Trying to decide career path from here. Appreciate any insight

[Moki1984]

Good afternoon. I know a lot of these come up, I have read many in multiple forums. I am at a point in my career where I need to take the next step forward and I am trying to determine what that is.

Currently, NP and PA are on my list of possibilities. I'll explain my situation and would appreciate hearing any insight you have

I currently have a Bachelors, majored in Psych with a minor in Bio, 3.89 cGpa, my science gpa is high although I don't recall exact number. Of course with a minor in biology, I took classes like microbiology w/lab, human anatomy, neuropsychology etc. Although this was years ago...would need to refresh myself on some topics and some schools won't take anatomy/physiology that is older than 3 years. I graduated in 2012.

I immediately began working as a Mental Health Technician at a behavioral health hospital, where I still work to this day. I was eventually promoted to Patient Advocate. In February I hit 7 years of experience in this field.

I know for NP, I would have to do necessary classes to get a BSN first THEN go to NP. As for PA, I already have most of the prereqs and years of experience. I intend to stay in psychiatry btw , this is my field.

One of my hurdles, I work fulltime right now at the hospital. I can't just quit my job, I have a family and bills to pay. So I will have to do this hybrid /distance education style. Of course, anything clinically related you have to do some in person hours, supervision etc. That is fine, I just mean the bulk of my schooling will be distance education.

Any thoughts?

Thanks!

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[pamac]

I didn’t catch what your question was, which might just be because I read too fast, but I’m assuming you are choosing between Pa and NP. You mention distance education. Only Yale PA program offers an online PA program currently, but look for hat to change quickly as other programs catch on to how successful that can be.

NP is really the only way to go if you are in psyche, and that’s because in most places, NPs are independent providers, and nowhere in the US are PAs independent. Here’s an example of how that translates to how PAs are treated: where I live, NPs are fully independent and START as new grads at $130k in psyche. They can open their own practices if they want to, and don’t report to physicians, and can take solo call. So apart from procedures like ECT, they are essentially interchangeable with physician psychiatrists. EXPERIENCED psyche PAs make $90k... just like most family practice PAs here. They have to have a supervising physician, which means that even if they take call, they still have to arrange a physician to be on call to them as backup. Most of them sign non compete agreements because they have to do whatever their supervising physician wants them to do or else they can go find another job working for a different physician.

I would never suggest someone become a PA if they wanted to do psyche. They will always be a surf. Go get an accelerated RN or a 2 year RN, even if it means taking time off of work, then immediately start on your psyche NP program while you work as an RN. RNs make decent enough money to make up for the time you will take off. I just did some tax stuff and saw that last year as an RN I made $85k without any overtime. That’s as much as PAs start at here, many of them working more than 40 hours a week. I pretty much just worked my 37.5 hours per week as an RN while I went to NP school. With PA shool you will have to take time off anyway, just invest that time in a better place, which is in nursing.

The only PAs I know who make quite a bit of money, which to me is $115 or above, are PAs who work a lot, and none of those folks even work in psyche.

 

[lemurcatta]

NPs are utilized more heavily in psychiatry than PAs in most areas, but it’s region dependent. Also keep in mind that if you do a psych NP program, that’s the specialty you practice in and there is no ability to do something else like surgery or medicine if it turns out you liked those better (short of doing a post program certificate in another area of NP practice). So I think you’d want to be very sure psych is for you and you had no interest in other areas of medicine.

So dead set on psych, NP has the advantage of having programs tailor made for that. However, PA programs will train you as a generalist, with rotations in all major areas of medicine (general surgery, adult medicine, pediatrics, ER, etc), and all programs in the US require a psychiatry rotation as part of the curriculum. So if it turns out psych is not for you, you aren’t limited to that once you graduate.

And as a counterpoint to the poster above me, I wouldnt worry so much about independent practice or zero physician oversight. More and more we practice on teams. It’s better for the patient and for the clinicians. What might be relevant is the pay and ability to work in your desired field. In psych, this might tip the balance for you. While psychiatric PAs might not make as much as NPs in the same field, the salary data quoted above doesn’t match what you’d expect as a PA elsewhere.

