ArtisticAthlete Posted August 29, 2009 Share Posted August 29, 2009 I've finally decided that I want to work in the Pediatric Orhopedic field. I have a B.S. in Biology but I don't know if I want to be a NP or PA. I know if I go PA, it will only be 2yrs but people have told me NPs have more autonomy? :confused: I've yet to be able to shadow either so I have to use forums for information...for now. I know this is the PA forum, and I'm not trying to start a PA vs NP war, I'm just trying to figure out which field will have more job opportunities (PA or NP) if my my main goal is to work in the Pediatric Orthopedic field? Also, feel free to explain your answer; the more info, the better. :D Thanks a bunch... Link to comment Share on other sites More sharing options...
coloradopa Posted August 29, 2009 Share Posted August 29, 2009 I've finally decided that I want to work in the Pediatric Orhopedic field. I have a B.S. in Biology but I don't know if I want to be a NP or PA. I know if I go PA, it will only be 2yrs but people have told me NPs have more autonomy? :confused: I've yet to be able to shadow either so I have to use forums for information...for now. I know this is the PA forum, and I'm not trying to start a PA vs NP war, I'm just trying to figure out which field will have more job opportunities (PA or NP) if my my main goal is to work in the Pediatric Orthopedic field? Also, feel free to explain your answer; the more info, the better. :D Thanks a bunch... Repeat after me autonomy is earned. Who do you think is going to have more autonomy. A new grad PA who has clinical experience in Orthopedics and Peds or a new grad PNP who has no surgical or orthopedic experience whatsoever and can't get into the OR without additional training. 10% of PAs work in orthopedics. Less than 2% of NPs work in surgery. Where are you most likely to find a job? That being said Peds Ortho is pretty specialized and there is going to be a large element of luck in landing a job. Best bet would be getting into an orthopedics practice and wait for a peds spot to come open. Personal experience (n=6) is that experienced ortho PA who has done some peds is going to be the preferred provider. David Carpenter, PA-C Link to comment Share on other sites More sharing options...
ArtisticAthlete Posted August 29, 2009 Author Share Posted August 29, 2009 Repeat after me autonomy is earned. Who do you think is going to have more autonomy. A new grad PA who has clinical experience in Orthopedics and Peds or a new grad PNP who has no surgical or orthopedic experience whatsoever and can't get into the OR without additional training... Very true, autonomy is definitely earned. Your degree doesn't really make a difference, I guess, when it comes to autonomy unless you're a MD. How long does a PA get orthopedic and pediatric clinical experience in PA school? 6 wks? (<--I heard that from someone a while ago). NPs get clinical experience in Pediatrics so the only thing a PA would have , over a NP, is 6wks of Ortho experience, right? Just wondering b/c both of them are going to need on-the-job training. I know NPs need extra training to be able to 1st asst but once they get that training, aren't the opportunities the same? A new grad PA needs to be trained...and a new grad PNP would need to be trained, correct? In my case, I guess PA would be the shortest route but I'm just curious... Link to comment Share on other sites More sharing options...
bradtPA Posted August 29, 2009 Share Posted August 29, 2009 You should also realize that pediatric ortho is a very specialized field. PA training is a generalist training model. If you want to do this, consider medical school. Link to comment Share on other sites More sharing options...
tracy w Posted August 29, 2009 Share Posted August 29, 2009 for what its worth (and i'm just on rotations now), PAs can get 6 weeks of ortho (which includes surg), but also have 6 weeks of lllooong days in general surgery, and may have a float block in another surgical specialty (heck, even my ob gyn rotation was 50% surgical)... so, surgical experience may be greater in PA programs than in the nurse or NP training program (but, then, i do not know what their training is at all). good luck. Link to comment Share on other sites More sharing options...
