Acebecker Posted May 20, 2014 Share Posted May 20, 2014 I grant you that. That's what I'm trying to get at... They technically have the same qualification - they are advanced practitioners. But the PA advanced practitioner has more clinical experience in training than the NP advanced practitioner. *AND* as an added bonus PA school requires a general surgery rotation and most of us have rotated through other surgical specialties as well. Now, lets change the scenario. You're the HR manager of a small practice. 5 docs, 3 advanced practitioners. You want to hire another advanced practitioner. You get a host of applicants and you narrow it down to two - an NP who was an office nurse for 3 years, a med-surge nurse for 2 years, and an ER nurse for a year. She attended a good school and had many rotations locally - did some time in the ER, several outpatient clinics, and even did an inpatient rotation. She has been out of school for 3 years and in a family practice office. The second is a PA who was an advanced EMT for 3 years, worked as an ER tech for 2 years, then moved on to become a CNA and ER Tech for a larger hospital doing a mix of inpatient and ER. She attended the local PA program and had the standard training. She has been out of school for 3 years working in a family practice office. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 20, 2014 Moderator Share Posted May 20, 2014 the np won't require "supervision", so is less "work" for the doc in the practice.....this is why nps are winning the battle for the outpt market... Link to comment Share on other sites More sharing options...
andersenpa Posted May 20, 2014 Author Share Posted May 20, 2014 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. It's not equal, and hypothetical situations are not real world- which is what is relevant to anyone who is hiring. There are many subjective factors that would come across in interview and experience. Be that as it may.... It's not the point of this thread. The question is- does a practice post an ad for ONLY PAs or ONLY NPs. The question is- is it good hiring practice to not even allow one type of credential to even make it to interview. I have no interest in a "PAs are better than NPs" battle because anyone who's been out there in the world (and worked with NPs) knows that's BS. I AM interested in killing the myth that "we are hiring for an ER position so post it for PA", or "this is a women's health clinic so we must hire only an NP" Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 20, 2014 Moderator Share Posted May 20, 2014 As PAs I think we have some incentive to maintain PA only depts, much like the NPs do. they do the same to us and they are winning in the eyes of the public and practice managers. surgery, ortho, and em are really the only PA strongholds left. when hospitals start posting peds, nicu, and psych positions as pa/np and hire based on competence, not just degree, I will be fine with opening up surgery, em, and ortho jobs to pa/np, but not until then...the problem that many folks don't recognize is it is nurses, not doctors that run hospitals....how often do you see dept director positions posted by hospitals that require that the applicant be an rn? I know of 1 ER dept director in the country who is a pa...and he is also a former er nurse.... Link to comment Share on other sites More sharing options...
Acebecker Posted May 20, 2014 Share Posted May 20, 2014 Not trying to derail your thread. Not trying to pick nits. The hypothetical was designed to get down to the nitty gritty - the basics of the question. I tried to address the variables in a meaningful way. Once you account for the variables, the answer will generally present itself. That's all I was trying to get at. Link to comment Share on other sites More sharing options...
Guest JMPA Posted May 21, 2014 Share Posted May 21, 2014 To the OP: PAs and nps do not and can not have equal clinical experience. One is a trained nurse and the other is a trained medical provider. They will never and can never have equal clinical experience. Please divert such inquiries to the section labeled " more insults to the working PA" Link to comment Share on other sites More sharing options...
