Should I have become an NP?

[CSCH]

Hi guys. Not trying to start a flame war here. Honest, serious answers only, please. My boyfriend just got accepted to a direct entry master's nursing program, and it's got me thinking. In four years, starting from a liberal arts degree, he's going to get a DNP. He's going to get to practice under his own license (albeit, it doesn't quite work out that way in all circumstances). APNs can work independently at the VA. APNs have the entire nursing lobby behind them. Seems like everything new granted to mid-levels goes to APNs first.

Did I make a mistake? I'm halfway through PA school, looking at a career in women's health, and wondering if I shouldn't have just become a CNM.

Do any of you regret not going the nursing route? Do you feel like PAs are going to be able to practice independently in the near future? Any other thoughts?

[ventana]

tough question

 

NPs are killing it in the political realm

 

AAPA was "asleep at the wheel" for about 2 decades and we are seriously far behind (just yesterday the VA granted NP full practice independence) 

BUT

AAPA has "seen the light" 

and the times are a changing....

 

so hold on, make sure to be politically active (or at least send the equivalent of a cup of coffee expense to the AAPA PAC cause in DC money talks and BS walks)

 

Join your state chapter - speak up for PAs

Join AAPA (not to debate it here but they are really our federal PAC)

 

Speak out

Educate

 

Push for terminal doctorate professional degree (lots of posts on this all over this board)

 

We will catch up as we are such an amazing group of people!

[MT2PA]

You're half way through school.  What good does it do to wonder now?  Don't dwell on it unless you plan to change it.

[Acebecker]

NPs are ahead with regard to practice rights nationwide.  They are moving toward universal doctorates.  They have clout.  But their education is still....  Shall we say...  Not good.  I have faced more than a few hurdles and have not gotten to practice the way I want to yet, but I would still pick my education over that of an NP program (unless it's the dual NP/PA program out of a school in California which would be the way to go). 

 

My $.02

[overthehorizen]

Two of my classmates got kicked out of my PA program. They are both NPs now. At the time they were kicked out, I thought "gee, I feel bad for them." Now, I look at them and think "Gee, I feel bad for me." Their misfortune turned out to be the greatest blessing of their lives. If PAs do not win practice independence, we will die. If there was independent practice for PAs, I bet that 5000 PAs would form private practices in the next twelve months and EXPAND the access for those who cannot find a doctor. NPs are killing us. They will drive our profession into nonexistence in less than ten years. If I were an undergraduate, I would never encourage a student to become a PA. I won't even take PA students from PA programs on rotation because I know that this profession is a dead end. These young people are being duped into spending $50,000 on tuition to take a job that will never grant them the right to get a return on their investment. If you are under 30, do not go to PA school. Choose medical school or NP school. If you are over 30, choose NP school. Med school will be a hard hill to get into and you'll be lucky to get a sub specialty you love. Going to med school to practice primary care vs going to NP school to practice primary care is not even a decision to think about. Go to NP school. IF you are a PA over 40, grit your teeth for ten more years until the profession dies. 

[BruceBanner]

OP, I dont think you made a mistake. NPs are leaps and bounds ahead of us politically, but I think their practical advantage over us is overstated.

 

The quality of NP education is not standardized and suspect at best. Believe it or not many physicians prefer PAs and will preferentially hire PAs, so I'm not sure I agree the profession is going to die anytime soon. Short term you have nothing to worry about. Long term, say 10 years and beyond---well it's anyone's guess. My hunch is that once large-scale, independent outcomes data on independent nursing practice comes out much light will be shed on their training.

[LKPAC]

 

The quality of NP education is not standardized and suspect at best. Believe it or not many physicians prefer PAs and will preferentially hire PAs, so I'm not sure I agree the profession is going to die anytime soon. 

 

Very true.  I know of medical groups and some individual docs that won't hire NP's.  They know that PA education is superior.  Some don't like the fact that NPs do not retest. How do you know if they're keeping up their knowledge?

 

I have worked with some excellent NP's, though.

[cbrsmurf]

OP, I dont think you made a mistake. NPs are leaps and bounds ahead of us politically, but I think their practical advantage over us is overstated.