 

[pamac]

NPs are utilized more heavily in psychiatry than PAs in most areas, but it’s region dependent. Also keep in mind that if you do a psych NP program, that’s the specialty you practice in and there is no ability to do something else like surgery or medicine if it turns out you liked those better (short of doing a post program certificate in another area of NP practice). So I think you’d want to be very sure psych is for you and you had no interest in other areas of medicine.

So dead set on psych, NP has the advantage of having programs tailor made for that. However, PA programs will train you as a generalist, with rotations in all major areas of medicine (general surgery, adult medicine, pediatrics, ER, etc), and all programs in the US require a psychiatry rotation as part of the curriculum. So if it turns out psych is not for you, you aren’t limited to that once you graduate.

And as a counterpoint to the poster above me, I wouldnt worry so much about independent practice or zero physician oversight. More and more we practice on teams. It’s better for the patient and for the clinicians. What might be relevant is the pay and ability to work in your desired field. In psych, this might tip the balance for you. While psychiatric PAs might not make as much as NPs in the same field, the salary data quoted above doesn’t match what you’d expect as a PA elsewhere.

You are right that there are PAs making good money in other realms. For instance, I do know PAs that do quite well in derm, ER, and surgery... into the $130s. I just don’t know any PAs in psyche that pull off that kind of money, and certainly not right out of school. Similarly, I don’t know many FNPs making psyche NP type of money either. New FNPs in my region make about the same as their PA colleagues, or even less.

Independence isn’ t really appealing to me only for the sake of working solo or forgoing the team environment (because indeed it is better for the patient to be dialed in to collaborative interdisciplinary treatment), but mostly for what I mentioned were the fruits of independence... which is latitude from not requiring oversight, more relative freedom of movement, and the ability to take on additional responsibility on your own terms that make you a more appealing hire. I personally know PAs of several specialties who had employers cite their supervision requirements as a burden. My facility even discontinued hospitalist PAs in favor of NPs because of that, as the physician hospitalists and traveling MDs didn’t want their names tied to decisions made by staff members they didn’t hire, and the medical director didn’t want that burden either. Apparently the one physician that was willing to allow them to assign him to be the physician of record wanted a significant premium to do so. Now my hospital staffs with NPs for hospitalist duties. They are supervised and have access to collaboration, but it’s on the hospital’s terms, and is not a legal requirement. So those kinds of instances are where being independent and having no requirement for physician supervision means better wages and preferential treatment due to increased lattitude. It’s not about being a cowboy and working in a clinic you own, or not having someone breath down your neck. But... I do know many folks in psyche that do a stint working on their own, which for me is appealing as a measure of last resort if I ever needed to.

Think about suboxone. It can be lucrative to have credentials to prescribe it. Lots of places want to hire folks who can give it. Currently, NPs and PAs can both do so. Guess who can do so on their own in independent states, and who cannot? Those who can do so on their own can command whatever they want to as far as the cut of the profits. The PA works for a physician, and can’t go out and do business on their own. How much of a cut can the PA demand? They both can prescribe it, yes, but which provider can tell the practice owner that they are leaving tomorrow to go practice down the street with suboxone? If the PA leaves, they have to file new paperwork and get it approved, and they can only make that jump when they have another physician ready to be their boss (and that new boss is probably not going to be much more generous than the old boss... but it’s up to him or her).

That’s the power of independence. You may never want to use it to it’s fullest extent, but it’s nice to have the options that come with the career. More states are turning to independent practice each year. But PAs don’t have those options, and may never have them to the extent that NPs already do. Collaborative practice and physician oversight might be your thing, but you might not always want the chains that come with being required to have that. I certainly only want that on my terms, which is why I specifically chose the NP career over PA.

