PA vs. NP hurts PA's

[UpRegulated]

Started as a new topic, per Paula's advice....  Was a post at http://www.physicianassistantforum.com/index.php?/topic/12251-pa-to-np/page-2

 

Perhaps slightly off topic, and I've touched on this before, but NP's (I am an NP student) and PA's should work together.  PA's stand to gain much more from working with NP's than the other way around, but if both of us are not careful, we'll shoot each other in the foot.  You PA's (and PA students) don't seem to realize that attacking NP's hurts you more than it hurts NP's.  The very arguments you level against NP's can be leveled right back at you.  The arguments you make that hurt you are basically these:

 

(1) NP's only have 800 hours in clinical training.  We (PA's) have 2000 hours, therefore, we are more qualified. How it hurts: MD's and DO's chime in and point that they have 12,000 hours.  What's a 1200 hour difference between NP's and PA's when the difference with physicians is 10,000 hours?

 

(2) NP's are trained in nursing, we are trained in medicine.  How it hurts: MD's and DO's chime in and say, "Yeah, we are trained in medicine too, and far more so (see #1).

 

(3) NP's are specialized, we are generalized.  How it hurts: NP's are trained to be "specialists" in family care, psych, etc.  PA's are jacks of all trades and masters of none.  That is NOT a winning argument when, again, the MD's jump in and say we are generalists too, THEN specialize in a structured, and supervised training environment (residency), for thousands of hours.  See # 1 yet again.

 

(4) NP programs are light on the sciences.  PA programs are heavy on the sciences.  How it hurts:  MD's jump in and say they have 1-1.5 more years of sciences, at a deeper level, and then follow up with 3-6 years of residency.

 

Simply put, every critique of the NP can be turned on the PA by an MD/DO.  You are shooting yourselves in the foot and undermining your own profession by criticizing the NP.  Have at it.  As a future NP, it doesn't matter to me.  In fact, it benefits me because you are cannibalizing.  Arguing over 800 vs. 2000 clinical hours is ridiculous.  The fact is, neither prepares the NP --OR-- the PA to practice independently upon graduation.  Compared to med school and residency, the difference is chump change and utterly meaningless, especially given the average NP's prior training and experience as an RN.

 

The fact is, 80-85% of primary care can be delivered as effectively by an experienced NP or PA as an MD/DO.  That's the "talking point."  But go ahead. Cannibalize by criticizing NP's, who are not your enemy, but potentially your friend.

[LT_Oneal_PAC]

Well I think I've made it clear on this forum I support NP and PA collaboration on issues that are mutually beneficial and that PAs should not treat NPs any differently than they would another PA.

 

But...your post come across as antagonistic. Not the way to win people over. I'm already on your side and you make me want to respond aggressively. As a friendly note, might want to work in the tone of these remarks. Usually I'm very pleased with your posts.

 

As a former NP student, ICU RN for 4 years, and current PA student, let just say that when I make reference that we (PAs) have more clinical hours it is only to demonstrate we deserve parity with NPs. It's an argument I make often. Lift us up, not drag you down. Other than that I can mostly, mostly agree with what you have said.

[UpRegulated]

Well I think I've made it clear on this forum I support NP and PA collaboration on issues that are mutually beneficial and that PAs should not treat NPs any differently than they would another PA.

 

But...your post is antagonistic. Not the way to win people over. I'm already on your side and you make me want to respond aggressively.

 

As a former NP student, ICU RN for 4 years, and current PA student, let just say that when I make reference that we (PAs) have more clinical hours it is only to demonstrate we deserve parity with NPs. It's an argument I make often. Lift us up, not drag you down.

 

Antagonistic?  Maybe.  Not trying to win anyone over, just sayin'.  I'm certainly not intending to be critical of PA's. I'm being critical of PA's going after NP's, which I think is hurting PA's, thus am trying to help, not hurt.

 

Familiar with your posts, O.  Love to read them.  Some of the best on here.

 

Clinical hours in a training program means jack re: PA's vs NP's.  Insist that it does, and get rolled by the doc's.  MD's laugh at our 800 vs. 2000 hour debates, when they have 12,000 hours.

