PA Training with NP Autonomy...

[MedicalRN]

Hello all, I'm new here, so a brief background:

 

I graduated from a top 15 private undergraduate college with a degree in chemistry/biology. I took all of the pre-reqs for medical school and planned on attending - I was (and am) quite a competitive applicant. By senior year, however, I felt burn out. My college is notoriously difficult and I was just sick of studying all the time. The thought of doing it for an additional 4 years seemed crushing. Meanwhile, my girlfriend and I became more serious and I was worried about ruining our future with medical school (60+ hour weeks in residency, etc). Finally, my family couldn't support me financially and the debt load I would have to take on was just too much - so I gave up. I graduated with my degree without even taking the MCAT and decided I would find something else to do. I considered PA and NP, but since both require healthcare experience I decided I would become an RN while I made my decision.

 

Now I'm an RN, and I'm trying to decide what to do. I really like the idea of a nurse practitioner - more autonomy, under the nursing board vs the medical board, don't have to deal with physicians as much...however I seriously worry about the preparation. I see advertisements on my screen for fully online NP programs at for-profit schools, and there seems to not be much of medical curriculum. The NP license exam is apparently very low on clinical questions, and the whole thing just seems scary. I can't imagine having the power of an NP with such little training. 80% of the classes in the curriculum are about research or epidemiology. Not a single school has a gross anatomy course (or even any sort of anatomy course), nor microbiology, clinical skills, diagnostic imaging, etc. In addition, they tout "500 hours of required clinicals" - really?? That's like 6 weeks fulltime for an entire graduate program. Subjectively, I have browsed nursing forums for information on NP programs and while I haven't found much, I am struck by the grammar of some of the NPs that post. They sound like they barely completed college, let alone a graduate degree to practice healthcare. And the vast majority of pre-NP students tend to post about "where's the easiest program?", "how can I do this online in one year?", etc. None seem to value quality or training..it's quite scary.

 

So now I'm stuck...I want the training of a PA. I want to be a PA, quite frankly. But I want the autonomy of an NP. I want to be able to specialize like an NP can, and be able to open my own private practice (in most states). I would love to open a small urgent care type clinic to prevent ED overcrowding, seeing patients on my own, but it seems a PA will give me the training but not the autonomy, an NP will give me the autonomy but not the training, and an MD/DO will give me both...along with 200K in debt, and 7-8 more years of schooling/residency.

 

Anyone have any advice or face a similar issue?? I have found the UC Davis combined PA/FNP program, this seems like it could be promising, but I don't know anything about it. Is this my only option?

[bradtPA]

Sounds like med school is your answer, as it is the only option of medical training followed by independent practice.

[EMEDPA]

PAs can work in any specialty. you are not limited to primary care.

PAs can open their own clinic, you just need to hire a physician to sign some charts or complete the min required supervision in your state(some states require doc on site X # days/mo for example while most only require a certain % of charts be reviewed monthly.)

several folks here on the forum have done this.

[MedicalRN]

^ I didn't know this, but feel it would be an obstacle. I would have to PAY this physician, lowering my income, and they would have to agree to put their license on the line.

[Boatswain2PA]

The privilege of practicing medicine independently should be reserved for those who made the sacrifices you chose not to make.

[EMEDPA]

if you pay a doc 1000/mo and take home 15-20k/mo after expenses you are still doing ok finanicaly...

[MedicalRN]

The privilege of practicing medicine independently should be reserved for those who made the sacrifices you chose not to make.

 

That's unnecessarily rude. Clearly NPs practice independently - I could take the easy path to independent practice and do that, but I'm posting because I want to be better trained. I'm looking for a more difficult path, quite frankly - just not one that carries the debt burden of medical school.

[UpRegulated]

I shared many of your same concerns before electing to go the RN/NP route over PA. The thing is, NP schools vary widely in quality, and, any educational endeavor is 80% of what you make it. A few things to think about:

 

(1) Ignore the major nursing forum on the internet. You'll drop several points in IQ simply by viewing their home page. And, most importantly, the posters are NOT representative of NP's at all, or even RN's. The one's you refer will likely never get in to NP school, and if they do, will likely fail out quickly.

 

(2) As for the curriculum. NP schools don't do a very good job advertising course content. This last semester (the second one in my NP program), I took 7 credit hours, which was considered full-time, which I thought was nuts...until I got in to it. It was tough. My physical assessment class included just that, however we covered every physical exams technique know to man (or so it seemed), a number of which my MD preceptor had not even heard of, along with labs, x-rays, developing differentials, etc. Yet it was only a 3 hour class + clinical. The second class I took was pharm, and it was co-taught by three instructors, including a DNP whose name is widely known nationally in the nursing community and has formally studied pharm, an MD who is a pediatric geneticist, and the third is a PharmD. It was very rigorous and I learned a ton. Websites of schools and courses descriptions tell you very little in this regard.

