PA or NP?

[Teacher2PAC]

Today while working a provider (Family Medicine MD) who I work with asked why I am not pursing NP instead of PA. I told him my reasons, and asked him why he thought NP was "better". He indicated that NPs can do more with their degree like gain administrative positions and some other things. I was shocked by this advice because it is the first time I have heard it since I have started working toward wanting to be a PA. If other commenters can provide some insight as to why someone would want to be a NP instead of a PA that would be great. 

 

Also, personally, I have never wanted to be a nurse (I am not grounded in that school of thought), this is why I have not moved in the NP direction. 

[Guest Paula]

What were the "other things" NPs could do that PAs can't?  I'm curious what the MDs thought pattern was on that?

 

Go back and ask the family medicine MD what he thinks a PA is and what a PA does and what is their educational background?

 

Ask him what his understanding is of NP education?

 

Ask him what he knows about the NP/PAs who are direct entry to the programs (meaning very little HCE before becoming an NP/PA)?  Are they equivalent?

 

Would a direct entry NP be "better" than a PA with background of EMT/Paramedic/RN who had had years of experience? 

 

 I wonder if the MD believes things about PAs that just aren't true.  

 

PAs do get administrative positions, probably more apparent in the military setting.  NPs or nurses  get administrative positions in hospitals and clinics and public health as that has been a standard for years and years.  Many hospitals are heavy with nurse administration and  is a common concept that only nurses are capable of administration of health issues in hospitals and clinics, or the Health focused MBAs are another choice.

 

It does not means PAs can't do it, we just haven't done much admin historically....admin is not the reason the profession was developed. 

 

I had a brief conversation with an MD administrator whose daughter was getting her DNP.  I mentioned DNP helps the NP to teach or become an administrator and it generally is not  clinically focused education.  He admitted he had no idea what a DNP program entailed, and did state that he thought PAs are certainly capable of administration and was open to the idea to add PAs on as administrators.  

[Teacher2PAC]

It is possible. He did not seem to understand the mobility PAs have. I was surprised he asked me this question. As I said in another post, I am all for PA. I made my mind up on that already. This is the first physician I met who did not encourage PA. I am sure there are more like him, and that is where advocacy comes into play. At this point in my life, I really do not care/know much about administrative positions (I should probably learn about them). Ultimately, I would like to work with patients and do what is best for their health. If there are providers who see things through a narrow scope, that is an issue that will have to be fixed. I appreciate the comments. 

[UpRegulated]

PA's have plenty of options, but NP's simply have many more, which is one of the reasons I chose NP over PA.  There are 1,800-2,000 or so nursing schools in the US, all of which can or do utilize NP's in clinical, teaching and/or administrative roles. There are 150 or so PA schools.  Furthermore, the overwhelming majority of clinical, education, and clinical administrative positions in clinics and hospitals are held by nurses, many of which are MSN prepared. It is not that PA's cannot do these jobs, it is just most of these jobs entail managing or educating fellow nurses, so hiring nurses for these roles often makes the most sense.

 

Having said that, if the PA route and role is more appealing to you, that is what you should do.

[EMEDPA]

FWIW there are almost 200 pa programs now with many more in the works.

agree that applicants should evaluate their future goals before making any pa vs np decision.

[Maverick87]

If a PA wants to go into an administrative role, can't they just get their MBA?

 

From what I've seen, there are tons of administrators that were never practitioners of any kind.

[UpRegulated]

If a PA wants to go into an administrative role, can't they just get their MBA?

 

From what I've seen, there are tons of administrators that were never practitioners of any kind.

 

It depends on the administrative role.  Many administrative roles are clinically oriented, in which case a clinical background is mandatory, such as nurse managers, directors and officers, medical directors, clinical nurse specialists, department educators (ICU, ER, med surg, etc.), clinical quality control, infection control, etc.  These roles, and many others, are held almost exclusively by experienced and well-trained RN's and NP's (with the exception of medical director, though it is not unheard of).

 

There are, of course, administrative roles that aren't clinical, like those in HR, marketing, finance, accounting, etc.  They can be held by anyone with the relevant experience and prior clinical training is by no means necessary.

[PACdan]

He probably said it because NPs have more favorable laws & regulations in many states with less impedance to their ability to practice. Whereas PAs, for the most part, have more restrictive regs despite having more formal training in the practice of medicine.

 

Makes complete sense.

[lanime]

As a RN, this is something I have evaluated extensively. There are several major differences and several similarities between the two. The best course for you depends on your long-term goals and your preferred objectives. I would suggest doing some additional research into the two, since this will help you to not only decide on a career path, but to be prepared for interview questions about each profession as well.

Here is a very helpful link: http://doseofpa.blog...01_archive.html

 

Good luck and I hope this helps!

[FfIghter23]

I think there are common misconceptions about the PA vs NP debate everywhere you go. It really irks me when people WHO are nurses don't even know the difference between their FNP co-workers and their ACNP co-workers. They have vastly different training as FNPs are being pushed into the outpatient, primary care setting (primarily), and ACNP programs focus their education on hospital/inpatient care and some outpatient clinics that ARE NOT primary care. Most programs are night and day as one focuses on vaccinations, rashes, obstetrics, health promotion...etc. while the other focuses on managing acutely ill patients, surgical procedures, critical-care procedures, vent settings, and so on... 

