hard question on NP vs PA and autonomy.

[TPA16]

Hi all. Long time lurker and upcoming interviewee for a pa school.

 

Question on np vs pa:

I know that the go to answer is "np is nursing model and pa is medical model" but what exactly does that mean? I could look up on google what that means, but i would rather know a more practical explanation from someone in the field! 

 

also to my understanding, NPs can only delve into like 3 specialties such as acute, inpatient, and outpatient or something like that? whats that all about

 

and ALSO

 

i know that PAs are always under the supervision of a doctor, but in the medical office i work at, the PA runs the office some days where the doctor isn't there. what law or rule allows this?

 

thank you in advance

[Nonlegit]

Its nuanced. What kind of medicine interests you?

 

Source: I've been playing this mental game for 10 years.

[LKPAC]

 

i know that PAs are always under the supervision of a doctor, but in the medical office i work at, the PA runs the office some days where the doctor isn't there. what law or rule allows this?

 

 

Supervision, or collaberation is a better word, does not mean constant presence.  Depending on the relationship, this can be minimal and only when needed.

[delco714]

The fact you're applying to pa school and know so little about either profession is disconcerting

 

[MT2PA]

The fact you're applying to pa school and know so little about either profession is disconcerting

Right?!  How did OP even decide on the PA profession without basic knowledge?

 

To be fair, OP, most of us here have more knowledge of the PA profession than NP.  But it is my understanding that while there aren't official specialty programs for NP's, they are increasingly able to work in specialties much the same way PAs started in primary care and branched out.  They are not just restricted to primary care or women's health or inpatient departments.  Honestly, it seems like career wise NPs and PAs have very similar opportunities available with very different educations to get there (save for ER and surgery which seem to be PA heavy over NP). *Just my perception, not necessarily hard and fast truths*

 

And as others have said an SP, or yes collaborating physician is a better term, is needed to practice but it is NOT a baby sitter situation.  They do not hold your hand all day and double check all your work (chart review rules are part of some laws, though).  PAs don't run all their decisions by doc.  

 

I strongly urge you to do your research, and not just ask on this forum for the answers, so that you can truly have an understanding of the profession before you interview.  Check out AAPA, PAEA, run a google scholar search on the PA profession, start getting that foundation.  I promise adcoms will be able to tell if you are giving a canned answer vs having a true knowledge of the profession.

[Hopeful2015]

Compare the curriculum of some NP and PA schools. You'll see a pretty stark contrast.

[HMtoPA]

 

 

To be fair, OP, most of us here have more knowledge of the PA profession than NP.  But it is my understanding that while there aren't official specialty programs for NP's, they are increasingly able to work in specialties much the same way PAs started in primary care and branched out.  They are not just restricted to primary care or women's health or inpatient departments.  Honestly, it seems like career wise NPs and PAs have very similar opportunities available with very different educations to get there (save for ER and surgery which seem to be PA heavy over NP). *Just my perception, not necessarily hard and fast truths*

 

I'm pretty sure there are, e.g., Family, Acute Care, Pediatric, and Womens' Health programs, to name a few.

[db_pavnp]

Compare the curriculum of some NP and PA schools. You'll see a pretty stark contrast.

 

Honestly, it seems like career wise NPs and PAs have very similar opportunities available with very different educations to get there

 

 

Compare the curriculum of some NP and PA schools. You'll see a pretty stark contrast.

 

The educational pathways are more similar than they are different.  The differences are exaggerated by individuals who have motivation to suggest they are different (and that includes both camps).  My ultimate proof of the similarity of the education is the simple fact that the two licenses are highly similar.  Reading curricula is not a good indication of educational differences.  The language of those curricula are carefully designed to highlight the differences of the models put together, once again, by individuals who are highly motivated to prove that pharmacology doesn't equal pharmacology and pathology is different than pathology.

 

When PA programs give up in 10 years and simply blend into the 3 year MD model, then you can say that the two professions differ significantly.

[Boatswain2PA]

The educational pathways are more similar than they are different.  The differences are exaggerated by individuals who have motivation to suggest they are different (and that includes both camps).  My ultimate proof of the similarity of the education is the simple fact that the two licenses are highly similar.  