 

[pamac]

Changing specialty as a PA is one of their hallmarks. The practicality of doing so is getting more complicated, as specialty certification exams are being pushed as a standard. Their experience and mastery are watered down with each jump, and employers respond with either hesitancy to hire, or hesitancy to pay a premium for someone who has an eclectic and or erratic job history. The prospect of familiarizing a derm PA for an ER job offers more of a gamble than hiring an experienced ER PA. Less of a learning/experience curve. So one should hope to jump specialties infrequently.

 

[Moki1984]

Thank you for the replies. I am pretty focused on psych, but I can definitely understand the value of changing one's specialty. Of course it is nice to have that option.

Pay is not everything, but it is a factor and I have financial goals. I am aware of Yale's program, spent time recently looking up online programs and I realized most of the online PA programs are for those who already operate as a PA and want to further their education. It is a little daunting to think about putting all of my eggs in one basket.

I need to keep doing more research into NP. Right now my goal is to determine which degree path I am taking, what is my end goal here (NP, PA or is it something else) then make a plan to go after it. I know for sure I want to do direct care.

 

[pamac]

There is one other truely online PA program. The rest of those programs you are thinking of are programs where PAs with bacteria or associates degrees can go back and get their masters. One way or another, you are going to have to spend time in a classroom. I don’t see how you can avoid having to take time away from your job.

 

[Moki1984]

If it means minimal time away from job, I can coordinate this with my boss and figure it out. If it means I am in a classroom frequently, more than one day a week ....I will have to determine if I can leave my job and take on loan debt to help pay bills. I am aware that no matter which route I go, I will have to do some type of clinicals/internship etc. that is not an issue, its about that initial schooling before getting to that phase.

 

[Moki1984]

There is one other truely online PA program. The rest of those programs you are thinking of are programs where PAs with bacteria or associates degrees can go back and get their masters. One way or another, you are going to have to spend time in a classroom. I don’t see how you can avoid having to take time away from your job.

Other than Yale, who? I am okay with some time away, we can coordinate that but it has to be minimal or I just don't know. No one else does my job at the hospital, I am the only Patient Advocate for the entire hospital so its not like I can drop down to part time or something. Leaving this job is difficult, I am the breadwinner and the provider of health insurance. For me to leave means he has to provide insurance , which will take away his already smaller paycheck, which as is could not pay the bills entirely let alone groceries and incidentals or the cost of raising our kiddo and I would have to take on more loans than I would like to pay the bills so I sink us into debt, which right now we have no debt minus our condo/car. That is a huge leap of faith to take, risking my family's financial stability BUT.....no risk, no reward and I cannot sit stagnant in this role. It is time I took steps forward in my career.

Just undecided right now, what is the best choice for my family and my goals. I don't want to hurt them, I also don't want to settle for something with no return on investment that leaves me saying "what if" in 10 years.

 

[pamac]

You are up against the fact that there are less than 50 seats out there in a PA program that you don’t have to show up for. There are also zero seats in an RN program that you would not have to show up to class for. That’s just not how it’s done. Even the PA programs that allow you to do most of your work online still require so much work that there’s no way you’ll be able to work full time while you are in the program. I was able to work full time in RN school and NP school, but I had a very accommodating employer and had significant flexibility with my hours that it doesn’t sound like you have.

That’s just how it is, and that’s how the rest of the world has to handle things. We take in debt and take time off of work.

 

[Moki1984]

Thank you for the insight.

If it was just me, I would be less hesitant to take a risk like that with my job, but this is not just me. As the main provider, I can't help but feel worry about putting my family into debt and not providing as I currently do. Mind you I don't make tons of money lol, but I make enough to be the provider. At the same time, I can understand that sometimes rewards require risk and fear often holds us back from greatness. I recognize this is an investment of time and money into something that can end up providing a better quality of life for my family alongside greater job satisfaction while helping those that I like to work with (psych patients).

