patient's advocate. We go through both medical and nurse training. I prefer the holistic approach to care b/c i feel that i will be a better healthcare provider. The nursing profession has and will continue to advance. There are now clinical doctoral programs for nurses, many sub-specialities to choose from and postgraduate residency programs as well. I do plan to pick a specialty and subspecialty b/c I want to be extremely competent in a specific area of medicine. I also plan to conduct research, publish and possibly teach later on in my career. And if the opportunity presents, go into politics and public health, nursing presents many opportunities for this as well. Also I'll graduate with no debt from school and i'll be making bank right from the start. Good luck drowning in debt. While your stuck in residency for 3-8 years making 40k ill be making 2-4 times your salary. Oh and i get to go home after an 8hr shift, and i wont have to work 60-80 hours per week and ill still be making more money than you. I'll get to go to work nice and fresh with my beauty sleep. Just keep that in the back of your mind when your a resident, that insignificant NP that you see, with less responsibility, yet making more $$. Why do you'aall think i chose nursing. The perks are just to delicious. Employers will even give nurses a sign-on bonus just to recruit you and even want you to further your education, hell they'll even pay you to become an NP. I absolutely love nursing! The most trusted profession in medicine! Let's see zero debt vs 250-300k debt, yeah ill go with the latter.

Don't forget you will get to call yourself "Doctor"!

Of course, nobody else on the team will....not without laughing at you!!

 

[Makati2008]

Don't forget you will get to call yourself "Doctor"!

Of course, nobody else on the team will....not without laughing at you!!

Honestly I doubt he gets into NP school. There is a reason why he edited all of his DPM post from the past

 

[Boatswain2PA]

I want to ask the PA's if it is possible for human beings to not mind being in a truly collaborative relationship where the product of their moves is always the inherited responsibility of someone else?

I wonder if the true state of a capable human mind is rather to always reach for mastery of the task in front of them. And thus if some animosity is inevitable. What's the timeframe of a PA career before you start to think...I'm doin the same job as this guy but making a fraction of the salary?

Dr. Stead, the "father of the PA profession", once said (and I'm paraphrasing) that the PA profession cannot be a true profession unless there is a way for a PA to achieve independent practice. His vision was for some sort of bridge program for PAs to continue their education and become physicians. If there were no "ladder" to the highest level of the profession, then it would eventually be the death of the profession. Unfortunately it has taken 40 years for this ladder to take shape (LECOM)....unless you consider those like Makati (who must loooooooooove being in school!)

So yes, it is possible. Being a PA is a second complete career for me (my first was a 20 year stint in the military...non PA). If it were my first career (ie: I was 20 years younger), then perhaps I would pursue the LECOM program, or try to follow in Makati's footsteps.

I don't know about the "timeframe" you asked about because I'm very new, but I don't see us as doing "exactly" the same job. Most PA's do NOT do the same job as their SP, and even those of us who do MUCH the same job....we always have YOU to call on when we need.

I'll put it another way. I'm a large guy, career military, and I have a certain "presence" about me. When doing my rotations I often worked with Med Students and Residents and we would talk about the professions. Me being much older, they would think I should know more than they did (I was older than most attendings). I always loved the look on their face when I mentioned to them that someday I was going to call them for advice/supervision on a patient, and they damn well better know what to do if I didn't!

 

[Makati2008]

Dr. Stead, the "father of the PA profession", once said (and I'm paraphrasing) that the PA profession cannot be a true profession unless there is a way for a PA to achieve independent practice. His vision was for some sort of bridge program for PAs to continue their education and become physicians. If there were no "ladder" to the highest level of the profession, then it would eventually be the death of the profession. Unfortunately it has taken 40 years for this ladder to take shape (LECOM)....unless you consider those like Makati (who must loooooooooove being in school!)

So yes, it is possible. Being a PA is a second complete career for me (my first was a 20 year stint in the military...non PA). If it were my first career (ie: I was 20 years younger), then perhaps I would pursue the LECOM program, or try to follow in Makati's footsteps.

I don't know about the "timeframe" you asked about because I'm very new, but I don't see us as doing "exactly" the same job. Most PA's do NOT do the same job as their SP, and even those of us who do MUCH the same job....we always have YOU to call on when we need.

