PA vs. NP...in the future

[Nonlegit]

There is a lot of doom and gloom on this board regarding PA's future status/utilization in medicine, so I'm curious to pose this question a different way. I think a lot of us are in a certain situation, and would appreciate the boards' opinion in this matter.

 

The best I can describe my situation is this: I have lots of experience (will be 20k+ hours at time of application), good to very good grades, and would more than likely be an excellent candidate for either school (PA or NP). Med school is off the table. I have access to a university that offers a "grad entry" program for those with an undergraduate degree to transition into NP after 3 years, with a period of time where one could work as an RN (maybe after year two? not that important but income factor IS there...). As this school is less time consuming, I could work throughout the program and get it paid for almost in full by my employer. Obviously no such option for PA school, although I understand that the school should not be prohibitively expensive. I do not have undergrad loans. The money and time gap between school options should not be a huge factor.

 

I am MUCH more interested in PA model vs. NP, although every "midlevel" I have worked with and admired, has been just that... personally admired regardless their background. What I am saying is that I work with and have worked with good examples of both, so my feel is that maybe I don't need to be so biased towards PA schooling?

 

I really don't want to be a floor nurse, ever, in any kind of unit. I promise I say that with no disdain. I have been a tech for a long time, and am done with that angle of patient care. The fall-back of always having your RN if you are a NP is a nice thing, but would really only be a factor in a worse-case scenario for me.

 

In the multiple places I have worked in, NPs and PAs have been doing the same things. As a matter of fact, in my current flyover state of residence, NPs do more. I will be leaving this state when I am done with my education regardless of what I do with my life, however. More than likely New England will be the landing spot, although North Carolina and the Pacific Northwest are options...all PA-friendly places, correct? So again, a non issue which one I choose?

 

My specialty of interest is overwhelmingly EM, although I wouldn't rule out others such as critical care, and maybe surgery. I am intrigued with rural and critical access type places, but don't want to pigeonhole myself to the north woods of Maine.

 

So basically, what I feel like could be said to me is, my options are about the same right now. I would get out of school in a similar amount of time for a more or less similar amount of money, apply to jobs that are labeled "NP/PA", and probably do just as well with either option. What about the future, though? I realize no one here can read the future, but if you were presented these basically identical options, what OTHER factors would come into play for you? Would the future of the PA profession scare you off in my scenario? Is there something I am missing?

 

Thanks in advance.

[smccccc]

I have the same debate going on.  But I am moving forward with applying to PA school.  PA school will be completed much faster than the grad entry level NP program.  I did think of becoming a NP because I wanted to be a CRNA, but they are going to be phased out in the near future.  I live in new england, and the NPs do not really do any survey, but PAs do, and I want to do surgery.  In New England, Pas are not being phased out at all, they are actually becoming more common and used more within hospitals, and many schools are being developed in this area in order to meet the current demand for Pas in this area.  So I think you should go for PA, if you do not get in do nursing.

[LT_Oneal_PAC]

I have the same debate going on. But I am moving forward with applying to PA school. PA school will be completed much faster than the grad entry level NP program. I did think of becoming a NP because I wanted to be a CRNA, but they are going to be phased out in the near future. I live in new england, and the NPs do not really do any survey, but PAs do, and I want to do surgery. In New England, Pas are not being phased out at all, they are actually becoming more common and used more within hospitals, and many schools are being developed in this area in order to meet the current demand for Pas in this area. So I think you should go for PA, if you do not get in do nursing.

 

You wanted to do NP, so you could be a CRNA, but you think CRNAs are being phased out? This is possibly the most ill informed statement I've seen on this forum.

[db_pavnp]

I feel what has finally forced my hand towards the nursing path is the lobby.

 

In any given state, the degree by which PA practice rights trail NP practice rights differs from zero to significant.  In the states they trail significantly, by the time PAs catch up (no guarantee they ever will), I cannot predict what additional job perks the nursing lobby will have acquired.  In the states where there is no difference, I can feel confident that the nursing lobby will acquire new practice rights as they arise.  I cannot say the same for PAs in that state.

 

Admittedly, I live and intend to live in a state ranked quite poorly for PA practice rights and I work in an inner city hospital and PCP network which appears to hire only NPs (I think this is for Medicare/aid billing, if anyone can speak on this).