 

The quality of NP education is not standardized and suspect at best. Believe it or not many physicians prefer PAs and will preferentially hire PAs, so I'm not sure I agree the profession is going to die anytime soon. Short term you have nothing to worry about. Long term, say 10 years and beyond---well it's anyone's guess. My hunch is that once large-scale, independent outcomes data on independent nursing practice comes out much light will be shed on their training.

 

It doesn't really matter if NP education is substandard or that they lack standardized testing, employers at big hospitals will prefer NP's because they do not require MD/DO supervision and patients will prefer NP's because they have doctorates.  The nursing lobby will push and eventually succeed for 100% reimbursement.  No study will be able to prove which type of provider is more effective as there are too many variables.  PA's are lagging behind and are at risk for falling even further behind.  On the other hand, we have been around for 50 years and are still kicking.

[Greg Cain PA-C]

A word to the wise.  I was evidently kicked out of the AAPA for voicing my concerns about the AAPA with regard to their failure on the VA Full Practice Authority issue.  When I tried to log in to Huddle this afternoon I was notified that "your account has been disabled."  Good riddance, they were a waste of dues money anyway if they are so sensitive as to get their collective feelings hurt that easily and ban me rather than engage in open discussion and debate.  If the AAPA were to go after the NP lobby as aggressively as their own members then they might actually get something done and win one of these battles instead of lose every time as if that was the intent.

[AliB]

Posted about 11 PM Eastern on Huddle:

Dear AAPA Members, 

If you tried to login to Huddle today (Thursday) between 4:30 and 8:00 PM, you were greeted with a rather confusing error message. A coding glitch in an update caused our login verification process to completely shut down, impacting all members. The issue has been fixed and everyone should once again have access to Huddle. 

We apologize for the inconvenience, and thank you for your patience as we worked to resolve the problem.

Best regards,

------------------------------
Catherine Gahres
Vice President, Membership Development & Services
American Academy of PAs
Alexandria VA
------------------------------

 

[3GeronimoPA]

Hi guys. Not trying to start a flame war here. Honest, serious answers only, please. My boyfriend just got accepted to a direct entry master's nursing program, and it's got me thinking. In four years, starting from a liberal arts degree, he's going to get a DNP. He's going to get to practice under his own license (albeit, it doesn't quite work out that way in all circumstances). APNs can work independently at the VA. APNs have the entire nursing lobby behind them. Seems like everything new granted to mid-levels goes to APNs first.

Did I make a mistake? I'm halfway through PA school, looking at a career in women's health, and wondering if I shouldn't have just become a CNM.

Do any of you regret not going the nursing route? Do you feel like PAs are going to be able to practice independently in the near future? Any other thoughts?

If you have to ask, then yes.  You should be a NP.

 

Less than one percent of NPs own their own practice.  When it comes to "independent practice", just because you can doesn't mean you should.  The VA definition of "supervised" is very very loose anyways.  PAs and NPs see patients and at the end of the month a Doc grabs like 10 charts with chief complaints where there could be hiccups in standards of care like "albuterol refill", "low speed MVC", "intermittent chest pain" etc. to make sure that things that are commonly missed by all types of practitioners are not missed by their providers.  They send feedback like, "good job", "strong work", or "it's important to do ECGs on these patients" etc and if there are egregious acts the SP conducts a sit down with a training plan.  Aside from the egregious stuff, it all resembles peer chart reviews that are done at other institutions.  Most importantly, if you have a bad outcome in a patient who goes to the state med board and you have 5+ years of documented flawless chart reviews it only serves you well in your defense.  I don't care what doctors read my charts.  If I'm screwed up and not providing evidence based medicine then I should be kicked in the pants.  The medical model is the science model plain and simple.  If you don't think it's for you, better to get off the train now than later.

[Guest ERCat]

I have never and will never want to be an NP. Wasn't even a consideration. Our education is night and day - this is confirmed by my multiple NP friends who are shocked how ill prepared they are to actually be critical thinkers and diagnosticians once they leave school. Also confirmed by the fact that nearly every single smart as heck ER doctor I've worked with said that they are more impressed by and comfortable with the new grad PAs than they are with the NPs with ten years of experience. They say we are trained to think like physicians. I love being a PA and am proud of it. At least in my ER and I suspect many ERs, PA or NP makes zero difference

[Guest ERCat]

I also think the independence thing is quite frankly ridiculous. How is one prepared to INDEPENDENTLY make the decisions that a physician makes after two years in an NP program, many of which are online, without any oversight by a doctor? The idea is ridiculous and it creates a lot of overconfident and dangerous NPs. If someone thinks they can practice independently after two years they clearly don't know enough to know what they don't know.