 

Not even remotely accurate.  The two educational pathways are VASTLY different.  

 

The little bit of medicine taught in NP programs seem to be protocol driven - "if this, then that".  "If hypokalemia, then Ca, insulin, gluc, bicarb", with very little understanding of what the calcium does to the myocytes, or when bicarb would actually be useful (or harmful).  And MUCH of what is taught in NP programs is educational fluff - ie: writing papers and creating "posters" on "nursing leadership" theories/skills/competencies/blah blah blah.  

 

NP programs are unbelievably deficient in their clinical requirements as well.  Clinical rotations, where the rubber meets the road when learning how to put the didactic into clinical use, are typically a farce with NP programs.  I believe 500 hours of clinical rotations is the minimum for NP programs.  Many programs require NP students to go find their own clinical site and preceptor, which means the student can simply tag along with their friend a few hours a week.  

 

PA schools, unfortunately, do have some fluff, but the vast majority of the didactic year is cramming 2 years of med school into your brain.  The clinical YEAR is a YEAR (at least 2000 hours) of high intensity, med-school level medical rotations with REQUIRED rotations in family practice, surgery, peds, psych, EM, etc.  

 

There is simply no comparison between PA education and NP education.  PA education >>>>>>>>>>>>>>>> NP education.

 

Just because the licenses are high similar does not mean the educational pathways are similar.  The more advanced licensure of the NP profession was attained strictly through political processes, not through academic/scientific processes like the DOs did with MDs.  

 

Again, there are many terrific NPs out there who practice great MEDICINE, but they do so because they realized how poor their NP education was and compensated for that by enormous self-study.  And, on the flip side, there are some terrible PAs out there who, after getting through PA school, have sit back on their laurels and stopped furthering their knowledge.  

[bio]

I have feeling people see PA being raked as "THE NUMBER ONE PROFESSION" and decide to become a PA. 

[Boatswain2PA]

Hi all. Long time lurker and upcoming interviewee for a pa school.

 

Question on np vs pa:

I know that the go to answer is "np is nursing model and pa is medical model" but what exactly does that mean? I could look up on google what that means, but i would rather know a more practical explanation from someone in the field! 

 

also to my understanding, NPs can only delve into like 3 specialties such as acute, inpatient, and outpatient or something like that? whats that all about

 

and ALSO

 

i know that PAs are always under the supervision of a doctor, but in the medical office i work at, the PA runs the office some days where the doctor isn't there. what law or rule allows this?

 

thank you in advance

Here is a recent example of "nursing model vs medical model"

 

In the ED, with a new NP at my side.  I'm writing admission orders for a LOL with advanced dementia.  She has somehow managed to continue living at home with her slightly less demented husband.  LOL is in a new environment (ED), so she is a little anxious and keeps walking the ED asking when can go home.  I ask the NP what meds she would write to help with the anxiety (and help the nurses on the floor if needed).  

 

New NP had very little knowledge about the medication options.  She had one benzo in mind, but didn't know any of the pharm differences between the various benzos, and no thoughts on benadryl or haldol.  

 

But, using her nursing model, she suggested giving the LOL a stack of blankets to fold (the LOL kept getting out of bed, folding her blanket, walking the ED, then when nurses put her back to bed she would unfold blanket and cover up....only to repeat steps in a minute).

 

Nursing model:  Give the LOL a stack of blankets.  Good stuff!

 

Medical model:  Understand the pharmaceutical tools at your disposal and choose the right one.

[HMtoPA]

Here is a recent example of "nursing model vs medical model"

 

In the ED, with a new NP at my side.  I'm writing admission orders for a LOL with advanced dementia.  She has somehow managed to continue living at home with her slightly less demented husband.  LOL is in a new environment (ED), so she is a little anxious and keeps walking the ED asking when can go home.  I ask the NP what meds she would write to help with the anxiety (and help the nurses on the floor if needed).  

 

New NP had very little knowledge about the medication options.  She had one benzo in mind, but didn't know any of the pharm differences between the various benzos, and no thoughts on benadryl or haldol.  

