Hello everyone, I know this topic is not new, but I wanted to get some opinions from people already working in these fields. What are the advantages to becoming one versus the other? I know the new trend is going to be for Nurse Practitioner's to go through a DNP program. I just want to see what current Practitioner's both PA and NP think about the future and how they like what they do.
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deleted6669
I think for the most part np's will control the midlevel outpatient primary care market( IM/peds/fp/gyn/psych) while pa's will control the hospital based specialty jobs ( surg., em, trauma, cardiology, ortho, hospitalist, etc).
this is very regional as there are pa and np friendly and unfriendly states, hospitals, and communities.
this is very regional as there are pa and np friendly and unfriendly states, hospitals, and communities.
I went the PA route because I was not interested in becoming a nurse or learning nursing skills on my path to practicing medicine. Plus I loved my surgical and EM training. The majority of my medical education was carried out by MDs (strangely, few PAs involved even during didactic).
PA = more efficacious curriculum
NP = speedier process
NP = speedier process
Not if you have to get your RN first. Otherwise true.
Since he has no science background he could theoretically knock out an associate degree nurse program in about the same amount of time he could take the sciences and get a year or so of clinical experienced needed for PA school.
are you saying having an AS in nursing satisfies PA school pre reqs?
No, he's saying that it's faster to get an ADN than it is to finish science prereqs for PA school, which I don't believe is true. I'm not saying it's SOOO much longer to be an NP, but it isn't faster. He doesn't say he doesn't have a science background first of all.
1 semester =4 months. If all you had to take was science prereqs it would take about 3-4 semesters. Clinical experience is not required for all schools and many (not all) that do only have like 400 hours, so that is a moot point I believe. But let's say you get 6 months experience, that still adds up to 2 years total. Then another 2 for PA school. Total 4 max if you really applied yourself. If he really has no science background then it would take 3 semesters to get the prereqs for ADN. An ADN takes 5. Thats at least 8 semesters =2.6 years.Then, if you find an RN to MSN degree, that's at least 5 semesters (if you do it full time). So 2.6+ 1.6=about 4.2 years. Not much of a difference but it is equal or longer. So it makes more since to go PA (if general medicine practitioner is your goal) because it takes less time (not wasting it learning nursing theory or how to assist the MD with Aline insertion) and it's a more medically relevant curriculum.
So, unless you want to be a nurse there is little reason to chose NP over PA to become a midlevel provider from scratch.
1 semester =4 months. If all you had to take was science prereqs it would take about 3-4 semesters. Clinical experience is not required for all schools and many (not all) that do only have like 400 hours, so that is a moot point I believe. But let's say you get 6 months experience, that still adds up to 2 years total. Then another 2 for PA school. Total 4 max if you really applied yourself. If he really has no science background then it would take 3 semesters to get the prereqs for ADN. An ADN takes 5. Thats at least 8 semesters =2.6 years.Then, if you find an RN to MSN degree, that's at least 5 semesters (if you do it full time). So 2.6+ 1.6=about 4.2 years. Not much of a difference but it is equal or longer. So it makes more since to go PA (if general medicine practitioner is your goal) because it takes less time (not wasting it learning nursing theory or how to assist the MD with Aline insertion) and it's a more medically relevant curriculum.
So, unless you want to be a nurse there is little reason to chose NP over PA to become a midlevel provider from scratch.
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No, I'm saying he could apply to NP programs with that since he already has a bachelor's degree. Don't argue with it. It's doable and routinely done.
You're right. I was thinking of a guy in another thread.
I am a PA and my wife is an NP and I can assure you, the difference between the two is minimal. While there are some minor variations from state to state, for the most part they are equal professions. While the NP profession likes to promote the fact that they can practice independently from a supervising physician, in actuality they can't, because in order to prescribe medications they must have the same physician supervision as a PA and without prescriptive authority, independent practice is basically useless. So, in actuality an NP must have a supervising physician just as a PA does.