[corpsman89]

The problem is that no one cares about these anecdotal stories of quality PAs. What matters is that NPs have the numbers, and tremendous clout in the political realm of things. I have serious concerns about my future as a PA, and feel as if everything is out of my hands and is totally up to the forces at be. The real issue is that there are substantially less PAs than NPs, this alone is a serious problem in regards to getting out voices heard. I really find that fact that the VA allowed NPs to have full practice rights while not allowing the same for PAs very troubling.

[newton9686]

All the PA students in this conversation need to calm down. As a PA student, we need to be worried about not killing someone, not how much independence we will have compared to our NP counterparts 5 years down the road. 

[corpsman89]

Is it not wise to worry about our future?

 

Please don't imply that because some of us express concern over the future of the profession that we do not care about the patients we will eventually care for.

 

I could care less about independence, or full practice authority. What I care about is being able to practice medicine as a PA. If we are not given the same privileges and authority as NPs then the PA profession will slowly drift away, and therefore I wont be able provide my care to those patients.  

[BruceBanner]

If you are already in a PA program, dont quit. That's a horrible idea.

 

If you are pre-med, you will less burdensome to employ as an NP, but at the cost of a dubious medical education. Lots of detailed threads on this whole issue right now.

[Acebecker]

Two of my classmates got kicked out of my PA program. They are both NPs now. At the time they were kicked out, I thought "gee, I feel bad for them." Now, I look at them and think "Gee, I feel bad for me." Their misfortune turned out to be the greatest blessing of their lives. If PAs do not win practice independence, we will die. If there was independent practice for PAs, I bet that 5000 PAs would form private practices in the next twelve months and EXPAND the access for those who cannot find a doctor. NPs are killing us. They will drive our profession into nonexistence in less than ten years. If I were an undergraduate, I would never encourage a student to become a PA. I won't even take PA students from PA programs on rotation because I know that this profession is a dead end. These young people are being duped into spending $50,000 on tuition to take a job that will never grant them the right to get a return on their investment. If you are under 30, do not go to PA school. Choose medical school or NP school. If you are over 30, choose NP school. Med school will be a hard hill to get into and you'll be lucky to get a sub specialty you love. Going to med school to practice primary care vs going to NP school to practice primary care is not even a decision to think about. Go to NP school. IF you are a PA over 40, grit your teeth for ten more years until the profession dies. 

 

Your crystal ball is hazy, my friend.  I disagree with all of your arguments against becoming a PA. 

 

First, reject PAs turning into NPs.  There's something backward about that.  It should *not* make anyone want to become an NP. 

 

Second, our profession is not going away any time soon.  I don't know what the future holds, but PAs are in demand and our education is becoming more well known.  It is common knowledge that PAs have a superior education to NPs, and I would even propose that it is a vastly superior education in most cases.  This makes us a desired commodity. 

 

Third, not taking PA students as a PA.  The lack of foresight and hypocrisy is astounding.  You wanted a good education as a PA student and now you would deny the next generation just because you have a hazy crystal ball and feel down about our profession?

 

Finally, return on investment - if you are smart, the return on your $50-80,000 investment is just fine.  Sure, you can invest less as an NP student and hopefully have a bigger ROI given that your investment is less and your return is the same...  But we go back to the education component.  You get what you pay for. 

 

I do agree that the nursing/NP lobby is killing us.  But I have hope that the AAPA sees the writing on the wall driven and that this vision is driven by PAFT which will get us heading in the right direction.  If they do not, there will be a lot of old PAs going back to medical school, not jumping over to NP school. 

[EMEDPA]

it makes no sense for someone who is already a pa to become an NP unless they are already an rn, can do it entierly online, and want to work in primary care or psych.

for the rest of us, it would be faster to become a doc through the bridge program at Lecom when you cosnider time required to become an RN/bsn (1 yr full time) plus time to become an np/msn (at least 2 years).

