Why should I hire a Physician Assistant over a Nurse Practitioner

[mistyPA]

I am a solo physician in the state of Massachusetts and I am in the processing of hiring a mid-level provider. I am researching both professions and would like to know if I should hire a PA or an NP and would like to hear from current PAs (I will post on NP website also). Many MDs I have discussed this with have told me they prefer working with PAs. I would like to hear from the PA perspective.

 

Also, I would like to hear from current PAs working in a solo practice. I would like to know what is important to you regarding the physician/pa relationship. I would like to discuss pt care with the midlevel not just because I want to know how my pts are being cared for, but because I find it very helpful to discuss the care of patients, so that we can be on the same page. I would like my patients to feel confident that they will continue to be treated in the same manner...is this a reasonable expectation in working with a physician assistant?

[MCHAD]

I am a PA student so I will be brief. I know one thing many Physicians like about PA's is the fact that they are trained in the "Medical Model" as opposed to the "Nursing Model" that NP's are trained in. This helps PA's and Physicians stay on the same page (so i am told).

[mistyPA]

I should note that I am using the account of the PA I am considering hiring. We got into a discussion about the differences and she suggested I post, so I did, but didn't want to open my own account on this site.

[Hemegroup]

PA program accreditation involves representatives from quite a few Physician organizations, including the AMA, American Academy of Family Physicians, and the American College of Surgeons. So, much of what PAs are taught is influenced by Doctors. That's nothing to take lightly, in my opinion.

 

P.S. It's just Physician Assistant, no s on the end ;)

[physasst]

As others have pointed out there are some differences in training. That being said, I think of an experienced non physician provider, such as an NP or PA, as bascially equivalent. When we post for openings (I'm in a supervisory capacity) we post the position for an NP OR a PA. It's more important from my perspective to find the right person, and the right personality, than the degree or initials after their name.

 

It's akin to the argument of would you like an MD or a DO as your physician....differences in training, and philosophy to a degree, but practically, the same. I am biased, and feel that PA education is superior as it is far better structured, and accreditation is done through one body ARC-PA. NP education is comprised of ten different specialties, and there are varying CEU requirements based on certifying body. Additionally, there is a lot of variance in education, IE; some NP programs only have 400-600 hours of clinicals, some have 1800 hours. In contrast, PA education is fairly uniform. Lastly, PA's have to take their certification exam every six years (modeled on the OLD family medicine board schedule), whilst NP's only take theirs once upon their initial certification.

 

If I were hiring a new grad, I would lean towards a PA....IF, I were hiring someone experienced, I would focus more on getting the right person and/or personality for the position, regardless of their educational base.

 

That's my 0.02 cents

 

Regards,

 

Mike

[JasonR]

If you are entertaining the idea of hiring a mid-level practitioner (PA or NP), I'd recommend you do sign-up with your own account on this forum. It will keep you abreast to the latest advancing/challenges/discussions occurring in the PA world.

 

Agreed with Physasst, that an experienced PA or NP are virtually equivalent. That is if they are experienced in the same specialty for which you are hiring. PAs are trained as generalists, meaning we can move among different specialties as desired with no additional formal training. NPs on the other hand, specialize and therefore become pigeon-holed in that specialty. So, I'd be cautious of hiring an NP that does not have extensive experience in your specialty, as their training may be inadequate. I asked a NP friend of mine who is in cardiology a question about Nizoral (Ketoconazole) when I was in PA school. She responded with a confused look and informed me she had never heard of the drug. She didn't even recognize the -zole part of the name as an antifungal.

 

Hire someone that will work well with your personality and has a passion and skill for learning new things. Everything else will fall into place.

 

jason

[coloradopa]

In addition to the training the other issue is scope of practice. Quickly looking at the Massachusetts nursing and PA practice act they are both very similar. You will have to generate guidelines for IV drugs and schedule II drugs for both. For nurse practitioners you will have to develop protocols for schedule II drugs and when consults or referrals are necessary. The OP does not say what specialty they are in but depending on the specialty and patient population there can be substantial difference between the PA and NP scope of practice. The PA scope is based on the physician scope while the NP scope is based on their NP specialization. The scope is also interpreted differently by different BONs.

 

David Carpenter, PA-C

[Iain1028]

Because NPs do not take biochem, gross anatomy or any of the other hard sciences in NP school. And because PAs are usually better looking in general.

