PA vs Nursing-Difficulty Deciding!

[Divergent]

So I'm having a lot of difficulty deciding which route to go. I know that I want to be a provider, but I'm having trouble figuring out which route would be the most satisfying. Here are my thoughts:

-no bachelor's degree

-I've completed most of the pre-reqs for entry to upper division BSN or PA. I plan on starting either program next summer/fall, 2014. I'll have everything by the time I apply in the fall/spring.

-In my area (NYC), we have a few upper division bachelor's PA programs as well as combined BS/MS programs (2-3 years) programs, so I'd apply to both types, preferring the BS/MS obviously, since you get both degrees in pretty much the same time.

-Financially, it seems like nursing would be the best route. I can continue to work part time during the BSN and on through to NP. With PA, work doesn't seem possible/I'd have to cut back on hours (I work as a tech on a cardiac unit, 30 hours/week). Trying to limit financial strain as I already have debt (60K) unfortunately.

-Ultimately, I know I want to be specialty practice. Family practice/peds/psych are not for me. I'm mostly interested in cardiac/pulmonary fields (cardiology (especially heart failure), cardiothoracic surgery, critical care, heart/lung transplant), since that's what I've been exposed to for the past couple years. I also worked as an EMT-B and ER tech for a few years in the past, though I'm not really interested in EM anymore (maybe because dealing with pediatric patients isn't my cup of tea), but who knows.

-PA programs look way more interesting to me than NP programs. Hardly any fluff. It seems like there's more hard science, including anatomy with cadavers, diagnostic imaging (I've heard a number of NP programs don't have a lot of that), and the clinical hours blow away even the ~1000 hours found in the DNP programs (the one's including the NP curriculum, not post-masters). I feel like I'd be better prepared as a clinician in a PA program.

-Tons more post-graduate residencies available for PAs, especially in the areas I'm interested in.

-While I've heard that PAs are more in the specialties/inpatient setting, I still see NPs (ACNP) in those settings as well, so I don't know if that's another plus for PAs. I do know that PAs are used way more intraoperatively, which is attractive though (being able to be involved with your patient pre, intra, and post operatively).

-With nursing, it seems like there are more leadership opportunities (at my hospital, I was just talking to someone that it looks like they practically invent VP and Director positions for nurses!), as well as more opportunities for research (especially when on faculty at a nursing school in addition to clinical responsibilities) than PA (someone correct me if I'm wrong). I'd like to continue to be involved in research (I have a publication on cancer pharmacology with a chemistry professor). Do PAs that are PA faculty at programs in medical schools do clinical research? If you're at a hospital without a PA affiliated program, are PAs able to have faculty appointments at the medical school (I'm assuming not)?

-Independent practice is attractive, but I'm not sure if there is really a benefit with that in the inpatient/specialty setting. Would that have any effect on PA vs NP practice in the hospital/specialty clinics?


Anyway, seems like a lot I've been thinking about. I'm leaning to PA, mostly because of the education, and it would be quicker to get to what I want to do. But I still think about the nursing route for the reasons given above, so that gives me pause.

Thanks for reading, and thanks for your help!

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[Makati2008]

I will start with my usual basic questions and others will chime in.
1.)GPA(science and total)
2.)Age

I will agree there is more advancement in NP(as far as the things you mentioned) but it seems like more money for PAs. Personally would do PA all over again(if I knew I wouldn't end up in medical school.).

Apologize if this doesn't make sense been a long day PM me with direct questions if you like.

 

[Divergent]

I will start with my usual basic questions and others will chime in.
1.)GPA(science and total)
2.)Age

I will agree there is more advancement in NP(as far as the things you mentioned) but it seems like more money for PAs. Personally would do PA all over again(if I knew I wouldn't end up in medical school.).

Apologize if this doesn't make sense been a long day PM me with direct questions if you like.

Thanks for the reply!

1) Science GPA= 3.5 (includes Bio I and II, A&P I and II, Gen Chem I and II, Microbio, Analytical Chem, and Orgo I, which I need to retake (got a D, guess I was overconfident since I got As in everything else), Total=3.6

2) Age=26

Health experience= almost 4 years as a tech in cardiology (current), prior to that, 3 years as a volunteer EMT-B, 2.5 years as ER Tech.

