Physician Assistant vs. Nurse Practitioner: at a crossroads; would love some advice

[2234leej]

I'm sure this topic has been beat to death in the past, but I was hoping to get some advice and wisdom regarding the two professions. I really respect everyone's opinion so please join in on the discussion; I could really use the help.

 

I've done considerable research about each profession but I am still at a crossroads as to which I would potentially like to do in the future.I currently graduated and received my clinical doctorate in physical therapy;however, I am fairly certain that I want to continue my education. I LOVE PT orthopedics, but there are certain aspects of medicine that I would like to participate in. I really enjoy PM & R/rehabilitation, but I really enjoy the other side of medicine that PA's and NP's do as well.

 

I have been married for 1.5 years and I am currently 25 years old. I am not interested in medical school because I have already been in school for 6.5-7 years. I considered applying to medical school but I really don't want to spend another 9 years in school (if I did medical school, I would like to be a physiatrist- 4 years of medical school + 3 years of residency + 2 years of fellowship).

 

I have asked for feedback from both PA's and NP's and I get different answers depending on who I talk to. Here are a couple things that I keep thinking about:

 

1. I absolutely LOVE the medical model that PA's learn compared to NP's. I really enjoy the sciences that you guys learn more about: pathophysiology,pathology. pharmacology, physiology, etc. The nursing curriculum looks like it has some solid classes, but there are some that seem like"fluff." Do PA programs have classes like that as well?

 

2. I really respect the nursing unions and lobbyists that represent their profession. I've been reading all these forums/posts about the AAPA and other organizations and it worries me because it seems as though PA's are less represented for the changes they want to make.

 

3. The amount of time is slightly longer for the NP route but less expensive given where I want to go (keep in mind I'm already in debt):

Rosalind Franklin PA program: 2 years (~24k/year for tuition)

University of Illinois Chicago GEP/NP program: 3 years (~12-14k/year fortuition; 15 mo of accelerated curriculum for RN license and 2 years forNP/masters degree).

 

4. I'm unsure as to whether or not I will be happy as a PA 15-20 years down the road. I keep hearing about PA's who grow tired of taking orders from younger,less experienced physicians, especially after they've been on the job for so long (and rightfully so). I've even heard some people say on the forums that if they could restart/go back in time they would have been physicians. I've also heard about PA's wanting to be NP's and NP's wanting to be PA's. Is that a"grass is always greener on the other side" mentality? do you guys feel the same way?

 

5. I am extremely passionate about teaching. I already have my bachelors in exercise physiology and a clinical doctorate in PT. I would like to think that a dual DPT + PA/NP would be marketable in an academic setting. Do you think either one would make me more marketable vs. the other?

 

6. Regardless of which I go into, at the moment I am currently interested in orthopedics and physical medicine and rehabilitation. I really want to incorporate my PT orthopedic skills, differential diagnosis and special tests and measures into my medical practice.

 

7. The PA profession, in general, has more men than nursing/NP. As a male, I'm not sure if nurses/physicians will look down on me as a male nurse practitioner. At the end of the day it doesn't really bother me but it is a thought that crossed my mind.

 

I apologize for writing so much but I would really appreciate any/all feedback.Hope to talk to you guys soon. Take care and God bless.

 

-Jamie Lee, DPT, CSCS

jamie.m.lee23@gmail.com

 

[2234leej]

This is open to both PA students and PA's who've been working for X amount of years. I'm really interested in all perspectives at this point. Thanks again.

[EMEDPA]

if you want to work outpt practice and/or own your own practice go np. psych, womens healthcare, and peds are more np friendly.

if you want to work in a hospital based specialty or in a hospital setting(especially em, ortho, or sug) go pa.

[UpRegulated]

1. I absolutely LOVE the medical model that PA's learn compared to NP's. I really enjoy the sciences that you guys learn more about: pathophysiology,pathology. pharmacology, physiology, etc. The nursing curriculum looks like it has some solid classes, but there are some that seem like"fluff." Do PA programs have classes like that as well?

 

All programs have fluff, but NP programs have more. You'll get those sciences at both the RN and NP level, but you'll get a few more sciences in a PA program.

2. I really respect the nursing unions and lobbyists that represent their profession.

 

I don't, and I'm an NP student. Some things they push for are good, but many of things just agitate the other professions that you will ultimately be working with.