I'll put it another way. I'm a large guy, career military, and I have a certain "presence" about me. When doing my rotations I often worked with Med Students and Residents and we would talk about the professions. Me being much older, they would think I should know more than they did (I was older than most attendings). I always loved the look on their face when I mentioned to them that someday I was going to call them for advice/supervision on a patient, and they damn well better know what to do if I didn't!

Bots- believe me I don't love school but love a good challenge. My family made a joke about me probably going to dental school next lol(I am done and have a kid that likes to eat has solidified that lol)

The profession has grown so much in these past 9 years that I wouldn't have been a betting man if you told me of some of the changes(practice climate, the bridge etc..) and when I graduate I want good providers(NP or PA). If they(NPs or rogue PAs(which I have met but fortunately in a very small) that want independence without gaining it the right way then I will refuse to collaborate or work for a company that forces me to do so. Also the state I am going back to is not an independent state and pray it remains that way.

As much as I complain about NPs I do respect them as long as they know their role in healthcare. I honestly have no respect for those pursuing the DNP though.

If typos noted my iPhone is autocorrecting as usual

 

[JourneyAgent]

Thanks. I've learned a lot listening to your perspectives gentleman. I agree that it seems the PA profession would flourish more as a longer slower route to md/do for people with children or who had developed the desire to do medical school at a later date. I think both arms of such a joint venture would benefit. A PA with experience would be a wealth of knowledge to their medical student colleagues. And a PA with options for career development would be happier while working as a PA. It's too bad medical schools have such elitist preoccupations that they haven't seen the utility of developing more such programs.

If I were a consulting strategist I would recommend to medical schools that they develop the equivalent of an OCS for PA forthwith. And for the other team that they keep fighting for independence but to do it with much much tighter quality control. What could we say to them if they passed step 3 and the specialty board exams and if they had a minimal residency. We'd be mumbling incorehently en masse. Then they could begin open season @ss kicking on us with their superior public alliance.

But they won't. They seem determined to fall on their own sword. Just as we have.

 

[pamac]

Bots- believe me I don't love school but love a good challenge. My family made a joke about me probably going to dental school next lol(I am done and have a kid that likes to eat has solidified that lol)

The profession has grown so much in these past 9 years that I wouldn't have been a betting man if you told me of some of the changes(practice climate, the bridge etc..) and when I graduate I want good providers(NP or PA). If they(NPs or rogue PAs(which I have met but fortunately in a very small) that want independence without gaining it the right way then I will refuse to collaborate or work for a company that forces me to do so. Also the state I am going back to is not an independent state and pray it remains that way.

As much as I complain about NPs I do respect them as long as they know their role in healthcare. I honestly have no respect for those pursuing the DNP though.

If typos noted my iPhone is autocorrecting as usual

How many DNPs are folks that want to enter the clinical arena and practice as "doctors"? I see them mostly as folks that want to be like the commenter with the multiple career paths that very remotely touch upon directly interacting with patients... Like policy, management, politics, "research" etc. I will probably have to get a DNP because the lions share of NP programs are making the transition. I'm not excited about the idea of tacking on an extra year or so of education that doesn't directly pertain to taking care of patients. I'm not at all wrapped up in the title "doctor" (nor would it appeal to me to use it in any setting, let alone a clinical one). I don't want to use independence as a tool to emerge as the guy who gets his way in a provider vs physician grudge match. If it helps take some pressure off my employer for me to have more leeway than a PA, like the ER groups in my region have done, then that's appealing. However, that kind of distinction has more to do with gains made in the political realm by the nursing movement than it is a reflection of the capabilities of PAs vs NPs.

Eugene Stead originally envisioned nurses as recruits to become PAs, and settled for medics when he was rebuffed. He may have been a visionary when it came to the notion of a midlevel provider, but it's obvious that making medicine into a stepwise process is a bitmod a stretch for many folks in the medical community. Even the bridge programs really only cut out about a year of training, and even then they want most of their grads to steer clear of specialties. You can get a grad through medical school in 3 years if you cut out breaks, so I really don't think the bridge program demonstrates physicians' seal of approval. They are basically saying "that's nice that you are a trained PA... Now go back and do almost everything we did and then you can be one of us....Your PA background means very little ".