 

But, using her nursing model, she suggested giving the LOL a stack of blankets to fold (the LOL kept getting out of bed, folding her blanket, walking the ED, then when nurses put her back to bed she would unfold blanket and cover up....only to repeat steps in a minute).

 

Nursing model:  Give the LOL a stack of blankets.  Good stuff!

 

Medical model:  Understand the pharmaceutical tools at your disposal and choose the right one.

 

I don't know how much weight I'd give an anecdotal example.  I think the key phrase here is New NP and that this is more a case of inexperience than an educational deficiency.  I'll be honest, I almost never prescribe anxiolytics because I just don't have occasion to, and I'm pretty sure someone more well-versed in their use could pimp me pretty good.  Granted, all it would take is a little time and study and I'm sure I could become pretty proficient with them.

 

Now, I admit that when I've reviewed NP curricula in comparison to what I studied, I very much had a "WTH?" reaction.  Course titles are vague and seem to be focused on lifespan periodicity rather than system-based.  And I share your concerns about the general intensity of the programs and relative dearth of clinical hours.  But, in spite of this, I have to think that the programs must be by and large producing competent grads because NP's are not failing en masse in the workplace.  

[LT_Oneal_PAC]

The educational pathways are more similar than they are different. The differences are exaggerated by individuals who have motivation to suggest they are different (and that includes both camps). My ultimate proof of the similarity of the education is the simple fact that the two licenses are highly similar. Reading curricula is not a good indication of educational differences. The language of those curricula are carefully designed to highlight the differences of the models put together, once again, by individuals who are highly motivated to prove that pharmacology doesn't equal pharmacology and pathology is different than pathology.

 

When PA programs give up in 10 years and simply blend into the 3 year MD model, then you can say that the two professions differ significantly.

As someone who has participated in both, I can say they are significantly different.

[db_pavnp]

The little bit of medicine taught in NP programs seem to be protocol driven - "if this, then that".  "If hypokalemia, then Ca, insulin, gluc, bicarb", with very little understanding of what the calcium does to the myocytes, or when bicarb would actually be useful (or harmful).

 

You have no sense of how many NP programs hit this or how many PA programs do not, nor how many PAs, MDs, and NPs get to rotation having forgotten it.  You probably don't have a sense of how MD programs hit this subject, either.

 

I don't know how much weight I'd give an anecdotal example.

 

Bingo.

[db_pavnp]

As someone who has participated in both, I can say they are significantly different.

 

They differ by a percentage.  The significance of that depends on who you ask.  It's a big deal to people with a lot invested in their choice.

 

Unless you have a hidden NP in your signature, find your claim of "participation" to be super dubious.

[FfIghter23]

They differ by a percentage. The significance of that depends on who you ask. It's a big deal to people with a lot invested in their choice.

 

Unless you have a hidden NP in your signature, find your claim of "participation" to be super dubious.

We can always count on you to be the sole NP expert on this forum. Oh, and PA expert. And MD expert. No one else can know anything about a specific profession as much as you do? Many on this forum either teach at NP programs, precept NP students, are married to NP's, and don't live in a box. We value your opinions on this forum. Please value ours.

 

And at the end of the day they are just that--opinions. Let's not turn this into a SDN-like discussion, where we bash people and not their ideas. Nobody benefits.

[LT_Oneal_PAC]

I did not complete the NP program, but participated for 2 full time semesters. Read 12 credits each semester because 9 was considered full time at that program. So 24 total credits in a 48 credit hour program. I found it lacking greatly and I decided it wasn't getting any better and left. The students ahead noted multiple times they were dissatisfied, which aided my decision. The university hospital I worked for footed the bill as part of the employee benefit package, so I did not have a financial interest in staying. I always like to note this was just one school and cannot be extrapolated to all NP programs. I like to mention it because I'm pretty sure I'm the only one here who has participated in 2 separate programs, so it's not just a hearsay evidence. I take great offense that you would suggest I would lie about such a thing. I'm a long time member here, not just some troll that started yesterday. It's not something I just claimed today either. I've said it multiple times over the years. But I will build a bridge and get over it. There is nothing I can do to prove it because anything I put on here can be doctored and I'm not faxing you my transcripts.

[db_pavnp]

We can always count on you to be the sole NP expert on this forum.

