The Doctor of Nurse Practitioner Program Will ROCK the Physician Assistant Profession

[FSUnoles]

The number of programs and total national seats is growing.

 

this. talk to any dean at a masters level program. With the increase of people going back to further education (thank you economy) i do not see a decrease in class size. Getting your bachelors is like a high school degree this day and age. Last cycle at my program they saw 1300 applications (for 75 spots). I imagine this cycle it just got worse. The only time i think you woud see a lowering of class size would be to improve education. (rotation sites etc) I know my program plans to start taking in less students just to increase the faculty/student ratio and lessen the stress on rotation sites

[physasst]

Not at the rate NPs are...In my class the BMS had over 60 students, the Masters about 25. Now that it's all MMS the count is down to 40.

 

This is factually inaccurate. NP graduation rates have remained stagnant at just over 7,000 graduates annually since the late 90's. PA's on the other hand have grown substantially to 6500 (roughly) graduates annually over the same time period.

 

PA education is seeing far greater growth than NP education. At least in the data.

[physasst]

AndersenPA—

 

I think you’re right: surgical PAs are largely immune to the effects of the DNP. From what I’ve seen, PAs rule the roost in surgical assisting. In fact, if anyone has stats comparing the number of surgical PAs v. NPs v. RNFAs, that would be insightful.

 

Regarding your comments about “shrinkage”—or, to much more accurately reflect my thoughts, the supposition that many PAs could leave the profession to become MDs through bridge programs—you’re looking at the current landscape, rather than possible future trends. I’m extrapolating out a decade or two, when PAs and NPs are practicing in far greater numbers than today and the growth rates have likely slowed; when the DNP focus could possibly produce large number of NPs who are publicly perceived to be nearly on par with physicians; when health care budgets are potentially under severe financial constraints due to demographics and other trends; and when corporate policy and public policy each increasingly serve to redirect the hiring of providers.

 

Don’t get me wrong: I definitely feel the PA profession has an incredibly positive future. I’m just surprised that a contingent of the nursing leadership can not only alter the face of the NP profession, but also, potentially, greatly impact the PA profession—as well as lead to significant changes in future health care costs. For the sake of physician assistants, I’m hoping some of the PA profession’s capable academic researchers will investigate, analyze, and debate the future impact of the DNP program on PAs and on society. This will become urgent should the DNP really take off.

 

We are. We already had a whole summit about this not too long ago. The problem is, the effects of the DNP, as I told the NP leadership are unknown. There are some specific concerns regarding workforce and utilization.

 

NP's have been an incredible asset in low income women's health clinics, CHC's, inner city HIV clinics, etc. These are typically lower paying jobs. The creation of the DNP could affect workforce flow to these areas negatively..

 

The other thing that you have to understand, is that the DNP is NOT mandated. It was RECOMMENDED that all programs be DNP by 2015. There was no mandate.

[sillycibin]

I was looking at DNP programs for comparison to PA programs and they are all 9 semesters. I think most PA programs are creeping out now to 7 semesters. I certainly wouldn't have minded doing 2 more semesters and graduating with a clinical doctorate and not have to worry about this degree creep, job competition, and scope of practice differences. And as it has been noticed, the DNP extension of the NP doesn't really add much. Our PA degrees are already comparable, just add a few more classes and call it a doctorate and be done with it.

 

I understand the arguments for keeping the PA profession at the masters level. I agree that logically it should stay there, however, the DNP movement will eventually force us there. The NPs are making a power/turf grab. We can't as a profession put our heads in the sand. We already don't like being called "Physician Assistants" anymore and want to be called "Physician Associates" to better reflect our roles. Just wait until the NPs are all "Doctors" and have "Doctor of Nursing Practice" on their coats.

[dm123]

I tend to disagree about NPs rocking PAs out of the boat, at least in my state of NC. There are guidelines in place for calling yourself a doctor in patient contact situations. Any midlevel practitioner cannot introduce themselves to a patient as a doctor unless the practitioner complies with written laws as spelled out by the State Board of Medical Examiners (see copy/paste of Section 90-1-1). I have always had "Physician Assistant" as well as PA-C on my name tag. The alphabet soap of acronyms for degrees means nothing to most patients. I can't fathom most of them myself. If someone introduces themselves as Doctor Smith, and they are a PhD, the lawyers, and the State Board will jerk their chain.

