Which Specialty do PAs have an Advantage Over NPs?

[corpsman89]

With the ever looming/advancing/encroaching NP advancement, and the ever slowly moving/stagnant PA advancement, I am beginning to heavily consider which specialty is the most PA friendly, and which specialty is least threatened by the new online, yet fully independent FNP and ACNP grad. 

Obviously as a student currently on rotations my number one priority in terms of jobs is finding a specialty that I enjoy working in. 

But aside from this I am very concerned with NPs having an advantage over me due to simple administrative reasons, hence why I am taking this into consideration. 

Right off the bat I would assume most surgical specialties would be mostly safe (mainly ortho, but vascular, cardiothoracic, general, etc) due to the additional step that NPs have to take in order to be involved in 1st assisting (RNFA). For a while now though I have assumed the ER was a generally safe place for PAs, but it seems that many FNPs are taking the next step and getting their ENP certification so they can work in any ER, and some ERs are simply ok with a FNP who can't even suture. 

Any thoughts?

Edited September 4, 2018 by corpsman89
grammar

[EMEDPA]

PA to NP/CNM/CRNA:

All surgical fields >EM>ortho>critical care>any hospital based specialty> primary care> peds/nicu>ob>psych>anesthesia

[Diggy]

I'm interested in attending an ENP Program (the PA bridge was sadly burned for me) but having a hard time locating a brick and mortar sit your a** in class program. 

But the ED that I did my last rotation in as a student nurse did not employ NPs as ED providers. Only Physicians and PAs filled this role. Their reasoning as to why PA over NP was a** backwords but eh the PAs there were happy. Emergency Medicine is largely PA friendly.

[EMEDPA]

Diggy- where do you live that there is no local NP program? 

[jmj11]

PA Program Instructor. 

[Cideous]

9 hours ago, jmj11 said:

PA Program Instructor. 

ROFL you beat me to it! Haha!

[Diggy]

15 hours ago, EMEDPA said:

Diggy- where do you live that there is no local NP program? 

I live in Philly. There are a lot of FNP programs but none are actually ENP (FNP + ACNP), and many of them are either online or hybrid. I'm not a fan of online courses because I learned nothing in the 3 masters ANP courses I took during my BSN. I want a full brick and mortar FNP (ENP preferably) program. I might have to go out of state for this if I can find one. 

[EMEDPA]

why not shoot for a solid ACNP program then do the FNP later online(or not at all)?

[Kaepora]

There are combined ACNP and FNP programs available, as well as ENP programs (which are essentially combined ACNP and FNP).  In my neck of the woods the ICUs (all specialties) are mostly NPs - NICU all NPs.  ER and inpatient medical specialties are split evenly.  OB is all NPs/CNMs.  Peds is split pretty evenly.  Outpatient specialties and primary care are split pretty evenly.  Surgery is mostly all PAs - partly because NPs have to get an extra certification, the RNFA, which can take a while.  The quickest RNFA program requires 120 hours of scrub time - from initial incision to dressing.  So it takes a while to collect those hours - it took me a few months on a general surgery service.  Plus, you have to have 2 years of preoperative RN experience to do one of these programs - or be an NP already.  Which is lame, but that's nursing for you.  Also, nurses are discouraged from surgical specialties because it is seen as a truly "assistant" role.  And to NP leadership this goes against what they envision for NP practice.  I got my RNFA so the option would be available to me.  And now I work in the OR.

[EMfuturePA]

13 hours ago, Kaepora said:

There are combined ACNP and FNP programs available, as well as ENP programs (which are essentially combined ACNP and FNP).  In my neck of the woods the ICUs (all specialties) are mostly NPs - NICU all NPs.  ER and inpatient medical specialties are split evenly.  OB is all NPs/CNMs.  Peds is split pretty evenly.  Outpatient specialties and primary care are split pretty evenly.  Surgery is mostly all PAs - partly because NPs have to get an extra certification, the RNFA, which can take a while.  The quickest RNFA program requires 120 hours of scrub time - from initial incision to dressing.  So it takes a while to collect those hours - it took me a few months on a general surgery service.  Plus, you have to have 2 years of preoperative RN experience to do one of these programs - or be an NP already.  Which is lame, but that's nursing for you.  Also, nurses are discouraged from surgical specialties because it is seen as a truly "assistant" role.  And to NP leadership this goes against what they envision for NP practice.  I got my RNFA so the option would be available to me.  And now I work in the OR.

