Hi PAs! (From an NP)

[Komorebi]

Nurse practitioner here! Don't know what the attitude toward us is on this forum but I find the nursing forums kind of one-note and the physician forums are degrading and arrogant. I browsed a bit here and I love it, I'd love to hang out here with my fellow providers and talk shop! :)

[UGoLong]

1 hour ago, Komorebi said:

Nurse practitioner here! Don't know what the attitude toward us is on this forum but I find the nursing forums kind of one-note and the physician forums are degrading and arrogant. I browsed a bit here and I love it, I'd love to hang out here with my fellow providers and talk shop!

Welcome! There are other NPs that wander through the forum. I personally work with several and we get along fine. I hope you have a good experience here.

[LKPAC]

Welcome.    I look forward to your input!

[Komorebi]

Thank you! I'm a PMHNP, are there many active psychiatric PAs here? I know that's not as popular of a field in the PA world.

[sas5814]

There are a lot of psych patients here.

It isn't that its not a popular field it is the way the laws are written both at the federal and state level that have made it a difficult field sometimes for us to get into. That has begun to improve and I suspect you'll see more PAs working in psych in the coming years.

[Komorebi]

1 hour ago, sas5814 said:

There are a lot of psych patients here.

It isn't that its not a popular field it is the way the laws are written both at the federal and state level that have made it a difficult field sometimes for us to get into. That has begun to improve and I suspect you'll see more PAs working in psych in the coming years.

Great! I welcome that!

 

I look forward to chiming in from an NP perspective on active topics. 

[rev ronin]

5 hours ago, Komorebi said:

Thank you! I'm a PMHNP, are there many active psychiatric PAs here? I know that's not as popular of a field in the PA world.

I'm in the progress of working towards my Psych CAQ.  I do sleep, pain, and eating disorders medicine, as well as having done anxiety, depression, and ADHD in primary care.

[CornellSPA]

Welcome! I'm actually a surgical PA but do part time work with gut microbiome and dysbiosis....the amount of constipation and GU issues in the depressed and anxious is huge! Lot of great literature on gut microbiome and psych, gut brain connection, butterflies in the stomach, etc!!

[Komorebi]

3 hours ago, rev ronin said:

I'm in the progress of working towards my Psych CAQ.  I do sleep, pain, and eating disorders medicine, as well as having done anxiety, depression, and ADHD in primary care.

Nice! So what's a CAQ? Is that the PA equivalent of a specialized NP degree?

[Komorebi]

3 hours ago, CornellSPA said:

Welcome! I'm actually a surgical PA but do part time work with gut microbiome and dysbiosis....the amount of constipation and GU issues in the depressed and anxious is huge! Lot of great literature on gut microbiome and psych, gut brain connection, butterflies in the stomach, etc!!

Yes!! I love this. I briefly did research on gut bacteria as an undergrad. I'd love to see some of the current research on the psych and gut connection if you have it handy. Always looking for alternative ways to improy mental health through holistic changes.

Did you go to Cornell? They have a PA program?

[rev ronin]

1 hour ago, Komorebi said:

Nice! So what's a CAQ? Is that the PA equivalent of a specialized NP degree?

https://www.nccpa.net/Specialty-CAQs

I would say no, because any PA can have any number of CAQs without necessarily earning any additional degrees or having any formal training approved by a particular specialty certifying body, but I could be wrong.

[ventana]

9 hours ago, Komorebi said:

Nice! So what's a CAQ? Is that the PA equivalent of a specialized NP degree?

 

8 hours ago, rev ronin said:

https://www.nccpa.net/Specialty-CAQs

I would say no, because any PA can have any number of CAQs without necessarily earning any additional degrees or having any formal training approved by a particular specialty certifying body, but I could be wrong.

loaded question

 

To be factual, the amount of in clinic education just to become a provider (when I have reviewed applicants to hire) for NP degree seems to start at about 500 hours - and mostly that is what I see on applications (400-600 hours).  PA have 2000+ hours across at least 8 different fields.  NP's then have some advanced nursing theory and classes that are not necessarily directly related to front line medicine.  

 

So although the CAQ does not confer a degree, I would actually place it above an entry level NP degree by a fair amount.

To get a CAQ you need a PA degree (min 2000+ clinical hours and many have FAR more) and then meet the following

something like 3000-4000+ hours in the field and an additional 75 CME hours (Cat 1), then attest and then take and pass an exam.  These together would (in my mind) almost equate to doing a fellowship in a field.  

I have worked with some excellent and not so excellent PA and NP so I think after about 3-4 years out of school it really depends on the motivation of the individual. 

 

Not to inflame, just to inform.

 

[PickleRick]

Welcome, Komorebi.  Pay no attention to the resident *****.  

