NP or PA

[Guest ral]

I typically don't partake in these PA vs NP type conversations, as I have dear friends on both sides, and would trust many of them with my life, regardless of their credentials.

There is one thing that I always take offense to though, and that is the perceived level of autonomy.  It has been pushed ad nauseum, that NPs don't require collaboration or supervision.  In many states, that is simply not true when it comes to prescriptive authority.  How pray tell, does one open up their own shop, invite the public in as patients, come up with a diagnosis, and then say, "I would love to prescribe you something for this but, I am unable to do so."

I have not vetted this but, it was co-authored by a DNP, so I would say the info is for the most part correct, and certainly in line with what I have known to be true for years.  State by state practice authority.  Pay specific attention to the "Prescriptive Authority" tab in each state.  Still think you have cut yourself loose from the doctors?  I beg to differ.

https://www.nursepractitionerschools.com/faq/how-does-np-practice-authority-vary-by-state/

 

[ventana]

53 minutes ago, ral said:

I typically don't partake in these PA vs NP type conversations, as I have dear friends on both sides, and would trust many of them with my life, regardless of their credentials.

There is one thing that I always take offense to though, and that is the perceived level of autonomy.  It has been pushed ad nauseum, that NPs don't require collaboration or supervision.  In many states, that is simply not true when it comes to prescriptive authority.  How pray tell, does one open up their own shop, invite the public in as patients, come up with a diagnosis, and then say, "I would love to prescribe you something for this but, I am unable to do so."

I have not vetted this but, it was co-authored by a DNP, so I would say the info is for the most part correct, and certainly in line with what I have known to be true for years.  State by state practice authority.  Pay specific attention to the "Prescriptive Authority" tab in each state.  Still think you have cut yourself loose from the doctors?  I beg to differ.

https://www.nursepractitionerschools.com/faq/how-does-np-practice-authority-vary-by-state/

 

very valid

 

in MASS NP are independent EXCEPT

1) if they are going to prescribe meds they have to have a SP

2) their is federal laws that apply in EVERY state 

          VNA

            Hospice Cert

           DM shoes

 

are just a few that you MUST have a MD or DO after your name - PA and NP can not do these... period 

 

 

so in no state can an NP  function "just like a doc and independently" unless then NEVER order VNA, Hospice, or DM shoes...... 

[JTATC]

14 hours ago, Diggy said:

The dual program I am referring to is UC Davis dual PA/NP program. It's for current RNs who get accepted into their FNP program. Once in the FNP Program there's the option to enroll into the PA program simultaneously if there is a PA-S seat available. There are no guarantees. 

Current UCD student here. Just FYI, as of this year the dual track is no longer an option. FNP students still take most of the same classes as the PA students and, according to the FNP program director, get a more thorough medical education because of that. However, we have been told that no one will have the dual track option going forward. 

[DiggySRNA]

2 hours ago, JTATC said:

Current UCD student here. Just FYI, as of this year the dual track is no longer an option. FNP students still take most of the same classes as the PA students and, according to the FNP program director, get a more thorough medical education because of that. However, we have been told that no one will have the dual track option going forward. 

Thank you for the heads up. That's a bit disappointing in one aspect, but great in the other. 

[LT_Oneal_PAC]

1 hour ago, Lightspeed said:

 

Classy of you to try to reduce the work that I do down to just the easy stuff. Says more about you than it does about me. If it’s so easy to manage mental health, then I guess I can just tell my 9 weeks of scheduled appointments, most of whom are referrals, to just go see their primary care PAs for management since folks like O’Neal have got this covered along with his dabbling in high risk practice on captive audiences.

Here’s the funny thing... I probably have saved more lives with my Zyprexa and Zoloft than you have with your codes, invasive lines, and intubations. People tend to exaggerate their exploits, which is likely the case with what you’ve said, too. Another funny thing is how you feel like your training hours somehow add up to the magic number for competence, which would be a surprise for the board certified ER physician that has 20 times that amount under their belt. But most ER PAs live in fast track, or with supervision close by. If you are operating outside of the norm as an ego boost potentially at your patient’s expense, so be it. It probably looks good here, but that might be the only place where you’ll get high fives for that. I’m sure your facility isn’t putting the fact that their ER PA will be the one intubating them alone at night on a billboard. My guess is that not a lot of physicians want to “collaborate” on that and be the one brought into the lawsuit. And right there is a reason maybe you should be independent for real, not just for play. You just made my point for me.

If you are proud to be a cowboy, I know plenty of NPs that do the same thing. In fact, their independent status is why a lot of the rural EDs near me that run a solo non physician provider choose an NP. So while I don’t doubt that you may be competent to be the only family practice provider for thousands of miles (its the military where regulations are different), independence would indeed be more appropriate for you. And you make the case for it to be formalized. And it isn’t. So that’s my point. NPs have it, PAs should but don’t. That’s something for a prospective PA to consider.

I don’t minimize what you do, psychiatrist do. I have called for psych to come down to see a patient and state “their is no such thing as a STAT psychiatric emergency” or “call me back when all the labs were done.” I’m sure lots of lives are saved by you, but seconds definitely don’t matter. I don’t diminish what therapy is and does. I do think that the majority of psych that clogs the system can be handled by primary care with a psychologist for CBT, they just don’t because they don’t want to take the time to learn it. 

your obvious lack of understanding of EM practice goes to show that you have no advice to give outside of psych. I am EM residency trained with physicians specifically so I could practice at rural positions without oversight. My hospital actually does advertise this, actually. Right by the front door, as they are happy to show that they will be cared for by a specialist in EM. I’m not proud to be a cowboy. I’m proud that I’ve spent 3.5 years outside of PA school in formal training (2 in anesthesia and 1.5 in EM) and 3 years informally (family medicine/military) to work as independently as I do today. 

Ive made my point that independence is not practice level issue, only an administrative one. You continue to want to be offended, so I’ll spare you any more disconcertion and walk away from this.

[ventana]

this thread is becoming suspect

 

please do not attack each other nor just sling mud

 

keeping on task on track and professional is helpful