As for which route is quicker, it really depends on where you are starting from. If starting straight out of high school (or without any college), it is actually quicker to go the PA route. Most PA programs require 60 to 66 hours of prereqs to get in and most take good candidates with prereqs only. And even if you complete your bachelors before applying it is still faster, because most APN programs require you to either have your MSN or a BSN with a few years work experience under your belt to gain admission. Therefore, the PA route is typically a quicker route if starting fresh. If you are a nurse, however, whether it be an RN or VN, it is likely faster to go the NP route. This route also allows one to go to work and earn a good paycheck while continuing the quest or even allows one to take a break with a good job and then continue later. Comparatively, if you do your PA prereqs, you have no real marketable skill while waiting to get into a PA program (an RN can always find work). So, while it is a longer overall route, the NP route does have its advantages.
You will hear that PA's are trained by the medical model and NP's by the nursing model, which is true to a degree, but the fact is, medical treatments are the same no matter the base model and both learn the same information. The nursing model claims to teach holistic medicine, as if that is not the case with the medical model, but the medical model teaches holistic care also and has for decades. It was the old allopathic model that taught only medical care and they changed that long ago.
One advantage for PA's is that PA's can work in any area of medicine, no matter what program you attend, and even change between them at will. Np's, on the other hand, can face some limitations on area of practice depending on the type of program they attend and the state for which they practice. While these limitations vary from state to state and are typically minimal, it is certainly something to consider.
One notable difference between the two is pay. While not a big difference, PA's typically make more than NP's when compared as a group, but in areas that use both equally often, the pay tends to be equal as well. It also appears that this difference is getting less each year.
So, the bottom line is, there is little difference between the two professions, so look at both routes and pursue the one that is the quickest for your to complete.
As for which route is quicker, it really depends on where you are starting from. If starting straight out of high school (or without any college), it is actually quicker to go the PA route. Most PA programs require 60 to 66 hours of prereqs to get in and most take good candidates with prereqs only. And even if you complete your bachelors before applying it is still faster, because most APN programs require you to either have your MSN or a BSN with a few years work experience under your belt to gain admission. Therefore, the PA route is typically a quicker route if starting fresh. If you are a nurse, however, whether it be an RN or VN, it is likely faster to go the NP route. This route also allows one to go to work and earn a good paycheck while continuing the quest or even allows one to take a break with a good job and then continue later. Comparatively, if you do your PA prereqs, you have no real marketable skill while waiting to get into a PA program (an RN can always find work). So, while it is a longer overall route, the NP route does have its advantages.
You will hear that PA's are trained by the medical model and NP's by the nursing model, which is true to a degree, but the fact is, medical treatments are the same no matter the base model and both learn the same information. The nursing model claims to teach holistic medicine, as if that is not the case with the medical model, but the medical model teaches holistic care also and has for decades. It was the old allopathic model that taught only medical care and they changed that long ago.
One advantage for PA's is that PA's can work in any area of medicine, no matter what program you attend, and even change between them at will. Np's, on the other hand, can face some limitations on area of practice depending on the type of program they attend and the state for which they practice. While these limitations vary from state to state and are typically minimal, it is certainly something to consider.
One notable difference between the two is pay. While not a big difference, PA's typically make more than NP's when compared as a group, but in areas that use both equally often, the pay tends to be equal as well. It also appears that this difference is getting less each year.
So, the bottom line is, there is little difference between the two professions, so look at both routes and pursue the one that is the quickest for your to complete.
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I have also known the actual practice difference between PAs and NPs is minimal despite some theoretical differences in education. Typically the PA track is chosen by people who are relatively new to healthcare. Of course not everyone can be pigeonholed like that, but I personally find it to be true where I work. NPs typically have more healthcare experience as a group (many years working as an RN, which makes up for some curriculum shortfalls). There are a very small number of programs that teach direct entry NP/MSN and DNP programs, but I would not recommend one over a PA program. In my opinion those programs should be shut down, or at least be similar to PA programs in clinical hours (NP programs have less on average). If you are an experienced inpatient or clinical nurse, then NP is what I recommend (you already have gone through an on the job residency). If you have a degree in biology (or something else relevant) and now want to work in healthcare, then I would go the PA route. There are experienced nurses who decide to go the PA route, but most of us go the NP route. In my opinion (and the NIH in several studies), both NPs and PAs are valuable, productive, and safe as providers. No matter which rout you choose though, please don't get caught up in the ridiculous flaming of one profession over the other, especially between midlevels. It will only reveal you as immature, and insecure. Always remember: You are a midlevel and nothing more. (There are many IMHO, insecure people that take issue with the existence of a midlevel position). And never, no matter which doctorate degree you earn, never refer to yourself as "doctor" in the clinical setting. All of the midlevels I know understand this and could care less, but there seems to be this myth out there regarding how we think of ourselves. In some states it's permissible to use the title "Dr" if a DNP or PhD is earned, but I use my first name and "Nurse Practitioner" to avoid confusion, and placate the ultra concerned. My patients don't really care, they just want to be seen quickly and provided with quality care.