[Komorebi]

2 hours ago, ventana said:

 

loaded question

 

To be factual, the amount of in clinic education just to become a provider (when I have reviewed applicants to hire) for NP degree seems to start at about 500 hours - and mostly that is what I see on applications (400-600 hours).  PA have 2000+ hours across at least 8 different fields.  NP's then have some advanced nursing theory and classes that are not necessarily directly related to front line medicine.  

 

So although the CAQ does not confer a degree, I would actually place it above an entry level NP degree by a fair amount.

To get a CAQ you need a PA degree (min 2000+ clinical hours and many have FAR more) and then meet the following

something like 3000-4000+ hours in the field and an additional 75 CME hours (Cat 1), then attest and then take and pass an exam.  These together would (in my mind) almost equate to doing a fellowship in a field.  

I have worked with some excellent and not so excellent PA and NP so I think after about 3-4 years out of school it really depends on the motivation of the individual. 

 

Not to inflame, just to inform.

 

Fascinating, I love it! 

I feel like both the PA and NP approach have pros and cons. For example I think having specialized population focused degrees is an NP advantage. I did a full 2.5 years of psychiatry combined with some general pharmacology classes, physical assessment, etc. So in preparation to become a psych NP I took specialized classes in psychotherapy, psychopharmacology, etc and all of my clinical hours were focused on psychiatry. I then took a board exam focused on psychiatric concepts.

 

That being said, the 700ish hours of the program didn't seen like enough so I did do a residency program adding an additional 2,200 supervised hours. So I started practice with almost 3,000 hours of supervised clinical rotations.

 

I wish PAs and NPs could learn from each other. Combine the education model of the PA with the population focus and advocacy/marketing of the NP!

Edited April 13, 2021 by Komorebi

[sas5814]

That is a very interesting comment and a subject that gets discussed a LOT. There are a lot of variables and its hard to have a consensus because of all the variables.

For instance there is a huge difference in how we work together "on the ground" and what happens at the political level. I won't go into a long rant about it because it has been discussed to death. I'll suffice to say politically we aren't friends for a lot of reasons.

PA training, initially, is pretty well prescribed and formulaic and NP training, initially, can be all over the map. The recent advent of the "shake and bake" online NP programs have widened the gap. Even some in NP world are beginning to complain that their brand is being watered down by a glut of poorly trained NPs.

Then there is the additional training as you described. I worked with a PA whose wife was an NP intensivist (which until then I didn't know was a thing) and she did a 3 year residency at Baylor. Sadly she came to work in an organization where the physicians in admin pretty much thought we were all dangerous idiots and dumbed everything down "for safety". She didn't stay long.

PAs can go on to do residencies and CAQ (as described above) and now there is a bloom of doctoral programs that have different foci.

So yes... it would be nice if we could all work together to carve out our place in health care but there are so many moving parts and so many factions and fractions I don't see it happening anytime soon.

Some very forward thinking PAs tried to form coalition orgs of PAs and NPs several years ago but it never got much traction. We were still very much tied to our "friends" the physicians who were always going to be in charge of medicine and would look after us, their good right hand. That plan didn't quite work out.

[ventana]

24 minutes ago, Komorebi said:

Fascinating, I love it! 

I feel like both the PA and NP approach have pros and cons. For example I think having specialized population focused degrees is an NP advantage. I did a full 2.5 years of psychiatry combined with some general pharmacology classes, physical assessment, etc. So in preparation to become a psych NP I took specialized classes in psychotherapy, psychopharmacology, etc and all of my clinical hours were focused on psychiatry. I then took a board exam focused on psychiatric concepts.

 

That being said, the 700ish hours of the program didn't seen like enough so I did do a residency program adding an additional 2,200 supervised hours. So I started practice with almost 3,000 hours of supervised clinical rotations.

 

I wish PAs and NPs could learn from each other. Combine the education model of the PA with the population focus and advocacy/marketing of the NP!

Wow that is awesome!!'

 

I think it is great to see that you identified a need for more training an did it!  I get afraid in both NP and PA quest for independence we have some how forget to protect the patients.  I don't believe any new grad PA or  NP or Physician should be allowed independent practice.  Doc get internship year, and PA  and NP should mirror this - some formula for staged independence (where a DOC, PA or NP has to be "supervisor" just like the SLP's do.)  I a likely not popular for this opinion, but I think we have a duty to society to ensure our "minimum standard" does not jeopardize society.

 

Thanks for the discourse - nice to see another point, and your experience/training speaks for itself

[Komorebi]

33 minutes ago, sas5814 said:

That is a very interesting comment and a subject that gets discussed a LOT. There are a lot of variables and its hard to have a consensus because of all the variables.

For instance there is a huge difference in how we work together "on the ground" and what happens at the political level. I won't go into a long rant about it because it has been discussed to death. I'll suffice to say politically we aren't friends for a lot of reasons.