 

(3) If you really want to consider NP, only consider schools that are part of a major, well-recognized and well-respected medical campus. This helps ensure that the NP program is most likely a better quality one. Steer clear of any for-profits, and steer clear of smaller schools with no medical school and allied health programs.

 

(4) Curricula full of nonsense classes tend be at those schools that, in my opinion, are subpar. I am sure there are exceptions, however.

 

(5) Look at the textbooks they use - seriously. Most every text book I have used so far are written or at least co-written by MD's. This can tell you a lot about the school and their approach and philosophy.

 

Based on what you have said, med school is still probably the best way for you to go. However, if you cannot do med school, don't rule out NP considering you are already an RN. Just choose your school carefully and if you do, you can get a very solid education.

[LT_Oneal_PAC]

That's unnecessarily rude. Clearly NPs practice independently - I could take the easy path to independent practice and do that, but I'm posting because I want to be better trained. I'm looking for a more difficult path, quite frankly - just not one that carries the debt burden of medical school.

 

Sent you a PM.

[LT_Oneal_PAC]

I shared many of your same concerns before electing to go the RN/NP route over PA. The thing is, NP schools vary widely in quality, and, any educational endeavor is 80% of what you make it. A few things to think about:

 

(1) Ignore the major nursing forum on the internet. You'll drop several points in IQ simply by viewing their home page. And, most importantly, the posters are NOT representative of NP's at all, or even RN's. The one's you refer will likely never get in to NP school, and if they do, will likely fail out quickly.

 

(2) As for the curriculum. NP schools don't do a very good job advertising course content. This last semester (the second one in my NP program), I took 7 credit hours, which was considered full-time, which I thought was nuts...until I got in to it. It was tough. My physical assessment class included just that, however we covered every physical exams technique know to man (or so it seemed), a number of which my MD preceptor had not even heard of, along with labs, x-rays, developing differentials, etc. Yet it was only a 3 hour class + clinical. The second class I took was pharm, and it was co-taught by three instructors, including a DNP whose name is widely known nationally in the nursing community and has formally studied pharm, an MD who is a pediatric geneticist, and the third is a PharmD. It was very rigorous and I learned a ton. Websites of schools and courses descriptions tell you very little in this regard.

 

(3) If you really want to consider NP, only consider schools that are part of a major, well-recognized and well-respected medical campus. This helps ensure that the NP program is most likely a better quality one. Steer clear of any for-profits, and steer clear of smaller schools with no medical school and allied health programs.

 

(4) Curricula full of nonsense classes tend be at those schools that, in my opinion, are subpar. I am sure their are exceptions, however.

 

(5) Look at the textbooks they use - seriously. Most every text book I have used so far are written or at least co-written by MD's. This can tell you a lot about the school and their approach and philosophy.

 

Based on what you have said, med school is still probably the best way for you to go. However, if you cannot do med school, don't rule out NP considering you are already an RN. Just choose your school carefully and if you do, you can get a very solid education.

 

We had different experiences in NP school. Not trying to start an argument. Just pointing out that my time in NP school before PA left me unimpressed, hence the new path. Yes, I went to a major medical center.

[UpRegulated]

Nothing I listed in my post guarantees a school is any good, and I did not mean to imply that it was a guarantee. It is just a starting point - the minimum criteria. As with a school of any kind, an applicant should do a ton of research about a school before accepting.

[LT_Oneal_PAC]

Nothing I listed in my post guarantees a school is any good, and I did not mean to imply that it was a guarantee. It is just a starting point - the minimum criteria. As with a school of any kind, an applicant should do a ton of research about a school before accepting.

 

Agree completely.

[Just Steve]

A quality medical team will collaborate when it comes to patient care, this is a given. The initials behind the name does not dictate which way the conversation flows. The team simply shares and learns from each other...if it is a good team. It does not require constant oversight to work as a PA. I have only been to one sight where the PA/doc relationship was a Mother May I arrangement. Turns out, they have been advertising open PA slots almost consecutively...seems they struggle at retention. Go figure. PAs want autonomy and trust..and can find it. Solo practice ER? They exist. Solo provider in rural clinic? Yep. Solo hospitalist position with an average census of 60? You betcha (the catch on that is that it is night shift)

 

So my point...PA does not equate "requires babysitter". Practices look to PA to be that physician extender. Expand the practice, get healthcare to more people, increase revenue for the clinic. If you not find this sort of working environment, and you desire it, keep looking. Some regions are more PA friendly than others. You may have to move but DO NOT believe for a moment that you can't be almost as independent as you want if you are willing to move.