 

I feel that with the RN in my back pocket, I can reliably wedge myself into any specialty, whereas a new grad PA is either applying from a position of zero experience or applying to positions they have explicit pre-PA experience in (likely one specialty, max).

 

I have more faith that nursing will adopt a clinical doctorate when it is appropriate for midlevels and that they will do so by embracing modern educational methods.

 

I am already over educated for my work in a small, clinical profession with a weak lobby.  The US is an oligarchy and for-profit healthcare is punishing on the little guy.  I am not going to repeat the mistake.

[CorpsmanUP]

"I have more faith that nursing will adopt a clinical doctorate when it is appropriate for midlevels and that they will do so by embracing modern educational methods."

 

That is the one part of your reply I completely disagree with.  Have you seen the curriculum for 90%+ of DNP programs?

 

 

On a different note, ONeal, do you ever consider going back to CRNA after working for a while and doing ICU/Periop care?

[Lexapro]

I went towards nursing because of my specialty (psych), interest in research/teaching/policy, and the desire to have my 'own' field. As I see NPs continue to gain power and progress, I know that I made the right decision. It's really unfortunate, but I know if I was a PA I would be driven nuts by the name issue and lack of authority/independence. I know that this is not always the case and in many situations PAs are quite independent, but it seems like NPs will likely just to continue to grow in their autonomy. Also, the fact that the lateral mobility seems to be going away for PAs reinforces my reasoning for choosing NP. That used to be a huge pro for the PA path in my mind, the idea that if I hate something or get bored I can just go work in another field. Now it seems like to specialize, many PAs will be doing one year residencies. Well as an NP I can go back to school for 1 year to become an FNP after my PMHNP, if I want, and be able to practice in many arenas... so it's a similar same amount of time.

 

It's up to you, but I would not get so caught up in the trees (ie: training model) that it blocks the forest (which field is moving in the right direction for me as a whole)? School is short (2-3 years), but your career is forever. Because your interest is EM/surgery, I would typically recommend PA, but since you're already concerned about autonomy, and interested in primary care, then yeah, if I were you I'd pause and consider which path will ultimately make you the happiest. There are clinically strong NP programs. Many med students teach themselves the first two years anyway, and there's nothing stopping you from studying from the same exact books. I recently seriously impressed a potential psychiatrist preceptor with my psychopharm knowledge, as I've been reading my Stahl book very closely... anyway, best of luck with whichever you decide!

[matchb0x]

I feel what has finally forced my hand towards the nursing path is the lobby.

 

In any given state, the degree by which PA practice rights trail NP practice rights differs from zero to significant.  In the states they trail significantly, by the time PAs catch up (no guarantee they ever will), I cannot predict what additional job perks the nursing lobby will have acquired.  In the states where there is no difference, I can feel confident that the nursing lobby will acquire new practice rights as they arise.  I cannot say the same for PAs in that state.

 

Admittedly, I live and intend to live in a state ranked quite poorly for PA practice rights and I work in an inner city hospital and PCP network which appears to hire only NPs (I think this is for Medicare/aid billing, if anyone can speak on this).

 

I feel that with the RN in my back pocket, I can reliably wedge myself into any specialty, whereas a new grad PA is either applying from a position of zero experience or applying to positions they have explicit pre-PA experience in (likely one specialty, max).

 

I have more faith that nursing will adopt a clinical doctorate when it is appropriate for midlevels and that they will do so by embracing modern educational methods.

 

I am already over educated for my work in a small, clinical profession with a weak lobby.  The US is an oligarchy and for-profit healthcare is punishing on the little guy.  I am not going to repeat the mistake.

The lobby is what did it for me too.  I highly value the PA model of education, but the the AAPA has been thoroughly embarrassed and shown to be slow to act and slow to evolve.  Say what you want about the nursing lobby, "militant" etc, you know that they will not only go to bat for the profession, they usually win, try saying that about the AAPA or AMA.... 

 

"I have more faith that nursing will adopt a clinical doctorate when it is appropriate for midlevels and that they will do so by embracing modern educational methods."

 

That is the one part of your reply I completely disagree with.  Have you seen the curriculum for 90%+ of DNP programs?

