discogenic Posted January 20, 2011 Share Posted January 20, 2011 In researching the PA profession, I've seen reference to the "medical model" vs. the "nursing model" of training, usually in the context of PA vs. NP. I think I've got a grip on the medical model, but how does the nursing model differ? And how can professions with a significant difference in training end up in essentially interchangable employment positions? Link to comment Share on other sites More sharing options...
andersenpa Posted January 20, 2011 Share Posted January 20, 2011 http://www.physicianassistantforum.com/forums/showthread.php?t=21961&page=1&highlight=holistic Link to comment Share on other sites More sharing options...
discogenic Posted January 21, 2011 Author Share Posted January 21, 2011 http://www.physicianassistantforum.com/forums/showthread.php?t=21961&page=1&highlight=holistic Thanks for the link; that thread is interesting. But I wasn't getting the impression from other things I've read that the Nursing Model is supposedly a superior model but conversely an inferior model. Which led me to wonder how NPs end up, in many situations, filling the same positions as PAs if their training is inferior. So is the Nursing Model that different than the Medical Model? Link to comment Share on other sites More sharing options...
Hemegroup Posted January 21, 2011 Share Posted January 21, 2011 PA program accreditation is overseen in part by representatives from the American Academy of Family Physicians, the American College of Surgeons, the American Osteopathic Association, and other Physician groups, in addition to numerous PA representatives. Nursing accreditation is overseen by Nursing boards (NLNAC and CNE). There are also Doctors who help oversee the PANCE, although I'm not sure who oversees the NP licensing exam (I'm guessing Nursing groups). Saying the NP model is inferior is perhaps harsh wording to use, but there are differences. Pre-reqs are typically more stringent for PA programs. NPs do not typically rotate in Surgery during their clinical year, and spend many less hours on rotations. That being said, I've seen some NP books which are great, in regards to family practice. But the degree of groundwork relationship with the MD/DO model is lacking, at least in comparison with PA education. Hey, as long as the job gets done, I always say. There's so much crossover and overlap, we all find our way. My main concern (as is that of many others), is the DNP and the push to be called 'Doctor'. I believe NPs are able to practice independently in 14 states now, and I know many in the medical community who are concerned about that. I've seen a study or two which show no issues, in so far as dealing with issues of diabetes and other lower-tier health issues, but only time will tell. To strive so frantically to remove themselves from association with medical Doctors is something I find very disconcerting. Knowledge is power, and I don't understand why they don't want to stay strongly connected with that library. Link to comment Share on other sites More sharing options...
andersenpa Posted January 21, 2011 Share Posted January 21, 2011 Thanks for the link; that thread is interesting. But I wasn't getting the impression from other things I've read that the Nursing Model is supposedly a superior model but conversely an inferior model. Which led me to wonder how NPs end up, in many situations, filling the same positions as PAs if their training is inferior. So is the Nursing Model that different than the Medical Model? There ARE many nursing advocates who claim that nursing (and advanced nusring practice) IS superior to the traditional medical model. In terms of clinical content (hours, patient encounters) NP education is inferior to PA education on the whole. Individual experiences may differ. The reason you see those positions being filled by NPs may be due to who is doing the hiring. There are many posts here that relay the same story. If nursing is involved in administration or HR, they may have a bias towards exclusively hiring NPs. Not to say that NPs are universally less qualified than PAs....or that an NP may be more qualified than a PA for a certain job. For experienced PAs/NPs, the differences are les pronounced. for new grads, PAs may have the upper hand in certain areas (our generalist training vs their focused training). The nursing model is advertised as being superior. I have yet to see any difference in the NPs I have worked with. They practice MEDICINE (not nursing)...they assess, diagnose, treat just like the rest of us. NPs need to say they practice nursing for legislative and political reasons. Link to comment Share on other sites More sharing options...