[Kaepora]

The problem is that no one cares about these anecdotal stories of quality PAs. What matters is that NPs have the numbers, and tremendous clout in the political realm of things. I have serious concerns about my future as a PA, and feel as if everything is out of my hands and is totally up to the forces at be. The real issue is that there are substantially less PAs than NPs, this alone is a serious problem in regards to getting out voices heard. I really find that fact that the VA allowed NPs to have full practice rights while not allowing the same for PAs very troubling.

 

 

This is, unfortunately, the bottom line.  Saying PAs have a more rigorous education and more clinical hours is of little or no consequence to this debate.  MDs have a more thorough and involved educational pathway than both PAs and NPs but that doesn't matter as far as NPs gaining independent practice.  The nursing lobby is huge and they are governed by the state boards of nursing.  PAs have had, historically, terrible representation and are governed by the medical boards.  Yes, NP education is extremely variable.  Across the board these programs are lacking in multiple areas.  I should know - I'm in the middle of it.  Many programs lack gross anatomy, they require less than 1000 clinical hours, etc.  One can compensate for this but it means more foot work.  I, for example, took gross anatomy and medical physiology through the medical school at my university and I plan on doing full time clinical work rather than the minimal required by my program which should net me ~3000 hours.  I'm also doing one of the rare surgical programs available as that is not included in 99% of NP programs.

 

It's too late to get out in front of this so the best you can do is ride the nursing lobby coat tails as far as possible.

 

Seeing as how you are half way through your PA education, just finish it - don't get crazy.  You'll theoretically be a good provider and have steady opportunity for work until you retire.  And I don't think PAs are in danger of disappearing as a profession.  I do think you will be granted more autonomous practice rights, but will always be a dependent provider - that's the name of the game as a PA (and should have been so for NPs as well but that ship has sailed).  There's always the LECOM bridge program should you want to leave the PA profession to gain TRUE independent practice.

[EMEDPA]

Nice post Ace, agree with your conclusions. the PA political machine is starting to gain some momentum after 50 years and I think the next ten years will be brighter for us than the previous ten.

[EMEDPA]

ACNP- appreciate your input and agree with all your points except about independence. I think eventually we will get to where Nps are now, it will just take a while and a change in our educational process to convert to doctorates and add a postgrad specialty year and a specialty board exam. see current "future of pa profession thread". you are doing the right thing by maximizing your educational opportunities. best of luck in your studies.

[Kaepora]

ACNP- appreciate your input and agree with all your points except about independence. I think eventually we will get to where Nps are now, it will just take a while and a change in our educational process to convert to doctorates and add a postgrad specialty year and a specialty board exam. see current "future of pa profession thread". you are doing the right thing by maximizing your educational opportunities. best of luck in your studies.

 

 

I hope you're right.  I would like to see that for the PA profession.  I am extremely skeptical about the ability of the profession gaining independence in the way NPs are currently.  To have no physician oversight would require the uncoupling of PAs from the boards of medicine.  Something I do not, or cannot, see happening. Much in the same way I would love to see NP programs more closely resemble PA programs - it's never going to happen.  So I always tell NP school applicants to only apply to schools that require you to come to an actual campus and to add in extra classes to fill in gaps, etc.  Work around your constraints.  

 

I would love to be proven wrong, however, it might make me regret my choice at some point.  Haha.  

[rev ronin]

Nice post Ace, agree with your conclusions. the PA political machine is starting to gain some momentum after 50 years and I think the next ten years will be brighter for us than the previous ten.

Agreed.  I would normally just 'like' this post (and Ace's, to boot), but I've apparently liked too many things already today.

[EMEDPA]

I hope you're right.  I would like to see that for the PA profession.  I am extremely skeptical about the ability of the profession gaining independence in the way NPs are currently.  To have no physician oversight would require the uncoupling of PAs from the boards of medicine.  Something I do not, or cannot, see happening. Much in the same way I would love to see NP programs more closely resemble PA programs - it's never going to happen.  So I always tell NP school applicants to only apply to schools that require you to come to an actual campus and to add in extra classes to fill in gaps, etc.  Work around your constraints.  

 

I would love to be proven wrong, however, it might make me regret my choice at some point.  Haha.  

there is a move to have independent state boards of PA medicine in all 50 states. I believe that is on the AAPA agenda. a few states have this already. it's one step from there to independence.