ArtisticAthlete Posted August 29, 2009 Author Share Posted August 29, 2009 You should also realize that pediatric ortho is a very specialized field. PA training is a generalist training model. If you want to do this, consider medical school. But Peds Orthos need PAs, right? I'm sure it will be harder to find a Peds Ortho job (vs an Ortho job) but I'm sure they're out there. I don't think I want to go to med school just so I can eventually work as a Peds Ortho. I'm in my late 20's and that would take 10 yrs...once I got in :eek: I already contemplated that... Link to comment Share on other sites More sharing options...
coloradopa Posted August 29, 2009 Share Posted August 29, 2009 Very true, autonomy is definitely earned. Your degree doesn't really make a difference, I guess, when it comes to autonomy unless you're a MD. How long does a PA get orthopedic and pediatric clinical experience in PA school? 6 wks? (<--I heard that from someone a while ago). NPs get clinical experience in Pediatrics so the only thing a PA would have , over a NP, is 6wks of Ortho experience, right? Just wondering b/c both of them are going to need on-the-job training. I know NPs need extra training to be able to 1st asst but once they get that training, aren't the opportunities the same? A new grad PA needs to be trained...and a new grad PNP would need to be trained, correct? In my case, I guess PA would be the shortest route but I'm just curious... A new grad PA needs to be trained but they can already scrub due to their surgical rotation. Most hospitals will make an NP get their RNFA which involves more classwork and clinicals. As far as experience its whats you get out of it. My coursework was 5 weeks peds = 300 hours. Surgery 5 weeks (around 1/4 peds) = 115 hours (15 cases including 4 Ortho). EM 5 weeks (2 weeks in PEDs ER) = 144 hours. Peds GI (elective) = 300 hours. So my total peds exposure was around 850 hours. Compare that to the local PNP program where they get 500 hours. If I wanted to do peds ortho instead I could have done my elective there and gotten 400 hours in 5 weeks pretty easily. So I would have almost as many hours in peds ortho as the local PNPs have in total hours. Its all what you make of it. Or you could do the CHAPs program and get even more peds hours (probably over 1100 over three years). Or the UAB program and get more surgical experience. I'm sure there are PNP programs that get more but thats the minimum to get certified and what most of the local PNPs did. Like I said if you want something the opportunity is there. Even with experience there is going to be an element of luck to get peds ortho. There just aren't that many jobs and the ones that are there are usually coveted (even though the pay may lag adult cases). David Carpenter, PA-C Link to comment Share on other sites More sharing options...
Mukisa Posted August 30, 2009 Share Posted August 30, 2009 Seattle Childrens has hired new grad PA's in Peds ortho, it appears to be mostly clinical and not much OR from what I have heard. Link to comment Share on other sites More sharing options...
bradtPA Posted August 30, 2009 Share Posted August 30, 2009 But Peds Orthos need PAs, right? I'm sure it will be harder to find a Peds Ortho job (vs an Ortho job) but I'm sure they're out there. I don't think I want to go to med school just so I can eventually work as a Peds Ortho. I'm in my late 20's and that would take 10 yrs...once I got in :eek: I already contemplated that... How many peds ortho surgeons do you see? Be honest, but they are not many and all at teriary care centers. If you only have a handful of these specialists per state, you are gonna really be bummed if you train as a PA to do this one thing, and can't find a job in it. If you become a surgeon and get the fellowship, you can make your own job..... Link to comment Share on other sites More sharing options...
PADad Posted August 30, 2009 Share Posted August 30, 2009 But Peds Orthos need PAs, right? I'm sure it will be harder to find a Peds Ortho job (vs an Ortho job) but I'm sure they're out there. I don't think I want to go to med school just so I can eventually work as a Peds Ortho. I'm in my late 20's and that would take 10 yrs...once I got in :eek: I already contemplated that... PAs are increasingly common in specialty pediatric hospitals within the surgical specialties. NPs pretty much dominate in general pediatric offices, NICUs, PICUs, and floors - though there are a scattering of PAson those services. As stated in prior posts, pediatric surgical specialties are primarily found at the ~275 pediatric tertiary centers in the U.S. There are about 50+ free-standing pediatric hospitals and the rest are pediatric hospitals-within-hospitals. These also include the Shriner's system. Use of PAs is relatively recent, compared to adult hospitals, but is increasing steadily. There are a number of PAs in peds ortho, with peds neuro being a relatively similar role. Most work is in the clinic and on the floor with very limited OR work. As for autonomy, there is no difference between PAs and NPs in the pediatric hospital. Specialty pediatric clinical care teams are often more integrated and team oriented than their adult counterparts. NP "autonomy" is only relevant in the FP or counseling practices - and even then their variety of patients is relatively limited. If you want it, go for it. :) PA use in pediatric hospitals will only be increasing. Get exposure to the area, get relevant rotations, and network. I got started by volunteering in a pediatric rehab hospital. Link to comment Share on other sites More sharing options...