[JasonR]

And because PAs are usually better looking in general.

 

I'd love to see that research study! Haha!

[andersenpa]

I think you're on the right page re: mutual discussion of patients.

 

Team approach is emphasized from day one in PA training and in general PAs are accustomed and receptive to this model.

The ideal partnership is one where the physician is available to the PA as needed and the PA's management skills are allowed to develop. As the relationship prolongs, the PA knows the doc's practice style and vice versa; there should be less need for "checking in" on routine issues, whule keeping the door open for discussion.

The didactic and clinical content of PA education is a bit broader than NP education, but an experienced NP in your specialty should equal out to an experienced PA within 3-5 yrs in practice.

[Houstonian]

I would recommend that you define the job responsibilities and what kind of training & experience would be required by a midlevel to satisfactorily fulfill those responsibilities, plus the intangible qualities that you are looking for, such as work ethic, compassion, ability to communicate, specific skills required. Then you could determine whether a physician assistant or nurse practitioner or either would best meet those requirements. For example, if you are looking for someone to provide surgical assistance, it is far more likely that you could find a PA with a surgical background than an NP, unless the NP's background was in surgery as an RN scrub nurse of RN first assistant. Also the scope of practice of an NP may not permit him or her to be a surgical first assistant.

 

On the other hand, if you are looking for someone to provide primary care, then you would need a provider trained in primary care. That includes all PA's but only a portion of the NP's. In family practice, you could hire a PA or a family nurse practitioner. In internal medicine you could hire a PA or an Adult Nurse Practitioner, or possible a Family Nurse Practitioner. However, an Adult Nurse Practitioner would be unable to examine anyone under the age of 16, so that wouldn't work in family practitice. In pediatrics, you could hire a PA or a Pediatric Nurse Practitioner.

 

Since you are in solo practice, I think it is unlikely you are staffing a critical care unit. However, in critical care you could hire a PA or an Acute Care Nurse Practitioner. Obviously you would probably want someone with prior critical care experience either as a PA or as an RN or NP. A new grad PA or NP without critical care experience would probably not be good fit for that position. But unless I am mistaken, even an Acute Care Nurse Practitioner would be unable to treat or examine anyone under the age of 16.

[merseur]

Good point!

 

I would recommend that you define the job responsibilities and what kind of training & experience would be required by a midlevel to satisfactorily fulfill those responsibilities, plus the intangible qualities that you are looking for, such as work ethic, compassion, ability to communicate, specific skills required. Then you could determine whether a physician assistant or nurse practitioner or either would best meet those requirements. For example, if you are looking for someone to provide surgical assistance, it is far more likely that you could find a PA with a surgical background than an NP, unless the NP's background was in surgery as an RN scrub nurse of RN first assistant. Also the scope of practice of an NP may not permit him or her to be a surgical first assistant.

 

On the other hand, if you are looking for someone to provide primary care, then you would need a provider trained in primary care. That includes all PA's but only a portion of the NP's. In family practice, you could hire a PA or a family nurse practitioner. In internal medicine you could hire a PA or an Adult Nurse Practitioner, or possible a Family Nurse Practitioner. However, an Adult Nurse Practitioner would be unable to examine anyone under the age of 16, so that wouldn't work in family practitice. In pediatrics, you could hire a PA or a Pediatric Nurse Practitioner.

 

Since you are in solo practice, I think it is unlikely you are staffing a critical care unit. However, in critical care you could hire a PA or an Acute Care Nurse Practitioner. Obviously you would probably want someone with prior critical care experience either as a PA or as an RN or NP. A new grad PA or NP without critical care experience would probably not be good fit for that position. But unless I am mistaken, even an Acute Care Nurse Practitioner would be unable to treat or examine anyone under the age of 16.

[primadonna22274]

I'll weigh in here as a PA educator. I absolutely agree that when comparing new grads, PAs are a much more consistent and reliable product. Our accrediting body ARC-PA mandates standards and competencies that we as PA programs have to meet. We have ONE certification exam which all PAs must pass to demonstrate minimum competency to practice medicine with physician supervision. We are trained alongside and by physicians and are taught to think like physicians. We emphasize differential diagnosis and medical decision-making and teach full-spectrum medicine. We produce generalists who are broadly prepared to enter any specialty of medicine; from there the PAs can gain further on-the-job training or enter a residency training program, if they wish.

