Are PAs and NPs "interchangeable"?

[CorpsmanUP]

EM would be one field where the preference would understandably be for a PA. You can have a PA handle all comers or an Acute Care NP that is limited in scope to either 18+ or peds. There has been recent pushback in using FNPs in EM as their training is specifically for primary non emergent care.

[coloradopa]

Any literature on this?

http://nursingworld.org/DocumentVault/APRN-Resource-Section/ConsensusModelforAPRNRegulation.pdf

 

You can look at the consensus statement above. Its very densely written and pretty ambiguous. Fundamentally NPs are trained in primary care or acute care roles and age groups. You can expand out of the role except by additional education and certification. 

 

Texas probably has the most consistent implementation of the consensus model. 

http://www.bon.state.tx.us/faq_practice_aprn.asp#t5

[coloradopa]

My question is specifically related to the field of practice; although it is further upstream.

As a recruiter, if you need to fill a surgical or EM position, would you recruit ONLY to PAs?

Would you post a job listing as "PA or NP"?

 

Are there practices where a PA or NP should not even be considered based on credential alone?

 

Comes down to prejudice and bias.

We use ACNPs and PAs interchangeably in the ICU. We no longer hire FNPs and the FNPs that we do have are required to get their ACNP by the end of this year. So for example I would not hire an FNP for critical care based on the credential alone. I would not hire an ACNP for a pediatric surgery (or ER) position. From what I here from the nursing side most of the inpatient nursing positions are going ACNP only. There is still a lot of discussion about what to do about positions with clinic and inpatient duties. 

[Acebecker]

Why would a PA and NP, each with 2 yrs surgical experience, be unequal in performance/competency?

Note what EMED said.  That's precisely why - even with 2 years of experience, it's unlikely that these two providers would be 100% equivalent - they will be interchangeable as far as the basics of the work, but the PA would be better.  Unfortunately, there are no studies to reflect this. 

[Acebecker]

there are far more em pas than em nps and pas are the "midlevel provider of choice" according to acep.

I'm sure there are jobs out there for nps working solo in rural facilities seeing all pts of all acuities and doing all procedures. I have just never seen one. the vast majority of these jobs are offered to pas, most who were former medics.

 

I fully recognize that PAs are a more popular choice for EM positions.  There are relatively few acute care NPs out there.  The medicine is the same, though, and NPs certainly have the ability to master the content.  I grant you, though, that mastery of full scope EM is not so much of a "time in the field" as it is dependent on good preceptors and being taught in a controlled setting the skills needed to practice EM. 

[Joelseff]

I guess it depends.

 

I've worked with 4 different NPs (all FNPs)  in our practice (a mixed inpatient and outpatient practice) over the past few years and have found the following:

 

1. They're good people who care about our patients

2. Their experience varies wildly, generally depending more on what they did as nurses than what they learned in their relatively-limited NP clinicals. The NPs who have come to our place did 400 hours in their primary area and another 200 in optional rotations. 

3. Patients accept them (they know what an NP is, as opposed to what a PA is, in general)

4. They seem to have a bit more of an issue adjusting to things outside of their prior clinical experience than the PAs I have known.

5. If you want a good NP, find one who either trained in your specialty or worked in it extensively as a nurse.

6. If you want a good PA, find one with a good work ethic. The generalist training seems to be a big advantage.

 

That said, I like NPs and have enjoyed training and working with them. They do good work.

 

I voted no. My reasons are closely in line with UGoLong especially 4. I work in a very niche subspecialty (HIV) of Primary Care.  I have met several PAs and NPs in this specialty. It is VERY easy to simply fall back on algorithm to treat HIV and I know of MDs, PAs and NPs who do this but in conversation with these colleagues, it has been my totally unscientific and perhaps somewhat biased opinion, that the NPs don't totally get it.  

 

I was at a dinner lecture 2 weeks ago on HIV/HCV coinfection and the topic of benefits of selecting ARVs with good penetration of the BBB for HIV and HCV tx came up. There present were several MDs a few PAs including me, and a few NPs.  The NPs have been in this longer than I was and they were simply baffled about BBB penetration and why that would be therapeutic for HIV and HCV related CNS effects...I nearly fell out of my seat and looked at my SP in astonishment. We looked at each other and said almost simultaneously "they're NPs..." One even asked "what's the blood brain barrier got to do with it?" I just kept eating my 40 dollar free ribeye dinner and drank my complimentary wine while the speaker had to give a review of A&P of the brain.

[Guest JMPA]

are underwear and socks interchangeable?

[GetMeOuttaThisMess]

Guess it depends on your style of "underwear" ;-)

[ventana]

I'm not so sure that the initial edge is lost, except for the actual field of practice. After 2 years (or whatever), one would expect an NP and a PA who have been practicing in the same area to be pretty much equivalent. The PA who has to keep taking the PANRE has to keep up some of his or her generalist skills and that might translate into being more readily able to transition to a new area. Just a thought.

 

 

If experience overrides education, then 2 to 3 years out of school a PA should be equal to an M.D.......  we know this is not the case, so why would an inferior NP education equate  a PA education after two years?