 

As I mentioned, my wife is a CRNA (nurse anesthesis). We debate the autonomy issue from time to time. She can work outside of a hospital setting but the surgeon who is performing the procedure supplies the drugs, in essence being the supervising physician.

 

Unless things have changed since I was in a hospital setting, nurse midwives, unless they are under a supervising physician, do not get hospital privileges. The MDs determine who gets these privileges and a stand alone midwife doesn't hve a chance. They can, if they can afford or obtain malpractice insurance deliver babies outside of a hospital setting but if something goes amiss, they have to call an ambulance to take the mom to the ER. The cannot follow the them to the ER themselves in any practical sense. State laws may vary on this but I would think it would be pretty much universal unless the location is in the sticks.

(5) The practice of medicine or surgery. – The practice of medicine or surgery, for purposes of this Article, includes any of the following acts:

a. Advertising, holding out to the public, or representing in any manner that the individual is authorized to practice medicine in this State.

b. Offering or undertaking to prescribe, order, give, or administer any drug or medicine for the use of any other individual.

c. Offering or undertaking to prevent or diagnose, correct, prescribe for, administer to, or treat in any manner or by any means, methods, or devices any disease, illness, pain, wound, fracture, infirmity, defect, or abnormal physical or mental condition of any individual, including the management of pregnancy or parturition.

d. Offering or undertaking to perform any surgical operation on any individual.

e. Using the designation "Doctor," "Doctor of Medicine," "Doctor of Osteopathy," "Doctor of Osteopathic Medicine," "Physician," "Surgeon," "Physician and Surgeon," "Dr.," "M.D.," "D.O.," or any combination thereof in the conduct of any occupation or profession pertaining to the prevention, diagnosis, or treatment of human disease or condition, unless the designation additionally contains the description of or reference to another branch of the healing arts for which the individual holds a valid license in this State or the use of the designation "Doctor" or "Physician" is otherwise specifically permitted by law.

f. The performance of any act, within or without this State, described in this subdivision by use of any electronic or other means, including the Internet or telephone. (2007‑346, s. 1; 2009‑558, s. 1.1.)

 

I still haven't quite got the hang of posting, so please excuse grammar.

[marilynpac]

I tend to disagree about NPs rocking PAs out of the boat, at least in my state of NC. There are guidelines in place for calling yourself a doctor in patient contact situations. Any midlevel practitioner cannot introduce themselves to a patient as a doctor unless the practitioner complies with written laws as spelled out by the State Board of Medical Examiners (see copy/paste of Section 90-1-1). I have always had "Physician Assistant" as well as PA-C on my name tag. The alphabet soap of acronyms for degrees means nothing to most patients. I can't fathom most of them myself. If someone introduces themselves as Doctor Smith, and they are a PhD, the lawyers, and the State Board will jerk their chain.

 

As I mentioned, my wife is a CRNA (nurse anesthesis). We debate the autonomy issue from time to time. She can work outside of a hospital setting but the surgeon who is performing the procedure supplies the drugs, in essence being the supervising physician.

 

Unless things have changed since I was in a hospital setting, nurse midwives, unless they are under a supervising physician, do not get hospital privileges. The MDs determine who gets these privileges and a stand alone midwife doesn't hve a chance. They can, if they can afford or obtain malpractice insurance deliver babies outside of a hospital setting but if something goes amiss, they have to call an ambulance to take the mom to the ER. The cannot follow the them to the ER themselves in any practical sense. State laws may vary on this but I would think it would be pretty much universal unless the location is in the sticks.

(5) The practice of medicine or surgery. – The practice of medicine or surgery, for purposes of this Article, includes any of the following acts:

a. Advertising, holding out to the public, or representing in any manner that the individual is authorized to practice medicine in this State.

b. Offering or undertaking to prescribe, order, give, or administer any drug or medicine for the use of any other individual.

c. Offering or undertaking to prevent or diagnose, correct, prescribe for, administer to, or treat in any manner or by any means, methods, or devices any disease, illness, pain, wound, fracture, infirmity, defect, or abnormal physical or mental condition of any individual, including the management of pregnancy or parturition.

d. Offering or undertaking to perform any surgical operation on any individual.

e. Using the designation "Doctor," "Doctor of Medicine," "Doctor of Osteopathy," "Doctor of Osteopathic Medicine," "Physician," "Surgeon," "Physician and Surgeon," "Dr.," "M.D.," "D.O.," or any combination thereof in the conduct of any occupation or profession pertaining to the prevention, diagnosis, or treatment of human disease or condition, unless the designation additionally contains the description of or reference to another branch of the healing arts for which the individual holds a valid license in this State or the use of the designation "Doctor" or "Physician" is otherwise specifically permitted by law.

f. The performance of any act, within or without this State, described in this subdivision by use of any electronic or other means, including the Internet or telephone. (2007‑346, s. 1; 2009‑558, s. 1.1.)