PADad Posted August 30, 2009 Share Posted August 30, 2009 which field will have more job opportunities (PA or NP) if my my main goal is to work in the Pediatric Orthopedic field? PAs have more job opportunities. As previously posted, peds ortho jobs are their but few. To gain relevant experience and to work your way towards that goal, PAs can work in a variety of practices and roles. NPs cannot. So, if you can't get that peds ortho job right off, you can still get there later. A PA can start in a general peds practice, move to peds ED, and eventually to peds ortho. An PNP trained in ambulatory pedatrics stays in ambulatory pediatrics. A PA can start in adult ortho and move to peds ortho. NPs cannot move from the adult to the strictly pediatric population. (FNPs are only certified to provide preventive pediatric services) There are a number of pathways a PA can take to reach a practice goal, such as peds ortho. Link to comment Share on other sites More sharing options...
coloradopa Posted August 30, 2009 Share Posted August 30, 2009 How many peds ortho surgeons do you see? Be honest, but they are not many and all at teriary care centers. If you only have a handful of these specialists per state, you are gonna really be bummed if you train as a PA to do this one thing, and can't find a job in it. If you become a surgeon and get the fellowship, you can make your own job..... On the other hand to become a peds ortho surgeon you have to get into medical school, get impossibly high step 1s plus great letter (ortho = step 1 +bench press > 500). Then after getting into an ortho residency you have to do some research and get into a peds ortho fellowship. Peds ortho fellowships don't generally fill so the major hurdle will be getting an ortho residency. This is out of reach for the majority of medical students. You might be more bummed if you do four years of medical school and can't even get into orthopedics. Of course if you've never worked in the field before then you might find something else you like, either as a PA or physician. David Carpenter, PA-C Link to comment Share on other sites More sharing options...
ArtisticAthlete Posted August 30, 2009 Author Share Posted August 30, 2009 So PNP's only work in primary care? PNPs can't work w/ specialists? I didn't know that... I saw a job ad for a PNP, at a huge specialty pediatric hospital/clinic where I live, and it was for Pediatric Surgery. Needless to say, that was the only job I saw so that could have been a fluke. In addition to being interested in Peds Ortho, I'd also be interested in any Peds specialty - Peds Neuro, Peds Cardio, etc. Peds Cardio would be my 2nd choice... Oh, and those of you guys who said I wouldn't have a lot of OR time, w/ these specialists...that's ok with me. Link to comment Share on other sites More sharing options...
coloradopa Posted August 30, 2009 Share Posted August 30, 2009 So PNP's only work in primary care? PNPs can't work w/ specialists? I didn't know that... I saw a job ad for a PNP, at a huge specialty pediatric hospital/clinic where I live, and it was for Pediatric Surgery. Needless to say, that was the only job I saw so that could have been a fluke. In addition to being interested in Peds Ortho, I'd also be interested in any Peds specialty - Peds Neuro, Peds Cardio, etc. Peds Cardio would be my 2nd choice... Oh, and those of you guys who said I wouldn't have a lot of OR time, w/ these specialists...that's ok with me. PNPs are divided. There are two PNP certifications. Acute Care PNP and Primary Care PNP (AC-PNP and PC-PNP). You essentially have to choose when you are in school which direction you will go. In states that don't really enforce their nurse practice acts you will see primary care PNPs working in the inpatient setting (just like you see FNPs there). In states that enforce the nurse practice act like Texas you will only see AC-PNPs in the inpatient setting. For NPs to work in surgery most hospitals require that the get RNFA certification which requires additional training and hours. David Carpenter, PA-C Link to comment Share on other sites More sharing options...
bradtPA Posted August 30, 2009 Share Posted August 30, 2009 On the other hand to become a peds ortho surgeon you have to get into medical school, get impossibly high step 1s plus great letter (ortho = step 1 +bench press > 500). Then after getting into an ortho residency you have to do some research and get into a peds ortho fellowship. Peds ortho fellowships don't generally fill so the major hurdle will be getting an ortho residency. This is out of reach for the majority of medical students. You might be more bummed if you do four years of medical school and can't even get into orthopedics. Of course if you've never worked in the field before then you might find something else you like, either as a PA or physician. David Carpenter, PA-C A valid point, Dave. If I was the OP and dead set to do this as a PA, I would go to PA school, do an ortho residency at a tertiary care facility, and hope the networking during residency would open doors to the subspecialty. Link to comment Share on other sites More sharing options...