PA training, initially, is pretty well prescribed and formulaic and NP training, initially, can be all over the map. The recent advent of the "shake and bake" online NP programs have widened the gap. Even some in NP world are beginning to complain that their brand is being watered down by a glut of poorly trained NPs.

Then there is the additional training as you described. I worked with a PA whose wife was an NP intensivist (which until then I didn't know was a thing) and she did a 3 year residency at Baylor. Sadly she came to work in an organization where the physicians in admin pretty much thought we were all dangerous idiots and dumbed everything down "for safety". She didn't stay long.

PAs can go on to do residencies and CAQ (as described above) and now there is a bloom of doctoral programs that have different foci.

So yes... it would be nice if we could all work together to carve out our place in health care but there are so many moving parts and so many factions and fractions I don't see it happening anytime soon.

Some very forward thinking PAs tried to form coalition orgs of PAs and NPs several years ago but it never got much traction. We were still very much tied to our "friends" the physicians who were always going to be in charge of medicine and would look after us, their good right hand. That plan didn't quite work out.

I appreciate this sort of discussion. I will say first off that yes, some of the fly by night online schools have jumped into nursing to make a quick buck and unfortunately nurses who have been unable to gain admission to traditional NP programs have taken to them. Putting a low performing student into a poor program and then expecting a competent provider is asking a lot. MANY nurse practitioners have expressed concerns with this. Unfortunately, just as PAs sometimes feel the almighty PA admins at the top don't look out for the profession, we feel the same way about ANCC and AANP at times. They do a great job of getting independent practice laws passed and marketing the profession to become a household word, but not so good at matching the rhetoric with a polished final product when they allowed these poorly regulated schools to continue.

Those of us who recognize the problem go to reputable schools and pursue residency programs. It makes a league of difference. A graduate from an open admissions online program fresh out of school versus an NP who completed a traditional program + a 1-2 year official residency program are not even in the same stratosphere. Unfortunately as the numbers of poorly trained graduates increase they are ruining our reputation for everyone after one or two bad encounters.

I agree PAs and NPs cannot likely work together as long as PAs are "tied" to physicians. Medical boards have long tried to keep the NP profession down so there is a cat and dog mutual dislike there. I do wish PAs could gain their own sort of PA boards and self governance, then they could be free to collude with the NPs :)

[Komorebi]

34 minutes ago, ventana said:

Wow that is awesome!!'

 

I think it is great to see that you identified a need for more training an did it!  I get afraid in both NP and PA quest for independence we have some how forget to protect the patients.  I don't believe any new grad PA or  NP or Physician should be allowed independent practice.  Doc get internship year, and PA  and NP should mirror this - some formula for staged independence (where a DOC, PA or NP has to be "supervisor" just like the SLP's do.)  I a likely not popular for this opinion, but I think we have a duty to society to ensure our "minimum standard" does not jeopardize society.

 

Thanks for the discourse - nice to see another point, and your experience/training speaks for itself

I appreciate that! I fully agree against independent practice for anyone fresh out of school. I do think residency programs should be mandatory, or at least mandatory for independent practice.

New York has passed an independent NP law that functions like this, and several other states are following the same model. They basically introduce secondary "Independent NP" licenses that allow independent practice, but only after 3 years working under a physician supervisor. I believe the California version might also include a secondary, California developed board exam to apply for independent practice. Illinois has a version called the NP-FPA license (Nurse practitioner Full Practice Authority) available after 4,000 hours of supervised practice. So I think a lot of states are "getting it right" in terms of allowing independent practice and ensuring there is "extra" training before granting it.

 

None of us want someone with 500 (or even 2,000) clinical hours hanging a shingle for their independent clinic

Edited April 13, 2021 by Komorebi

[CSCH]

On 4/13/2021 at 12:07 PM, Komorebi said:

I wish PAs and NPs could learn from each other. Combine the education model of the PA with the population focus and advocacy/marketing of the NP!

^^^ THIS ^^^

I graduated from a critical care residency (and am currently pursuing a DMSc). I now precept and train NP students and NP residents, in addition to PAs. Every single (not exaggerating) NP I have trained has at some point, without any prompting or questioning from me, made the comment that "NP school wasn't super useful" or "I don't feel like I learned much of what I need to know in school."

Frankly, PA schools are far more rigorous (on average) when it comes to fundamentals and number of clinical hours, but NP schools integrate self-promotion, leadership, etc, and nurses have one of the best lobbies in the healthcare sector. I feel like NP schools can benefit from turning their attention more toward clinical knowledge before getting into all the other classes, and PAs need to teach their students to take themselves and their profession seriously. I know it would never happen, but I just dream of someday having one single APP pathway. Imagine if we combined our powers! True disruptive innovation.

I also see residencies (or fellowships, if you want to call them that) as a path forward for rounding out both types of clinicians in many fields., and an opportunity for us to train together formally. (We already seem to do a great job working together irl.)