Houstonian Posted January 22, 2011 Share Posted January 22, 2011 PA program accreditation is overseen in part by representatives from the American Academy of Family Physicians, the American College of Surgeons, the American Osteopathic Association, and other Physician groups, in addition to numerous PA representatives. Nursing accreditation is overseen by Nursing boards (NLNAC and CNE). There are also Doctors who help oversee the PANCE, although I'm not sure who oversees the NP licensing exam (I'm guessing Nursing groups). Saying the NP model is inferior is perhaps harsh wording to use, but there are differences. Pre-reqs are typically more stringent for PA programs. NPs do not typically rotate in Surgery during their clinical year, and spend many less hours on rotations. That being said, I've seen some NP books which are great, in regards to family practice. But the degree of groundwork relationship with the MD/DO model is lacking, at least in comparison with PA education. Hey, as long as the job gets done, I always say. There's so much crossover and overlap, we all find our way. My main concern (as is that of many others), is the DNP and the push to be called 'Doctor'. I believe NPs are able to practice independently in 14 states now, and I know many in the medical community who are concerned about that. I've seen a study or two which show no issues, in so far as dealing with issues of diabetes and other lower-tier health issues, but only time will tell. To strive so frantically to remove themselves from association with medical Doctors is something I find very disconcerting. Knowledge is power, and I don't understand why they don't want to stay strongly connected with that library. I would love to see statistics regarding nurse practitioners in those states that actually have independent practice. What percentage of NP's hang out their own shingle, so to speak? What percentage are employed by physician practices? What would happen in the state if physicians boycotted hiring or employing "independent NP's"? Would it result in MORE NP's going into totally independent practice? Is there truly a huge swell of demand for NP services from the general public? Or would it create so much pressure on the NP organization(s) in the state that they would back down from insisting on independent practice? And if the physician groups are so concerned about NP's having independent practice, then why don't they put their money where their mouth is, and quit hiring them? Link to comment Share on other sites More sharing options...
andersenpa Posted January 22, 2011 Share Posted January 22, 2011 The last numbers I saw have NPs in their own practices at about 5% or less. Less than half the states have true independent practice (I think 12 or so). There is too much money to be made for groups that hire nonphysicians to provide billable physician services. Money outweighs dogma. Link to comment Share on other sites More sharing options...
browndog Posted January 22, 2011 Share Posted January 22, 2011 NP education is inferior. I wish it were not so, but it is. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 22, 2011 Moderator Share Posted January 22, 2011 4-5% of both pa's and np's own their own practices. Andersen is right. while 20 states or so do not require np's to have physicians supervise them only 12-14 or so let them write scripts without a physician "collaborator" so this 12-14 # is a better representation of "true independence". David carpenter has previously posted a nice chart showing what np's can do in different states. don't know where it is at this point so if anyone has it, reposting would be appreciated and advance the dialogue here. Link to comment Share on other sites More sharing options...
coloradopa Posted January 22, 2011 Share Posted January 22, 2011 I would love to see statistics regarding nurse practitioners in those states that actually have independent practice. What percentage of NP's hang out their own shingle, so to speak? What percentage are employed by physician practices? What would happen in the state if physicians boycotted hiring or employing "independent NP's"? Would it result in MORE NP's going into totally independent practice? Is there truly a huge swell of demand for NP services from the general public? Or would it create so much pressure on the NP organization(s) in the state that they would back down from insisting on independent practice? And if the physician groups are so concerned about NP's having independent practice, then why don't they put their money where their mouth is, and quit hiring them? Two issues. The number of PAs and NPs that list themselves as self employed is the same at 2%. The number of PAs that have some ownership in the practice is higher at almost 5%. Unfortunately Advance didn't ask the question this way. Second issue is that if you look at the environment where NPs are working it resembles PAs with an increasing number of NPs going into medical specialty practice. The reason is that you can make more money working in a specialty than you can in primary care. The other part of this is that even if you work in a state where NPs can "practice independently", Medicare requires you to have a collaborating physician and most insurance companies will not credential you. There are tons of barriers to "independent practice" by NPs. Thats on top of all the problems that anyone has running a small business. Remember less than 50% of small businesses last out the first year (depending on the data you look at). Link to comment Share on other sites More sharing options...
Leeg Posted January 22, 2011 Share Posted January 22, 2011 I have recently started a job that uses both PA's and NP's. While interacting with the NP's, I have become aware that there is very little difference in their practice of medicine from my practice of medicine. Are there differences in the education? You betch! While in new employee orientation at this job, there was a NP student there who was just starting her clinical rotations. She had taken all of the NP didactic courses...ONLINE! and was already talking about getting her doctorate. I can't imagine PA's ever being able to take didactic online nor would I want to. Link to comment Share on other sites More sharing options...
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