You also can rest assured that PAs will be licensed and regulated by YOUR medical board. You do not have this guarantee with NPs. And, NPs think like nurses--whereas PAs think like physicians. Throughout their training, PAs are acclimated to the "team medicine" role. This plays out in practice as a very strong supervising physician-PA team.

In my opinion, you would more predictably be able to train/influence a PA to treat patients the way that you would treat them than with an NP. This may be my bias, I admit--but keep in mind that nursing is an independent field, independent licensing boards, with a long history of animosity between medicine and nursing (sadly).

After about 5 years in practice, I agree that the lines between PAs and NPs blur quite a bit and at that point you should evaluate individual knowledge, talents, and "fit" for your practice.

Of course I want you to hire a PA, but ultimately it is YOUR choice. I do applaud you posting this important question to us as a forum and I am glad to help.

If you need more specific information on hiring a PA, the AAPA (www.aapa.org) has some very good literature to help you get started. Sounds like you already have a potential PA in mind--she could help you also with navigating the hurdles. I've broken in a few new SPs in my time and it's always a transition, but usually a good one with positives on both sides.

Best wishes,

Lisa

[browndog]

One NPs perspective.......

 

- PAs are better educated "out of the box", no question

- There should be little difference between NP and PA after a couple of years of practice

- Not all NPs think like nurses....in fact, please don't shoot me, most male NPs that I have met do not think like nurses, and probably did not as an RN. It seems that the we gravitate to flight, ED and ICU. I know....it is a stereotype....but it seems to be true in "my neck of the woods".

- I agree with the postings above that "fit" is the most important aspect. That is true in most situations....business, medicine or what have you.

[Contrarian]

If you are going to pay the premium for an experienced provider (3-5 yrs) then its gonna be all about the "Practice Fit" and "provider compensation" because the clinical skills are likely established equitably between these two types of providers at this point.

 

The issue for you here may be trading a bit of hand-holding and micro-managing for someone who has already established a practice style and can hit the ground running" if properly supported. Simply put... a experienced (PA/NP) provider will likely cost more initially, but will make you much more at the onset, be less of a liability, and only need/appreciate your "supervision" in name only. Hiring this "experienced" provider will be much more like hiring another "physician" (for a bit less) in that as long as the tools for success are available, this provider will do well with minimal input and can act as a consultant that you can bounce ideas and questions off of and will consult you PRN.

 

Whereas if you are not willing to pay for experience and want to spend a yr or two to "groom" the practice style of this provider then you will probably be better suited with a new grad PA because the medical knowledge base will be wider than that of a NP and as a new grad... this provider is basically a clean slate and won't mind being micro managed.

 

Another option may be to volunteer to serve as a preceptor to the local NP & PA programs.

Then you can spend a yr "pimping" a couple PA students and a couple NP students.

Doing so will allow you to "sample the product" yourself, see the differences in the raw product and make an informed decision.

 

Just a few thoughts...

 

Contrarian

[mistyPA]

I would like to thank everyone who responded to this thread. I have made the decision and will be hiring the PA for many of the reasons that were suggested. I have found that the PA education is...dare I say superior to that of NPs given the model I am looking for. I want to work in a team environment and welcome the opportunity to bounce things off of a colleague. I believe I have a better chance of this with the PA...my reasoning includes training in the medical model and the team approach to medicine and to my practice in particular. I want our patients to know that they will receive similar treatment with whomever they see. I think that is important for a variety of reasons from everything from continuity of care to antibiotics not being prescribed recklessly.

 

One of the main reasons I have opted for the PA is that I was having dinner with another internal medicine MD 2 nights ago and he had a horror story with his NP...there was a certain amount of challenge or animosity that developed when he made suggestions regarding the care of the patient. This isn't the first time I have heard of this happening.

 

Again thank you all for weighing in and I will post in a few months to let everyone know how things are going.

[marilynpac]

Congratulations Dr. you made an excellent choice.

[primadonna22274]

Hurrah! So glad we were able to help you make an informed choice. Now you just have to determine fit...I hope this will be the beginning of a long and successful relationship :)

[Guest Aliome]

Did I miss something? Did the original poster not contact previous employers/personal references? Did a person's personality not come into play here? That should weigh the most heavily in the general practitioner forum...

