If you had to...what would you do?

[EMNP]

This question is for current PAs.

 

If you had the opportunity to attend a PA program or an FNP program, which one would you chose if you had to do it all over again?

 

The reason I ask is because I have been accepted to both and seeing how the NPs are gaining so much strength in terms of autonomy and independence/rights makes me feel anxious about going PA.

 

I love the PA philosophy and the medical model, but I like the support NPs have and are gaining, simply the future looks brighter for them compared to PAs.

 

If you had the choice, which route would you take?  If you knew you wanted to work primary care, ER or Hospital?  CEP (California) hires both PAs/NPs and pays them the same.  I see myself working in primary care, ER and maybe inpatient once I am done.  I have no desire to do surgical specializations.

 

I simply want an honest, unbiased answer.

 

Thanks in advance

[rev ronin]

I'd still be a PA.  I'm not a nurse, not going to ever be a nurse. I manage crises and solve problems; I think up worst-case scenarios in order to prevent them.  I make risk/reward decisions, and I'm better than most at convincing people to do the right thing by explaining the odds and consequences in a way that makes the abstract concrete.

It's what I did in IT security before I ever went to EMT school, let alone PA school, and it's not a nursing outlook on life.

[RURALMED]

I'd still be a PA.  I'm not a nurse, not going to ever be a nurse. I manage crises and solve problems; I think up worst-case scenarios in order to prevent them.  I make risk/reward decisions, and I'm better than most at convincing people to do the right thing by explaining the odds and consequences in a way that makes the abstract concrete.

 

It's what I did in IT security before I ever went to EMT school, let alone PA school, and it's not a nursing outlook on life.

PA student perspective: I absolutely agree! there's nothing more rewarding than working your butt off learning the detailed pathophysiology of the kidney for example to understand a patients disease and to guide your decision making. I recently finished a rotation with a primary care PA in an office with 6 doctors and 2 nurse practitioners. The PA was the only one in the office doing procedures because the NP's weren't taught how to suture in their program. My preceptor thought it would be a good learning opportunity to follow the NP for a day and I quickly realized how differently we approached diagnosis and treatment. For example, we saw a recently pregnant patient who was on an SNRI for anxiety and was told by her OB to taper because it is category C, and referred her to PCP for alternative. The NP went through epocrates looking up all of the different SNRI's and SSRI's while I was thinking of a drug in a different drug class like buspirone which is category B. 

 

Anyway, I honestly do not have any negative feelings towards NP's and think that they can be excellent clinicians with a lot of independent study during and outside of school. In fact, my PCP is a nurse practitioner and she says that if she could do it all over again, she would have gone to PA school. So If you like science and understanding the pathological basis of disease, I don't think you will be satisfied in an NP program. Good luck on whatever you decide. 

http://allnurses.com/nurse-practitioners-np/frustrated-with-quot-481146.html

[Joelseff]

Yes I would. As far as NPs go, I don't think very highly of their training. I work with several NPs at my work. IMO we run circles around them. There are times that they are pretty competent but the variability of their training is apparent. I am generalizing and I've only been there a little over a month but It's almost like they practice from a menu. Algorithm like. And most of the ones I work with (all but one) have been practicing longer than me so I don't think it's a lack of experience thing. I really think their training/education is lacking basic pathophysiology and pharmaco. Just my observations. Maybe it will change the more I work with them but some things they do are downright scary like last week I saw a pt c/o right sided facial pain who I saw behind a NP who dx'd her initially with "facial cellulitis" despite no hypereremia or edema. Or s/sx of cellulitis. The NP ordered a STAT head CT (I don't know why or what she was looking for it didn't say on the rec) and put her on clinda. Pt saw me after 2 days of worsening sxs and clinda was making her sick. I look up her right nostril and saw severe right side inferior turbinate edema with TTP of the right ethmoid and maxilla. I dx'd her with sinusitis, put her on decongestants, motrin and avelox. D/c'd the clinda. Pt calls me the day after and says she was 80% better. Another NP asked me to consult on a pt who she thought had scabies because the pt was unkempt. I look at the rash and immediately saw it was dyshidrotic eczema. NP looks at me bewildered... Just saying. These are some things I have observed since working more closely with NPs. I've worked with one or two in the past who were OK if they were seeing the same things over and over like STDs, URIs etc. Throw something else at em and they go in all directions (again, from the ones I have had the chance to observe). Yes I know it's all anecdotal and just my experience.