Also have a publication in on a cancer pharmacology/biochemistry topic (not a major journal like Cell or Nature)

Not interested in med school, at least at this point in my life, as I'd really like to start my life already, have 60K in debt already, etc.

Interesting thing about the money, I was just reading a thread over at allnurses on that topic, and there are a few NPs talking about how they themselves, or others they know, make $200-300K. Obviously I know that isn't the average NP salary, but do you think that sort of salary is possible for PAs? I honestly don't care about rolling in money, I'd be fine in the 100s.

Thanks again. I'll definitely PM you later on with specific questions.

 

[princekc]

It's premature to discuss earning potential at this point.

Consider shadowing a PA & an NP in your specialty of interest.

 

[futurepsych0]

Thanks for the reply!

1) Science GPA= 3.5 (includes Bio I and II, A&P I and II, Gen Chem I and II, Microbio, Analytical Chem, and Orgo I, which I need to retake (got a D, guess I was overconfident since I got As in everything else), Total=3.6

2) Age=26

Health experience= almost 4 figure as a tech in cardiology (current), prior to that, 3 years as a volunteer EMT-B, 2.5 years as ER Tech.

Also have a publication in on a cancer pharmacology/biochemistry topic (not a major journal like Cell or Nature)

Not interested in med school, at least at this point in my life, as I'd really like to start my life already, have 60K in debt already, etc.

Interesting thing about the money, I was just reading a thread over at allnurses on that topic, and there are a few NPs talking about how they themselves, or others they know, make $200-300K. Obviously I know that isn't the average NP salary, but do you think that sort of salary is possible for PAs? I honestly don't care about rolling in money, I'd be fine in the 100s.

Thanks again. I'll definitely PM you later on with specific questions.

The 200k+ salaries, unless you are a crna, are from NPs that opened their own practice or are a partner in a group practice. They make that much because they are both the business owner/part owner and practitioner. I haven't seen any posting offering an NP that type of salary as an employee(most start at high 5 figure and top off low to mid 100s). However, that doesn't mean it doesn't exist and if they do it is extremely rare. If you want to go a specialty, I have heard doing a FNP and a residency is best bet if you go the nursing route. FNP offers you the largest scope of practice and residencies prefer that. Here is a short list of some.
http://www.graduatenursingedu.org/nurse-practitioner-residency-programs/
Best of luck to you on whatever path you choose.

 

[deleted6669]

also consider part time pa programs. there are probably 6-8 nationwide. they split yr 1 into 2 years allowing you to work yr 1 and 2 then you do year 3 as the nl yr 2 schedule and you can't work much then.
I did a part time program and worked 30 hrs/week for the first 2 years then just occasional shifts third yr.
if you want em/surgery/hospital based practice pa is a better bet.
if you want outpt practice or to own your own clinic np is a better bet.
pas typically get at least twice or even 3-4x the clinical hours of nps and the didactic portion is more like medical school.typical np program = 500-800 hrs of clinicals. typical pa program is 1500-2500 hrs. mine was over 3000 hrs in 54 weeks.
specialty pas can easily make 100 k after a few years and with a bit of overtime in the right specialties 150-200k is not out of the question. the lead pa in my group makes 250k/yr but works a lot of overtime. most pas in my group(there are 15 of us) make 110-160k.

 

[Makati2008]

Agree with EMED. I made 186k(could have hit 200k with a little more effort.) I had a Cush job that I slept at, studied for my MCAT, and just took it easy for most of the time. So yes the money is out there if your willing to make a trade off(I wouldn't make that much in a big city IMO). I will tell you though when the shix hits the fan at a rural place it's what makes you grateful for your pay rate.

 

[deleted6669]

. I will tell you though when the shix hits the fan at a rural place it's what makes you grateful for your pay rate.

indeed. I see and manage more acuity at my rural job in a weekend than at my big city trauma job in a month.
why? at the big trauma ctr there are teams who sweep in and take over all the trauma, stemi's, cva's, and truly critical/septic, etc pts almost as soon as they hit the door. at the rural job you are it. you might not even have an on call surgeon available. for the first few years at one of my rural jobs we had ortho and gen surg on alternate days and zero ob coverage. no cards or neuro either. stabilize and transfer.often multiple critical pts at the same time.
the folks at my rural job have no problem keeping up their #s for procedures like intubations, central lines, etc while the folks at my urban job have to fight to keep their #s up and often go to the o.r. to get enough intubations to stay credentialed.