3. The amount of time is slightly longer for the NP route but less expensive given where I want to go (keep in mind I'm already in debt):

Rosalind Franklin PA program: 2 years (~24k/year for tuition)

 

Don't just look at tuition, but lost income. If it takes you 1 year longer to become an NP that is $70,000 - $100,000 in lost income as a new PA. You must factor that in.

 

4. I'm unsure as to whether or not I will be happy as a PA 15-20 years down the road. I keep hearing about PA's who grow tired of taking orders from younger,less experienced physicians, especially after they've been on the job for so long (and rightfully so).

 

You'll likely face that as an NP too. Not only do state laws vary (e.g. you may not be able to practice independently in a given state), but the other thing is, you must consider what an "orthopedic NP" is actually capable of doing. You will not be an orthopedist, therefore your practice will be limited by your ability and training even if it is not limited by the law.

 

7. The PA profession, in general, has more men than nursing/NP. As a male, I'm not sure if nurses/physicians will look down on me as a male nurse practitioner. At the end of the day it doesn't really bother me but it is a thought that crossed my mind.

 

Not at all. I am a male nurse and if anything, I have found it to be exactly the opposite. At the risk of getting in trouble, men and women (on average) think differently. Male nurses tend to think more like physicians.

 

Considering you want to do ortho, I think the PA path is better for you, as it includes a surgical rotation, which would be extremely important to your practice. Secondly, with your background, I would think if you worked with an ortho or physical medicine group you would be quite respected and allowed quite a bit of autonomy.

[physasst]

Here are a couple things that I keep thinking about:

 

1. I absolutely LOVE the medical model that PA's learn compared to NP's. I really enjoy the sciences that you guys learn more about: pathophysiology,pathology. pharmacology, physiology, etc. The nursing curriculum looks like it has some solid classes, but there are some that seem like"fluff." Do PA programs have classes like that as well?

 

Every program has some fluff, but less in PA than in NP.

 

2. I really respect the nursing unions and lobbyists that represent their profession. I've been reading all these forums/posts about the AAPA and other organizations and it worries me because it seems as though PA's are less represented for the changes they want to make.

 

The thing that everyone keeps forgetting is that no one, regardless of their lobbying skills is going to get everything that they want. The AAPA is not horrible, despite the consensus on here, but they aren't really good about letting the grassroots PA know WHAT they are doing. Nursing unions and lobbyists have clout because of the sheer size of nursing. Only two things motivate politicians, money and votes. Physician organizations have the money, and nursing unions have the votes. We are always going to be playing catch up as PAs in that environment, which is why we have to be smarter than the other two. We can't make threats we can't back up, and we can't waste money on fights that we won't win.

 

3. The amount of time is slightly longer for the NP route but less expensive given where I want to go (keep in mind I'm already in debt):

Rosalind Franklin PA program: 2 years (~24k/year for tuition)

University of Illinois Chicago GEP/NP program: 3 years (~12-14k/year fortuition; 15 mo of accelerated curriculum for RN license and 2 years forNP/masters degree).

 

How much money will you lose that 3rd year in NP when you could have been earning? You have to factor in opportunity cost.

 

4. I'm unsure as to whether or not I will be happy as a PA 15-20 years down the road. I keep hearing about PA's who grow tired of taking orders from younger,less experienced physicians, especially after they've been on the job for so long (and rightfully so). I've even heard some people say on the forums that if they could restart/go back in time they would have been physicians. I've also heard about PA's wanting to be NP's and NP's wanting to be PA's. Is that a"grass is always greener on the other side" mentality? do you guys feel the same way?

 

A lot of that is grass is greener. There are a lot of very happy, satisfied PAs too. Each person's personality is different though. There is no way we can answer whether or not you would be happy as a PA or not. Only you can answer that.

 

5. I am extremely passionate about teaching. I already have my bachelors in exercise physiology and a clinical doctorate in PT. I would like to think that a dual DPT + PA/NP would be marketable in an academic setting. Do you think either one would make me more marketable vs. the other?

 

Of course it would make you marketable. DPT + PA would probably be more marketable than DPT + NP only because the PT portion is heavy musculoskeletal stuff which most NPs don't get into. You could likely teach at a medical school or PA school, or even be involved in PM&R research.

