RN (BSN) to PA

[sophialaurel]

Hi! I am deciding between being a NP and a PA, but I feel like I will need the work experience as an RN prior to making a final decision. Is it possible to go from RN (having a BSN) to PA, and will a BSN meet the pre-requisites for most PA programs?

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[Noisewater-TDX]

a BSN will not meet all PA school requirements. If you go to RN school, just do NP. it's cheaper and more direct.

 

[mariajane]

PA school more like mini medical school. Get the prerequisites and go to PA school.

 

[pamac]

If you become a nurse, there’s no way I’d ever make the switch to become a PA vs moving on to become an NP. It doesn’t make financial sense at all, not by a long shot.

 

[mariajane]

But it does make academic sense.

 

[scoopdaboop]

Pretty sure you will need to take more pre-reqs for PA schools as you work as a RN. But i don't see why you would want to do that, when being a NP is much easier, offers similar responsibilites except maybe surgical specialties. Even then, I'm not sure.

 

[pamac]

But it does make academic sense.

That’s a nebulous argument. I worked all over the hospital as an RN, working in all sorts of roles, running codes, carrying the highest responsibilities for patient care. Most PA school grads are taking on their first professional healthcare role of any kind their first day of work. That makes a difference. You see it with some of the NP folks too. In psyche, I know a PA who is a smart kid with no valuable intuition. Never worked with a patient before PA training, let alone any real exposure to psyche patients. As a result, he’s probably going to be sent on by his employer. Of all of my NP buddies, even the most green among them has taken on more responsibility, and has more out-of-the box insight than any new PA I’ve seen churned out in the last 5 years. The PA folks are generally smart kids, and well trained, but it’s not as cut and dried as that.

 

[mariajane]

I agree...it boils down to the individual. I’m an NP and do strong work.... but I’m very motivated and always learning.

My experiences previously helped form my opinion on PA vs NP programs.

1) I attended a prestigious university in the south for NP school..i was blown away at how easy it was. There was no struggle, tbh. Also, the clinical hours requirement for NP school is so low.

2) I was hired on by a hospitalist program extender/mid-level group several yrs ago. The physicians hired about 12 mid levels, a mixture of PA’s and NP’s. They anticipated the NP’s blowing the PA’s out of the water due to their bedside experience. The reverse occurred due to the much greater knowledge base of the PA’s.

Unfortunately NP school is too brief and sprinkled with fluff courses. I’d get my DNP but what’s the point? I looked at a sample curriculum... more fluff. Just wish I had gone to med school. Oh well.

 

[pamac]

PA education is very good. It has to be, because there is more ground to cover. From what I’ve seen, it evens out for both career paths, especially with a little bit of time. I haven’t seen many people blowing anyone out of the water, but I’ve noted the strengths and weaknesses of both professions. The big weakness I’ve noted recently is folks without much experience that gum up the works due to their unfamiliarity regarding health care processes as a whole. New nurses hurrying to become NPs, and PAs without prior healthcare experience are becoming more common than seeing the seasoned folks coming onboard. I don’t think that prior experience fills in gaps in knowledge or makes up for instruction. The value of HCE comes into play when it comes to knowing when you are looking at an issue that you need help on, or the intuition that it takes to ask more questions. My prior experience as a nurse didn’t help me with technical knowledge base as much as it contributed to my maturity and familiarity with how to tackle tough problems. I run into new NPs that don’t have that in their side either, so I can’t say that it’s green PAs that are alone in their greenness. What I also see a lot of is new NPs and PAs not knowing how to negotiate for the best wages and benefits, which is dragging us all down.

I practice with an independent license in an independent practice state. That’s one of the biggest reasons I chose NP vs PA (I had the choice and the prereqs and invites to do either). That intuition I had to take the NP path is bourn out with my leveraging that independence into excellent pay and benefits. As a psyche NP I have opportunities that I would never have had as a PA, hands down. There’s no comparison as far as freedom as well.

 

[mariajane]

Agree... the NP degree, as I understand It, was originally designed to allow very seasoned nurses an opportunity to further their scope. It has become, however, a default option for new grads. This is why I believe, beyond requiring bedside experience, a much greater level of rigor should be there in terms of the education itself. As it stands, there is hardly any weeding out process in order to permit only the brightest of minds access to this degree (as is the case with medical school). Currently, basically if a nurse wants to be an NP, chances are she WILL get admitted into a program and she WILL earn the degree.... these shouldn’t be givens.