 

I am not saying anything that you aren't.  It isn't a stretch to suggest that these programs, which generate nearly the same license, differ by an average value which largely pans out to be inconsequential.

 

You can be as insulted by that suggestion as you want to be.

[LT_Oneal_PAC]

 

You can be as insulted by that suggestion as you want to be.

...obviously, I do declare. Any more thoughts on life captain obvious?

[Guest Paula]

How do they generate nearly the same license?  NP must first have and RN license, then get the NP credential.  Their licenses are granted by the Nursing Board. The Nursing Board develops the NP scope of practice. 

 

PAs get a medical license granted by the Medical Board. The Medical Board develops the scope of practice. 

 

Do you mean the two professions are credentialed nearly the same at the employee level?

[db_pavnp]

They have roughly the same scope of practice.  For all the suggested advantages of the nursing lobby and for all the suggested superiority of PA education, the scope is largely the same.  I get the devil is in the details and all, but by and large...

[Boatswain2PA]

I don't know how much weight I'd give an anecdotal example.  I think the key phrase here is New NP and that this is more a case of inexperience than an educational deficiency.  I'll be honest, I almost never prescribe anxiolytics because I just don't have occasion to, and I'm pretty sure someone more well-versed in their use could pimp me pretty good.  Granted, all it would take is a little time and study and I'm sure I could become pretty proficient with them.

 

Now, I admit that when I've reviewed NP curricula in comparison to what I studied, I very much had a "WTH?" reaction.  Course titles are vague and seem to be focused on lifespan periodicity rather than system-based.  And I share your concerns about the general intensity of the programs and relative dearth of clinical hours.  But, in spite of this, I have to think that the programs must be by and large producing competent grads because NP's are not failing en masse in the workplace.  

My example was more for the difference between nursing model and medical model.  My medical model was to give medications.  Her nursing model was to give a stack of blankets to fold.  Both have their places in patient care.  However the CNA on the floor doesn't need a written order from me (or the NP) to give the LOL a stack of blankets.  

 

You have no sense of how many NP programs hit this or how many PA programs do not, nor how many PAs, MDs, and NPs get to rotation having forgotten it.  You probably don't have a sense of how MD programs hit this subject, either.

 

 

Bingo.

 

Correct, I don't know how many NP programs hit this.  I don't know if ANY NP programs hit this.

 

INcorrect (again).  I DO know that EVERY PA and MD program hit this because it is on the standardized boards.  PA education is standardized.  Every PA program teaches much the same stuff as every other PA program because they are highly regulated by the ARC-PA, and every graduate must pass the same standardized test to get certified from the NCCPA.  

I am not saying anything that you aren't.  It isn't a stretch to suggest that these programs, which generate nearly the same license, differ by an average value which largely pans out to be inconsequential.

 

You can be as insulted by that suggestion as you want to be.

 

The educational difference between PA and NP programs are enormous.  The scope of practice is (often) inconsequential, but the pathway to get there is vastly different.

 

You can get butt-hurt about the truth if you want, but you can't change the facts.

[db_pavnp]

I DO know that EVERY PA and MD program hit this because it is on the standardized boards.  PA education is standardized.  Every PA program teaches much the same stuff as every other PA program because they are highly regulated by the ARC-PA, and every graduate must pass the same standardized test to get certified from the NCCPA.  

 

PA programs are not "standardized".  You have a single exam which follows a blueprint.  The same is true of MD programs, albeit they take more exams.

 

The educational difference between PA and NP programs are enormous. 

 

It is super funny to me that each time I suggest the difference is negligible you use a more dramatic adjective to describe the rift.

[TPA16]

The fact you're applying to pa school and know so little about either profession is disconcerting

The fact that instead of offering me advice as an established PA, you shut me down claiming I haven't done my own research is disconcerting

 

But I wish you best

[TPA16]

Its nuanced. What kind of medicine interests you?

 

Source: I've been playing this mental game for 10 years.

Im interested in surgery but I wasn't sure of any NPs working in surgery. I have been more focused on my path to become a PA to consider NPs in surgery, but I would like to know if there are NPS in surgery and the differences between them. to what I have gathered, First assist duties are best fit to PAs rather than NPs?