Almost all PA's and NP's that work for big hospitals are not truly "independent" 

We all follow and report patients to attendings and they make final calls on management

Only some PA's who had some EM/urgent care experiences that work in a single provider urgent care with no physician oversight is truly independent. 

Most NP's and even PA hosptialists say they seem "independent" but I alway see them take attending o senior physicians' orders and following them. I bet these providers cant manage patients on their own since they had to rely on their decisions the whole time. I have seen many hospitalist mid-levels struggle when they go to ER or urgent care and make their own decisions

Edited September 6, 2018 by EMfuturePA

[Lexapro]

I'm starting to think you might be a bit of a troll, EMfuturePA.

Edited September 6, 2018 by Lexapro

[EMfuturePA]

42 minutes ago, Lexapro said:

I'm starting to think you might be a bit of a troll, EMfuturePA.

you can think whatever you want. 

I am a practicing PA inpatient medicine in a large university hospital. Planning to transition to ER soon. Have been doing some ER/UC gig thanks to having some friends in ED/UC here.  I am just sick of no advancement in PA profession - no name change, no OTP and so forth - and thus have been considering making a jump to DO or MD schools. This is why I know much about the DO bridge program and all these free MD programs out there too.

 

I have the right to be critical and frustrated about nothing happening with this profession and voicing it out on this forum. Stop trying to curtail free speech

 

[LT_Oneal_PAC]

4 hours ago, EMfuturePA said:

you can think whatever you want. 

I am a practicing PA inpatient medicine in a large university hospital. Planning to transition to ER soon. Have been doing some ER/UC gig thanks to having some friends in ED/UC here.  I am just sick of no advancement in PA profession - no name change, no OTP and so forth - and thus have been considering making a jump to DO or MD schools. This is why I know much about the DO bridge program and all these free MD programs out there too.

 

I have the right to be critical and frustrated about nothing happening with this profession and voicing it out on this forum. Stop trying to curtail free speech

 

Oh gosh, now you’re really trying. We all feel like more could be done to improve our profession, but you’re going so far as to say people can’t manage without their attending, which I think is wrong. This is an attack on the practice, not advocacy. Some of them, sure. Bad apples in every barrel. You’re broad generalization is wrong, however. Free speech is not freedom of consequence.

 

 

[Lexapro]

8 hours ago, EMfuturePA said:

I have the right to be critical and frustrated about nothing happening with this profession and voicing it out on this forum. Stop trying to curtail free speech 

 

Seems to me like you don't understand how free speech works. You are free to talk and I'm free to criticize you and say I think you're trolling.

Edited September 7, 2018 by Lexapro

[lemurcatta]

No OTP? I think OTP was passed by the AAPA very recently in the grand scheme. That means it’s policy at our professional org level. It’s going to take time for state laws to be changed. Hopefully you can turn your frustrations into action by joining and staying a member local pa chapter and AAPA, and voting for people who support OTP. 

We have a strong advantage over NPs in training department. Let’s use that fact to at least get parity with them. 

[2234leej]

On ‎9‎/‎4‎/‎2018 at 5:12 PM, corpsman89 said:

With the ever looming/advancing/encroaching NP advancement, and the ever slowly moving/stagnant PA advancement, I am beginning to heavily consider which specialty is the most PA friendly, and which specialty is least threatened by the new online, yet fully independent FNP and ACNP grad. 

Obviously as a student currently on rotations my number one priority in terms of jobs is finding a specialty that I enjoy working in. 

But aside from this I am very concerned with NPs having an advantage over me due to simple administrative reasons, hence why I am taking this into consideration. 