 

As for the no med school because of girlfriend issues...1. I am curious if you are still together, and if not, do you now regret not going? 2. I have it on very good authority, first person experience in fact, that PA school can be a HUGE BLOODY STRESSOR on even the strongest relationships. If your relationship was overly taxed with undergrad, I have little to no faith it will survive PA school without intensive, professional assistance aka: couples counseling. Don't wait until there is a problem but rather attend to discover new ways to maintain.

[Houstonian]

We had different experiences in NP school. Not trying to start an argument. Just pointing out that my time in NP school before PA left me unimpressed, hence the new path. Yes, I went to a major medical center.

 

Please tell us your impressions/experiences in NP school!

[LT_Oneal_PAC]

Please tell us your impressions/experiences in NP school!

 

I'm more than happy to answer questions in PM.

[Brotherman]

Preparation for the practice of medicine is all that matters. There are no short cuts. PAs practice independently. We just do it in a team. There are very few NPs I've been impressed with and the ones I have taken notice to had lots of prior experience in their respective fields of discipline. PAs specialize by working in whatever area where the doc is in. We are adequately trained to enter any field and build from there. There are NPs I work with who were never trained or educated about suturing. Never. If you want total autonomy, go to medical school. Otherwise, become a physician assistant.

[UpRegulated]

So my point...PA does not equate "requires babysitter". Practices look to PA to be that physician extender. Expand the practice, get healthcare to more people, increase revenue for the clinic. If you not find this sort of working environment, and you desire it, keep looking. Some regions are more PA friendly than others. You may have to move but DO NOT believe for a moment that you can't be almost as independent as you want if you are willing to move.

 

Yes, and no. The autonomy of the NP vs. the PA is overrated (and I'm saying this as an NP student). It not only varies considerably state-to-state, but in the case of a new grad, it is all but irrelevant. No new grad NP or PA should be autonomous anymore than the newly minted MD should be, unless you want to lose your license and/or fail quickly.

[UpRegulated]

PAs practice independently. We just do it in a team.

 

I see your point, but you are sort of splitting hairs and redefining "independent."

 

There are very few NPs I've been impressed with and the ones I have taken notice to had lots of prior experience in their respective fields of discipline.

 

Sigh. Anecdotes.

 

 

There are NPs I work with who were never trained or educated about suturing. Never.

 

What speciality do you work in? How often do you suture (in percentage of patients seen)? FWIW, my NP program teaches suturing, I just fail to see how this is a trump card. :)

 

If you want total autonomy, go to medical school.

 

Agreed. Well, except that physicians have the most autonomy -- no one has total autonomy.

[crossbone2007]

I can identify with you. I was in the same situation as you (except for the gf's part) I wanted to practice medicine independently but I was unwilling to accrue the dept associated with becoming an MD just for greater gain or autonomy. I sat and thought about it deeply and I came to realize that all I wanted to do is practice medicine, independent or not, as long as my patients are satisfied with my service while I earn a living. I had 2 choices, becoming an RN then DNP or go PA. Comparing the 2 paths, PA seems to be the most efficient way for me since it was build on the medical model, you have more hardcore sciences and more clinical exposure then NP. But at the end of the day 5 to 10 yrs down the line, there is no difference between NP and PA when it comes to experience. We all work as a team, beneficial to the patients, that is what count.

[Gordon, PA-C]

Hello all, I'm new here, so a brief background:

 

I graduated from a top 15 private undergraduate college with a degree in chemistry/biology. I took all of the pre-reqs for medical school and planned on attending - I was (and am) quite a competitive applicant. By senior year, however, I felt burn out. My college is notoriously difficult and I was just sick of studying all the time. The thought of doing it for an additional 4 years seemed crushing. Meanwhile, my girlfriend and I became more serious and I was worried about ruining our future with medical school (60+ hour weeks in residency, etc). Finally, my family couldn't support me financially and the debt load I would have to take on was just too much - so I gave up.

 

So now I'm stuck...I want the training of a PA. I want to be a PA, quite frankly. But I want the autonomy of an NP. I want to be able to specialize like an NP can, and be able to open my own private practice (in most states). I would love to open a small urgent care type clinic to prevent ED overcrowding, seeing patients on my own, but it seems a PA will give me the training but not the autonomy, an NP will give me the autonomy but not the training, and an MD/DO will give me both...along with 200K in debt, and 7-8 more years of schooling/residency.