andersenpa Posted May 21, 2014 Author Share Posted May 21, 2014 As PAs I think we have some incentive to maintain PA only depts, much like the NPs do. they do the same to us and they are winning in the eyes of the public and practice managers. surgery, ortho, and em are really the only PA strongholds left. when hospitals start posting peds, nicu, and psych positions as pa/np and hire based on competence, not just degree, I will be fine with opening up surgery, em, and ortho jobs to pa/np, but not until then...the problem that many folks don't recognize is it is nurses, not doctors that run hospitals....how often do you see dept director positions posted by hospitals that require that the applicant be an rn? I know of 1 ER dept director in the country who is a pa...and he is also a former er nurse.... Trust me E, I read you This is the situation for me and the reason I started this thread I am trying to get the non-physician hiring model standardized across the institution so that we don't have to get in that circular argument of "when the nursing areas start hiring PAs then the medicine areas will start hiring NPs" as you alluded to. Keep it consistent and "top-down" across the system so it's not department-specific. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 21, 2014 Moderator Share Posted May 21, 2014 To the OP: PAs and nps do not and can not have equal clinical experience. One is a trained nurse and the other is a trained medical provider. They will never and can never have equal clinical experience. Please divert such inquiries to the section labeled " more insults to the working PA" I think it depends largely on the field and the individual's background. I have worked with a few nps who were former ICU nurses, later working as critical care NPs. they were very sharp. also the director of our county hep c/hiv program is an np. I would put him up against any infectious dz doc regarding tx of hep c and HIV. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 21, 2014 Moderator Share Posted May 21, 2014 Trust me E, I read you This is the situation for me and the reason I started this thread I am trying to get the non-physician hiring model standardized across the institution so that we don't have to get in that circular argument of "when the nursing areas start hiring PAs then the medicine areas will start hiring NPs" as you alluded to. Keep it consistent and "top-down" across the system so it's not department-specific. fair enough. makes sense. Link to comment Share on other sites More sharing options...
andersenpa Posted May 21, 2014 Author Share Posted May 21, 2014 Not trying to derail your thread. Not trying to pick nits. The hypothetical was designed to get down to the nitty gritty - the basics of the question. I tried to address the variables in a meaningful way. Once you account for the variables, the answer will generally present itself. That's all I was trying to get at. No not a derail, I just know that the discussion can become an us vs them issue I firmly believe that this needs to be a free market for positions and free of bias. I don't want NPs biased against listing jobs for PAs because we're not "holistic enough" or that our medical model training doesn't meet some philosophical standard And because of that I can't rightly dismiss NPs as less qualified because of the content of their training- especially when experience, raw talent, technical skills, communication abilities, work ethic, honesty, and 1000 other factors that create a job applicant are what REALLY determine if someone is a good fit for a job. And not some arbitrary metric in their academics. Link to comment Share on other sites More sharing options...
PACdan Posted May 21, 2014 Share Posted May 21, 2014 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 I agree, if you have the time and inclination to screen all applicant pools at that level. If you have to take broad strokes in the beginning to whittle down shear volume, I stand by PAs. I think EMED hit the nail on the head with WHY we should support PA-dominant areas of medicine. It's a matter of rational self-interest and preservation. Sent from the Satellite of Love using Tapatalk Link to comment Share on other sites More sharing options...
andersenpa Posted May 21, 2014 Author Share Posted May 21, 2014 To the OP: PAs and nps do not and can not have equal clinical experience. One is a trained nurse and the other is a trained medical provider. They will never and can never have equal clinical experience. Please divert such inquiries to the section labeled " more insults to the working PA" I'm a working PA so that shoe doesn't fit. Your comment falls in the same bucket as when organized nursing says PAs (and docs) are inferior because they lack a holistic approach, or that they are patient focused and not disease/diagnosis/procedure focused, etc. Someone else may fall for it but I've been around long enough to know that 1. NPs practice the same medicine that we do, only under different license and boarding 2. Training gets you in the club but talent/drive/skill are what makes a clinician- NPs and PAs share that same opportunity You or I or anyone else is not the final arbiter of who has "worthy" experience. Each profession has had the chance to prove its mettle, and due to that and PAs and NPs are both legitimate players in the patient care workforce. You can be insulted that NPs provide an equal level of competent care as you, but being insulted doesn't make it any less so. Link to comment Share on other sites More sharing options...
andersenpa Posted May 21, 2014 Author Share Posted May 21, 2014 I agree, if you have the time and inclination to screen all applicant pools at that level. If you have to take broad strokes in the beginning to whittle down shear volume, I stand by PAs. I think EMED hit the nail on the head with WHY we should support PA-dominant areas of medicine. It's a matter of rational self-interest and preservation. Sent from the Satellite of Love using Tapatalk Well I'll put it this way- I live in a big and popular city (Seattle). No problem in attracting candidates in this part of the country. When we open a position it is not as if we are so deluged with applicants that we need to impose arbitrary filters (that "broad stroke" isn't necessary) There is MORE than enough resources to deal with all the applicants, PAs and NPs included. Taking a "PA ONLY" or "NP ONLY" is prejudicial. No problem with supporting you profession but not to the extent that it excludes the best candidate- which may be an NP. Ask yourself if you are serving your patient base or your profession first. Link to comment Share on other sites More sharing options...