[EMEDPA]

. Other than that I can mostly, mostly agree with what you have said.

me too...except for this:

"especially given the average NP's prior training and experience as an RN."

there are just as many experienced folks who go to pa school as np school and just as many direct entry folks in both...other than that once phrase I was ok with the post.

[EMEDPA]

MD's laugh at our 800 vs. 2000 hour debates, when they have 12,000 hours.

what about 400-500 vs 3000....:)

[LT_Oneal_PAC]

Antagonistic? Maybe. Not trying to win anyone over, just sayin'.

 

Familiar with your posts, O. Love to read them. Some of the best on here.

 

Clinical hours in a training program means jack. Insist that it does, and get rolled by the doc's. MD's laugh at our 800 vs. 2000 hour debates, when they got 12,000 hours.

I think you misinterpreting my posts, understandably.

 

I know you aren't being antagonistic deliberately. Just saying it comes off that way. If you aren't trying to win anyone over, I don't see why post it at all. I can see why you say and empathize with the need to say it with a certain gravitas to get people's attention, but it will put off people here. Like you say, just sayin'

 

I'm not debating the clinical hours issue. My response was meant to show you a different view point in case you see someone making the point about NP and PA clinical hours difference. I think you misinterpret my point. NPs have studies and reports out the wazoo showing safety and efficacy. If PAs have more science and more clinical training, it would stand to reason that we deserve equal treatment, meaning we get up to NP level. I'm somewhat riding on NPs success to bolster PAs, not say NPs are inferior and need to be brought down. Perhaps it's pedantic to say if billy gets a cookie for working 2 hours in the yard then shouldn't I get a cookie for working 3, but that's what I'm doing ;)

 

ETA: I don't think yore being critical of PAs. I agree and have made similar statements on the forum that we shouldn't attack NPs. There isn't a single argument that can help us by tearing another down.

[Guest Paula]

At some point the direct entry NP and PA programs will equalize us all.  It might take 10 years but as both professions are becoming first time careers for many we will be seen as the same.   LELTs according to Dr. Doug Farraro who likes neither profession.

 

Less Educated Less Trained.  

 

Physicians rule.  

 

Unless we work together for inter-professional training and residencies for PAs/NPs to show employers we all are smart and can do the job.  Both professions need to be stand alone and in charge of themselves.  Do we get there together or apart?  I don't know. 

 

Does working together mean that AAPA and AANP are the ones to take the step in that direction?  I don't see it happening since we are different professions and there will always be turf issues. 

[myironlung]

i think you may just be bitter that on paper PAs are indeed "better trained" than NP's to be a healthcare provider and practice medicine. I don't think any PA would be so dumb to not realize MDs and DOs are out there who are most certainly "better trained" than PA's. In the end it doesn't matter because we are both still midlevels and always will be. I had some NP  the other day say NPs were "better" than PAs because they didn't need physician oversight or some shite like that. So then there's that perspective as well. Like I said...who cares, we're still both midlevels.

[EMEDPA]

who cares, we're still both midlevels.

cough, cough...advanced practice clinicians if you don't mind....:)

[PACdan]

I worked for a major university hospital system that was just warming up to PAs. They had ~15 employed when I left. Compared to 100+ NPs. Needless to say NPs ruled the day (Big nursing program that blocked any hopes of a PA program springing up). One-fourth of the young RNs I worked with were on the NP master's track. They worked full-time, did school, and had social lives. They'll graduate in less time with an NP than it will take me to get a PA master's; during which I cannot work, will have 60+ hour clinical weeks, and will probably be sleeping in any free moments I get.

 

I just see a disparity in the graduate training modalities force per force. I'm not shaming or disparaging in any way the NPs. Lots of the RNs I worked with were sharp as tacks. But the investigative differences were there and apparent. As well as some of the rigorous nature of schooling. Yes PA school is not med school, but is NP education as rigorous as PA?

 

This is just my anecdotal experience. I welcome you to enlighten me.

 

 

Sent from the Satellite of Love using Tapatalk

 

 

[skyblu]

I don't understand what physicians have to do with the argument, since they are not practicing at the level of a PA/NP. The comparison there doesn't hold water because it's apples to oranges.