 

 

LOL so let me get this straight.

 

You dont have enough time to commit to a 60 hour workweek in residency, but you do have the time/energy to start up your own small business?

 

Let me put this to you bluntly -- starting your own clinic is 10 times more work/effort than anything you would do in med school/residency.

 

This is why I always laugh when I hear that NPs are going to take over primary care -- they mistakenly think that running their own clinic is a 9-5 bankers hours type job

 

I also laugh whenever I hear NPs say they want to open up their own clinic but they also say that they didnt choose MD because of the "debt load." I hope you have a million dollars in cash sitting in your bank account because otherwise you are going to go into some serious debt to start your own clinic.

[Boatswain2PA]

That's unnecessarily rude. Clearly NPs practice independently - I could take the easy path to independent practice and do that, but I'm posting because I want to be better trained. I'm looking for a more difficult path, quite frankly - just not one that carries the debt burden of medical school.

 

I was not being rude. It is these sacrifices that make Doctors stand out from us mid-level providers.

 

Just because some NPs can practice independently does not mean they should.

[MedicinePower]

The privilege of practicing medicine independently should be reserved for those who made the sacrifices you chose not to make.

 

I don't necessarily disagree with this but the question has to be asked if the sacrifice they made was in line with the necessary knowledge needed to practice independently. There have been recent studies and proposals to reduce medical school by up to 30% and there are some large medical schools which have gone to a 3-year model. Clearly physicians have far more training when you factor in residency, which would put them at the level of "Physician" in my 3-5-7 year proposal. PAs and NPs would meet the Assistant Physician level provided they added 1 year mandatory residency, and be granted the title "Doctor".

 

Lastly,

But because accreditation standards do not dictate the fine points of curriculum, the committee has approved N.Y.U.’s proposal, which exceeds by five weeks its requirement that schools provide at least 130 weeks of medical education. Link

a 24 month PA program comes very close to that of the 130 weeks of medical education. One might wonder why we don't strive for that goal.

[futurePAS]

Wow OP, I feel that I could have written this post as I'm going through the exact same thing (well, except I'm not a RN). It really is such a difficult decision to make.. there's no doubt PA education is far more superior, but the legal independence and not having to constantly educate people that you're not an assistant is extremely attractive.

 

I've met a great NP who expressed that she had to go out of her way to supplement her training by sneaking into lectures, reading a TON on the side, opting for longer rotations etc. I too was mortified when I started researching NP/DNP programs at the lack of clinical medicine being taught, but programs like Vanderbilt's that provide a dual RN/NP in two years is very tempting. I do think that you certainly can be a great practitioner as a NP, but you will have to work your butt off.

 

Crazy idea, but I'm assuming you have a BSN.. so you could pretty easily complete a NP program part time after you've graduated from PA school, and you'd have best of both worlds!

[Timon]

Have you thought of going to a dual NP/PA program like the one at UC Davis?

[physasst]

I was not being rude. It is these sacrifices that make Doctors stand out from us mid-level providers.

 

Just because some NPs can practice independently does not mean they should.

 

You can consider yourself a "midlevel" provider, most of the rest of us do not. I know I am not a "midlevel". I noticed how you capitalized doctor....interesting.

 

Personally, physicians are just another component to the healthcare team. That's it. They are not better or worse than any other part of the team (although they certainly think they are) and while they sometimes have more knowledge in some areas, other members sometimes have more knowledge in other areas. The doctor should never be in charge of the team all the time. We need to move away from heirarchical models of care into circular leadership models. Any member of the team should be able to move into the leadership role of the team depending on the circumstance. Perhaps it is a wound care issue and the RN should be giving directions to the physician and the rest of the team? Perhaps it is a rehab issue? Perhaps it is medication issue that the PA or NP knows more about than the other members? We are always stronger together than apart and physicians don't usually recognize that......ego bias (hindsight bias too really) being what it is. I just wrote a paper that is in submission now to JIPC on physicians, PA/NP providers, and status characteristics theory, and how physicians view their status, how it impacts interprofessional relationships and team care.

 

While everyone else was chomping at the bit over the AMA resolution regarding the performance of procedures. I was much more concerned with the definition of the team, and the physician led team language that the AMA used. Knowing the chairman of the AMA board, I had a nice email conversation with him about this. The chronic pain management language was also a problem, a big problem for me.

 

I practice in a complex nonoperative PM&R spine practice. I have my own panel of patients and get referrals to see patients from all over the world. I manage chronic pain daily, in a completely autonomous model. I sometimes consult my physician colleagues, and they sometimes consult me. YMMV.