Just to clarify here, there are quite a few states where no physician supervision at all is needed. In other states there is varying levels of "collaboration."
I'll have to get my numbers confirmed but I read in a journal that less than 10% of NPs practice independently. i.e. it's not really a viable career option and those considering NP over PA shouldn't base their decision on this fact alone.
also collaboration/supervision you're arguing semantics here. all PAs are "supervised" in some form but I personally know a few who perform much of their surgical attendings' cases when they're routine.
someone else said that NPs typically have more HCE but I dont think that is true. streamlining education is more prevelent now but PA school was built on the idea of giving health care professionals additional education and another avenue to practice in. I also think the clinical rotations in PA school are more relevant to practicing medicine than being a floor RN but thats just my opinion.
The fact is the PA programs are about teaching medicine, and strictly medicine.
The NPs programs focus on a nursing model. As hard as it is to accept, many NP programs are very weak in Internal Medicine and this shows in their graduates. I know because I have trained NPs during their internships in offices I have worked in over the last 17 years.
If the NP programs really want to reach the standard of the PA programs, they need to limit the nursing model and focus more on medicine. That also means they need to step up the amount of clinical training hours. In the PA program I graduated from, we had ten clinical rotations- all one month long rotations: these included Psychiatry, Internal Medicine, Pediatrics, Gerontology, Orthopedics, Obstetrics/Gynecology, Emergency medicine and three surgical rotations (Forgut, Vascular and General surgery).
This it the kind of intense medical training the NPs need. Not nursing training.
JMHO
The NPs programs focus on a nursing model. As hard as it is to accept, many NP programs are very weak in Internal Medicine and this shows in their graduates. I know because I have trained NPs during their internships in offices I have worked in over the last 17 years.
If the NP programs really want to reach the standard of the PA programs, they need to limit the nursing model and focus more on medicine. That also means they need to step up the amount of clinical training hours. In the PA program I graduated from, we had ten clinical rotations- all one month long rotations: these included Psychiatry, Internal Medicine, Pediatrics, Gerontology, Orthopedics, Obstetrics/Gynecology, Emergency medicine and three surgical rotations (Forgut, Vascular and General surgery).
This it the kind of intense medical training the NPs need. Not nursing training.
JMHO
I disagree. If this were the case, then there would not be a need for an NP program. I went with psych NP as I wanted most of my training in psych and certainly do not want "intense medical training." As the psychiatrist Lewis Mehl-Madrona says, "We learn best how to do therapy through reading novels, watching movies, writing stories, acting in plays, studying dancing, and living life large-talking, loving, laughing..."
Yes, zenman, I agree, some things are best learnt out of the class room/clinical setting. I can see the argument in therapy, but medicine?
Even in psychiatry, being a branch of medicine, there is no reason there shouldn't be "intense medical training". There is a reason why psychiatrists go through 4 years of med school before residency. How can a psychiatrist rule out medical problems without having a foundation in medicine?
And even so, if we even stop to pretend that the kind of training psych NP's are getting is relevant, then they should get more of it. About 3 times as much. I would like to see a minimum of 2000 hours of clinicals and classes that focus on pathophys / physio / pharm / body systems / clinical diagnosis / biochem / microbio. And even after that curriculum overhaul, the scope should be of a dependent practitioner.
Now, most NP programs cover some of the above, but a solid hold on all should be a must for a provider. If NP programs offered an intensive didactic curriculum, atleast 2000 hours of clinicals and in-person classes where students could practice hands-on, then I would have no problem with the NP. Infact, I would be typing this very message talking about how NP programs train there students for practice and should be respected as providers.
Until then, I'm going to just keep on trying to wonder why such "advanced nurses" have the scope of practice of some physicians.
Zenman, personally, do you agree with the "no collaboration" privileged to NP's in certain states?
PharmBound you're right on the money! I agree completely with you.
There are also those who advocate a different route for training psychiatrists. Probably wouldn't hurt for all health care programs to be revamped. I would certainly have preferred more time in learning about medical conditions that mimic psych conditions versus some other activity. But then again, all my patients have regular physicians so all I'd be doing is maybe catching something they missed.
I agree more hours might be useful but where is the"cutoff" point considering that many meds are as effective as a placebo, or patients don't take them because of side effects. How much training should go into learning something that frankly has a pretty dismal track record? I'll leave that up to someone else to decide.
Power, and physicians spend so much time in one area they have no time or knowledge of what's going on around them...at least according to a thoracic surgeon I once had business classes with.
Personally, I always want to be able to consult others smarter than me. But since I have an interest in indigenous medicine there are not a lot of western-trained physicians I can consult, at least in that area. 😀
Then maybe you should have gone for Psychology. Because Psychiatry involves medicine, and all doctors who specialize in Psychiatry had to first go through intense medical training.
What I cannot understand is why NPs feel they should have the right to practice medicine like PAs, DOs or MDs and NOT get the extensive, important medical training which includes extensive clinical training that is necessary to practice medicine correctly.
I reiterate sadly, that my experience over the last 17 years in Internal Medicine both training and working along side NPs has been nothing short of frustrating. Too many times I have had to go behind an NP who saw one of my patients and completely rediagnose and/or change the treatment because they diagnosed and treated by rote and came to the wrong conclusion. And this is because they lacked the fundamentals in understanding pathophysiology and the disease process in order to make a correct diagnosis.
As I stated above, in the PA program I graduated from, in addition to the months and months of didactics, we had ten clinical rotations- all one month long rotations: these included Psychiatry, Internal Medicine, Pediatrics, Gerontology, Orthopedics, Obstetrics/Gynecology, Emergency medicine and three surgical rotations (Foregut, Vascular and General surgery).
This is what NPs should have if they are to work in Internal or General medicine.
A. Who are these people, are they the majority? Why do health care programs need to be revamped? The only health care program I can see that needs a revamp are the "advanced nursing" ones. Also, just because your patients would have "regular physicians" means you don't need to know vital medical information about the patient & associated conditions? Sounds risky...
B. Are you suggesting that medicine has a "dismal track record" ? Sorry a bit confused on that one..
C. Power? I was asking you specifically why "advanced nurses" should have the scope of some physicians (in some states) in your opinion. As to your comment on physicians knowing "too much" to not know what else is happening around them... well, as long as they can do what they are trained to do, that's all that matters, in medicine.
D. Indigenous medicine? sounds very interesting. I agree, there are several parts of natural medicine that could be very useful in clinical medicine. Although, I was wondering that, regardless of whether you know anyone in the field to supervise, are you for or against the "no collaboration" requirements and why do you think they are well-deserved? Frankly, to me it just seems like a person who can function basically like an independent doctor, with more then 10 folds less training.
-Thanks for your insight, it has been helpful
I'm not stuck in the biomedical dogma, more of which I personally do not want, but which is a valuable track for others. So be it.
You're trying to understand the feelings of others. You can try that or you can look at how they got there.
I listened very carefully to one of my psychiatrist preceptors, especially when he was pissed off at non-psychiatric physicians and had to change the prescriptions they wrote. I guess everyone has someone coming behind them sweeping up the mess.
Let's take 2 patients I saw last week. One a 24 yr old with PCOS and hx of sexual abuse where both medicine and therapy were not working. The other a male with a cancer in the mucous membrane in his nose. He had already visited major cancer centers and chemo is not an option. Radiation is, however, his nose will fall off and his optic nerves will be fried.
Just think about it. I don't care for an answer and I will not discuss the options I have.
I didn't realize it was within the scope of a PA's practice to go around correcting another mid-level's orders. I would have thought that would be up to the attending physician. You must not be very busy if you have the time to follow around other mid-levels double-checking their work.
For the record, I'm not a fan of NPs. But I'm no fan of PA's, either. I want a physician to take care of me (MD/DO), period.
Don't worry, I pour over over medical condition and medication a patient is on.
Dr. Carlat is one physician who thinks psychiatry needs looking at. Whether it a majority or not doesn't matter. Are we still doing the same as we were 50 years ago? You don't still use a Walkman do you? Are you aware other countries have better health care than we do? What's their training and delivery like?
You shouldn't be as there is plenty of studies for you to find. We put a man on the moon back when I was in middle school and we still can't produce a drug that alleviates one condition without creating others.
You're asking a "should" question. It's not that they "should," it's because they can and do. My opinion doesn't matter when it's law. It is what it is. You want my opinion on Obama?
Personally, I want to practice with the least hassle and paperwork. I do not want to have to pay someone to do useless chart review after the fact. A psychiatrist preceptor I had earlier has discussed with me plans about us going into practice together. That would be fine with me as I can do my own thing and come to him if I have any questions.
Your "well-deserved" comment is difficult especially since I once worked with a physician who had gone through intense medical training but who actually needed to be put down in order to save the general public.
Read my post. I was following up on my own patient! The NP was covering this patient in my absence. I had every right to change treatment if I deemed it was incorrect and not in the best interest of my patient.
Your two patients sound interesting. However, you are veering off my point. I was pointing out the inadequate training NPs obtain in their programs in relation to being equipped to practice in Internal Medicine.
All of your responses to Pharmbound's very good questions are very evasive and veer offpoint. You do not address the overall issue which is: NPs graduate their programs poorly equipped in the medical model to adequately practice medicine, at least for sure Internal Medicine.
You said "Too many times I have had to go behind an NP who saw one of my patients..." That hardly sounds like you were "following up." And what is up with "my patient"? If the NP is seeing the pt. as well, how come you feel like only you own the patient? Aren't you supposed to be part of a team?
If you have issues with someone on your team, you should be taking them to your attending.
Perfect example of why I want a physician providing my care, not a mid-level.
Just curious. If they were covering in your absence why were they jacking around with treatment and diagnosis? That's not cool.
No, I want you to think about what even those with "adequate" training would do in these situations...or in your case pick a patient with pancreatic cancer.
First you need the research to "prove" your statement. I'm evasive because your "overall issue" needs clarifying, ie., are NP's training in the medical model; are they practicing medicine; do they have a different focus, etc. And they will always be considered poorly equipped, as will PA's, since they have not suffered through as much as physicians.
I agree IM is very difficult. So is primary care. That's why I switched from FNP to psych so I could get all my hours in one area.
Thanks, fab for changing your avatar.
It's Labor Day, I have 2 days left in clinical, and and I'm going to have some fun and get off this forum. 😉
Exactly! Both myself and my supervising MD had to finally resort to leaving directives on the charts that our patients were NOT to be seen by NPs in the facility. How sad is that?!
Hopefully "going behind" means discussing with and educating this disgraceful NP, so she will not make the same mistakes over and over...
Since it is "your" pt after all...
You are, after all, captain of the ship right?
"Going behind" someone reminds me of RN behavior...
🙄
I never said the NP was disgraceful, you did. And if you want to grapple with semantics, "going behind" for me was doing my job in following up on a patient that was initially assigned to me and for whom I was ultimately responsible for. That is my job and I do it with pride and caring for my patients.
For all the NPs here who are bashing me for my post, do not blame me that the majority of NP programs allow their graduates to start practice without the needed medical training (both clinically and didactically), specifically in Internal Medicine. I did not create that situation with your programs.
I just know for a fact based on my own experience the NP training in medicine is NOT adequate for them to enter the Internal Medicine area right after they graduate. And definitely not adequate for NPs to practice independent of MD oversight.
That is based solely on my experience over the last 17 years of training and working with NPs.
Don't shoot the messenger.....
Exactly.
For the record, neither chimi nor I are NPs. We are both long time RNs.
And you are not "ultimately" responsible for any patient since you must work in collaboration with a physician; you don't work independently. So please don't try to portray yourself as more than what you are. You're a dependent practitioner; no more, no less.