 

But I agree that PAs and NPs should work together and be supportive of each other's professions.

[UpRegulated]

"especially given the average NP's prior training and experience as an RN."

there are just as many experienced folks who go to pa school as np school and just as many direct entry folks in both...other than that once phrase I was ok with the post.

 

True enough.  But not all prior experience is the same, and that goes for both NP and PA.  And, for the record, I think DE is a bad idea for both.

[UpRegulated]

I think you misinterpreting my posts, understandably. I know you aren't being antagonistic deliberately. Just saying it comes off that way. If you aren't trying to win anyone over, I don't see why post it at all.

 

Correct, I don't mean to sound too antagonistic.  But at times (both here and other places) when I've mentioned that PA and NP's should work together, I've been blown off by PA's, hence the tone of my post.  That tone, however, was not meant to antagonize so much as it was meant to challenge.

 

Fair point on my statement that I am not trying to win anyone over.  I guess your right in that I sort of am. 

[True Anomaly]

Correct, I don't mean to sound too antagonistic.  But at times (both here and other places) when I've mentioned that PA and NP's should work together, I've been blown off by PA's, hence the tone of my post.  That tone, however, was not meant to antagonize so much as it was meant to challenge.

 

 

 

Alliances are forged in many places- in online forums (such as here), in professional organizations, and in the legislative arena. 

 

Ideas start in places such as this, progress onto professional organizations, and maybe hopefully in the legislative arena they are manifested as true change.

 

We discuss things pretty freely here- there has always been a few NP's here who (I would hope) feel welcomed and part of the discussion.  One of our "intermittent regulars" is both a PA and NP.

 

There have been mutliple attempts at different professional alliances- the American College of Clinicians is one that comes to mind.  As well as forums such as Clinician1 meant to serve both PA's and NP's.  And professional magazines like Advance for PA's and NP's.  All serve to treat us as equals.

 

Where the difference comes is the political arena.  I have RARELY seen or heard about legislation introduced that includes both PA's and NP's.  Why?  Because the NP lobby is coupled with the nursing lobby in general- which FAR EXCEEDS both our numbers and our budgets.  NO ONE is out there in the legislative arena backing PA's other than PA's.  The physician groups aren't doing it.  And the nursing lobby certainly isn't- in fact, more often than not we are left in the dust.  This isn't from a lack of trying- it's having tried to unite on legislative issues in the past with the stronger (nursing) side saying "No thanks". 

 

So you'll understand if there just happens to be some confusion on our part when PA's and NP's talk up forging alliances, but when it gets down to brass tacks in the legislative arena, it pretty much never happens.

 

That doesn't mean it SHOULDN'T happen, and doesn't mean that I agree with what I said- I'd LOVE to do legislation that consistently benefited both professions.  But this DOESN'T HAPPEN.  Because the nursing lobby does not need us, and since their resources far exceed ours, I would think it's more up to them to help us out because I guarantee you they know from what kind of weak position we're coming from.  It's not up to us to beg for inclusion- it's up to us to fight for ourselves, because no one else is going to.

[Corpsman2PA]

I don't understand what physicians have to do with the argument, since they are not practicing at the level of a PA/NP. The comparison there doesn't hold water because it's apples to oranges.

 

But I agree that PAs and NPs should work together and be supportive of each other's professions.

I was thinking the same thing.

 

According to OP's logic, NP is to PA, as PA is to MD?

 

My program has had some fantastic NP lecturers. Top notch. I think a lot of it comes down to the individual. I've met both good and bad MDs, PAs and NPs-regardless of hours of clinical training.

[Mainer]

Lots of misleading statements in your post

 

When discussing education, "years" is a broad and sweeping term. 

 

PA complete 125+/- credit hours of education in two years with 4000-5000 hours of didactic and clinical education.  Medical school is similar to this over 4 years.  My PA school also had an MD school.  I was in class until 5pm each day.  The medical students were out by 12-noon to 1pm each day (if they even went to class).  You get your MD/physician after medical school, not after residency.  ***NOTE: These PA school hours do not include projects, homework/case reviews, study for exams, ect outside of class.