Right off the bat I would assume most surgical specialties would be mostly safe (mainly ortho, but vascular, cardiothoracic, general, etc) due to the additional step that NPs have to take in order to be involved in 1st assisting (RNFA). For a while now though I have assumed the ER was a generally safe place for PAs, but it seems that many FNPs are taking the next step and getting their ENP certification so they can work in any ER, and some ERs are simply ok with a FNP who can't even suture. 

Any thoughts?

Couple thoughts on your post:

1. Not all NPs get their degrees from 100% online, for-profit schools.

2. I am not sure which hospital/geographic location you are in, but I have not seen one FNP in the ER who was unable to suture. I work as an ER nurse (getting my FNP) and all the NPs and PAs can suture at the hospital. I do think PAs are better suited for the ER than NPs, but some of your comments are inaccurate.

[Kaepora]

8 hours ago, lemurcatta said:

We have a strong advantage over NPs in training department. Let’s use that fact to at least get parity with them. 

 

4 hours ago, 2234leej said:

1. Not all NPs get their degrees from 100% online, for-profit schools.

I think it's worth noting, as well, that NPs are currently in the process of changing the problems within their education.  There is a large grassroots movement among NPs calling for education reform.  It seems to be working slowly but surely, as the CCNE (NP accrediting body) just released their 2019 guidelines and NP programs are now required to place their students with preceptors and clinical sites.  This was a huge problem amongst for-profit, 100% online schools.  Placing the onus of finding preceptors on their students allowed them to admit cohort after cohort, taking money with essentially no oversight or quality control.  Talk about a huge money grab.  But this new requirement will effectively cause many of these crappy programs to close.  There's more things we want to change, but it comes one step at a time.

[Kaepora]

21 hours ago, EMfuturePA said:

Almost all PA's and NP's that work for big hospitals are not truly "independent" 

We all follow and report patients to attendings and they make final calls on management

Only some PA's who had some EM/urgent care experiences that work in a single provider urgent care with no physician oversight is truly independent. 

Most NP's and even PA hosptialists say they seem "independent" but I alway see them take attending o senior physicians' orders and following them. I bet these providers cant manage patients on their own since they had to rely on their decisions the whole time. I have seen many hospitalist mid-levels struggle when they go to ER or urgent care and make their own decisions

The hospitalist and intensivist APPs are far more independent than you are giving them credit for.  95% of the time, the APP will do the admission and their attending will go see the patient, listen to heart/lungs, ask if they have any questions, and then sign off on the note without adding any value to it or the plan of care - same with daily soaps.   I work in surgery, and the APPs are far more dependent in these roles.  It's partly the typical surgeon's personality, but they are the ultimate decision makers.  I can't perform the surgery on my own, so guess what, the surgeon has to make the final call.  It is what it is.  I've actually started picking up time for the hospitalist service because I need a little more cerebral stimulation.  Haha.

[EMEDPA]

we used to run an ED obs unit for treadmills, TIA workups. etc. 100% PA run. An attending would come in the day of d/c, review the chart, introduce themselves to the pt, then sign a face to face attestation for full billing. they were on the unit 15-30 min out of a 24 hr day. we did everything else.

[ventana]

as to the initial post

 

my answer

 

"All of them" 

[Acromion]

I want to go to a PA -> NP bridge program, so I can make up for all the nursing theory I missed out on in PA school, like the spirituality of heart failure. 

I also want to get all those letters after my name RN, BSN, MS, CRNP, FNP-BC, ANCS-BC, NP-C, ACHPN, DNP, CDE. 

[ventana]

3 hours ago, Acromion said:

I want to go to a PA -> NP bridge program, so I can make up for all the nursing theory I missed out on in PA school, like the spirituality of heart failure. 

I also want to get all those letters after my name RN, BSN, MS, CRNP, FNP-BC, ANCS-BC, NP-C, ACHPN, DNP, CDE. 

ha ha

 

I have put my initials on one thing...

 

Mr Bozo, AS, BA, MS, MBA, PA-C, DFAACP, NCCHC

 

sorry it looks stupid...... and some people coming into my office actually commented "geez that is a lot of initials"

I guess I am a better provider due to it.....

 

 

wink wink my PA degree was an AS and it was the hardest degree I have!!