 

I still haven't quite got the hang of posting, so please excuse grammar.

Maybe not in NC but there's more to the US than NC.....In IL the NPs are growing rapidly...PA not really. Same can be said for KY and TN...

[dm123]

Can NPs hang up their on shingle and prescribe autonomously in IL? If, not what is the difference in a practice situation?

 

I'm not denying growth of the NP profession. The next 10 or so years will have plenty of need for both groups. The silver tsunami of aging baby boomers is upon us. Population growth is contributing to need. Cost cutting will be significant in the future from third party payers. It is the docs, especially the specialist who will take the hit.

 

I was at a recent CME conference where a MD from DC spoke. He reported the undercurrent discussion of the future of medicine in the USA being discussed in Washington will be drastically different form today. There will be less stand alone doctors offices. Hospitals are already buying up practices making the Physician, NPs and PAs part of, and somewhat employed by the hospital chain. This speaker even went so far as to say surgical re-embursement would be made to the hospital which would pay the surgeon. If a surgeon cranked out the cases efficiently, he/she would be financially rewarded. If not----. He also said, for instance there would be only on brand of knee or hip available and the ortho guys would have to use them not their chosen favorite. No more individualized instruments either. Same for CPAP devices for sleep apnea and many other devices.

 

I have no one-up-manship issues with NPs. The medical board, not the various other boards, have the power to determine who does what. PAs and NPs would be better off joining forces rather than squabbling with who has to clean out the bed pan. After 30 years in this business, I've come to hate all forms of my dogs better than your dog. It is a detriment to patient care. If a BP needs taking, don't sit on your butt while the NA is in the weeds, help out. It is supposed to be a team effort.

[Firemedic13]

Maybe not in NC but there's more to the US than NC.....In IL the NPs are growing rapidly...PA not really. Same can be said for KY and TN...

 

+1 to the bolded

 

In NM the NPs are growing rapidly, though not as rapidly as the PAs. Unlike the PAs, however, they ALL can independently prescribe everything (within their focus). Pretty much the only thing they can't do is surgery. They can all hang their own shingles. The NPs can prescribe narcs and have no physician oversight requirements. CRNAs do not need an anesthesiologist, and the only thing they need surgeons for is doing the actual surgery. Nurse Midwives can get hospital privileges, though I understand some hospitals won't give it to them. But I know of two that do, and the only thing they need an MD for on an even vaguely regular basis is C-sections.

 

Now, NM is a pretty progressive state... but it is just a matter of time until cost factors force the rest of the country to go this way.

 

On the other hand: Most NPs, CRNAs, etc in the state work for physicians. Furthermore, I don't really see a downward spiral or anything like that for PAs- except in family practice where I predict the NPs will own y'all (however, this is entirely my opinion based on anecdotal evidence). PAs are, and will continue to, own specialty practice. Their education is built to make them perfect to help a busy specialist. And the specialists- who are already busy- are going to see their practices EXPLODE in 10-15 years. I ain't worried at all about the fact that many of my friends and a member of my family are heading to PA school. I see, in fact, a much more secure future for them than what I potentially see for me after 3 years and a JD.

 

On an only vaguely related note: degree creep happens everywhere. It has only been about 30 or 40 years since JD became the big thing, replacing the LLB. And, if it helps, it is still a joke in many ways. We all know that this is at best only a master's level program, and more realistically a baccalaureate one. But the prestige made them change it to JD, and now we have a-holes who want to be called "Doctor" because they did 3 years learning how to argue. Whatever. No one takes them seriously.

[marilynpac]

Can NPs hang up their on shingle and prescribe autonomously in IL? If, not what is the difference in a practice situation?

 

I'm not denying growth of the NP profession. The next 10 or so years will have plenty of need for both groups. The silver tsunami of aging baby boomers is upon us. Population growth is contributing to need. Cost cutting will be significant in the future from third party payers. It is the docs, especially the specialist who will take the hit.