 

[pamac]

I don’t really care about all that at this point. I came to nursing with two bachelors of biological science degrees that would have gotten me into PA or DO school, and had interview invites to PA programs. I went to a great NP school. I was offered jobs at everywhere I did rotations, plus had places reach out to me wanting to hire me. Never even filled out any applications except as a formality after they extended jobs to me. And now I have experience in the field now that I’ve been working for a decent amount of time. Due to those points, I’m marketable in a way that makes me stand out so far from those other folks that there’s no comparison. An employer gets what they pay for, and if they look at the overall picture, they will easily see that for a little bit more money, they get a lot more efficiency, insulation from liability, gravitas, patient satisfaction, prestige, employee satisfaction, workflow, etc from me than a poorly trained novice. I don’t know if all that adds up outside of my realm of psyche, but it’s a big deal with psyche patients. It’s the same facts on the ground that work in favor of physicians as well. For the docs, though, they face a bit of a problem due to the potential in most of their roles due to the wider disparity In wages between themselves and those of PAs/NPs. However, many also have procedures they can bill for which brings in quite a bit more revenue.

So overall, I’ve decided to be less concerned over time about the potential for saturation among my peers. I’ve always believed that there is always a market for high talent. The new breed can take up all the jobs in the places that I don’t want to work. Hint: cruddy places have always been around, but now they have a more ready supply of people to circulate through until they get burned out. Meanwhile, the worthwhile places that hire quality will still be hiring quality, and will reap the benefits of that. I’m worth the extra $50k over and above what the lowest paid psyche NP around here might possible stoop to. I know that this is the case because I was recruited by two places in particular who tried to go insultingly low with the salary offer. I immediately countered with $60k more for both places, and both entities didn’t blink before they agreed to my counter. What that indicated was they both must have thought there was no harm in trying for a huge bargain if they could, but still were willing to bring me onboard at a much higher price if they had to. In the end, that put out red flags for both of those places in my mind, but taught me a ton. If the market becomes saturated and wages drop dramatically for me, I’ll go out and start my own clinic, and hire NPs at a cheap rate, and be a task master myself.

 

[mariajane]

Yeah, I’m not worried about market saturation at all....I’m pretty secure as well. I worry about the lackluster education from a standpoint of reputation and quality. There are likely hundreds if not thousands of physician posts throughout SDN laughing at NP training.... and I can’t say I disagree with them. The NP world can and should produce better clinicians..... and that doesn’t threaten me whatsoever. It’s just good for NP students and their future employers/patients.

 

[pamac]

SDN is filled with grumpy med students who are in the rough patch of their lives. I don’t have a beef at all with physicians because they recognize me as a competent provider when I walk in the room for the first time. I’m not after their share of anything. I’m the guy they want to hire because I’m not calling them in the middle of the night, and they aren’t co-signing bad charts (neither of those are even issues because I’m an independent provider).

I benefitted from the environment that produces a lot of the glut we see now If it weren’t for the masses, the universities would have stuck to teaching formats that wouldn’t have allowed me to go to school full time while working full time. I would have had to possibly relocate, but definitely commute (and thereby waste plenty of productive hours doing so). I obtained fantastic education in the sciences before I became a nurse. I spent years as a nurse in demanding roles. I guess the answer is probably for schools to scale back their acceptances and filter out for more folks like me, which could be done. Look for things to change a bit once the requirement to place students in clinical is rolled out entirely (there is a move requiring it for re accreditation, but I understand it is on a rolling basis).

But I’m not really worried about the hit to the reputation of the profession being a hinderance to me and my friends. If I show up to work dressed like a slob every day with a poor reputation preceding me, then that’s one more nail in my coffin. When I have a generally satisfied patient panel (that includes all types of healthcare professionals and their family members), coworkers and bosses that like me, AND no messes for another provider to clean up in my wake, then all the slackers just make me look better by comparison. But I also know the NPs (and it’s not just the new generation) that leave dents in the profession. A lot of times it’s the old ladies out there that are dishing out the “toadstool tea“ and “eye of newt” to their patients and dashing off to a new job every other year because they can’t get along with anyone long enough to get vested in their 401k. Psyche is full of them. They were like that as nurses, and they did the easiest thing they could once they burned all the bridges as RNs, and that was going back to school in an attempt to re emerge as a beautiful new butterfly with more letters behind their name.