 

[Makati2008]

How many DNPs are folks that want to enter the clinical arena and practice as "doctors"? I see them mostly as folks that want to be like the commenter with the multiple career paths that very remotely touch upon directly interacting with patients... Like policy, management, politics, "research" etc. I will probably have to get a DNP because the lions share of NP programs are making the transition. I'm not excited about the idea of tacking on an extra year or so of education that doesn't directly pertain to taking care of patients. I'm not at all wrapped up in the title "doctor" (nor would it appeal to me to use it in any setting, let alone a clinical one). I don't want to use independence as a tool to emerge as the guy who gets his way in a provider vs physician grudge match. If it helps take some pressure off my employer for me to have more leeway than a PA, like the ER groups in my region have done, then that's appealing. However, that kind of distinction has more to do with gains made in the political realm by the nursing movement than it is a reflection of the capabilities of PAs vs NPs.

Eugene Stead originally envisioned nurses as recruits to become PAs, and settled for medics when he was rebuffed. He may have been a visionary when it came to the notion of a midlevel provider, but it's obvious that making medicine into a stepwise process is a bitmod a stretch for many folks in the medical community. Even the bridge programs really only cut out about a year of training, and even then they want most of their grads to steer clear of specialties. You can get a grad through medical school in 3 years if you cut out breaks, so I really don't think the bridge program demonstrates physicians' seal of approval. They are basically saying "that's nice that you are a trained PA... Now go back and do almost everything we did and then you can be one of us....Your PA background means very little ".

The length is a few weeks above the minimum number of weeks to gain a Medical degree so it's not a slight to PAs in this bridge but a way to remain compliant while recognizing our unique skill set. Also I will ask again why weren't the NPs invited to this party? (I know I beat dead horses lol)

I do applaud you for recognizing its inappopriate to call yourself doctor as a Dnp(although in academic lecture setting I think it is fine)

 

[pamac]

The length is a few weeks above the minimum number of weeks to gain a Medical degree so it's not a slight to PAs in this bridge but a way to remain compliant while recognizing our unique skill set. Also I will ask again why weren't the NPs invited to this party? (I know I beat dead horses lol)

I do applaud you for recognizing its inappopriate to call yourself doctor as a Dnp(although in academic lecture setting I think it is fine)

NPs could attend the party, just not at lecom. They would apply to medical school at the NYU program where one could complete medical school in just above the minimum number of weeks......just like PA bridge programs. Those kinds of 3 year programs expose the bridge as not really being much of a validation of PAs because they do the same thing in the same amount of time with NON PA's. I'm aware of how minimum length of a medical program can't be sidestepped, but my point is that other schools are experimenting with the same time frames. So yeah, any PA could come along and treat the NYU program like a bridge... But so could any NP that wants to go take the MCAT and complete the med school prerequisites. The difference is that the PA would probably have the science prereqs already completed, as they are often the same ones for PA school. The MCAT requirement all but ensures that lecoms applicants need to have taken physics and ochem. But in theory, as an NP, I could take the MCAT and apply for NYU's program and call it a bridge. Since I've taken physics and ochem, as well as all the sciences at the appropriate levels, I'd qualify. Notice that even lecom isn't letting any PA in, just ones that could go and apply to medical school on their own merits and get in. PA bridge programs are indeed not actually recognizing your skill set. You don't get to skip the MCAT, nor get out of any of the minimum program length requirements. So what does that demonstrate besides PAs being just the same in the medical community's view.......on par with any other talented premed?

To sum it up.... NPs that take the MCAT and meet prereqs can attend a program like NYUs 3 year program. PAs that take the MCAT and meet prereqs can attend a PA-MD bridge program and be done in 3 years. Regular premeds can take the MCAT and meet prereqs and attend NYU's 3 year program and be done in 3 years. What is the difference among those 3 pathways? PAs attending the bridge program think that their PA training saved them some steps and time in the process....

I think that there are plenty of ways to make the case that PAs are very well trained, but using the bridge as evidence of them being invited to the party vs NPs is the wrong way to do it. Any NP or PA with MCAT and science requirements completed can attend a program that will turn them into physicians in just above the minimum amount of time. Non Midlevel providers can do it too! Guess everyone gets a trophy.