 

6. Regardless of which I go into, at the moment I am currently interested in orthopedics and physical medicine and rehabilitation. I really want to incorporate my PT orthopedic skills, differential diagnosis and special tests and measures into my medical practice.

 

Good for you. I currently practice in PM&R in a non operative complicated spine center. I have a background in Orthopedics and Emergency Medicine, and I have a grad degree in Sports Medicine in addition to being a PA. There aren't many NPs in the Ortho/PM&R world outside of Pediatric Orthopedics where there are some.

 

7. The PA profession, in general, has more men than nursing/NP. As a male, I'm not sure if nurses/physicians will look down on me as a male nurse practitioner. At the end of the day it doesn't really bother me but it is a thought that crossed my mind.

 

Non sequiter.

 

I apologize for writing so much but I would really appreciate any/all feedback.Hope to talk to you guys soon. Take care and God bless.

 

-Jamie Lee, DPT, CSCS

jamie.m.lee23@gmail.com

 

 

 

See above bolded replies.

[2234leej]

if you want to work outpt practice and/or own your own practice go np. psych, womens healthcare, and peds are more np friendly.

if you want to work in a hospital based specialty or in a hospital setting(especially em, ortho, or sug) go pa.

 

EMEDPA: is it really as simple as that? Do you know of any NP's who work in the hospital setting? And after working 20+ years as a PA, is there anything you would have done differently?

[2234leej]

UPREGULATED I appreciate your input. I do have some thoughts/questions for you:

 

1. Why did choose the NP profession? was it your first choice and what specialty are you interested in doing? did you ever consider PA, and if so, why did you not go in that direction?

 

2. I have heard NP's being upset about certain aspects of their profession as well, namely the alphabet soup of certificates that are required if you want to practice in a certain setting. Is that true or is that all hearsay?

 

3. Is it possible that PM & R/orthopedic physicians would hire me as an NP over a PA with my PT background? Or do you think they would just choose the PA?

 

4. What certificates would I need to work in primary care? ANP? FNP? There are so many that I have a lot of difficulty sifting through each one.

[2234leej]

PHYSASST: Thank you so much for the advice. If you don't mind I have some questions for you as well:

 

1. I would like your bias in this answer: having been a PA for quite some time, do you wish you had done anything differently? Do you feel like you get the autonomy that you deserve? I really want to know because you sound like you have a lot of drive and passion for your work.

 

2. If nursing has the votes and physicians have the money, is an NP degree more advantageous to have in the future? If PA's are farther behind in this regard do you think this could have a negative impact down the road on the profession?

 

3. That's awesome that you have a sports medicine/orthopedic background. It sounds like you're at the perfect place given your experience and knowledge of the subject. I do have a question in this regard (you may or may not be able to answer since you're not an NP): do you think that being an NP + DPT could make me more marketable than a PA + DPT in the sense that there are not as many out there? I know of PA + ATC's / PA + PT's. Do you think I could "separate myself from the pack" with the NP? Or could I be digging myself a ditch since NP's don't really go that route?

 

Again thanks for the feedback. Look forward to hearing what you have to say.

[EMEDPA]

EMEDPA: is it really as simple as that? Do you know of any NP's who work in the hospital setting? And after working 20+ years as a PA, is there anything you would have done differently?

I should have gone to medschool. it has taken me years to find positions with adequate autonomy that utilize my skill set appropriately. in my state there are probably only 5- 10 em pa positions like this and they all require 10+ years of experience and having an "in" with someone who already works there. they are all in very small, rural depts.

in a hospital you will almost always be someones "assistant".

there are some nps in hospitals and some pas working outpt psych but for the most part pas own the hospital environment and specialties and nps own the outpt setting to include psych/women's health and peds. fp is a toss up but if you want to own your practice go np.

[2234leej]

I should have gone to medschool. it has taken me years to find positions with adequate autonomy that utilize my skill set appropriately. in my state there are probably only 5- 10 em pa positions like this and they all require 10+ years of experience and having an "in" with someone who already works there. they are all in very small, rural depts.

in a hospital you will almost always be someones "assistant".

there are some nps in hospitals and some pas working outpt psych but for the most part pas own the hospital environment and specialties and nps own the outpt setting to include psych/women's health and peds. fp is a toss up but if you want to own your practice go np.

 

EMEDPA:

1. Did you not choose medical school because of a similar situation I am in? I have to factor in my wife, kids, house, debt, etc. which is why medical school seems like it's out the door.

 

2. I currently live in Chicago. This could just be temporary, but it seems like Rush University, UIC, etc. are hiring more NP's than PA's in the hospital. It could just be a phase but I'll look into it and see how it's like in Illinois.

 

3. If you could take it back would you have gone the NP route (in the sense that medical school was still removed as an option)?

[Guest JMPA]

3. Is it possible that PM & R/orthopedic physicians would hire me as an NP over a PA with my PT background? Or do you think they would just choose the PA?

 

You should not disregard the factor of personality when it comes to being hired and working in any particular field. NP or PA would probably have less factor to do with hiring ( if they were both equally skilled ) and more of a "how would you fit into this practice" factor for orthopaedics/ PM&R without OR.

[2234leej]

3. Is it possible that PM & R/orthopedic physicians would hire me as an NP over a PA with my PT background? Or do you think they would just choose the PA?

 

You should not disregard the factor of personality when it comes to being hired and working in any particular field. NP or PA would probably have less factor to do with hiring ( if they were both equally skilled ) and more of a "how would you fit into this practice" factor for orthopaedics/ PM&R without OR.

 

thanks for the reminder. I definitely keep that in mind.

[EMEDPA]

I chose pa school because it was the easy way out for a guy with a bs in medical anthro and a paramedic cert.

never had to go back to take specific prereqs, etc as I already had all of them done with my bs. had no desire to ever take ochem or biochem(and never did).

I seriously considered the PA to DO 3 yr bridge program at lecom a few years ago but can't afford 6 yrs with no income at this point + the price of school. I am married, have kids, mortgage, etc and the wife is an artist and does not have a regular dependable income stream.

illinois is a very pro-np state. chicago in particular is a tough pa job market.

I would never have gone np as I had/have no desire to ever be a nurse.

I would have stayed a paramedic and probably gotten an MPH if I didn't get into pa school after several attempts.

[2234leej]

I chose pa school because it was the easy way out for a guy with a bs in medical anthro and a paramedic cert.

never had to go back to take specific prereqs, etc as I already had all of them done with my bs. had no desire to ever take ochem or biochem(and never did).

I seriously considered the PA to DO 3 yr bridge program at lecom a few years ago but can't afford 6 yrs with no income at this point + the price of school. I am married, have kids, mortgage, etc and the wife is an artist and does not have a regular dependable income stream.

illinois is a very pro-np state. chicago in particular is a tough pa job market.

I would never have gone np as I had/have no desire to ever be a nurse.

I would have stayed a paramedic and probably gotten an MPH if I didn't get into pa school after several attempts.

 

EMEDPA: when I read this...I feel like you would have been a great DO/MD. It saddens me because I feel like I can empathize with you. I honestly didn't know I had such a passion for the health sciences/medicine until I was in my 5th/6th year of PT school. I realized I had a problem when I was tutoring pharmacology to biomedical science/PT/PA students (I only took two courses in pharmacology, not trying to sound like I'm amazing at it, I just love the subject).

 

My wife is a pharmacist so I'm grateful in that sense. However, she's been wanting me to get done for quite some time. She supports me, but in the back of her mind she is always hopeful that I put it to rest and work as a physical therapist. It has already been 7 years so I do see her point of view...

 

I really don't want to live with regret. I'm seeking out answers because I'm so torn. I would probably be happy working as a PT...but I feel like I could potentially be happier with something else.

[EMEDPA]

DPT+ Ortho PA would be a great combo for a PM+R practice.....

[bradtPA]

iMHO for ortho it's better to go PA than NP. PA will not require an additional cert for the OR, while an NP will need a cert in first assist to do the same function.....

[UpRegulated]

UPREGULATED I appreciate your input. I do have some thoughts/questions for you:

 

1. Why did choose the NP profession? was it your first choice and what specialty are you interested in doing? did you ever consider PA, and if so, why did you not go in that direction?

 

PA was my first choice as I like the medical model better being a science-oriented person. My specialty is family primary care - have never wavered on that. I chose NP for several reasons. One, NP's are used much more widely where I live and want to stay. Two, broad flexibility of being a nurse - NP, teaching, administration, management, specialized clinical positions, RN per diem, whatever, in the event I ever decided not to be a practicing NP anymore or want to do a little more on the side. In some areas, you can get this too a certain degree as a PA too, but nursing as a field is considerably larger on average. Three, I would have had to relocate at great financial expense and family disruption to go PA. So in the end, the pros of going the NP route outweighed the PA route (though it would have been a shorter path for me and I like the medical model better). Also, in some areas (not mine necessarily), you can have a bit more autonomy if I ever felt I needed that.