 

good luck when Sven, the self absorbed PA encounters your very blue collar patients up there in rural yankee Mass( I'm from there.) Serioulsy, you didn't mention your patients once-not how THEY would feel about NP versus PA-because I can tell you now( and my goal is to be a PA) all those western Mass yankees will accept an NP over a PA-they know an NP is an advanced nurse- they don't CARE what a PA is SUPPOSED to be TO THEM....

[smeegal9]

I had an interview with a DR. looking for a PA or NP. He revealed that he was disillusioned with the previous NP because she disagreed with his treatment plans and changed them often because felt that she was an independent practitioner; therefore, it would be fine to change medical protocol and his personal preferences because she could practice on her own. As most NP's work with a collaboration agreement and a PA works with a delegation agreement, she was not in "collaboration" with him and he was less than thrilled with the care she gave his patients.. I'm not saying that this is the norm, but it is sometimes the direction taken with an "independent practitioner".

[smeegal9]

Aliome....no patient is initially open to seeing anyone but an MD, unless they have heard good things about the midlevel practitioners beforehand. With self confidence and portraying your depth of knowledge to the patient during your first encounter, you win over your patients. They develop confidence in you. They appreciate that you can spend more time with them, you illicit a full history...things they have not thought of before surface. They go home and google "PA". They know that you have the support of ther MD, because you were hired by them. You treat their problems effectively and treat them as a whole person. Then they tell somebody, and they tell 2 people, and they tell 2 people, etc....etc...., and your practice grows! You could live in East Jablipee and this will still work for you.

[smeegal9]

Hahahahahahaha...the picture of a "self absorbed PA" is foreign to me! Can I get a witness! Can you be self absorbed and be a PA? It's a total Oxymoron!

A PA has to prove him/herself every day, at every turn, to everybody!

[Contrarian]

Did I miss something? [ummm... Apparently you did..!!! It was likely a class in manners and avoiding faulty ASSumptions...] Did the original poster not contact previous employers/personal references? [it appears that you are ASSuming that the OP has no experience hiring employees and also ASSuming those things weren't done before the OP came here to SPECIFICALLY inquire about the differences between NP & PA training and practice] Did a person's personality not come into play here? That should weigh the most heavily in the general practitioner forum... [How do YOU know this....??? Are you a MD/DO/NP or PA...??? Do you practice medicine... Or are you ASSuming and Speculating/Guesstimating...???]

 

good luck when Sven, the self absorbed PA encounters your very blue collar patients up there in rural yankee Mass( I'm from there.) [This is just silliness considering it was clear from the original post that this physician was considering hiring a FEMALE PA and simply wanted info on what should be considered as it pertains to the differences in training between and the clinical practice of NPs and PAs] Serioulsy, you didn't mention your patients once-not how THEY would feel about NP versus PA-because I can tell you now( and my goal is to be a PA) all those western Mass yankees will accept an NP over a PA-they know an NP is an advanced nurse- they don't CARE what a PA is SUPPOSED to be TO THEM....

[sERIOUSLY.... It is rare (as in never) that a Practice queries/polls the public and makes internal decisions about who to/not to hire based upon how they... the general public FEELs about these things. If they did, there would be lots of practices without African Americans, Jewish Americans, Latino/Latina Americans, DOs, etc... or without a mid-level at all, because MOST patients would prefer to ONLY be seen by a BC Physician.

 

As has been mentioned, confidence by the Physicians and clinical excellence is usually how the general public is convinced that ANY person other than a physician is competent. What is interesting is that YOU are NOT a MD/DO/NP/PA... YOU don't now and have never practiced medicine... but seem to think that YOU can read the minds of everyone in western Mass...!!! Its really coool if you can, but I doubt it. If I'm wrong, your mind reading is gonna be helpful when you DO get a PA school interview, and when you get into practice because then you will be able to continue to speak for everyone in western Mass with such learned authority...!!! ]

 

Its kinda odd that YOU claim to be trying to become a PA... but come across as angry and disturbed that the OP decided to hire a PA versus a NP. Its also particularly odd that YOU think the general public gets to decide who a practice hires and that YOU know what the gen pop in 'western mass' wants/thinks.

But I'm sure YOU got it all figured out... :;DD:

 

Just a few thoughts...

 

Contrarian

[istat2]

And I was going to congratulate everyone on having a cogent, collegial conversation. Then Aliome showed up (sigh). Hey Aliome, your classed as other. What do you do for a living? Can you validate your remarks? Or are you just emoting?:=Z:

[Contrarian]

I'm gonna put my cash on "emoting"... :wink: