hard question on NP vs PA and autonomy.

[delco714]

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

Yes I also got your original response in my email notification. Don't be a child. You come off as obvious about both professions...what else need I say?

[MT2PA]

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

Maybe so.  I wouldn't consider family care/practice to be a specialty and, truth be told, I feel like those tend to be the more common places NPs practice whether or not they attend a program that focuses on that area.  But it's not derm, ortho, ID, etc which is what I think of when I think specialty, which was more of what I meant.

[HMtoPA]

Maybe so. I wouldn't consider family care/practice to be a specialty and, truth be told, I feel like those tend to be the more common places NPs practice whether or not they attend a program that focuses on that area. But it's not derm, ortho, ID, etc which is what I think of when I think specialty, which was more of what I meant.

I meant that different NP programs specialize in different fields.

[Boatswain2PA]

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.

 

 

 

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.

PA programs ARE standardized around the blueprint for passing the NCCPA, just like MD programs ARE standardized around the blueprints for passing the Step exams.  NP programs, however, are......not.  

 

I"m not saying that all PA programs are the SAME, because they obviously are not.  But they all have a core curriculum that is utterly lacking in NP programs.  

 

We get it though, you think it's "super funny".  You bury your head in the sand when given the truth.  However many people come here to get (and give) factual information.  Fortunately there are many people here who will refute what you tell these people.  

[TPA16]

Yes I also got your original response in my email notification. Don't be a child. You come off as obvious about both professions...what else need I say?

needless to say, this post started a hefty conversation involving many PAs on my oblivious question

[Guest Paula]

 If we all ever meet each other in person we will either have a great time or will start cat fights and be mud wrestling each other. 

[Boatswain2PA]

Mud wrestling?  <insert sexist joke here>....I'll get the fire hose out! lol

 

I have met some folks at the SEMPA conference in Vegas 2.5 years ago and we had a good time over dinner and drinks (True, Medic, Emed & others).  No mud wrestling was allowed! :-)

[db_pavnp]

PA programs ARE standardized around the blueprint for passing the NCCPA, just like MD programs ARE standardized around the blueprints for passing the Step exams.  NP programs, however, are......not.  

 

I"m not saying that all PA programs are the SAME, because they obviously are not.  But they all have a core curriculum that is utterly lacking in NP programs.  

 

If this is the language you want to use, that "standardization" is generated from the need to pass exams, NPs have exams, too.  NPs have more diverse exams, but each exam has a blueprint and NPs could not pass them without addressing the tested material.  Maybe your argument is that PAs exhibit greater standardization immediately after PANCE.  While true, I don't find it especially troublesome that psych NPs have an education which differs from acute care NPs, nor do I find it troublesome that a psych PA vs acute care PA exhibit skillset differences after 4 years.

[Boatswain2PA]

Further standardization comes from the single test that ALL PAs must pass, AND from the single organization that oversees ALL PA programs.  The ARC-PA accreditation standards is there to ensure that all PA programs cover standard material.  

Let's talk for a minute about acute care NP education.  I think we can all agree that clinical rotations are where we put together all of the didactic learning as we look at and care for actual patients.  Where lecture learning turns into learning about medical care.

 

NP student need 500 clinical hours.  Let's assume that an acute care NP spends all of their 500 hours in an acute care setting (I don't know if that is required or not).  

 

PA students need 2000 clinical hours.  This includes mandatory rotations in EM, Surgery, and Cardiology.  .  Even at the bare minimum of 40 hours/week and only 4 weeks per rotation, a PA student would have 480 hours of EM/Surgery/Cardiology critical care.  Realistically EM, Surgery & Cards rotations are 60-70 hour weeks, and usually 6 week rotations (sometimes 80 hour weeks and 8 week rotations), so the mean is probably 1080 hours of acute are, and sometimes as many as 1920 hours.

 

Oh, and that PA student who wants to use their rotations to "specialize" in acute care can add on an ICU rotation, a trauma rotation, or another EM/surgery rotation.

 

Kinda makes that "500 clinical hours in the NP specialty" look pretty silly.

 

Between my EM, Peds, Cards, Trauma rotations, and then EM preceptorship, I would estimate I had over 2000 clinical hours of acute/critical care.  Plus I did two FP rotations and an IM rotation to round it out.

 

PA Education >>>>>>>>>>>>>>>>>> NP Education.  Period.  No reasonably informed person believes otherwise.

[db_pavnp]

Your number of >'s is arbitrary, not evidence driven, and gets three >'s added each time you type it.

 

Also, you err on the side of "extra" when it comes to PAs, with adjectives like as "realistically" and suggestions of "mean",  and err on the side of minimums, or invented minimums, when it comes to NP education.

 

My suggestion from the start has been that individuals in both camps will bend over backwards to exaggerate the differences between the models and you really play directly into it.  Between anecdotes, propaganda, and exaggeration, you are exactly that guy.

[cinntsp]

While this certainly isn't a randomized controlled trial and folks on this board are saltier than the average PA, anecdote may be worth listening to when coming from many different folks at different stages of their careers with different backgrounds. If everyone is saying the same thing it's not necessarily 100% accurate but it's worth considering.

 

Sent from my Nexus 5 using Tapatalk

 

 

[Boatswain2PA]

Okay DB.  Here you go.  Just for you.

 

PA Education > NP Education by a large margin, however such margin is unmeasurable.  No reasonable and informed person believes otherwise.  

[PACdan]

My suggestion from the start has been that individuals in both camps will bend over backwards to exaggerate the differences between the models and you really play directly into it.

 

Well, it's NPs that benefit from the suggestion that the difference between PA and NP training is negligible. Because when we look at the averages for credit and clinical hours for programs across the country, PA students complete 2-3x as many credit hours, and 3x as many (if not more) clinical hours than NP students. There is no parity there. And I don't care if the NP student was working as a floor RN or whatever, just as I don't care if the PA student was a 20-year medic, because the thing we're comparing is the formal training modality that leads to certification.

 

While it may be true that after years of practice, the difference in HOW a PA and NP work is negligible, it doesn't discount their formal education and the foundation they build on. Just as we don't discount the difference in PA and MD education, even though some may become indistinguishable in practice after a number of years. But talk to any physician that works with new PAs and NPs and you will find that they almost universally have a strong preference for PAs. They can recognize the difference in training modalities with ease. The means of getting there matters, and it's pretty evident at the onset of practice.

[db_pavnp]

Well, it's NPs that benefit from the suggestion that the difference between PA and NP training is negligible. Because when we look at the averages for credit and clinical hours for programs across the country, PA students complete 2-3x as many credit hours, and 3x as many (if not more) clinical hours than NP students.

 

Yes, we could take any two related "professions" and the one with more credit hours will exaggerate the difference and the one with less will under emphasize it.  Both professions do so out of self interest.  My experience in healthcare has had me on the "exaggerating the difference" side.

 

Hopefully I am not being too reactionary here, but credits do not equal credits and comparisons between NPs and PAs using some sort of credit "multiplier" is inaccurate.  Medical model translates raw lecture hours into credits and I don't think any other model does that.

[PACdan]

Yes, we could take any two related "professions" and the one with more credit hours will exaggerate the difference and the one with less will under emphasize it.  Both professions do so out of self interest.  My experience in healthcare has had me on the "exaggerating the difference" side.

 

Hopefully I am not being too reactionary here, but credits do not equal credits and comparisons between NPs and PAs using some sort of credit "multiplier" is inaccurate.  Medical model translates raw lecture hours into credits and I don't think any other model does that.

 

I'm afraid you're completely wrong.

 

If that was the case, I'd have 40-credit hours per semester, x 4 semesters, through didactic year alone. Spending 40-hours a week in class, and many more hours studying outside of it. Most major colleges and universities calculate the credit hours of a course in a given term by the number of hours spent in class each week during that semester. That's why 3-credit courses usually meet on Tue. and Thur. for 1.5 hours, for example. Or Mon., Wed., Fri., for one hour each. It's expected that each one of those class hours (be it pure lecture, PBL, etc.) has about 2 hours of reading or work attached to it outside of class. That produces the total number of credit hours. This was as true when I was taking 12-credits a semester in undergrad or 18-19 credits a semester in PA school. But in PA we are not even awarded 1/2 a credit per hour of class time, so I have no idea where your "medical model", "raw lecture" hour-converison is coming from, that's complete bunk.

 

All that aside, you didn't even touch on the fact that PA students do much more in terms of clinical experience compared with NP students. This is probably even more important. Our diversity of rotations is much more complete, both total time-wise and exposure-wise. I don't see the NP students rotating through IM, FM, OB, Peds, Gen. Surg, EM, Ortho, Psych, and two electives for 2,400-2600 hours of clerkships in about one year. Sorry, leaps and bounds there.