 

[AudiLova619]

if someone attended pod school and was dismissed would that affect your chances of getting into PA school? Or a ABSN program.

 

[pamac]

I think the ABSN program would be easier to get into under the circumstances of a dismissal from a POD program. PA schools would raise an eyebrow. Their seats are just simply more valuable, and they involve more inquiry. I don’t even know of any ABSN programs off the top of my head that interview.

 

[leonard J]

I don’t really care about all that at this point. I came to nursing with two bachelors of biological science degrees that would have gotten me into PA or DO school, and had interview invites to PA programs. I went to a great NP school. I was offered jobs at everywhere I did rotations, plus had places reach out to me wanting to hire me. Never even filled out any applications except as a formality after they extended jobs to me. And now I have experience in the field now that I’ve been working for a decent amount of time. Due to those points, I’m marketable in a way that makes me stand out so far from those other folks that there’s no comparison. An employer gets what they pay for, and if they look at the overall picture, they will easily see that for a little bit more money, they get a lot more efficiency, insulation from liability, gravitas, patient satisfaction, prestige, employee satisfaction, workflow, etc from me than a poorly trained novice. I don’t know if all that adds up outside of my realm of psyche, but it’s a big deal with psyche patients. It’s the same facts on the ground that work in favor of physicians as well. For the docs, though, they face a bit of a problem due to the potential in most of their roles due to the wider disparity In wages between themselves and those of PAs/NPs. However, many also have procedures they can bill for which brings in quite a bit more revenue.

So overall, I’ve decided to be less concerned over time about the potential for saturation among my peers. I’ve always believed that there is always a market for high talent. The new breed can take up all the jobs in the places that I don’t want to work. Hint: cruddy places have always been around, but now they have a more ready supply of people to circulate through until they get burned out. Meanwhile, the worthwhile places that hire quality will still be hiring quality, and will reap the benefits of that. I’m worth the extra $50k over and above what the lowest paid psyche NP around here might possible stoop to. I know that this is the case because I was recruited by two places in particular who tried to go insultingly low with the salary offer. I immediately countered with $60k more for both places, and both entities didn’t blink before they agreed to my counter. What that indicated was they both must have thought there was no harm in trying for a huge bargain if they could, but still were willing to bring me onboard at a much higher price if they had to. In the end, that put out red flags for both of those places in my mind, but taught me a ton. If the market becomes saturated and wages drop dramatically for me, I’ll go out and start my own clinic, and hire NPs at a cheap rate, and be a task master myself.

Why did you decide on NP and not DO/MD?

 

[pamac]

Why did you decide on NP and not DO/MD?

There were a number of factors. It didn't appeal to me to have to relocate to whatever medical school I would get in to, not to mention the residency training. I really like where I live, and didn't want to leave even for a few years. I didn't feel I was patient enough to deal with the single minded effort surrounding medical school and training that I think I would have had to put in. I hadn't started a family, and I didn't want to go to medical school before I settled down, and conversely, I didn't want to risk neglecting that family while I was in school. I worked and went to school at the same time for years while juggling family life, but I was more comfortable with that aspect of living vs school and residency. I liked the balance that I was able to maintain. I can't say that I did more fun things in life by not going to medical school, but I felt I got to live a more normal life along the way than what I would have had as a medical student and resident. The monetary payoff, and the perception of respect from society by becoming a physician didn't motivate me enough to go that route given the kinds of stress I think I would have placed on myself. I'm also debt free. Completely. No house payments, car payments, student debt. Granted, money isn't hard for a physician to come by, and it doesn't take long for a physician to be better off financially than I am if they avoid spending like a mad person after finishing training, but it feels great to have no debt burden. I've gone ahead and invested well, too.