 

I was at a recent CME conference where a MD from DC spoke. He reported the undercurrent discussion of the future of medicine in the USA being discussed in Washington will be drastically different form today. There will be less stand alone doctors offices. Hospitals are already buying up practices making the Physician, NPs and PAs part of, and somewhat employed by the hospital chain. This speaker even went so far as to say surgical re-embursement would be made to the hospital which would pay the surgeon. If a surgeon cranked out the cases efficiently, he/she would be financially rewarded. If not----. He also said, for instance there would be only on brand of knee or hip available and the ortho guys would have to use them not their chosen favorite. No more individualized instruments either. Same for CPAP devices for sleep apnea and many other devices.

 

I have no one-up-manship issues with NPs. The medical board, not the various other boards, have the power to determine who does what. PAs and NPs would be better off joining forces rather than squabbling with who has to clean out the bed pan. After 30 years in this business, I've come to hate all forms of my dogs better than your dog. It is a detriment to patient care. If a BP needs taking, don't sit on your butt while the NA is in the weeds, help out. It is supposed to be a team effort.

It has to do with a doc on site...they don't need one and the insurance co. Our IAPA is working very hard with the insurance cos but in the meantime NPs are getting the jobs head and shoulders over us...

[marilynpac]

Yes,in IL they do hang our their own shingle...PAs do not.

[marilynpac]

+1 to the bolded

 

In NM the NPs are growing rapidly, though not as rapidly as the PAs. Unlike the PAs, however, they ALL can independently prescribe everything (within their focus). Pretty much the only thing they can't do is surgery. They can all hang their own shingles. The NPs can prescribe narcs and have no physician oversight requirements. CRNAs do not need an anesthesiologist, and the only thing they need surgeons for is doing the actual surgery. Nurse Midwives can get hospital privileges, though I understand some hospitals won't give it to them. But I know of two that do, and the only thing they need an MD for on an even vaguely regular basis is C-sections.

 

Now, NM is a pretty progressive state... but it is just a matter of time until cost factors force the rest of the country to go this way.

 

On the other hand: Most NPs, CRNAs, etc in the state work for physicians. Furthermore, I don't really see a downward spiral or anything like that for PAs- except in family practice where I predict the NPs will own y'all (however, this is entirely my opinion based on anecdotal evidence). PAs are, and will continue to, own specialty practice. Their education is built to make them perfect to help a busy specialist. And the specialists- who are already busy- are going to see their practices EXPLODE in 10-15 years. I ain't worried at all about the fact that many of my friends and a member of my family are heading to PA school. I see, in fact, a much more secure future for them than what I potentially see for me after 3 years and a JD.

 

On an only vaguely related note: degree creep happens everywhere. It has only been about 30 or 40 years since JD became the big thing, replacing the LLB. And, if it helps, it is still a joke in many ways. We all know that this is at best only a master's level program, and more realistically a baccalaureate one. But the prestige made them change it to JD, and now we have a-holes who want to be called "Doctor" because they did 3 years learning how to argue. Whatever. No one takes them seriously.

It sounds like it's virtually the same in NM as it is in IL...Nurse Midwives also hang out their own shingle...

[dm123]

Yes,in IL they do hang our their own shingle...PAs do not.

 

First, how can I preview a post without copying to Word or something?

 

marilynpac,

 

What about the prescribing? You didn't answer that part, and I'm talking totally independent of a physician. There are many groups that hang up their own shingles, DCs, even acupuncture people, but if you cannot Rx prescription medication it is tough to make a living unless you promote vitamin therapy, then you are in the realm of chiropractors and Nutritions. I've never seen or heard of a sign out front of a NPs office to the effect of "Advanced Registered Nurse Practitioner, in Adult "MEDICINE", or Dr xxxx NP, PhD., Adult Medicine. I know the nursing lobby is powerful, but nothing like the AMA. Infringe on their turf at your own peril.

 

What matters in most places where PAs and NPs work is policies of their on clinic or practice group. If there is a conglomeration of PAs and NPs, the group most likely assigns either a PA or NP that knows the ropes to be a sub-boss. A PA could make it hard for a NP to keep their job or visa-versa. It could even be a bean counter office manager with little medical training.

 

PAs, depending on the state, do not necessarily have to have an on site physician supervisor. Most do in recent years but the doc doesn't have to be. Here again, each state may be different. It depends on experience and what their practice entails. I once worked in Florida where a good friend worked at a retirement community. His supervisor would drive up once a week and countersign his charts. His supervisor was available, or a backup by phone 24-7.