 

[pamac]

So I'm having a lot of difficulty deciding which route to go. I know that I want to be a provider, but I'm having trouble figuring out which route would be the most satisfying. Here are my thoughts:

-no bachelor's degree

-I've completed most of the pre-reqs for entry to upper division BSN or PA. I plan on starting either program next summer/fall, 2014. I'll have everything by the time I apply in the fall/spring.

-In my area (NYC), we have a few upper division bachelor's PA programs as well as combined BS/MS programs (2-3 years) programs, so I'd apply to both types, preferring the BS/MS obviously, since you get both degrees in pretty much the same time.

-Financially, it seems like nursing would be the best route. I can continue to work part time during the BSN and on through to NP. With PA, work doesn't seem possible/I'd have to cut back on hours (I work as a tech on a cardiac unit, 30 hours/week). Trying to limit financial strain as I already have debt (60K) unfortunately.

-Ultimately, I know I want to be specialty practice. Family practice/peds/psych are not for me. I'm mostly interested in cardiac/pulmonary fields (cardiology (especially heart failure), cardiothoracic surgery, critical care, heart/lung transplant), since that's what I've been exposed to for the past couple years. I also worked as an EMT-B and ER tech for a few years in the past, though I'm not really interested in EM anymore (maybe because dealing with pediatric patients isn't my cup of tea), but who knows.

-PA programs look way more interesting to me than NP programs. Hardly any fluff. It seems like there's more hard science, including anatomy with cadavers, diagnostic imaging (I've heard a number of NP programs don't have a lot of that), and the clinical hours blow away even the ~1000 hours found in the DNP programs (the one's including the NP curriculum, not post-masters). I feel like I'd be better prepared as a clinician in a PA program.

-Tons more post-graduate residencies available for PAs, especially in the areas I'm interested in.

-While I've heard that PAs are more in the specialties/inpatient setting, I still see NPs (ACNP) in those settings as well, so I don't know if that's another plus for PAs. I do know that PAs are used way more intraoperatively, which is attractive though (being able to be involved with your patient pre, intra, and post operatively).

-With nursing, it seems like there are more leadership opportunities (at my hospital, I was just talking to someone that it looks like they practically invent VP and Director positions for nurses!), as well as more opportunities for research (especially when on faculty at a nursing school in addition to clinical responsibilities) than PA (someone correct me if I'm wrong). I'd like to continue to be involved in research (I have a publication on cancer pharmacology with a chemistry professor). Do PAs that are PA faculty at programs in medical schools do clinical research? If you're at a hospital without a PA affiliated program, are PAs able to have faculty appointments at the medical school (I'm assuming not)?

-Independent practice is attractive, but I'm not sure if there is really a benefit with that in the inpatient/specialty setting. Would that have any effect on PA vs NP practice in the hospital/specialty clinics?


Anyway, seems like a lot I've been thinking about. I'm leaning to PA, mostly because of the education, and it would be quicker to get to what I want to do. But I still think about the nursing route for the reasons given above, so that gives me pause.

Thanks for reading, and thanks for your help!

You seem like a good candidate for medical school for a bunch of reasons. Clinical research is usually out of the mainstream for PA's. If you arent in front of a patient, or doing patient oriented work, you aren't pulling in cash for your practice. You can specialize pretty easy as a PA, but all the outside interests you seem intent on are a bit of a stretch for the typical PA. PAs are trained very well, though, so you are right about that.

Its true about nursing having plenty of options for administration. A lot of facilities see nurses as being a good fit for supervising the everyday nuts and bolts of management. I know several nurses in management that also have thier NP qualifications. They make more in thier role as managers than they would as NP's (which also means they would make more than they would as PAs as well, since they make about the same overall).