One of the things I'm jealous of with physicians is that they have an international reach with their credentials. I have a friend who moved to Australia, and can practice there without a problem. I don't want to move internationally, but I think its cool that American physicians (at least MD's) have that kind of reach. I couldn't do that as a psyche NP as far as I know. But we do live pretty well overall, and I feel like I have had a good time along the whole trek. If I had gone to medical school, I personally would have probably seen the medical training part as a big black hole where I just wanted to get through it. I never felt that way as I was working and going to school, because I felt really motivated.

 

[leonard J]

There were a number of factors. It didn't appeal to me to have to relocate to whatever medical school I would get in to, not to mention the residency training. I really like where I live, and didn't want to leave even for a few years. I didn't feel I was patient enough to deal with the single minded effort surrounding medical school and training that I think I would have had to put in. I hadn't started a family, and I didn't want to go to medical school before I settled down, and conversely, I didn't want to risk neglecting that family while I was in school. I worked and went to school at the same time for years while juggling family life, but I was more comfortable with that aspect of living vs school and residency. I liked the balance that I was able to maintain. I can't say that I did more fun things in life by not going to medical school, but I felt I got to live a more normal life along the way than what I would have had as a medical student and resident. The monetary payoff, and the perception of respect from society by becoming a physician didn't motivate me enough to go that route given the kinds of stress I think I would have placed on myself. I'm also debt free. Completely. No house payments, car payments, student debt. Granted, money isn't hard for a physician to come by, and it doesn't take long for a physician to be better off financially than I am if they avoid spending like a mad person after finishing training, but it feels great to have no debt burden. I've gone ahead and invested well, too.

One of the things I'm jealous of with physicians is that they have an international reach with their credentials. I have a friend who moved to Australia, and can practice there without a problem. I don't want to move internationally, but I think its cool that American physicians (at least MD's) have that kind of reach. I couldn't do that as a psyche NP as far as I know. But we do live pretty well overall, and I feel like I have had a good time along the whole trek. If I had gone to medical school, I personally would have probably seen the medical training part as a big black hole where I just wanted to get through it. I never felt that way as I was working and going to school, because I felt really motivated.

I love this answer because it does hit on a lot of points I have in mind, even how viable my position would be internationally! I agree with you on location and maintaining a balance of life in school. As of now, I'm currently thinking of PA and DPM, possibly MD/DO. Although, the title and degree of DPM isn't the same as doctor, the autonomy compared to PA, the difficulty to enter, and the process is slightly easier than MD/DO. Also, the range of care DPM's can do int the foot is more than I thought which is a big plus.

I want your advice and how you would answer these questions, if you can or don't mind. How do you think the job market and salary will be for NP/MD/PA in the future? Do you think you would be better as a MD/DO when you settle down compared to NP even though you're debt free? What do you know about DPM and the potential they have in the future?

 

[pamac]

I thought hard about DPM. DPM programs pretty much take you unless your grades are totally in the tank. That takes a stress of competing to get into school out of the picture. From there it’s just whether you want to relocate to where the programs are, and whether you want to go and do a residency for pod surgery. At least I think that’s how it all goes. I don’t think I personally know any pods, so I don’t know what kind of money they bring in. If they are doing surgery, they are competing against orthopedic surgeons, who make like $600k+ per year and can do feet plus everything else. But I really don’t know the market or how their niche pans out. Go to their forums, but certainly be wary about folks who are like “I know a pod who makes this much $$$, but he does this…. Etc”. Same with PA/NP. Everyone knows a PA that makes $200k. Nobody I know is one. I do have a friend who is a very well paid psyche NP, and I’ve seen the check stubs.the person makes what they told me they make. However, you shouldn’t assume you’ll be one of the outliers too, because here are issues like location, benefits, hours, work environment…. other things that come into play that make a good paying job suck real quick. My staff at my primary makes up for the extra money I don’t make, and because they are doing the other things, I’m able to see more patients and do more work, so I bonus easier. And the job is far s less stress.