 

 

On a different note, ONeal, do you ever consider going back to CRNA after working for a while and doing ICU/Periop care?

 

I initially felt this way as well.  If you research the core reasons for the DNP degree escalation than you find more compelling and legitimate reasons for it.  RE: they are really pushing the ideal that you can bring the research that is being done to the bedside much sooner than the 10-15 yr lag time that has been shown to be the current average.  You might disagree with the premise BUT there is ever increasing evidence that they are in fact doing just that, decreasing time from research results to clinical application time and the PATIENT benefits.

 

 

 

Overall, good take on the subject OP.  I appreciate this board and its members so much.  This could easily turn into a shit show about "dumb ass nurses blah blah blah" instead it remains civil and professional and THAT is a testament to the fiber of the PA profession, if only the powers that be championed that attribute to the people and opinion makers of this country so that they didnt find themselves so woefully behind, if only.  

[Nonlegit]

Overall, good take on the subject OP.  I appreciate this board and its members so much.  This could easily turn into a shit show about "dumb ass nurses blah blah blah" instead it remains civil and professional and THAT is a testament to the fiber of the PA profession, if only the powers that be championed that attribute to the people and opinion makers of this country so that they didnt find themselves so woefully behind, if only.  

I'm glad you found the topic to be worthy. I felt a little nervous treading this ground again. Hopefully I articulated what I was thining. Through every thread I have ever read over all the years on SDN, allnurses, here, all over the place really, I have never exactly pinned this down. Good thing I have taken so long to get to this point haha

 

Again, thanks for the comments.

[honeybell2012]

I'm wondering about people's take on this combined PA/NP program at UC Davis (actually, I think it's technically an NP/PA program)..

 

https://www.ucdmc.ucdavis.edu/nursing/education/education_nppa_dualtrack_program.html

[LT_Oneal_PAC]

I'm wondering about people's take on this combined PA/NP program at UC Davis (actually, I think it's technically an NP/PA program)..

 

https://www.ucdmc.ucdavis.edu/nursing/education/education_nppa_dualtrack_program.html

If I could have done it, I would have. They seem to be real big on people who are going to practice there though.

[Joelseff]

I'm wondering about people's take on this combined PA/NP program at UC Davis (actually, I think it's technically an NP/PA program)..

 

https://www.ucdmc.ucdavis.edu/nursing/education/education_nppa_dualtrack_program.html

Its a joint program. If you are a RN/BSN you can take the NP track and get both a NP and PA degree. Stanford had a similar program but killed it in 2007 because of the demand for NPs to have a nursing masters which Stanford could not grant since they had no nursing school. Many of the faculty at Stanford are NP/PA but could not practice outside the state as a Np due to this reatriction. UCD upgraded their program a few years ago to comply so theyre the only NP/PA prog left...

 

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[matchb0x]

I'm wondering about people's take on this combined PA/NP program at UC Davis (actually, I think it's technically an NP/PA program)..

 

https://www.ucdmc.ucdavis.edu/nursing/education/education_nppa_dualtrack_program.html

I am interested in the program but CA programs of the health field variety are notoriously hard to get into for CA residents even let alone non residents (NE resident I am).  So Im unlikely to even try.  UC Davis is a beautiful campus/city though.  

[honeybell2012]

I was thinking of the problem more in a philosophical sense - the concept of obtaining joint NP and PA credentials giving the best of both worlds (on paper, anyway). Seems there are strong pros and cons, and there is probably a good reason (or ten) why this is such a unique program (above and beyond the fact that it would only be available to RNs transitioning into PA). Personally, I like the idea, but I don't see how it would work out in reality; even simple questions about how you would identify yourself professionally (are you an NP or a PA?) seem tricky. 

[EMEDPA]

I was thinking of the problem more in a philosophical sense - the concept of obtaining joint NP and PA credentials giving the best of both worlds (on paper, anyway). Seems there are strong pros and cons, and there is probably a good reason (or ten) why this is such a unique program (above and beyond the fact that it would only be available to RNs transitioning into PA). Personally, I like the idea, but I don't see how it would work out in reality; even simple questions about how you would identify yourself professionally (are you an NP or a PA?) seem tricky. 

you can use both certs but not in the same place so at facility A you are a PA and at facility B you are an NP.