If debt is a big thing for you, I can appreciate that. One of the big reasons I didnt stay a pre-PA was in part because it would have cost significantly more for me than going the NP route. School would have been close to 90k (another school I got an interview at was closer to 130k), then theres two years of not working and lost wages, relocation, etc. All told I felt like I was losing out of close to 200k. My facility paid for my RN. I worked full time. They will pay for a significant portion of my NP, and I will work through that as well if I want. When I start as an FNP, Ill make as much as I would as a PA... with no 1800 dollar a month payments on my student loans, and no trying to land a spot in a facility that qualifies for the government to repay my loans. You can teach, move up the chain into management, work in the clinical environment.... there are tons of opportunities.

 

[Divergent]

You seem like a good candidate for medical school for a bunch of reasons. Clinical research is usually out of the mainstream for PA's. If you arent in front of a patient, or doing patient oriented work, you aren't pulling in cash for your practice. You can specialize pretty easy as a PA, but all the outside interests you seem intent on are a bit of a stretch for the typical PA. PAs are trained very well, though, so you are right about that.

Its true about nursing having plenty of options for administration. A lot of facilities see nurses as being a good fit for supervising the everyday nuts and bolts of management. I know several nurses in management that also have thier NP qualifications. They make more in thier role as managers than they would as NP's (which also means they would make more than they would as PAs as well, since they make about the same overall).

If debt is a big thing for you, I can appreciate that. One of the big reasons I didnt stay a pre-PA was in part because it would have cost significantly more for me than going the NP route. School would have been close to 90k (another school I got an interview at was closer to 130k), then theres two years of not working and lost wages, relocation, etc. All told I felt like I was losing out of close to 200k. My facility paid for my RN. I worked full time. They will pay for a significant portion of my NP, and I will work through that as well if I want. When I start as an FNP, Ill make as much as I would as a PA... with no 1800 dollar a month payments on my student loans, and no trying to land a spot in a facility that qualifies for the government to repay my loans. You can teach, move up the chain into management, work in the clinical environment.... there are tons of opportunities.

Thanks for the reply. Yeah, debt is a very big thing for me at this time. Already being in a lot of debt, being 26, etc, I really would like to not add on another 100K+ of debt onto that. Either way, I have preference for my state schools, as well as looking into as many scholarships as possible. I do find the nursing route attractive for that reason.

On the other hand, I'm not sure if I'm really interested in the RN role. I've worked as a tech for a number of years, and see what they do. Now, nurses certainly have a valuable role, an important one, and I think it's really up to the nurse to be the best clinician they can be (I'm sure you know and work with nurses that just the bare minimum, just like with any profession). However, with PA, that would be the fastest route to the role I envision myself in, i.e. provider.

I think what sums up how I view this is: Nursing has the most opportunities for advancement in leadership, administration, and has independent practice (I say that not to discount the education and training of physicians, just that to me, it makes sense to have advanced practice providers be independent, and know and be trained as to when to refer and consult, as it happens already). Nursing has all the benefits that come with being a long established profession. On the other hand, PA would be a faster route to what I want to do. They also are better trained, and have a more attractive curriculum, IMO.

Med school would be nice, perhaps later on in life (that PA-DO bridge, as well as 3 year MD programs, like at NYU and other schools, seem nice). I've talked to a few people that started med school in their 30s, and at my hospital it seems like we have quite a few older residents. Oh and I haven't even taken Physics I and II, or Orgo II (need to retake Orgo I).

Oh, and I still need a bachelor's degree, so it would be either PA (again, BS and BS/MS programs in my area) or BSN.

If money wasn't an issue, I'd most likely just suck it up, do 2 more years to get my BS in Biology at 28-29, then start med school at 29, 30...

 

[pamac]

Thanks for the reply. Yeah, debt is a very big thing for me at this time. Already being in a lot of debt, being 26, etc, I really would like to not add on another 100K+ of debt onto that. Either way, I have preference for my state schools, as well as looking into as many scholarships as possible. I do find the nursing route attractive for that reason.

On the other hand, I'm not sure if I'm really interested in the RN role. I've worked as a tech for a number of years, and see what they do. Now, nurses certainly have a valuable role, an important one, and I think it's really up to the nurse to be the best clinician they can be (I'm sure you know and work with nurses that just the bare minimum, just like with any profession). However, with PA, that would be the fastest route to the role I envision myself in, i.e. provider.