[Will352ns]

I usually don't chime in on the NP vs PA debates but the idea that "credit hours are not reliable indicators" isn't correct.  As PACdan eluded to, credit hours are regulated and have actual meaning in all schools/programs.  Schools just cannot say "I think this class should be a five credit hour class."  They have to break down the amount of in class time and hourly expectation of outside classwork.  Schools cannot fudge this as it gets into cost amounts.

[db_pavnp]

I'm afraid you're completely wrong.

 

I did not mean to imply that medical model credit hours are calculated as a 1:1 ratio.  It is a fraction of total lecture time.  The medical model does not credit the time you spend studying on your own because, as the argument goes, given the relative simplicity of the information there are students who require no additional review of the material.

 

Credit hours do not equal credit hours unless they can be transferred between institutions.  Additionally, I am specifically aware of programs affiliated with undergraduate institutions that award different credits for the same program.  So, yes, to some extent, schools do dictate what credit to award, within reason, I suppose.

 

So, in summary, no, credit hours are not equal, especially under the medical model.

[Will352ns]

I guess you get credit for not giving up....but you are really not correct on this.

[Boatswain2PA]

....... given the relative simplicity of the information there are students who require no additional review of the material.....So, in summary, no, credit hours are not equal, especially under the medical model.

 

Yeah, because learning how the human body works, how it can go wrong, and what we can do to hopefully make it better is "relatively simple".

 

You no longer have ANY credibility.  None.  Zip.  

[db_pavnp]

You are surprised by the suggestion that clinical education is difficult due to volume, not complexity?  Dunno what to tell you, man.

 

I don't set your ratio of lecture hours : credits, your institution does.  So if you have an issue with your credit calculation, you know who to complain to.

 

Your responses here really smack of trolling in the face of defeat.  Do some Googling on the Carnegie Unit and how it is or isn't applied in various med schools to gain some insight on the topic.  Seeing that this is such a sore point, maybe I will find some way to concisely address it in a paragraph or two.  I understand that it really stabs at the heart of one your favorite ego boosters.

[Delbert]

 A physician assistant must practice under the supervision of a physician. Although pysician assistants, or PAs, may be able to perform certain duties on their own, they do this under the authority of their supervising physician. On the other hand, nurse practitioners may have more independence in that they can carry out some tasks in providing healthcare and assistance independently, without supervision by a physician, depending upon state laws, level of education, and additional certifications and qualifications achieved.

[browndog]

I am An NP. PA didactic education is superior. Clinical hours or greater. Quality of clinical education is dependent and very variable. I had excellent clinical experiences as an NP student. I know some PAs who had terrible clinical experiences. Bottom line, PA is the better education route. Frankly I think this horse is way beyond dead.

[browndog]

Oh, and to the OP. Go to med school, you will never regret being a "full level" provider.

[PACdan]

You are surprised by the suggestion that clinical education is difficult due to volume, not complexity?  Dunno what to tell you, man.

 

I don't set your ratio of lecture hours : credits, your institution does.  So if you have an issue with your credit calculation, you know who to complain to.

 

Your responses here really smack of trolling in the face of defeat.  Do some Googling on the Carnegie Unit and how it is or isn't applied in various med schools to gain some insight on the topic.  Seeing that this is such a sore point, maybe I will find some way to concisely address it in a paragraph or two.  I understand that it really stabs at the heart of one your favorite ego boosters.

 

The paralysis by analysis game is a fallacy. I have reviewed the entire FNP curriculum my institution offers, which is in-line with a majority of the FNP programs across the country, and both the volume and complexity of all courses pales in comparison to the offerings in the PA school. Which is one reason, AMONG SEVERAL, that we do not intermix classes with NP students like we do with med students. You can mince words about credit calculations, but when the NP courses simply do not contain the same depth of material, then it does not even matter that we also have 2.5x the number of credits.

 

I'm sorry if the notion offends you that NP curricula does not reach the same depth and expanse as PA curricula. It's the same apology I'd offer to someone who was whining about PA and MD school comparison. There is a knowledge divide there, just as there is a knowledge divide between PA and NP schooling. It's just a fact.

[db_pavnp]

I have never suggested the two were equal and, realistically, they cannot be.  No two PA programs are equal, how could any NP and PA program be equivalent?  This is a strawman that you, and others, have built based on my assertations that the education between the two share more similarities than differences.  So, please, you may keep your apology to yourself and your invented argument.