As far as being called a doctor, the pervasiveness of doctorates in other fields has led to many of the physicians in my market to refer to themselves not as doctors, but physicians. "Hi, I'm joe Johnson.... I'm the ER physician" or "hi, I'm Jane Smith, the orthopedic surgeon" is the kind of introduction to patients I hear most around here. Personally, I'm a traditionalist, so I address physicians as "dr. X". Non physician providers and Mr. or Ms. (As are patients unless they indicate a preferred name). But they are trying to get folks to say things like "your physician will be right in" vs "your doctor will be right in", mostly for the sake of accuracy I guess. Either way, if I were a DNP, the distraction of having to explain that I'm not a physician would immediately be counterproductive to my professional image because id be explaining that im not what they expected me to be, so why bother? Just skip the "Dr." part. It's part of the vernacular as belonging to physicians, and codified by law in many clinical settings in the nation, so I'm at peace with that.

 

[Boatswain2PA]

Pamac, as you probably well know, most NPs feel the same way as you do, fit in well into the (real) Doctor led medical team, and do great patient care. It's the rare militant ideological "holistic nursing taught by bureaucrats in 3 years is much better/cheaper than that mean greedy medical doctor" nurse (like Mary Mundinger) who stirs up the pot.

Good luck in your studies.

 

[Makati2008]

NPs could attend the party, just not at lecom. They would apply to medical school at the NYU program where one could complete medical school in just above the minimum number of weeks......just like PA bridge programs. Those kinds of 3 year programs expose the bridge as not really being much of a validation of PAs because they do the same thing in the same amount of time with NON PA's. I'm aware of how minimum length of a medical program can't be sidestepped, but my point is that other schools are experimenting with the same time frames. So yeah, any PA could come along and treat the NYU program like a bridge... But so could any NP that wants to go take the MCAT and complete the med school prerequisites. The difference is that the PA would probably have the science prereqs already completed, as they are often the same ones for PA school. The MCAT requirement all but ensures that lecoms applicants need to have taken physics and ochem. But in theory, as an NP, I could take the MCAT and apply for NYU's program and call it a bridge. Since I've taken physics and ochem, as well as all the sciences at the appropriate levels, I'd qualify. Notice that even lecom isn't letting any PA in, just ones that could go and apply to medical school on their own merits and get in. PA bridge programs are indeed not actually recognizing your skill set. You don't get to skip the MCAT, nor get out of any of the minimum program length requirements. So what does that demonstrate besides PAs being just the same in the medical community's view.......on par with any other talented premed?

To sum it up.... NPs that take the MCAT and meet prereqs can attend a program like NYUs 3 year program. PAs that take the MCAT and meet prereqs can attend a PA-MD bridge program and be done in 3 years. Regular premeds can take the MCAT and meet prereqs and attend NYU's 3 year program and be done in 3 years. What is the difference among those 3 pathways? PAs attending the bridge program think that their PA training saved them some steps and time in the process....

I think that there are plenty of ways to make the case that PAs are very well trained, but using the bridge as evidence of them being invited to the party vs NPs is the wrong way to do it. Any NP or PA with MCAT and science requirements completed can attend a program that will turn them into physicians in just above the minimum amount of time. Non Midlevel providers can do it too! Guess everyone gets a trophy.

As far as being called a doctor, the pervasiveness of doctorates in other fields has led to many of the physicians in my market to refer to themselves not as doctors, but physicians. "Hi, I'm joe Johnson.... I'm the ER physician" or "hi, I'm Jane Smith, the orthopedic surgeon" is the kind of introduction to patients I hear most around here. Personally, I'm a traditionalist, so I address physicians as "dr. X". Non physician providers and Mr. or Ms. (As are patients unless they indicate a preferred name). But they are trying to get folks to say things like "your physician will be right in" vs "your doctor will be right in", mostly for the sake of accuracy I guess. Either way, if I were a DNP, the distraction of having to explain that I'm not a physician would immediately be counterproductive to my professional image because id be explaining that im not what they expected me to be, so why bother? Just skip the "Dr." part. It's part of the vernacular as belonging to physicians, and codified by law in many clinical settings in the nation, so I'm at peace with that.

Still think your wrong about the bridge and here is why. Those spots are set aside for those who are PAs ONLY unlike the other programs where there are tons of applicants that you compete against but for the bridges spots you only compete against that subset. Also the bridge doesn't focus soley on the MCAT(like most medical schools do) and in turn sets an acceptable min. Personally I think the MCAT is worthless(it's by no means an easy test and maybe I am not feeling your tone correctly but you seem to feel like it is?)but found step 1 to be more relevant. So yep I'll stick to my guns about why NPs not being invited to the party -variance in curriculum among other reasons I mentioned earlier-and that the bridge is indeed something very important for the advancement of PAs into medicine.

 

[pamac]

Still think your wrong about the bridge and here is why. Those spots are set aside for those who are PAs ONLY unlike the other programs where there are tons of applicants that you compete against but for the bridges spots you only compete against that subset. Also the bridge doesn't focus soley on the MCAT(like most medical schools do) and in turn sets an acceptable min. Personally I think the MCAT is worthless(it's by no means an easy test and maybe I am not feeling your tone correctly but you seem to feel like it is?)but found step 1 to be more relevant. So yep I'll stick to my guns about why NPs not being invited to the party -variance in curriculum among other reasons I mentioned earlier-and that the bridge is indeed something very important for the advancement of PAs into medicine.

So what if they are set aside by an institution for PAs only? That would just demonstrate the bridge as a version of PA affirmative action, as evidenced by a decreased reliance upon MCAT (does that mean lower scores are kosher?). The bridge is like an offer that comes in the mail saying "you've been preapproved for this special offer", when it goes out to everyone. In any event, that feels more like a targeted recruiting effort than a real leg up.

 

[Boatswain2PA]

I think another issue between LECOM's bridge program and the other 3 year DO programs is residency. LECOM has a 3 year DO program, but I believe you can only match into FP. With the bridge program you can compete to match into any residency.

 

[Makati2008]

So what if they are set aside by an institution for PAs only? That would just demonstrate the bridge as a version of PA affirmative action, as evidenced by a decreased reliance upon MCAT (does that mean lower scores are kosher?). The bridge is like an offer that comes in the mail saying "you've been preapproved for this special offer", when it goes out to everyone. In any event, that feels more like a targeted recruiting effort than a real leg up.

From a $ standpoint I don't think that would be viable(long term) to set up a medical school for PA's soley. (Only 1% of PAs go onto become medical doctors). As far as the bridge how is it targeted at "everyone" it's not like they are taking the weakest PAs and letting them into medical school but they would be the stronger ones with the self drive to want to pursue medicine and not take the easy way out like some DNPs/PAs do.(I understand your situation about being forced into a DNP program and disagree with your society making that the new suggested standard for you guys/gals). Lastily, I guess we will disagree about the bridge so we can continue to go back and forth or just agree to disagree and leave it at that.

Personally I think the MCAT is not a good indicator of how well one will do in medical school(at least not the whole exam now the biological science section I think would have the highest correlation I could be wrong). How can reading passages about different types of clouds in the Verbal section decide how good of a doctor I will become? Also the Physics portion of the exam is worthless. I used very little physics in medical school and when I say very little I would have known the answer from the very basic high school Physics I had.

 

[Makati2008]

I think another issue between LECOM's bridge program and the other 3 year DO programs is residency. LECOM has a 3 year DO program, but I believe you can only match into FP. With the bridge program you can compete to match into any residency.

Boats-It's 1/2 and 1/2 from what I read. 50% must go into Primary care(Ob/Gyn, FM, IM, Peds) and the other 50% do as they please if I remember correctly but my thing is how do they decide who goes into which category. I would personally hate to be pigeonholed into a situation like that. I had a similar offer from a MD school to go into primary care but turned it down because I was still battling in my head EM vs FM and since my school was covered by an outside entity I didn't have to worry about cost

 

[pamac]

I think another issue between LECOM's bridge program and the other 3 year DO programs is residency. LECOM has a 3 year DO program, but I believe you can only match into FP. With the bridge program you can compete to match into any residency.

That's Lecoms choice to only allow primary care. NYU is an MD program that allows for any residency choice for its students.... It's non PA students.

 

[pamac]

From a $ standpoint I don't think that would be viable(long term) to set up a medical school for PA's soley. (Only 1% of PAs go onto become medical doctors). As far as the bridge how is it targeted at "everyone" it's not like they are taking the weakest PAs and letting them into medical school but they would be the stronger ones with the self drive to want to pursue medicine and not take the easy way out like some DNPs/PAs do.(I understand your situation about being forced into a DNP program and disagree with your society making that the new suggested standard for you guys/gals). Lastily, I guess we will disagree about the bridge so we can continue to go back and forth or just agree to disagree and leave it at that.

Ok, then if they are taking strong students that further negates the notion that PA bridges are a leg up, because it goes to show that those students would probably be just as successful on the open market for applying to one of the non bridge 3 year programs. Ultimately, bridge programs are only a manifestation of recruiting preferences, just like the PA programs that only take folks with RN experience, or really high hce, and insist that only those folks are suitable to show up to the party.... All the schools that churn out new grad PAs that pass the pance having no prior Hce weaken that arguement. The bridge offers very little if any benefit other than maybe a better chance at getting a seat... As long as you are a competetive applicant. Its probably not the fact that they are PAs that contributes to success, its likely to be the Fact that they are, in your words, "stronger ones with the self drive".

I'll agree to disagree along with you. What I gained from this discussion was that I essentially have "bridge" programs available to me as a future NP if I were to look for them. Frankly, I'm not interested in medical school, so that's not an issue. I want to be an NP.

 

[pamac]

The NP diehards freak me out, but they are like insane union bosses that carve out concessions that improve the environment for union members (often to the detriment of others). In that regard, i cant help but think that i benefit from their inflated self esteem. Its surely better than what the aapa is able to muster. I don't mind doctors having the last word on diagnosis, but I don't think it's healthy to hand over all aspects of the financial leverage to them to divy it back out as they see fit. That's changing right now in the healthcare environment due to conglomerates and systems absorbing independent practices and making physicians into employees. Incidentally, I think that transition will bring a push for more lattitude for PAs, since they also will need to be employees of theses systems just like physicians. I think that tends to even out the landscape. You'll probably see more NPPs wages and benefits falling more in line around an average vs highs and lows in the market. And just like the medical groups in my area that enjoy the status nps have as working with fewer strings attached, I could see hospital systems as a good ally in pushing for more pa "independance", as it benefits them to have employees in their labor pool with fewer arrangements that need to be made on their behalf.

 

[JoBreeze]

Good luck drowning in debt. While your stuck in residency for 3-8 years making 40k ill be making 2-4 times your salary. Oh and i get to go home after an 8hr shift, and i wont have to work 60-80 hours per week and ill still be making more money than you. I'll get to go to work nice and fresh with my beauty sleep. Just keep that in the back of your mind when your a resident, that insignificant NP that you see, with less responsibility, yet making more $$. Why do you'aall think i chose nursing. The perks are just to delicious.

+1

I agree that finding shortcuts/a back door into medicine provides a more favorable return on the investment when compared with the work required for getting into med school, passing board exams, training for multiple years at 80 hrs/week etc. It's also obviously a more viable option for most of the population that desires a career in healthcare.

 

[SpecterGT260]

No. The underlying reason why I want to live in an independent practice state is so that I have that option later down the line. I never said I planned on having my own independent practice the second I graduate. There's a difference.

Meh, people are free to see whoever they want. MD, DO, PA, NP, whatever. I've been to good ones and bad ones, surprisingly, it had little to do with the initials after their name. Let people see who they want and if physicians are as innately superior as they seem to believe, then they have nothing to worry about, right?

The single biggest issue in mid level expansion is the understanding of the complexities of pathologic processes. In my opinion this goes hand in hand with understanding other such complexities such as the stats in EBM (for no other reason than it conveniently allows me to draw a direct parallel to this post in criticism of both)

The fact that you don't seem to know that patient perceptions very rarely correlate with real outcomes or level of skill of the practitioner is very telling.

p.s. http://en.wikipedia.org/wiki/Dunning–Kruger_effect