I think what sums up how I view this is: Nursing has the most opportunities for advancement in leadership, administration, and has independent practice (I say that not to discount the education and training of physicians, just that to me, it makes sense to have advanced practice providers be independent, and know and be trained as to when to refer and consult, as it happens already). Nursing has all the benefits that come with being a long established profession. On the other hand, PA would be a faster route to what I want to do. They also are better trained, and have a more attractive curriculum, IMO.

Med school would be nice, perhaps later on in life (that PA-DO bridge, as well as 3 year MD programs, like at NYU and other schools, seem nice). I've talked to a few people that started med school in their 30s, and at my hospital it seems like we have quite a few older residents. Oh and I haven't even taken Physics I and II, or Orgo II (need to retake Orgo I).

Oh, and I still need a bachelor's degree, so it would be either PA (again, BS and BS/MS programs in my area) or BSN.

If money wasn't an issue, I'd most likely just suck it up, do 2 more years to get my BS in Biology at 28-29, then start med school at 29, 30...

You'll have no shortage of schools that will be willing to take 100k from you to offer you training that you find appealing and fast. I meet or run into people every month who have no experience in healthcare that are excited to change careers and become PAs. They also often have no desire to just be a nurse. They have decent grades, so they will have no problem finding a program. Folks like that are quickly becoming the face of physician assisting. There will also always be avenues to help you obtain even more debt through your journey. Hopefully you can find some arrangement with the military or a public health program to whittle down your payments.

Ive only been an RN for 6 months. I'm debt free and make over 65k with differential. My manager makes 6 figures and isn't even a department head. She's been doing nursing for 5 years. I work 3 days a week, and will soon pick up a PRN job at a different facility in a few months one extra day a week, and will make enough to pay my entire house payment just from those 4 shifts per month (that's how many nurses I work with operate). Im not certain, but I think I get close to 4 weeks PTO a year, and coverage is provided any time I need it from the PRN pool. I self schedule, which means I work when I want. The cost of my NP degree will be partially offset by my employer.

I throw this out there to add a little perspective.... because if I had gone to PA school, I'd have been over 120k in debt, lost 100k or more in income, had to relocate fairly far from home, and now been looking for a job in an area where PAs generally start at about 82k. Yeah, I'd be done with school about now and out looking for jobs. It will be a few years before I become an NP (although I might start a program next year). I'd never consider going to PA school knowing what I know now unless I was brand new to health care and disnt know any better. The difference in training isn't worth $200k to go out and do the same job. When I got into nursing school, I scrapped plans to attend my remaining PA school interviews. PA school can be a great opportunity, but it's not always the best opportunity.

There are a lot of factors that go into a career, and it's important to look at the whole picture and see what works best for you. I really, really respect physicians.There's no two ways to it, they put heart and soul into what they do. I'm not interested in parity with them if I end up as an NP. I don't want to be "independent" as a way to compete or equate my abilities with theirs, but I do think that by me being able to act with more independance, it gives them some freedom as well. I think there is some advantage being taken by PA programs, and I didn't let my excitement about the prospect of becoming a PA overcome my desire to be wise about how I spend my money. I kept thinking about how every thousand dollars I borrowed was another thousand dollars (plus interest) that I had to pay back. I don't know about you, but when I cut a check for 1k, I freaking feel it. 1k stretched really far for nursing, and frankly, each thousand I spent towards nursing training has been returned well over 20 fold.... The first year. I wasn't seeing that kind of return happening for a while as a PA. My fiends who are PAs are doing fine, and most are very smart about their finances (and are trying to pay down loans as quick as possible), but most of them send house payment sized checks to their loan originators every month. If you end up with 200k debt total after you add your existing loans to PA school, you face an extremely serious burdon that will require some significant workload as a PA to pay down. It's PA school, not dental school. If you do pull in the big bucks, you then have taxes and expenses that take a chunk out. 100k in income per year quickly gets shaved down to 75, then even lower once you pay everyday expenses. I work with someone that wants to go to pharmacy school that will cost 90k. That person would do better overall just staying put once everything is factored. Medical school is usually a good deal when given enough time to recoup. Beyond that, things get more blurry given the way debt can factor in.