If you can't articulate your message, that's your problem, and maybe you do deserve to be criticized. I'm not the only one who has picked up on your "fuzzy" descriptions.
Again, the best care is provided by physicians...real ones.
You are correct, I threw in disgraceful. Though it's the first word that came to mind after reading (the negativity and counter productive mentality in) your posts...
I don't support solo NP or PA practice. Never have...
I support a collaborative team model, run by the physician...
Your posts imply that you are somehow better than the NP...(We are all on the same team dude)
When I work alongside another RN or an aide who is lacking in any area, I believe it is up to the team to bring that person up to speed by mentoring and teaching...If that person continues to practice dangerously after teaching, then off he goes...But to throw the baby out with the bathwater...Shame on you.
You specifically stated that you "went behind" the NP and "fixed" the problem...
My point: That's no way to run a practice. whether you are a PA or an MD. It breeds secrecy and resentment...I certainly hope you asked her side of the case before just "mopping up and badmouthing"
FWIW, I have always been against the current state of NP education (read: online and not enough clinical hours)
Riiiight, because a physician would never have issues with someone on their team (or the other way around).
If you don't understand what it means to have a "my patient", an individual who you have been responsible for and following for an extended length of time, then I suggest you get some more experience in healthcare before you comment.
Another ridiculous post. Yea, and nurses aren't responsible for their patients either, right? And of course, no Doc is dependent on a group or board. Further, PAs have been found to be solely responsible for patients, in certain cases. Maybe you should educate yourself better before you start spouting your 'information'.
I'll take a NP or PA with experience in their specialty any day, over a Doc without it.
But you, that's a different story. You're simply a nurse, nothing less, nothing more.
This is actually sound advice, tending towards a mature and wise approach. Everyone wins.
D
deleted6669
wow...mellow guys...
medicine is a team sport, remember?
there are good and bad pa's/docs/np's/rn's etc...I know np's who run circles around me in their areas of expertise and docs and pa's I wouldn't take my dog to. it all depends on the individual, their background, and their motivation for lifelong learning.
some folks run circles around others while others struggle to keep up. we all need to approach this with a certain level of humility. we were all newbies once. I try to learn from those who know something I don't(regardless of the initials after their names) and teach those who want to learn something that I know that they don't(regardless of the initials after their names).
as advanced practice clinicians ( pa's and np's) we do a lot of the same things and have a lot of the same goals.
wouldn't it be refreshing if posts in the clinicians forum focused more on what we have in common than what makes us different? you know, cme opportunities, volunteer positions, long term goals...I know I have been guilty of my share of bashing other folks here over the last decade....let's just say I've had an interesting yr(much of it spent in disaster zones) and that has served to mellow me somewhat as well.
medicine is a team sport, remember?
there are good and bad pa's/docs/np's/rn's etc...I know np's who run circles around me in their areas of expertise and docs and pa's I wouldn't take my dog to. it all depends on the individual, their background, and their motivation for lifelong learning.
some folks run circles around others while others struggle to keep up. we all need to approach this with a certain level of humility. we were all newbies once. I try to learn from those who know something I don't(regardless of the initials after their names) and teach those who want to learn something that I know that they don't(regardless of the initials after their names).
as advanced practice clinicians ( pa's and np's) we do a lot of the same things and have a lot of the same goals.
wouldn't it be refreshing if posts in the clinicians forum focused more on what we have in common than what makes us different? you know, cme opportunities, volunteer positions, long term goals...I know I have been guilty of my share of bashing other folks here over the last decade....let's just say I've had an interesting yr(much of it spent in disaster zones) and that has served to mellow me somewhat as well.
D
deleted6669
yup, it goes both ways. most often it has more to do with something going on in the practice of the individual provider than the np or pa community at large. I know I have been guilty of this as well, usually after "issues" with certain np's or docs I work with.
not an excuse, just an explanation....
sigh...indeed it does
I'll put my 25+ years up against your what?
Why don't you put it up against my lily-white ***.
I don't care how long you've been in healthcare, it doesn't give you the right to be a bully. And fyi, my first healthcare position was in 1993. Which means I probably have better skin.
I'd like to see how happy you get with another nurse coming in and screwing with one of your, doh, I mean, 'the teams', patients.
