An anecdote from the other side

[BruceBanner]

Found this on the Physician Assistant Reddit today. For all the time we spend discussing NPs....

 

This is why I think "takeover" concerns are overstated and our jobs aren't going anywhere.

 

So I've made a mistake.

This post might be a bit long to fully explain the background regarding the problems with the NP profession. I am a soon to be graduating family NP student in a top NP school in the country affiliated with one of the best hospitals in the country and yet I still feel that the training we get is piss poor. When I was in undergrad I originally thought that I wanted to do family practice and work internationally leading me to choose an NP over a PA. I figured that by going to a good NP school that I would receive good training so I choose to be a family medicine NP. I was proud and excited but now I've realized that I have wasted years of my life and thousands of dollars going to this program.

Throughout the course of my rotations, I realized that family practice is not for me and that I fit much better in emergency medicine, but our faculty pressures family students that they should only be doing primary care as that is what our training and curriculum are focused on. Our clinicals are located mainly at family medical practices, very few urgent cares OB/pediatric offices that a few lucky students get sent to. We receive no inpatient experience and thus most of us will probably graduate never having done so much as a suture on a real patient.

My colleagues who are adult acute care NP and actually trained in inpatient stuff, have a lot of difficulty getting jobs in the ER because they cannot treat pediatric patients. Most ERs say they would rather hire PAs or family NPs instead. Our school even opened up a PA program recently and many of the acute care NPs lost clinical rotations to them in the ICU/ER. With the exception of the psychiatric and pediatric NPs among us, almost all of us, even some of our instructors admit they would have rather become PAs to receive generalized training and clinical rotations throughout inpatient and outpatient; it is has created a lot of bitterness and tension among us and a faculty that is apathetic to our concerns.

One of the acute care NP instructors who teaches skills labs to acute care NPs/PAs and med students said the other day "yeah you probably won't be doing this skill as an NP, the PAs do it at my hospital which makes sense since they are better trained in it and in retrospect I should have probably become a PA instead." I have toyed with the idea of doing optional NP residencies but the majority of them are in primary care or very rarely urgent care, almost all of the emergency ones go to acute care NPs or PAs. In addition, since we never received any inpatient experience on medicine, OB/gyn, pediatrics or sugery I feel like I am at a severe disadvantage. One of my best preceptors who is an NP working at a stepped up urgent care (it used to be an ED, so we still get chest pains, SOB, anaphylaxis, codes etc.) will be rotating to the ED and will have to learn intubation and LPs for the first time. I'd probably have to start from the ground up, work in urgent care for a few years before I could go to the ER.

So here I am almost 3 years after finishing my NP program (I was a direct entry student) thinking the best use of my time would be to become a PA instead. People have suggested that this is a financial blunder (cost of PA school + lost earnings as an NP would be around 200k+) and that everything I learn can be on the job or on my own. I'm just worried that like most on the job training I'll still be unprepared for what I need to do. Any thoughts by PAs?

 

 

 

 

https://www.reddit.com/r/physicianassistant/comments/5iusy5/np_to_pa/

[Ol_tumbleweed]

Thanks for sharing, this is helpful.

 

 

Sent from my iPhone using Tapatalk

[corpsman89]

"the grass is greener on the other side" - Its amazing how true this is throughout our lives, but its just so hard to believe sometimes. :/

[overthehorizen]

I have to point out that this story confirms what we already believe to be true yet is is irrelevant. Said differently, the OP believes that NP education is inferior to PA education. Most if not all of us agree. It doesn't matter. NPs could be less competent or even incompetent. They are still WINNING. Remember,NPs have independent practice in 22 states. PAs have DEPENDENT practice in all 50 states. NPs are independent providers in the VA. PAs are dependent providers in the VA. 

 

Let's stop comparing skills and competency. Nobody else is paying attention. We need to focus on winning independent practice rights NOW or else we will die. PAs are being eliminated from the VA. The decision to choose NPs over PAs was a nail in the coffin for PAs at the VA. Denni Woodmansee is the Chief of PA Services , an SES level position, at the VA. He has remained totally silent on this issue. No statement from his office. No effort to include PAs in independent practice. Yet, Mr Woodmansee works tirelessly at the NCPAA board to keep the PANRE exam and fight any changes to remove it. 

 

Wake up folks. You think you see the target and are trying to fight what you see (competence vs incompetence) while you are being flanked by your own people (Woodmansee PA-C) and powerful nursing lobbyists.

[ohiovolffemtp]

A couple of points from my experience as an ED PA:

• The critical decision comes from the person doing the hiring.  In EM groups and specialty groups that's a physician.  From what I've seen, those doc's primarily value experience.  PA vs NP doesn't matter if you have that experience.
• From what I've seen, once a person has worked 2+ years in EM, the difference between PA and NP is totally overwhelmed by the individual's desire and ability to learn.
• For hiring of new grads (minus that critical experience), the doc's in EM seem to prefer PA's due to broader training, including procedural skills.

Net: for either an NP or a PA, your second job is very easy to get.  Your first one is the hard one.