 

[Makati2008]

I had a long thought out reply but it wasn't worth the drama. I will say to all the PrePAs do your own research because anecdotes are worthless. We are all guilty of them

 

[pamac]

I had a long thought out reply but it wasn't worth the drama. I will say to all the PrePAs do your own research because anecdotes are worthless. We are all guilty of them

Anecdotes are what people come on forums to encounter.

 

[Makati2008]

Lol ok.

 

[pamac]

Lol ok.

No?

 

[quailbot050688]

No?

I agree with pamac. I've been lurking on this thread for the past two days as I'm going over this conundrum myself. Essentially, I was accepted to a medical program, than came to a realization about the financial debt, time debt, my age (26), wife & life goals, etc. and realized that this route has MUCH more than meets the eye. Simply put, there was more to life than becoming the best clinician there is to be by going to medical school."What about being the best father/husband/athlete/musician/church leader/etc. I could be?" I continually asked myself. I decided that a route similar to pamac's would be much more suitable option, and so I applied to nursing school.

Anyway, what pamac has stated is exactly the type of anecdotal evidence I came to this board to witness, and if true (like many close friends and family members can attest to as well) gives my family and I a much needed push in the right direction.

Thanks, pamac! 👍

 

[Makati2008]

I agree with pamac. I've been lurking on this thread for the past two days as I'm going over this conundrum myself. Essentially, I was accepted to a medical program, than came to a realization about the financial debt, time debt, my age (26), wife & life goals, etc. and realized that this route has MUCH more than meets the eye. Simply put, there was more to life than becoming the best clinician there is to be by going to medical school."What about being the best father/husband/athlete/musician/church leader/etc. I could be?" I continually asked myself. I decided that a route similar to pamac's would be much more suitable option, and so I applied to nursing school.

Anyway, what pamac has stated is exactly the type of anecdotal evidence I came to this board to witness, and if true (like many close friends and family members can attest to as well) gives my family and I a much needed push in the right direction.

Thanks, pamac! 👍

Sounds like a lot of "reasons" but if that is your justification then have at those. Started a tad older than you and doing well in my life but we all have to find balance and some are better than others.

Also there was a reason you considered MD/DO (to the point of an acceptance) before NP previously?

 

[pamac]

Being accepted to a med school changes things considerably, at least of it were me. You already fought one of the tough parts of the process and succeeded. For most folks, that's the biggest feat to overcome. Not that the rest of the process of medical school and residency are easy, but at least you are at the point where you have some concrete plans ahead of you if you embrace them. Turning around and applying to nursing school, becoming a nurse and then becoming an NP now could take almost as long as it wound take to be an MD.

Most of my intentions are to speak towards folks that aren't as far in as being accepted to medical school (or even PA school). Because its so competetive to land a seat in med or PA school (even many nursing schools have PA style applicant-to-accepted ratios), its tough for many folks to flesh out a plan because they just don't know what hey can count on. So they spend time and money, and effort trying to improve and get to the next step (acceptance) so they can figure things out. Mostly I hate to see folks spin wheels trying to go into PA school by retaking or taking a bunch of prereqs, and not looking at alternatives. Nursing, respiratory therapy... Things like that... Are great waypoints along the way to PA school because they offer a backup plan in the event that you don't get in. I was glad I was a medical lab scientist when I didn't get into PA school when I applied. I made over 55k a year even on a laid back schedule, and didn't fret at all. I wasn't a CNA who had to go back and make $12 an hour for the following year, getting advice from folks who suggest retaking prereqs at who knows how many hundred dollars a credit, just do they can roll the dice again the next cycle when things are even more competetive. There's always caveats. In 6 years you could be making great money reading x rays 3 days a week as an MD radiologist, and use your money and free time to do a lot of good. You may even find that as you are forced to cut the fat out if your life due to time contrainsts, you end up achieving excelence in the really vital areas. Having more time on your hands doesn't mean you will automatically be able to knock down every goal you have. So think about it even more, because medical school, for all it's potential drawbacks, is still an opportunity that sets you apart as elite. It might not be worth it for many people to give Ho everything in the process to get there, but if you are there already, it makes sense to keep trucking a little farther to nail it down.