[JohnnyM2]

you can use both certs but not in the same place so at facility A you are a PA and at facility B you are an NP.

Seems a bit schizophrenic to me. In describing their program they (UC Davis) say: "Students in the dual-track program must complete additional coursework and supervised clinical hours to meet both the nurse practitioner and physician assistant education requirements," essentially acknowledging that PA education is more advanced in both coursework and clinical requirements than NP. Would anyone want a PA/MD program? Well, maybe if you don't pass the USMLE steps or don't get matched, at least you can be a PA rather than a total failure. (Tongue in cheek). I would say, if you want to be an MD, go to med school; If you want to be a PA, go to PA school and be proud of what you are and what you have achieved. Otherwise, you can be an NP or DNP and pretend you have the same training and competence as a PA. Bottom line: If you aren't already an NP and want to be a PA, why bother with the lesser degree? Is it because in norcal the nursing lobby has fixed the job market so that all jobs are listed as NP?

 

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[Joelseff]

The davis program I believe was originally "ran by the nurses." A colleague once told me.

 

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[EMEDPA]

the advanatage of having both is that some states/organizations/hospitals prefer one over the other. having both means you are more likely to be able to find a job anywhere.

for instance, my group only accredits PAs to work in the ER and another group across town only uses NPs. a PA/np could work at one and moonlight at the other. some states have better laws for one over the other in terms of clinic ownership, etc. If I could buy a msn/fnp for 500 bucks I would just for the flexibility. I don't think it would add anything beyond that.

[Z PA-C]

The davis program I believe was originally "ran by the nurses." A colleague once told me.

 

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The UC Davis PA program is part of the Nursing School. Must be really confusing for patients seeing PA students from the program wearing a white coat that says School of Nursing.

[Dunedain]

I have the same debate going on.  But I am moving forward with applying to PA school.  PA school will be completed much faster than the grad entry level NP program.  I did think of becoming a NP because I wanted to be a CRNA, but they are going to be phased out in the near future.  I live in new england, and the NPs do not really do any survey, but PAs do, and I want to do surgery.  In New England, Pas are not being phased out at all, they are actually becoming more common and used more within hospitals, and many schools are being developed in this area in order to meet the current demand for Pas in this area.  So I think you should go for PA, if you do not get in do nursing.

 

 

CRNAs phased out by what? AAs? lol wut.....

[Nonlegit]

Going through both programs seems a little...silly to me. I'll be picking one or the other.

[KMD16]

PA vs NP ? Sounded like a football or soccer match. They will crush us. lol. Just a joke.

[JohnnyM2]

the advanatage of having both is that some states/organizations/hospitals prefer one over the other. having both means you are more likely to be able to find a job anywhere.

for instance, my group only accredits PAs to work in the ER and another group across town only uses NPs. a PA/np could work at one and moonlight at the other. some states have better laws for one over the other in terms of clinic ownership, etc. If I could buy a msn/fnp for 500 bucks I would just for the flexibility. I don't think it would add anything beyond that.

Yep! $500 is about right. Maybe PA schools could just offer the NP degree along with the PA degree for an extra 5 bills.

 

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[db_pavnp]

It has occurred to me that neither occupation will allow the other to trivially acquire cross certification as it could be viewed as making a negative statement about the quality of the profession you are joining.

[Nonlegit]

Another little dig on all this that I keep thinking of is the ACNP/FNP thing. There is a really awesome sounding job here for NPs on a trauma service. It honestly sounds like a fantastic job, but the requirement is an ACNP. I really wouldn't want to be relegated into ONLY trauma, forever. So back to school for a little bit longer for an FNP... and the ability to moonlight somewhere else...

[JohnnyM2]

the advanatage of having both is that some states/organizations/hospitals prefer one over the other. having both means you are more likely to be able to find a job anywhere.

for instance, my group only accredits PAs to work in the ER and another group across town only uses NPs. a PA/np could work at one and moonlight at the other. some states have better laws for one over the other in terms of clinic ownership, etc. If I could buy a msn/fnp for 500 bucks I would just for the flexibility. I don't think it would add anything beyond that.

Thanks for the insight. Does that mean graduates of the program need to apply to the state nursing board for an NP license and to the medical board for a PA license in order to represent themselves as either or both?

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