 

Note:  I respect physician training, but remember, the 4th year of medical school isn't so tuff.  It's basically an extra year to complete a few extra rotations (which is very important) and MATCH FOR RESIDENCY. 

 

NP is less than 1600 hours actual training over two years.  THEY WORK FULL TIME.  YOU CAN'T WORK FULL TIME AND LEARN WHAT YOU NEED TO PRACTICE MEDICINE.  Are the differences between the nursing and medical model becoming more apparent?

 

PAs frequently complete residency's as well, but it is not currently required.

 

NP's do not specialize nor do they complete generalist training by medicines standards.  They simply use the term "specialize" to suggest competency.  Another great example of their clever, but misleading marketing tactics.  The reality is MD specialize through residency training.  NPs simply prefer the term "specialization" instead of "limited scope of practice" which is what their training provides them. 

 

PA education is like putting AdultNP, FNP, PND, WomenshealthNP, pychNP all together plus additional training and education, but with higher expectations.......The medical philosophy is that you really can't become a competent provider in family medicine, pediatrics, internal medicine if you never completed both didactic and clinical training in psych, surgery, EM, so forth....

 

Yes, like physicians, PA's specialize through apprenticeship after a long, hard, educational and grooming process.  NPs continue to "dump down" their educational opportunities by lobbying for complete independence.  Basically a very limited education without any physician guidance after (aka independent practice).  Remember, newly minted NPs are autonomous also.  SCARY!

 

 

Wish I had more time to continue.  The point is, it's the content and expectations of the education that matters.  Completing 30 credits over 6 years doesn't make it a "6 year degree". 

[Mainer]

One last comment while I'm fired up

 

The PA vs NP doesn't hurt PA's.  I think it is the opposite

 

I'm pretty new to my career as a family medicine PA.

 

Relatively large organization with multiple stand alone medical homes throughout the county

 

I'm the 3rd PA they've ever hired in the whole organization.  There are probably 10 NP's and 15 MD's

 

The NPs are constantly nagging the administration.  Being a person who's willing to say what I want, I have aggressively pointed out exactly the data in my previous post to the CEO, COO, MDs.  They never new the difference (not even the MDs), but have been impressed with the quality and clinical abilities of the PAs and find the disparity between our education compelling.

 

Our latest recruiting ads now read, "New grad PA's welcome to apply.  Will consider experienced FNPs.  Willingness and ability to see pediatrics a must."

 

NPs in the organization have softened their tone towards administration. 

[LT_Oneal_PAC]

Lots of misleading statements in your post

 

When discussing education, "years" is a broad and sweeping term.

 

PA complete 125+/- credit hours of education in two years with 4000-5000 hours of didactic and clinical education. Medical school is similar to this over 4 years. My PA school also had an MD school. I was in class until 5pm each day. The medical students were out by 12-noon to 1pm each day (if they even went to class). You get your MD/physician after medical school, not after residency. ***NOTE: These PA school hours do not include projects, homework/case reviews, study for exams, ect outside of class.

 

Note: I respect physician training, but remember, the 4th year of medical school isn't so tuff. It's basically an extra year to complete a few extra rotations (which is very important) and MATCH FOR RESIDENCY.

 

NP is less than 1600 hours actual training over two years. THEY WORK FULL TIME. YOU CAN'T WORK FULL TIME AND LEARN WHAT YOU NEED TO PRACTICE MEDICINE. Are the differences between the nursing and medical model becoming more apparent?

 

PAs frequently complete residency's as well, but it is not currently required.

 

NP's do not specialize nor do they complete generalist training by medicines standards. They simply use the term "specialize" to suggest competency. Another great example of their clever, but misleading marketing tactics. The reality is MD specialize through residency training. NPs simply prefer the term "specialization" instead of "limited scope of practice" which is what their training provides them.

 

PA education is like putting AdultNP, FNP, PND, WomenshealthNP, pychNP all together plus additional training and education, but with higher expectations.......The medical philosophy is that you really can't become a competent provider in family medicine, pediatrics, internal medicine if you never completed both didactic and clinical training in psych, surgery, EM, so forth....