 

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[EMNP]

Thanks for the replies so far.  I understand that in terms of training PAs are superior, but I am talking about future and opportunities.  As mentioned in the original post, NPs seem to be going up like smoke in terms of their presence, autonomy and setting their strong presence everywhere.  How will the future be for PAs knowing how strong the NP movement is becoming?  It seems that NPs will be regarded as solo practitioners along MD/DOs and PAs will be the collaborative mid levels now.  Will it get to the point that NPs will be making more money than PAs do to their autonomy?

[BruceBanner]

Is this a serious question?

 

I would absolutely be a PA. Personally I don't think NPs are all that and a bag of chips. Their training is highly variable and they just lack the pharm and pathophysiology background of a PA. Like rev ronin alluded to it's more a difference thought process and diagnostic approach than just sheer fund of knowledge. The ones I've see more or less practice from protocol.....just like a nurse. Imagine that. 

 

Also don't be fooled by the ostensible outlook of NPs. They just have greater numbers. NPs are hired mainly by corporations for logistical ease. Physicians know the real score, and I've yet to meet one who preferentially hires them.

 

None of this is to crap on their side of the profession---we are still professional analogues, practically speaking. NPs can be good at a lot of things. The other day I asked an NP student to start an IV for me on an frail old lady. I'm not too proud---he's probably started 1000 IVs to my 20. One thing I am confident in though is my pathophys background and my ability to think critically and independently. This, I think, is what sets us apart as PAs.

[Joelseff]

The other day I asked an NP student to start an IV for me on an frail old lady. I'm not too proud---he's probably started 1000 IVs to my 20. One thing I am confident in though is my pathophys background and my ability to think critically and independently. This, I think, is what sets us apart as PAs.

Well in truth our scope is not IVs and basic procedures which if called we should be able to do but as providers like Docs. Most of whom I wouldn't trust starting an IV. lol I myself have started countless IVs but not in the past 5 years so I would trust a RN more too.

 

 

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[Joelseff]

Thanks for the replies so far. I understand that in terms of training PAs are superior, but I am talking about future and opportunities. As mentioned in the original post, NPs seem to be going up like smoke in terms of their presence, autonomy and setting their strong presence everywhere. How will the future be for PAs knowing how strong the NP movement is becoming? It seems that NPs will be regarded as solo practitioners along MD/DOs and PAs will be the collaborative mid levels now. Will it get to the point that NPs will be making more money than PAs do to their autonomy?

There is already a perception at least at my job that the "hierarchy" (what a dumb and inaccurate concept) goes Doc->NP->PA. I had to tell some ppl (mostly RNs) that it is not correct. This comes from the supervision aspect. In that sense I see their logic. Collaboration and loosening restrictions on Docs who collaborate with us are a move in the right direction. My state association (CAPA) Has been very active in that arena. I foresee a time when we are on par with NPs in the legal arena but it will take a United front/push from all PA's, all PA societies etc. I am encouraged by the recent moves of AAPA and PAFT. Let's keep pushing the envelope for our futures. I think it's weak thinking to go for NP just because they're better situated legally (right now). There are 100k PA's and growing and we're expanding our programs too. When I graduated a few years ago there were only about 80 programs. Today there are like 180. All those newly minted PA's along with those of us existing PA's need to be a little selfish for our profession and move it through the current barriers.

 

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[jmj11]

Pragmatically speaking, my life would be a whole lot of a lot easier if I were an NP right now.  However, it depends what you want to do. If you are not trying to start and run your own clinic, which I don't recommend for most, then I would prefer to be a PA. 

[True Anomaly]

PA all the way

[Febrifuge]

Ideally, I would train as a PA and then challenge the NP licensing exam, or get credentialed as both.

[jmj11]

Ideally, I would train as a PA and then challenge the NP licensing exam, or get credentialed as both.