My Mother says I overthink and worry, it is showing right now. For me this has to be a calculated decision and I will not rush. I will continue to think on my options, make a list of schools in state that have the NP and PA option for me to compare as well as online resources and once I narrow that down I can speak with my boss again. She is willing to work with me, but she can only bend so much as I am the only one responsible for my office and this is a demanding role. It is just not feasible that I could take a lot of time away during the week, I still need to maintain fulltime hours. So I have to consider the option of what if I cannot work while doing this?

 

[pamac]

I’d suggest you look over the older posts on here to get a handle on the career field. I spend a lot of typing to try to lay out concepts for folks that are in the very early stages of considering the career when they could find a lot of answers in old posts.

 

[pamac]

So I’ll fill you in in some aspects of medical and nursing training that you will have to deal with. For PA school, they want you here in person, for 2 or more years. They are in school quite a bit of each day of the week for the first year, and when they aren’t in school, they usually always have something to study for. It’s more than a full time job for that first year. There is a lot of ground to cover for all their students, as they all come from different backgrounds as far as their health care experience, if they have any. But they all tend to be good students and it’s really quite competitive. The sencond year they are out doing clinical rotations and learning to deal with patients hands on. That’s also a full time job and then some. May times they have to travel far and wide for those clinical trainings. And at the end of that, you have your certification exam, and then a first year where you have a steep learning curve, unless you are like the woman on here that posts under the name “NP not-well-trained”, and in that case you jump into SOLO practice in urgent care where the physicians actually come to you to ask you hey should handle complicated cases. Don’t worry, though...it’s only a rare elite few like her that has those expectations heaped upon her. That’s sarcasm, by the way.... that poster is weaving tall tales. The pro PA movement would be far better served with a more believable advocate. But anyway, PA school is demanding, and close to all consuming for those that take it upon themselves. And I think I’ve previously highlighted some of the drawbacks they face in the psyche realm.

Nursing school is a requirement for those who later go on to become an NP. You don’t always need to have a BSN if you can find an Np program that will allow you to bridge your associates RN degree to a masters or doctorate. But one way or another, you must attend a nursing school and go through nursing clinical rotations. There are just too many hands on skills that they go her to have a truly online and part time experience there. I worked full time through RN school, but my hospital job was not one that had traditional hours. I could work evenings and nights, and had coworkers who would sub for me if I was in a bind. I could work 12 hour shifts and cut my work week down to 3 days if I needed. I could work weekends when I wanted.my boss made it happen, and even then, it was a hard pull. My nursing school was not flexible at all, but they also kept interesting hours. Some semesters I was only in school a couple days per week.

But once I got my RN, it was fairly straightforward to work as an RN while pursuing my NP in psyche. You can watch almost all of your lectures online. Some schools don’t have you go to campus. My program has regular campus visits where we train and get evaluated. I like that, and would be hesitant to put my money in a program that didn’t offer that kind of experience. But, just like PA school, that pathway will likely require you to make some sacrifices. You can find what is called a “direct entry NP program” where over the course of the program, you do an accelerated RN program, and then immediately roll into the NP curriculum , and then finish that and graduate to be an NP. Those are relatively rare, and as expensive as most Pa programs, and require you to be there in person for almost all of it. They also tend to be fairly robust as far as their academic requirements and demands on their students. But it’s like most PA programs in that they don’t need you to show up with a high level of high quality health care experience.

Those are some things to think about.

 

[lemurcatta]

Also you can work as an RN during NP school. That helps with the $$ aspect of life as a grad student. Most PA programs recommend you do not work. As what was said earlier, we take people from various backgrounds (RN, respiratory therapists, paramedics, scribes, medical assistants, research techs, etc) and put all them through the same abbreviated version of medical school. You really can't have a job, its all consuming and you're never truly done studying for something during the didactic year. Also, we probably get less total training (didactic/clinical) in psych stuff than a dedicated psych np program. There are now specialty certificates in psychiatry for PAs which may start allowing them to command higher salaries once the PA gets enough experience to take the exam and then passes it. Check out nccpa CAQ for more info.