 

Yes, like physicians, PA's specialize after through apprenticeship after a long, hard, educational and grooming process. NPs continue to "dump down" their educational opportunities by lobbying for complete independence. Basically a very limited education without any physician guidance after (aka independent practice). Remember, newly minted NPs are autonomous also. SCARY!

 

 

Wish I had more time to continue. The point is, it's the content and expectations of the education that matters. Completing 30 credits over 6 years doesn't make it a "6 year degree".

Yet study after study shows that NP care is as safe as physician. So we should let it go, provide moral (not financial or lobby because we need to save all we can for us right now) support for their efforts, and hope one day they'll do the same. If not, at least we know we were true to the evidence, which is more than we can say for physicians who dog everyone at every turn with scare tactics and lack of evidence.

[Guest JMPA]

the op sounds like just another nurse pretending to know more than a doctor

[DPAM]

First, your argument is completely is baseless because you state Pa vs Np when all your points are Pa vs Md. But I have few points that i want to elaborate on. first, 12,000 hours that mds "supposedly" do that pas dont do. this is the same argument that Mds (mainly students) mention when they try to put down the Pa education. They always say you can't compare 7 years of medical education to two years of pa school. this is such a misleading and unfair comparison. First, pa school is seven semesters long while medical school school is 10 semesters long (because in pa we start the summer before the fall vs medical school they start in the fall and we graduate in summer vs medical school where they graduate in the winter. In addition medical school take the summer of second year off to study for step 1). so the real difference between MEDICAL SCHOOL and Pa SCHOOL is 3 semester (mainly elective rotations and some basic medical sciences such as histology and embryology that are barely tested on step 1 anyways). Now of course medical graduates must do residency for at least three years (they work intensely for three years)  but when a pa graduates he/she is gaining experience and skills as well due to real working experience in that particular field. So now if you are going to compare a medical school graduate to a pa graduate then there is a difference of three semester but if your comparing a medical doctor who graduate from a primary care residency program then out of fairness they must be compared to a pa who been working at least 5 years (because usually residency programs are 80 hours a week esp. first two years of residency so thats like 6 years of full time work by pas but we know that pas work around 60 hours per week. so at least 5 years experience would be comparable to a three year residency). So if you have a pa who been working for five years in primary care then he/she would be at par or pretty close to the clinical knowledge and skill of a newly md graduate of a primary care residency program. Now thats a fair comparison. of course im only talking about primary care. no doubt md specialist know more than any pa specialist.

[db_pavnp]

Short, fast, and hard isn't necessarily better than longer, slower, and easier.  Credit hours also seem quite arbitrary.  I would be interested in reading the opinion of an educator or faculty who deeply understands the reasons that credit hours are allocated differently between NP and PA programs.  I have a hunch they are institutional or wrangled by the accrediting organizations and are meaningless in the big picture.

[LT_Oneal_PAC]

Short, fast, and hard isn't necessarily better than longer, slower, and easier. Credit hours also seem quite arbitrary. I would be interested in reading the opinion of an educator or faculty who deeply understands the reasons that credit hours are allocated differently between NP and PA programs. I have a hunch they are institutional or wrangled by the accrediting organizations and are meaningless in the big picture.

I've been in both and can tell you all about it.

[EMEDPA]

the difference is the extra hours pas do in basic sciences and clinical rotations.

if you took out 1/3 of my didactic year courses and 3/4 of my clinical year you would end up with the # of credit hrs for the np program at the same university.

[UpRegulated]

Can't reply to everyone, so let me say to PACdan, skyblu, Mainer, and especially, JMPA, and DPAM:

 

My post was not about the efficacy or validity of NP compared to PA training.  AT ALL.  It was to say that the arguments that PA's use against NP's are arguments that MD's can (and do) make against PA's.  The "bombs" you lob at NP's are bombs that can be lobbed right back at you by MD's, so the more you do it, the more your hurt yourselves as a profession.

[UpRegulated]

the difference is the extra hours pas do in basic sciences and clinical rotations.

if you took out 1/3 of my didactic year courses and 3/4 of my clinical year you would end up with the # of credit hrs for the np program at the same university.

 

Sigh.  Nevermind.