PACdan Posted May 21, 2014 Share Posted May 21, 2014 Taking a "PA ONLY" or "NP ONLY" is prejudicial. It may be, but that's business. A fact of the world we live in; competition. Windows PCs and Apple PCs both do computing things, they serve the same general functions. Should the companies admit that you can buy either and do pretty much the same thing with both? Or do they promote their product and give reasons based in development, performance, or design that makes their product the better choice for you? If you say that NPs are interchangeable with you long enough, well maybe you'll be out of a job one day. *for passage below* If the PAs and NPs are properly credentialed and trained, then any selection from both or EITHER pool is due diligence. Yet there can be reasonable limits in hiring that don't put patients in any harm. Maybe you only searched for applicants for 30 days. Well, 90 days would have netted you more, MAYBE BETTER, applicants. Have you done a disservice to the patient base by this? I think you wanna say that NPs and PAs can do the same work, so both should be considered, to find the "best". Well, an MD or DO can also do that job, so include them too or you're possibly excluding the best candidate. Or, we can realize that our training differs, our licenses are under different regulatory bodies, and in fact; although performing similar functions, we are not identical. Failure to promote oursleves in the delivery of medicine and acquiescing will result in very capable PA providers being walked-on. I don't think that's an illegitimate stance. No problem with supporting you profession but not to the extent that it excludes the best candidate- which may be an NP. Ask yourself if you are serving your patient base or your profession first. Link to comment Share on other sites More sharing options...
andersenpa Posted May 21, 2014 Author Share Posted May 21, 2014 It may be, but that's business. A fact of the world we live in. Windows PCs and Apple PCs both do computing things, they serve the same general functions. Should the companies admit that you can buy either and do pretty much the same thing with both? Or do they promote their product and give reasons based in development, performance, or design that makes their product the better choice for you? They can say whatever they want- an educated consumer of computers or HCPs knows the service they get from those products is pretty similar. In fact consumer research (to continue with your analogy) shows that people make those purchase decisions on irrational bases- the VERY problem I have with PA over NP or vice versa. Just look at the popular culture opinion of Apple consumers- they are overpaying for a brand label, not substance. If you say that NPs are interchangeable with you long enough, well maybe you'll be out of a job one day. *for passage below* If the PAs and NPs are properly credentialed and trained, then any selection from both or EITHER pool is due diligence. Yet there can be reasonable limits in hiring that don't put patients in any harm. Maybe you only searched for applicants for 30 days. Well, 90 days would have netted you more, MAYBE BETTER, applicants. Have you done a disservice to the patient base by this? you're looking at it vertically not horizontally. A wide vs narrow search base is prone to less error than a short vs long term. I think you wanna say that NPs and PAs can do the same work, so both should be considered, to find the "best". Well, an MD or DO can also do that job, so include them too or you're possibly excluding the best candidate. First, fiscal is part of the picture in hiring and you are mixing two different pay scales.The starting point for recruiting ALWAYS starts with overhead flexibility and this includes talent. The premise of the OP is for a role which is PA/NP appropriate (eg not an interventional radiologist). Second not every practice had MD-PA/NP equivalency in role. So if the practice needs a PA/NP level of service (think inpatient surgery) then they don't hire a surgeon to do postop care and clinic. They hire a surgeon to operate and a PA/NP for the other stuff. Or, we can realize that our training differs, our licenses are under different regulatory bodies, and in fact; although performing similar functions, we are not identical. Failure to promote oursleves in the delivery of medicine and acquiescing will result in very capable PA providers being walked-on. I don't think that's an illegitimate stance. The model I am proposing where positions are recruited for based on talent/experience and not credential will net the best candidate more often than credentials based hiring. A free(er) market of hiring will promote competition and make each side, PA or NP, step up its training to fill the need. Link to comment Share on other sites More sharing options...
