PAs and NPs

[MexicanDr]

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As current residents and soon to be attendings, do you find more comfortably working with a PA or an NP? and why?

Do you feel that since PAs follow the medical model, there is more of a team connection when it comes to team work than if you were to work with an NP?

 

[filter07]

There's no difference for me. Good and bad in each group.

 

[MexicanDr]

For example?

 

[efex101]

PA hands down their model of education is more like ours.

 

[beanbean]

I agree there are good and bad in each group, but I prefer working with PAs. In general I find they have more solid pathophysiology knowledge and stronger patient assessment skills. The NPs I work with in the ED are great and have a great deal of experience, but some of those I have dealt with on the wards and who admit for hospitalists have been pretty awful and should not be making patient management decisions independently.

This is just my personal experience. Please don't be offended if you are an NP. I think the lack of standardization in the NP program leads to the differences from one NP grad to another.

 

[Winged Scapula]

I agree there are good and bad in each group, but I prefer working with PAs. In general I find they have more solid pathophysiology knowledge and stronger patient assessment skills. The NPs I work with in the ED are great and have a great deal of experience, but some of those I have dealt with on the wards and who admit for hospitalists have been pretty awful and should not be making patient management decisions independently.

This is just my personal experience. Please don't be offended if you are an NP. I think the lack of standardization in the NP program leads to the differences from one NP grad to another.

That has been my experience as well. Together with the political ambitions of many NPs and their governing bodies made my partner and I decide to go with the PA when hiring a mid-level for the office.

 

[pillowhead]

On the whole, I think PAs think more like physicians because they train more like physicians. Therefore, if I had to pick, I'd feel more comfortable with a PA. In my own personal experience, I've never felt that a PA I worked with was trying to be the physician or did anything completely wacko. I can't say the same for the NPs I've worked with. Some of the NPs have been absolutely wonderful, but I've seen some wacky medical decision making by NPs and more than one which has been pretty militant about expanding her scope of practice into things they have no business doing (like TEE) or just flat out misrepresenting their training and knowledge.

Overall, it probably has more to do with the individual than the title, but my bias would be for PAs.

 

[Frugal Traveler]

It depends. I've had better experiences with older NPs than younger PAs. I think that if either a NP or PA has been in the field for a while, then they are fairly reliable. The people just out of school or the young attractive females that went into the field to meet a doctor are not as useful.. the young attractive females had to find something else after the pharm rep field dried up thanks to social activists killing my free lunch and pens (I had to go out and buy a pen like 6 months ago).

Bottom line: Mid-levels have a role in the health care obviously if they are used as part of the team (that being with a doctor supervising). Autonomy of mid-levels can vary greatly depending on how much they are trusted.

 

[TysonCook]

Lots of experience, but in the ED having a PA is far better.

 

[TexasPhysician]

I also prefer PA's. I don't have TONS of experience with both, but so far I have found PA's more intelligent/helpful.

 

[jbp100]

One awkward PA story-

I was working in the ED last month and was assigned to work in Fast Track for a few shifts. One day I show up and the "provider" was a PA who graduated last May from my school. Pretty weird to work under someone who I knew I had more experience and training than. Not to knock PAs but if they can practice independently after three years of training, I think 4th year medical students and higher should be able to function at the same autonomy level as mid-levels for moonlighting purposes, etc.

 

[deleted6669]

One awkward PA story-

Not to knock PAs but if they can practice independently after three years of training, I think 4th year medical students and higher should be able to function at the same autonomy level as mid-levels for moonlighting purposes, etc.

they weren't practicing independently. they have a supervising physician of record who reviews their charts.

 

[jbp100]

they weren't practicing independently. they have a supervising physician of record who reviews their charts.

True, but they could sign orders and I could not. 😀

 

[gluon999]

they weren't practicing independently. they have a supervising physician of record who reviews their charts.

There is a difference. The PA will be make >70k and the 4th year med student will be paying around 40-50k. That is a >100k discrepancy! Big difference!

 

[core0]

True, but they could sign orders and I could not. 😀

Thats because they have a license and you don't. If med students had a medical license then they could do everything the PA could do. However, the powers that be decided that the license comes after the training.

David Carpenter, PA-C

 

[toomuch]

as a surgery resident, i liked having nps because they never went to the or, on the other hand, i was not happy with certified nurse first assistants in the resident atmosphere. PAs always wanted to go to the or and sometimes i never did much even with assisting the case, but hopeful it gets better when a senoir resident as opposed to a junoir.

 

[mig26x]

Thats because they have a license and you don't. If med students had a medical license then they could do everything the PA could do. However, the powers that be decided that the license comes after the training.

David Carpenter, PA-C

how ironic and sad, why can a PA do everything a med student should be able to do after med school if he (the PA) doesnt have a medical license.

I bet a 4th year medical students with its two USMLE approved and having passed the shelf exam has alot more clinical experience than a PA that just graduated.

 

[filter07]

I know it is endlessly frustrating for M4s, interns, and other junior residents that NP/PAs essentially function as equals. But this level of responsibility is temporary for you, and permanent for them.

You are both limited in scope, and that might make you feel like your prior education is not fully appreciated. But there is a big difference, in that your educational background allows you to progress further and become truly independent practioners.

Even Albert Pujols had to spend time in the minors. But he eventually became a star in the MLB, while the rest stayed in the farm system. We have to learn how the hospital system works and gradually earn our independence, just like everyone else. I'm sure Pujols had way more experience and skill compared to others in the minors but he put in his dues.