There are a few dual ACNP/FNP programs (Vandy, S. Alabama), but for the most part NPs are one or the other. An ACNP can't just go work in primary care either as they do not do have core rotations in peds, ob/gyn/womens health, etc. I recently met a FNP who finished his whole program without ever doing a single suture (wow...) and was trying to apply for ER jobs, but only wanted fast track so he didnt have to suture (I told him he better learn quick ;) ) and he would be a horrible candidate for an inpatient FNP job. 

On the same token, PAs can have vastly differently educational experiences. You may have a PA who comes from the background of a RRT or ICU RN who does their elective rotations in the ICU, w/ IR, and in surgical sub specialty who would be great for any inpatient job. And then you may have a PA who has the background as an MA in a outpatient peds setting who only does electives in extra OB/gyn and peds who would then be perfect for an outpatient job in one of those settings. THAT is the beauty of the PA educational system in that you can take providers with the different backgrounds and they get to choose the area of medicine they will focus on, BUT both will always be able to go back into a primary care/IM role if needed because they get the core training in school. 

In summary, don't choose PA or NP based on the fact that one has more opportunities for administration. Research and TALK to PAs and NPs about their jobs and their career paths and what they like or dislike about their career path. If administration is a goal down the road you will be able to seek those out... whether as a PA or an NP. Believe me, admin isn't all it is cracked out to be. Learning medicine as a PA or NP should be your focus right now. 

[zabak2015]

I think the NP and PA are in the same level. The difference I see is the way they get there. NP takes longer time to complete. You must become Rn first, have BS degree, then go for NP. PA however can be done in two years. The other difference is that NP can work independently, on the other hand PA always under the supervision. Please correct me if I am wrong.

[DiggySRNA]

I think the NP and PA are in the same level. The difference I see is the way they get there. NP takes longer time to complete. You must become Rn first, have BS degree, then go for NP. PA however can be done in two years. The other difference is that NP can work independently, on the other hand PA always under the supervision. Please correct me if I am wrong.

 

There are some PA programs out there that are 3 years in length, just like NP schools. You can earn your RN credentials (after passing the NCLEX) after the first year of direct-entry-NP programs (hence 3 years). 

 

You are correct that NPs have the opportunity to practice independently, BUT in the state of Massachusetts, both PAs and NPs must have a supervising physician. 

 

As the experienced PAs stated above, the only concrete difference between PAs and NPs is the level of training they receive. At the end of the day, one practice medicine while the other practice advanced nursing, per training. But the layperson/patient sees no difference between the two in a clinical setting.

[EMEDPA]

zakbak- Most PAs have prior medical careers as well, so the path is not always faster unless it is one of the few direct entry programs(nps have these too). for example my path was this:

emt in high school

er tech 24 hrs/week for 4 years while in college and 60 hrs/week summers 

paramedic school

5 years as a medic

PA school (3 years)

 

pa supervision/collaboration can take many forms. I work solo the vast majority of the time and physicians have no direct input into my pt care in real time. occasionally I get an email a month after seeing someone when the docs review charts and they say "consider xyz next time" or I prefer drug x over drug y.

[firefowl]

Multiple NP schools I am aware of have direct entry into the masters program and RN is obtained in the first year. No prior medical experience needed, only a 4yr. degree.

[armymedicchris]

Many of the physicians I talk to believe the person as a whole is more important than the initials/professional title by their name. It's similar to the MD/DO debate. You can be a great provider with either route. 

[EMEDPA]

yup, a friend of mine is an infectious dz np who runs a county health system. he is as good as any ID doc when it comes to hiv, hep b/c, STIs, etc

[lanime]

I think armymediccris said it best!  Both professions are really about patient care and one isn't better or worse than the other, they are just different.  As a person with a nursing background who is interested in PA school, I appreciate the similarities and differences of both and appreciate each career choice as a valuable way to provide good care to patients.

[BARONEUS]

 

You are correct that NPs have the opportunity to practice independently, BUT in the state of Massachusetts, both PAs and NPs must have a supervising physician.

Same rule applies in my state. NPs can have their own stand-alone clinic, but they still have to have a "collaborative agreement" with a physician, as well as pre-defined prescribing rights consistent with that MD's scope of practice.

 

I really wish the whole pre-PA script of "NPs can practice independently, PAs can't" would be done away with. It bothers me because it reflects a poor understanding of how medicine is actually practiced. At my job, PAs, NPs, and MDs all work together, on the same level, and do the same thing. The doc reviews our charts, just like administrators and auditors review his/her charts., and it doesn't matter who's more independent when there's 20 people in the waiting room.

 

Also, a friend of mine who's a PA works by himself in a clinic, just him, a nurse, and an OA, perfectly within the guidelines set by the state.

[Joelseff]

^so true. Admins (RNs) at my work spew some of this nonsense. I work in California where both NP and PA have to have collaborative/supervisory relationship with docs. A RN manager told me that the NPs at my work "are sacrificing their independence" because now PA's are being hired and must be supervised so now all the AHPs have to be supervised... I tried to correct her but she insisted. I didn't want to argue with her. But here are scopes of practice by state for both.

 

NP scope per state:

 

http://www.bartonassociates.com/nurse-practitioners/nurse-practitioner-scope-of-practice-laws/?am_force_theme_layout=desktop

 

PA scope per state

 

http://www.bartonassociates.com/nurse-practitioners/physician-assistant-scope-of-practice-laws/

 

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