PAMAC- agree with you in principle about the independence thing. I don't know a lot about suboxone, but I do know PAs are able to prescribe it and can do so even if it isn't in the realm of their supervising/collaborating physician. But they still have to be employed by the MD

 

[pamac]

I agree, here is no way to carry in with meaningful work while in PA school. I went to school alongside Pa students, and they were there before I got to class, and stayed until after I left, and I was only there three times per week. They were also there the other two days doing the same thing. I went in late one evening to retrieve something from a locker and saw all the PA folks who had been there all day doing a study group after their class. There is no way I could see someone having enough time to be able to bring in any worthwhile sum of money while doing that kind of regimen. PA school has 3 semesters to cram as much medical knowlege as they can into a diverse group of folks with disparate levels of knowlege, and they all have to be brought up to be on the same page by the end of it all.

I looked back at my wages though Np school, and each year allowed me to work full time making an average of $75k per year before any overtime.

With suboxone, PAs are able to prescribe it. But PAs are never independent of the overall scope of supervision of their supervising physician. What I mean by that isn’t that the Md/DO has to also be approved for suboxone administration, just that the practice of the PA in administering suboxone is not outside of the supervision, and therefore control, of the MD. The MD is the life force of the MD/PA relationship, and without the MD, there is no practicing PA. The PA doesn’t get to prescribe suboxone if they don’t have an MD signed on to supervise them. So who has all the power in that relationship? That same imbalance is the reason that things like certification in psyche won’t command any kind of premium. If they are rewarded, it will all be subjective to the generosity of the physician that they have to work under, and what he feels is reasonable. If he or she wants to pay a qualified Psyche PA more because of the utility of the extra knowlege, then he or she may do so, but it’s up to how they feel. That extra knowlege needs to be something that contributes to greater efficiency and profit, and it also needs to be compelling. And again, the MD has undue influence in that relationship because if a psyche PA comes to him or her with a certification in hand, it means they are looking for a narrow area like psyche to work in. They are invested. The physician who doesn’t want to pay a premium for that PA knows that the PA has to go out and find another psychiatric physician to sign with, or they can’t use that certification. Psyche NPs in independent states can go chase work without having to nail down that kind of agreement. If you are an apprentice, you have to find a master to work under. If you aren’t an apprentice, you go out and work. Any time your ability to work is predicated on maintaining the favor of someone else, then they have more power over you. That’s how most jobs out there are, so no big deal. However, when comparing between NP and PA, and Np in an independent state has a significant edge.

Independence is the name of the game. It’s the reason I’m not a PA. Love the training, hate the subservience.

 

[Moki1984]

Taking this all in, talking with family, internalizing the fact that I will have to edit my working hours to achieve either of these, possibly to the extent I leave my job. My family seems to lean towards PA, with one reasoning being we have a local school and my family feels timeline wise this is faster because I would have to do the accelerated plan to get BSN then the masters for NP. I can drive to this school in about 25 min and the tuition is not THAT bad compared to what else we see. Of course they state they don't give preference to residents, but naturally...when you are that close to campus and it is your intention to work here in the same community afterwards, people might smile at that. This of course requires in person fulltime. It also means the clinicals should be local I assume, we have medical schools in my area with multiple teaching hospitals, many clinics of varying specialities etc My area is known for healthcare and I know people in my current hospital that might help me if need be plus my Mom has contacts in healthcare. If I stay local, I can use the connections I already have.

Of course the idea of more independence is appealing to me. For my state, NP's are not as independent as other states, but I know people locally are trying to push for change on that.

I like Psych, my experience is in psych, I want psych. Yet, the idea of doing a rotation in surgery, specifically neurosurgery, is interesting to me. During my undergrad I loved neuropsychology, neurobiology etc. Actually my favorite classes were the ones that combined psych and bio, hence I got a minor in biology. I am grateful for that minor now, will help me no matter which path I take although I do feel a need to refresh myself as it has been years since I graduated (2012) and I don't use any of my bio schooling, only my psych.