 

It is the autonomy from licensed MDs or DOs to practice medicine and Rx meds that I don't think NPs have anymore authority to do than PAs do. If IL does, they have a very different Medical Board that I have ever heard of.

[EMEDPA]

Something like 18 states allow np's to run an independent outpt primary care practice and rx on their own name.

[dm123]

Firemedic13,

 

Very interesting, I didn't know that. How do the two groups fair income wise, PAs and NPs? I'll have to admit, if I had it to do over again, I would have been a CRNA. My wife has always made gobs more money than me, currently well over $150k and NC is not a high cost of living state, plus more time off, easier work (unless something goes wrong), matching retirement and other disgusting benefits I would never see. PAs have come a long way in income. I'm ashamed to say what my first salary was, but it was less that $15k.

[marilynpac]

No they don't have anymore authority, but their union/lobby here has pushed them aggressively while our has not. Because of that the NP name is something that docs think of when they here of the term midlevel. They don't think PA. The NP school that runs through the Univ of IL, "guarantees" them a job when they graduate.....does any PA school do that????

[bobuddy]

Here in Ky, the NP's can hang out their own shingle and practice without supervision and prescribe own meds. The PA's put forth a bill again this year to prescribe scheduled drugs - to be knocked down once again. I suppose there is always next year....... and the year after that...... and the year after that...... to try again. Sigh......

[marilynpac]

At least we can prescribe scheduled II drugs in IL...do you know how this was knocked down? Evidently someone is lobbying against PAs in KY or not lobbying hard enough for them....I know KY is NP very friendly...

[Devildog]

The number of programs and total national seats is growing.

 

Indeed. There were 44 in my class. 8 years later, up to 77 with "pressure from the top" to accept 100 in the next year / or two..

[LESH]

The NP school that runs through the Univ of IL, "guarantees" them a job when they graduate.....does any PA school do that????

 

Marilyn I know of at least 9 programs that can "guarantee" a "job". IMHO it all goes back to geographic workforce needs. It may not be the job/specialty one wants to end up, but it will still be an honest day's work helping people.

[kittryn]

whoever pulled my post -- thank you :) definitely don't like to inflame things, was just venting.

impulse control, impulse control, impulse control, count to ten, 1, 2, 3, 4....

[LESH]

PA education is seeing far greater growth than NP education. At least in the data.

 

Over the past year and a half, there has been significant funding/dialogue at federal and state levels for increasing the number of PAs trained. I have to give props to AAPA and PAEA for their working the hill on that one. Some of the new PA-S folks here on the forum are part of that growth. Feds funded several expanison of program grants (to increase seats). I think they are 5 year grants. These grants give some of the largest stipends/awards to the students I have ever seen. PA Programs that can are gearing up.

 

There's also at least one state looking into developing new programs. They may be about five years from seeing anything materialize but you got to start somewhere. PA growth is doing okay IMHO. This time the Academy and Association leadership are thinking about the process a little more carefully and seem to be more evidenced based in their decision making. Again IMHO.

[dm123]

Of those states that allow NPs to function and prescribe without physician over-site, what is the average pay scale? Is the work in under privilege areas or along side, and in the same areas as physicians? Do they compete with physicians for patients, i.e. does the patient have a choice between physician and NP?

[marilynpac]

Marilyn I know of at least 9 programs that can "guarantee" a "job". IMHO it all goes back to geographic workforce needs. It may not be the job/specialty one wants to end up, but it will still be an honest day's work helping people.

 

Well Les start naming...I'm sure there are PrePAs that would like to go to a school that guarantees a job...don't be surprised if you see more threads going up by PAs who can't find one...

[marilynpac]

Of those states that allow NPs to function and prescribe without physician over-site, what is the average pay scale? Is the work in under privilege areas or along side, and in the same areas as physicians? Do they compete with physicians for patients, i.e. does the patient have a choice between physician and NP?

 

There's very little competition with the docs b/c docs charge so much due to high malprac ins premiums. An NP can/will do a yearly physical and charge 25 bucks!!! No doc does that...and the NPs office is usually very full....

[RLVPAC]

If NPs or PAs want to be called Dr., go to medical school. We are mid-levels. Our field is very respectable and has a great place in the medical field. I believe DNP will be NPs downfall, trying to make themselves feel more valid, while intentionally misleading patients to believe they are MDs.