Also, don't begrudge the NPs and PAs for their higher salaries. Although they make more money now, their income is relatively fixed, whereas your income will substantially increase. They have debt too; tuition isn't unique to medical school. Plus, don't discount the high level of social respect you are granted simply because you are a physician. Although many will treat you like a "dumb medical student" or "dumb intern", deep down, most acknowledge your accomplishments and potential. To be frank, NPs and PAs do not enjoy the same level of respect that a physician does, so to be angry at their salary is a little petty. Other highly respected professionals, like judges, scientists, or professors, are often also paid less than NP/PAs. But they are allowed to follow their passions to the full extent of their potential, just as you will in medicine. I don't think many premeds went into med school to earn a lot of money in their 20s, have barbeques every weekend, or go on a lot of vacations. Sure life goals change but you have to realize when you've moved your goal posts and stop being angry at others because you didn't have enough foresight in the past, or enough steadfastness/dedication now.

 

[jbp100]

I know it is endlessly frustrating for M4s, interns, and other junior residents that NP/PAs essentially function as equals. But this level of responsibility is temporary for you, and permanent for them.

You are both limited in scope, and that might make you feel like your prior education is not fully appreciated. But there is a big difference, in that your educational background allows you to progress further and become truly independent practioners.

Even Albert Pujols had to spend time in the minors. But he eventually became a star in the MLB, while the rest stayed in the farm system. We have to learn how the hospital system works and gradually earn our independence, just like everyone else. I'm sure Pujols had way more experience and skill compared to others in the minors but he put in his dues.

Also, don't begrudge the NPs and PAs for their higher salaries. Although they make more money now, their income is relatively fixed, whereas your income will substantially increase. They have debt too; tuition isn't unique to medical school. Plus, don't discount the high level of social respect you are granted simply because you are a physician. Although many will treat you like a "dumb medical student" or "dumb intern", deep down, most acknowledge your accomplishments and potential. To be frank, NPs and PAs do not enjoy the same level of respect that a physician does, so to be angry at their salary is a little petty. Other highly respected professionals, like judges, scientists, or professors, are often also paid less than NP/PAs. But they are allowed to follow their passions to the full extent of their potential, just as you will in medicine. I don't think many premeds went into med school to earn a lot of money in their 20s, have barbeques every weekend, or go on a lot of vacations. Sure life goals change but you have to realize when you've moved your goal posts and stop being angry at others because you didn't have enough foresight in the past, or enough steadfastness/dedication now.

I do not disagree with anything you said here, but my point was that maybe M4 - resident level should be able to function at the same pay grade and level of supervision as a mid-level. This would attract more people to go in to medical school if they knew that they could pull in at least SOME money after three years and not have to sacrifice their entire 20's.

I don't mind paying my dues playing in the minors, but at least in your metaphor, minor leaugers still get paid! Also, minor leaguers aren't forced to play the game differently than they would in the major leagues (i.e. the inability to write orders). You are essentially forced to play the game without a bat as an MS4.

 

[filter07]

I agree M4 year is essentially a waste of time. But most of the year is spent on meaningless electives, and you only function as a subintern for a few months at most. It sucks paying $30,000 in tuition for a year-long vacation, but it's not like you work all year as a lowly med student. I had radiology, pathology, 2 months of vacation, a research elective... those months I would not consider work. 🙂

Once you're an intern you basically have the same level of autonomy as a PA/NP, although some more experienced midlevels are given a bit more autonomy. If you swallow your ego for a bit you can learn a lot from them. Things quickly even out by mid-year and end of the year at the latest. It's temporary.

BTW, it also sucks that a PGY7 (or 9) cardiothoracic surgery fellow, which is pretty much a demigod at this point, still earns only a few thousand dollars more than a PGY1. I feel your pain, definitely. I think residency would benefit greatly if residents were paid reasonably like in other countries. That would reduce a lot of the frustration.

 

[Grace34]

As a resident, sometimes I'm quite productive (clinic, on-call, inpatient medicine). However, when I'm off doing some elective, following around a specialist and learning something new...no so much. I'm not trying to say that we residents aren't the hardest workers on the planet, or anything, but I think our argument about how "productive" we are sometimes has holes in it. I'm just sayin'.

 

[surftheiop]

What about residents who have licenses? We work more hours on average than a PA/NP, have more knowledge and skill than a PA/NP, and get paid wages that are usually less by 50% or more. The system will truly not be fixed until PA/NP get paid equal or less than a resident. Good luck trying to get Medicare to pay for that though.

I think the arguement that residents are in training only holds water if it means you aren't doing the same amount of work. residents are still learning but their productivity (after a few months on the job) rivals or exceeds a PA/NP.

You also have to consider that in residency the training your getting is quite valuable. Im sure there are many people who would gladly take a residency without pay if it meant they could get a derm/rads/etc position.

 

[rockit]

I agree M4 year is essentially a waste of time. But most of the year is spent on meaningless electives, and you only function as a subintern for a few months at most. It sucks paying $30,000 in tuition for a year-long vacation, but it's not like you work all year as a lowly med student. I had radiology, pathology, 2 months of vacation, a research elective... those months I would not consider work. 🙂

Once you're an intern you basically have the same level of autonomy as a PA/NP, although some more experienced midlevels are given a bit more autonomy. If you swallow your ego for a bit you can learn a lot from them. Things quickly even out by mid-year and end of the year at the latest. It's temporary.

BTW, it also sucks that a PGY7 (or 9) cardiothoracic surgery fellow, which is pretty much a demigod at this point, still earns only a few thousand dollars more than a PGY1. I feel your pain, definitely. I think residency would benefit greatly if residents were paid reasonably like in other countries. That would reduce a lot of the frustration.

I agree with most, but I though M4 was a very good year. I learned a ton because there was no pressure to take tests at the end of the rotation, so you could just practice and learn. I that Sept-Nov of my 4th year was the best 3 months (in terms of learning) that I had in school.