PACdan Posted May 21, 2014 Share Posted May 21, 2014 The model I am proposing where positions are recruited for based on talent/experience and not credential will net the best candidate more often than credentials based hiring. A free(er) market of hiring will promote competition and make each side, PA or NP, step up its training to fill the need. You make sound points. I'm just trying to "circle the wagons" for PAs a bit. Maybe it's what I experienced working in an NP dominated hospital system and how I feel about the -initial- training of PAs vs. that of NPs... I feel that PAs are the underdog by far. And even in a "best candidate will out" scenario, if you have a lot of political clout and broad legislative support (as nurses do) you have a leg up from the start, it's nearly intrinsic. Why should PAs give up their niches (if PAs have any say in the matter) before we have equal footing? Parity as practitioners. Anyway, I'm just a beginning PA-S. All I know is that this is a very polarizing topic, but I'm trying to stay abreast of what is to come. Thanks for your input. Sent from the Satellite of Love using Tapatalk Link to comment Share on other sites More sharing options...
matchb0x Posted May 21, 2014 Share Posted May 21, 2014 I'm a working PA so that shoe doesn't fit. Your comment falls in the same bucket as when organized nursing says PAs (and docs) are inferior because they lack a holistic approach, or that they are patient focused and not disease/diagnosis/procedure focused, etc. Someone else may fall for it but I've been around long enough to know that 1. NPs practice the same medicine that we do, only under different license and boarding 2. Training gets you in the club but talent/drive/skill are what makes a clinician- NPs and PAs share that same opportunity You or I or anyone else is not the final arbiter of who has "worthy" experience. Each profession has had the chance to prove its mettle, and due to that and PAs and NPs are both legitimate players in the patient care workforce. You can be insulted that NPs provide an equal level of competent care as you, but being insulted doesn't make it any less so. I'm a nobody around here but I really want to publicly thank you for this opinon. It is the level headed and professional approach to this topic that has continually impressed me with this site and the majority of it's members. This is a really stimulating conversation on a real topic that is worth considering out loud. A few comments lately have smelled all too much like SDN nonsense but this reestablishes the bar. Link to comment Share on other sites More sharing options...
andersenpa Posted May 21, 2014 Author Share Posted May 21, 2014 You make sound points. I'm just trying to "circle the wagons" for PAs a bit. Maybe it's what I experienced working in an NP dominated hospital system and how I feel about the -initial- training of PAs vs. that of NPs... I feel that PAs are the underdog by far. And even in a "best candidate will out" scenario, if you have a lot of political clout and broad legislative support (as nurses do) you have a leg up from the start, it's nearly intrinsic. Why should PAs give up their niches (if PAs have any say in the matter) before we have equal footing? Parity as practitioners. Anyway, I'm just a beginning PA-S. All I know is that this is a very polarizing topic, but I'm trying to stay abreast of what is to come. Thanks for your input. Sent from the Satellite of Love using Tapatalk I'm all for parity, on each side of the issue PAs have their underdog areas (eg PC) and strongholds (surgery, EM) The summary is that we get contempt from nursing and resentment from (some) of the state med societies/specialty groups. Hard to fight two battles at once. And, as you said, with little lobbying power. Link to comment Share on other sites More sharing options...
Guest JMPA Posted May 22, 2014 Share Posted May 22, 2014 I'm a working PA so that shoe doesn't fit. Your comment falls in the same bucket as when organized nursing says PAs (and docs) are inferior because they lack a holistic approach, or that they are patient focused and not disease/diagnosis/procedure focused, etc. Someone else may fall for it but I've been around long enough to know that 1. NPs practice the same medicine that we do, only under different license and boarding 2. Training gets you in the club but talent/drive/skill are what makes a clinician- NPs and PAs share that same opportunity You or I or anyone else is not the final arbiter of who has "worthy" experience. Each profession has had the chance to prove its mettle, and due to that and PAs and NPs are both legitimate players in the patient care workforce. You can be insulted that NPs provide an equal level of competent care as you, but being insulted doesn't make it any less so. Don't drink the coolaide. nps do NOT practice medicine. nps are NOT licensed to practice medicine. nps do NOT provide an equal level of competent care. I'm insulted because of your ignorance of the PA profession and your attempt to belittle my profession with such careless disregard for the earned title. I do not have any issues with a nurse practicing nursing. I do have issue with nursing claiming to practice medicine in equivalence with Physician Assistants or MDs at that. If you are so quick to support such notions then i would assume that you are pro "assistant physician" in missouri. You have shown your colors. PS. the PA profession should never allow nursing nor its own associations to erode our lateralization capabilities. It is on of the greatest attributes to being a PA. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted May 22, 2014 Share Posted May 22, 2014 Whether it is liked or not, a NP in a free-standing facility making diagnoses and prescribing therapy IS practicing medicine, regardless of how it is stated. There is no other way around it. Link to comment Share on other sites More sharing options...