While NPs could ( I don't know if they can now ) challenge the PA boards and get certified as PAs, PAs were never allowed to take NP boards because it didn't fit their (the NPs) narrative that NPs are far better trained than PAs. So, I don't know why we ever let then take our boards.

[UGoLong]

To the best of my knowledge, no one can take the PANCE without having graduated from an accredited PA program.

[jmj11]

To the best of my knowledge, no one can take the PANCE without having graduated from an accredited PA program.

I worked with a PA/NP who told me that he finished a NP program and then challenged the PA boards and was a PA-C.  This is him on his web page (look down at Casey Straight).

[Joelseff]

I think a few years back (nineties?) NPs were allowed to take PA boards. Not sure maybe E or LesH can comment. On another note, My coworker is a PA/NP having graduated from UC Davis' dual program. She just took the NP boards and said it was a cake walk. Nothing compared to PANCE.

 

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[LESH]

I think a few years back (nineties?) NPs were allowed to take PA boards. Not sure maybe E or LesH can comment. On another note, My coworker is a PA/NP having graduated from UC Davis' dual program. She just took the NP boards and said it was a cake walk. Nothing compared to PANCE. Sent from my S5 Active...Like you care...

It was possible up to 1985 or1986 I think. Then the pathway was closed. 

[EMEDPA]

I had a pa partner at my first job who was an rn who became a pa. to become an np in the late 80s he had to take 1 class on adv. nursing theory and pass their boards once. he did this to get rx rights in ca when pas didn't have them. he still signs PA, FNP.

[LESH]

I had a pa partner at my first job who was an rn who became a pa. to become an np in the late 80s he had to take 1 class on adv. nursing theory and pass their boards once. he did this to get rx rights in ca when pas didn't have them. he still signs PA, FNP.

I remember that E. Im not sure but I think that pathway is closed also.

[LESH]

In answer to the OP, knowing what I know now about both professions I would still be a PA.

[cbrsmurf]

I would go with a good NP school.  They have way more political clout and a brighter professional future, in my opinion.  

[Guest Paula]

I'd still choose PA school because I like practicing medicine. Now that I'm working with a group  (there are 2 PAs and 5 NPs in the group) and also the docs I am just beginning to understand the nursing NP profession.  Some of them are coming to me to ask questions such as "do you read EKGs and stress tests, what does this mean?" And..."I'm afraid to tell someone they can't get their percs for their muscle strain, I hate being the bad guy" ...(Ok, I'll do it for you, sigh, I just found them an appropriate alternative and documented their heroin addiction), and trying to respond to the NPs when they say "you need to know how to practice within your scope"  (that one almost made me laugh, it was mentioned in my interview by one of the NPs), to the nursing staff wondering what I meant when I asked if we had any splint material so I could take care of a patients broken 4th and 5th metatarsals, and the nursing staff say "Do you mean like a popsicle stick?" to the NPs asking me if I can look at  xrays for them because none of the docs are around. 

 

Yup, pick PA again. 

[KMD16]

^ like an NP I&D and digging with a #11 blade at an abscess or what she thought to be an abscess sitting on the Achilles' tendon in a poorly ctrl T2D pt w/ Hb A1c 11%.

 

 

[Will352ns]

^ like an NP I&D and digging with a #11 blade at an abscess or what she thought to be an abscess sitting on the Achilles' tendon in a poorly ctrl T2D pt w/ Hb A1c 11%.

WTF

[ventana]

If positive that you are going into a Primary Care field - NP  -  way more clout politically

 

If not POSITIVE of PCP - then PA - way better training

 

 

With NP route you can equal it to PA by doing a one year residency.... make sure NP is FNP so you are not restricted from age of patient, but be aware FNP will likely not allow you to work in OR or ICU - you would need CC NP or something like that....

[TWR]

I am happy to be a PA.  I think the original question was more about the future of NPs vs PAs.  Not a pissing contest of the 2 professions.  No matter what you think about which is better trained, etc.  The NPs are miles ahead of us in getting things done and we play catch up.  It is a sad thing IMHO.