ArtisticAthlete Posted August 30, 2009 Author Share Posted August 30, 2009 10% of PAs work in orthopedics. Less than 2% of NPs work in surgery. Where are you most likely to find a job? That being said Peds Ortho is pretty specialized and there is going to be a large element of luck in landing a job. Best bet would be getting into an orthopedics practice and wait for a peds spot to come open. Personal experience (n=6) is that experienced ortho PA who has done some peds is going to be the preferred provider. David Carpenter, PA-C Why? Are most PAs just not interested in orthopedics? From what I've seen, there are a lot of Ortho practices so it's not like the opportunities aren't there. Link to comment Share on other sites More sharing options...
bradtPA Posted August 30, 2009 Share Posted August 30, 2009 Why? Are most PAs just not interested in orthopedics? From what I've seen, there are a lot of Ortho practices so it's not like the opportunities aren't there. 10% is actually a large number. Think about it, 10% of the entire career field is involved in ortho; thats thousands of jobs..... Link to comment Share on other sites More sharing options...
ArtisticAthlete Posted August 30, 2009 Author Share Posted August 30, 2009 10% is actually a large number. Think about it, 10% of the entire career field is involved in ortho; thats thousands of jobs..... Not really. 10% is 10%. I just read that there are about 80,000 people who work as PAs in the U.S. So, about 8,000 of them work in Ortho. Yes, 8,000 is a large number but that leaves 72,000 PAs that aren't working in Ortho; that's a large number. In comparison to the career, Ortho PAs are a small number. But then again, I guess there are fewer Orthopedic Surgeons, in the medical career, than family practice, pediatricians, etc. Eh...whatever. I'll just cross my fingers and hope I land a job in Ortho...esp Peds Ortho if I pursue a career as a PA. :) Link to comment Share on other sites More sharing options...
bradtPA Posted August 30, 2009 Share Posted August 30, 2009 Well, most of us are in primary care. Its where the shortage is, and what the job originally was designed for (filling in for the shortage of primary care docs), and why our training model is a generalist model;). That said, the only thing stopping you from being a specialist as a PA is not finding a physician willing to train you and hire you. Link to comment Share on other sites More sharing options...
HawkeyeFan Posted December 2, 2009 Share Posted December 2, 2009 I just stumbled upon this thread and am extremely intrigued by it, mostly because I found the golden ticket. I graduated in June of 2009 and started a job in Pediatric Orthopedics with a fellowship trained surgeon in private practice 4 months ago. I am 50% clinic and 50% surgery and I love it. I can't imagine doing anything else. But what I have also learned is that this job is rare. It is hard to find true pediatric orthopods (as opposed to general ortho surgeons that like to deal with peds) outside of university and training settings. Most of these places have residents which can decrease the needs of PAs. So I guess the moral of the story is that these jobs do exist.....and that I very lucky to have found one! Link to comment Share on other sites More sharing options...
dsstandiford Posted May 28, 2011 Share Posted May 28, 2011 I also landed a job in peds Ortho and start Wednesday. I was wondering what you guys/gals in the field feel is appropriate compensation. With all the medicaid my Doc is not generating a ton of revenue. That and he has only 1-2 full days of sx. I have zero experience in either peds or Ortho (lab background). He already has an FA to help in the OR but they are willing to let me learn and stand in. Link to comment Share on other sites More sharing options...
garyjames84 Posted November 11, 2013 Share Posted November 11, 2013 Cook children's in Fort Worth, TX has an excellent pediatric ortho group, and I was lucky enough to be able to observe and develop a working relationship with one of their PAs, Russell Smith, before PA school. I was an athletic trainer for a private school (k-12) and I would refer a lot of the student-athletes to Russell. He would let me stop by on a regular basis to observe him; he also was an athletic trainer prior to becoming a PA so we had some common ground. He has a great job with excellent pay and hours: Mon-Tue-Thur-Fri 8am-330pm, 4pm-10pm on Wednesdays for call and OR Link to comment Share on other sites More sharing options...
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