Guest JMPA Posted May 22, 2014 Share Posted May 22, 2014 ^^^^ no its not. it is a nurse practicing nursing, you should note that it is illegal to practice medicine without a medical license. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted May 22, 2014 Share Posted May 22, 2014 I think I'm well aware of that fact, but thank you anyway. It isn't worth getting hung up on semantics. This profession, IMO, missed it's chance to carve it's niche by the 90's and I don't think that there's any going back. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted May 22, 2014 Moderator Share Posted May 22, 2014 Don't drink the coolaide. nps do NOT practice medicine. nps are NOT licensed to practice medicine. nps do NOT provide an equal level of competent care. I'm insulted because of your ignorance of the PA profession and your attempt to belittle my profession with such careless disregard for the earned title. I do not have any issues with a nurse practicing nursing. I do have issue with nursing claiming to practice medicine in equivalence with Physician Assistants or MDs at that. If you are so quick to support such notions then i would assume that you are pro "assistant physician" in missouri. You have shown your colors. PS. the PA profession should never allow nursing nor its own associations to erode our lateralization capabilities. It is on of the greatest attributes to being a PA. His "colors"? I assure you that you are the only one on this forum who is confused about what his true "colors" are. He's one of the founding members of PAFT. He's a moderator on this forum, for free, that allows you and I to even have this conversation. Maybe you should check your caustic attitude a bit. Link to comment Share on other sites More sharing options...
rcdavis Posted May 22, 2014 Share Posted May 22, 2014 Just a quick biased opinion. NP And PA are not equals, neither in practice nor education. But the line in the sand, for me as a hire-fire guy, is the political philosophy the NP organization has, which is, succinctly, to put the PAs out of business, and eventually become the nation's sole advance practice providers.. CRNA and Nurse midwives exceptions. NPs are NOT our friends.. There is NO parity between the two professions. Do you see any movement or efforts on the NPs part to include PAs in their practice models? Do you see any NP organization promoting the PAs as fellow advance practice clinicians??? North Carolina PAs were on the receiving end of nurse practitioner politics in 1994... At that time the state legislature authorized the PAs narcotic privileges.. Next year, the NPS came to us, asked us to endorse them in an effort to be included into that legislation.. Which we did ... The next year ( having achieved parity with the PAs in prescriptive practice), the NPs and nursing organization instituted the " we are nurses, practicing nursing, we do not heed supervisory agreements, we will accept only a collaborative agreement", in recognizing the differences between those "dependent practitioners"( read: PAs ) and those not dependent by virtual of an independent license( NP). We laid down with dogs and were surprised when we got fleas. Assisting NPs into " our" realm is akin to selling a hangman the rope he will use to tie around our neck. I can think of no time when the NP organization has helped us... Or even given us cursory lip service. While I have influence in the region ( and I admit that I do have a little), no NP WILL BE HIRED IN THE ED. and my patients will do just fine, thank you. I will support your efforts. Mike, when I do not see them as a suicide pact. Rc Link to comment Share on other sites More sharing options...
rcdavis Posted May 22, 2014 Share Posted May 22, 2014 Whether it is liked or not, a NP in a free-standing facility making diagnoses and prescribing therapy IS practicing medicine, regardless of how it is stated. There is no other way around it. Whether it is liked or not, a NP in a free-standing facility making diagnoses and prescribing therapy IS practicing medicine, regardless of how it is stated. There is no other way around it. You have a point. My objection is that they do this under the penumbra and legislation of being A nurse, practicing nursing.. Which they have parlayed as a profession which can also diagnose and prescribe. They have end runned the medical establishment and legislated themselves into that which they should not be: independent practitioners. But, I do concede you have been successful in that endeavor. Well played sir, well played. So we come full circle.. A nurse can and does practice medicine while hiding behind a nursing license, and enjoying the greatest privilege one can have: treating patients. We simply disagree on limitations... I think that to practice medicine you should have a physician somewhere in the equation.. And in a lot of states, the nursing profession doesn't.. Therein lies the dimension of distinction... And why I do not consider us equal. We can gently agree to disagree on this, I am sure. Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.