If you are a physician, and aren’t remotely profligate with your spending habits, or aren’t married to a spouse who will spend all of your money before you even have it, you’ll do fine, and probably always do fine. It might not be like it used to be as far a the sheer quantity of opportunity, but they seem to do well. The ones I see that struggle are ones that have kids, grandkids, spouses, ex spouses, and sometimes relatives with hands out to ask for money. Or their child gets caught up in drugs or has custody battles with a former partner. Or they end up raising a grandkid, etc. Divorce also takes a toll, and I do know several new physicians who are young and divorced with kids involved. Meaning that the hot rebound spouse also becomes an instant step parent. I like my first spouse so much that I don’t want a second, and I don’t know if medical school would have been worth it for me. Lots of folks manage like champs though. So much comes down to what you are willing to sacrifice, and how well you can navigate life while in medical school. It’s not a given that you’ll get divorced, make low wages, get stuck in places and situations you don’t want to be in. I fully acknowledge that my decisions were made based on what I knew about myself and what I wanted, so I’m not sure the best advice about going to medical school comes from the folks like me that didn’t feel up to it. Not going to medical school is a lot easier on the brain than going to medical school, because it represents a pathway that instantly rewards you with an decision that you don’t have to continually fight for emotionally…. Because it’s made, and you are then off to a different adventure. Burden lifted, for the most part.

to be continued….

 

[Splenda88]

If one is mostly after monetary reward, and you are <=30 yr old, I think med school is the way to go. But the path to get there is not easy. 400k/yr is not difficult to make even as a IM/FM doc.

I just graduated from residency as non trad and I am glad I did not take the short cut to practice medicine even if I was a RN for ~8 yrs.

 

[leonard J]

I thought hard about DPM. DPM programs pretty much take you unless your grades are totally in the tank. That takes a stress of competing to get into school out of the picture. From there it’s just whether you want to relocate to where the programs are, and whether you want to go and do a residency for pod surgery. At least I think that’s how it all goes. I don’t think I personally know any pods, so I don’t know what kind of money they bring in. If they are doing surgery, they are competing against orthopedic surgeons, who make like $600k+ per year and can do feet plus everything else. But I really don’t know the market or how their niche pans out. Go to their forums, but certainly be wary about folks who are like “I know a pod who makes this much $$$, but he does this…. Etc”. Same with PA/NP. Everyone knows a PA that makes $200k. Nobody I know is one. I do have a friend who is a very well paid psyche NP, and I’ve seen the check stubs.the person makes what they told me they make. However, you shouldn’t assume you’ll be one of the outliers too, because here are issues like location, benefits, hours, work environment…. other things that come into play that make a good paying job suck real quick. My staff at my primary makes up for the extra money I don’t make, and because they are doing the other things, I’m able to see more patients and do more work, so I bonus easier. And the job is far s less stress.

If you are a physician, and aren’t remotely profligate with your spending habits, or aren’t married to a spouse who will spend all of your money before you even have it, you’ll do fine, and probably always do fine. It might not be like it used to be as far a the sheer quantity of opportunity, but they seem to do well. The ones I see that struggle are ones that have kids, grandkids, spouses, ex spouses, and sometimes relatives with hands out to ask for money. Or their child gets caught up in drugs or has custody battles with a former partner. Or they end up raising a grandkid, etc. Divorce also takes a toll, and I do know several new physicians who are young and divorced with kids involved. Meaning that the hot rebound spouse also becomes an instant step parent. I like my first spouse so much that I don’t want a second, and I don’t know if medical school would have been worth it for me. Lots of folks manage like champs though. So much comes down to what you are willing to sacrifice, and how well you can navigate life while in medical school. It’s not a given that you’ll get divorced, make low wages, get stuck in places and situations you don’t want to be in. I fully acknowledge that my decisions were made based on what I knew about myself and what I wanted, so I’m not sure the best advice about going to medical school comes from the folks like me that didn’t feel up to it. Not going to medical school is a lot easier on the brain than going to medical school, because it represents a pathway that instantly rewards you with an decision that you don’t have to continually fight for emotionally…. Because it’s made, and you are then off to a different adventure. Burden lifted, for the most part.

to be continued….

I've been working with a few pods closely and even though they tell me to truly make my own decision and give me advice on NPs and PAs (one of them said NPs would ""takeover" in the future) they also tell me the field is great to get into. After seeing that I was realizing that I was rushing to get into any field and saw PA as the fastest way so now I'm truly trying to be patient and see my options at the nice age of 24. I'm still leaning on PA because I have everything I need, but DPM and DO/MD seem almost viable to me. I put a lot of info out there but I just want to make sure I make a decision worth the sacrifice and I won't regret at 40+, appreciate the advice!