[EMEDPA]

If experience overrides education, then 2 to 3 years out of school a PA should be equal to an M.D.......  we know this is not the case, so why would an inferior NP education equate  a PA education after two years?

also, the quality of practice/experience matters. 5 years of fast track does not equal boarded em doc, but 10-15 years working main ED seeing all comers, like say RC Davis does? I'm guessing on a practical level he is better than any new em doc coming out of residency. sure, the doc will know more esoteric stuff that almost never applies to practice, but when the rubber meets the road, a pa who has been doing full scope work side by side with a doc without restrictions on their practice for over a decade(in a non-surgical specialty) likely is indistinguishable from a doc in terms of outcomes, patient satisfaction, ability to do procedures, etc

Along the way, the PA learns all they need to learn to master the job and the doc forgets the stuff they never use and the practical product meets in the middle on very similar grounds.

they say an expert is someone with 10,000 hours doing the same thing. also, an expert is someone who has already made all the errors possible in a given field( and learned not to make them again).

[KMD16]

^ nice one E!

[andersenpa]

are underwear and socks interchangeable?

They both can stink but for different reasons

[andersenpa]

If experience overrides education, then 2 to 3 years out of school a PA should be equal to an M.D.......  we know this is not the case, so why would an inferior NP education equate  a PA education after two years?

This puts too much weight on the training and not enough on the individual

Can't make a generalization

There are EASILY MANY cases where at 2 yrs the PA and NP are equivalent

Furthermore I wouldn't put the PA-MD on the same as NP-PA

The former has far too much difference in clinical training than the latter whe you consider residency

[Nonlegit]

And my thread died out with only a few posts of advice! I should have made it more controversial. Haha.

[Guest JMPA]

i find it insulting to be degraded to the level of a nurse. I never practiced nursing nor studied it. no its never acceptable to devalue a profession with degrading association with a different profession. no im not interchangeable with a nurse. no length of experience cannot be compared. no practice does not make perfect, perfect practice makes perfect. go tell a police officer that he is interchangeable with a meter maid and see what response you get

[PACdan]

This puts too much weight on the training and not enough on the individual

Can't make a generalization

There are EASILY MANY cases where at 2 yrs the PA and NP are equivalent

Furthermore I wouldn't put the PA-MD on the same as NP-PA

The former has far too much difference in clinical training than the latter whe you consider residency

Yet that same logic of "onus on the individual" can be extrapolated to PAs and MDs. You can't use that metric, it's highly subjective. If a department wants to objectively evaluate which class of provider to utilize, then only educational and training metrics suffice. In that case; MD > PA > NP

 

You can make arguments for years of experience and the qualities of the individual on a case by case basis, but not on a macro scale.

 

 

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[db_pavnp]

If a department wants to objectively evaluate which class of provider to utilize, then only educational and training metrics suffice.

 

This is either simply untrue or only pertinent for an extremely narrow definition of "objectively evaluate".

[PACdan]

This is either simply untrue or only pertinent for an extremely narrow definition of "objectively evaluate".

As a matter of broad hiring policy for a department, how else would you decide which candidates to interview? Other than based on the credentials of their formalized education and training?

 

 

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[db_pavnp]

C'mon, son, use your imagination.

[PACdan]

C'mon, son, use your imagination.

Eh, that's not a productive answer, sport.

 

 

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[db_pavnp]

You're not going to get a productive answer.  No one is going to blow a novel explaining to you how people get jobs (aka - how the real world works).  It'll just have to be a mystery to you.

[PACdan]

You're missing the point of this post with your anger. It's about a filter for hiring; should a group hiring a provider consider PAs, NPs, or both (with same exp. but not education) and why. The only factors to look at outside of this hypothetical exact "same experience" is education and training for objectivity. Of which the NP educations have much less than the PA education. That's just a fact.

 

Let a little grace & civility not be a mystery to you, my friend.

 

 

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[andersenpa]

Yet that same logic of "onus on the individual" can be extrapolated to PAs and MDs. You can't use that metric, it's highly subjective. If a department wants to objectively evaluate which class of provider to utilize, then only educational and training metrics suffice. In that case; MD > PA > NP

 

You can make arguments for years of experience and the qualities of the individual on a case by case basis, but not on a macro scale.

 

 

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This is what I'm referring to

I don't think you should make macro decisions about hiring

Recruiting for a position requires considering all the assets a provider brings to the table

If you filter by "objective" criteria alone you diminish the talent pool and will fail in attaining the best candidate for the position

[Acebecker]

Andersenpa -

 

Hypothetical situation:  You're an ER director looking to hire an advanced practitioner.  You have a host of applicants.  You narrow it down to two - a PA who was a military medic and civilian medic for 10 years before PA school.  During PA school he rotated through a main ER and did a general surgery rotation (these are required rotations).  He has 5 years of experience main side ER in a relatively busy PA-MD run ER.  The second is an NP who was an ER nurse for 10 years prior to going to get his NP certification.  He attended a relatively good school and had rotations in the ER (no requirement to do surgery rotations).  He has been working side-by-side with a MD in a relatively busy ER for 5 years. 

 

Both interview well and will be a good fit.

 

Who do you pick for your ER? 

 

Everything is equal in this situation except 1. prior experience and 2. education. 

[EMEDPA]

ace- your applicants above are not equal. the pa applicant has >1500 MORE hours of clinical training.....pa school has 2000 hrs of clinicals in specialties the np is not exposed to. typical np program has 500-800 hrs total, mostly in 1 specialty.

add a year on to the nps experience and have them work in multiple depts since graduation and they would be more closely matched.