 

2. I have heard NP's being upset about certain aspects of their profession as well, namely the alphabet soup of certificates that are required if you want to practice in a certain setting. Is that true or is that all hearsay?

 

Not sure what you mean, but I assume you mean that NP's are specialized, and are somewhat hampered if they want to change specialties. In my area, and in many areas, it really isn't that big of a deal. Many use the FNP as "generalist" training and it works quite nicely for them. I know of FNP's in nephrology, cardiology, neurology, EM and inpatient medicine (hospitalist), and I know of those in one specialty switching to another after several years (nephro to cards). There is a lot of talk about how PA's can easily switch specialties, but I've seen the same with FNP's. Maybe it is just my area though.

 

3. Is it possible that PM & R/orthopedic physicians would hire me as an NP over a PA with my PT background? Or do you think they would just choose the PA?

 

I don't know. I suppose it would depend on how a group/practice intended to use you (PA's can chime in here). My guess is that if you want to work to your fullest ability related to an ortho area, they would prefer a PA due to the surgical rotation that you would get. Either way, being both a PT and either an NP or PA on top of that, you would be a uniquely trained clinician.

 

 

4. What certificates would I need to work in primary care? ANP? FNP? There are so many that I have a lot of difficulty sifting through each one.

 

Do FNP if you do anything NP wise. As I mentioned, it is considered the "generalist" NP and would give you the most flexibility. In general, the specialties are family (primary care), adult (primary or acute), pediatric (primary or acute), women's health, nurse midwife, and CNS (clinical nurse specialist) in the advanced practice realm. Some schools have combined-type programs too. As a rule of thumb, family is the only one that allows you to truly work with all ages unless you do a combined major/dual certification (which some do).

 

The only way I could think of that NP could work for you is if when you land a job as an NP, convince the ortho doc/group to give you a surgical "rotation" as part of signing on with them - I'd bet many groups would be completely open to that, especially given your unique background. It would also be a rotation specifically in ortho which would be kind of cool (no time wasted watching/suturing/assisting on an orchiectomy :). Another additional option is that in your final clinical training in a NP program, many schools can be flexible with you in your rotations allowing you to do some surgery time, but the amount of time you would be granted is limited (check with potential NP schools). I'd think you'd also need to pick up either some serious time in rads during NP school and/or when you are first hired, which should also be doable with the right school/employer.

[UpRegulated]

while an NP will need a cert in first assist to do the same function.....

 

That's not true. It is state dependent and to my knowledge (correct me if I'm wrong), the overwhelming majority of states do not require RNFA (maybe Texas?). And in those that do, that could be picked up by the OP in a year or two after graduation.

[Just Steve]

You do know why you hear the negative comments from older PAs, right?

 

The unhappy ones complain loudly to everyone, the happy ones just keep working quietly along. Listening to random stories is a skewed survey unless you ask specific questions.

[HopefulPA]

If you want ortho PA would be a better route. In 2 hospital systems in my state they won't allow NPs in the OR without a separate first assist certification. So it isn't only based on the state laws but the hospital policies.

[2234leej]

UPREGULATED: thank you so much!

 

Your situation is considerable to mine so I can definitely relate to you. And according to EMEDPA, Illinois is a more NP friendly state compared to PA's (never knew that until now).

 

If I were to go the NP route I will definitely do FNP or ACNP (considering FNP more though).

 

"The only way I could think of that NP could work for you is if when you land a job as an NP, convince the ortho doc/group to give you a surgical "rotation" as part of signing on with them - I'd bet many groups would be completely open to that, especially given your unique background. It would also be a rotation specifically in ortho which would be kind of cool (no time wasted watching/suturing/assisting on an orchiectomy . Another additional option is that in your final clinical training in a NP program, many schools can be flexible with you in your rotations allowing you to do some surgery time, but the amount of time you would be granted is limited (check with potential NP schools). I'd think you'd also need to pick up either some serious time in rads during NP school and/or when you are first hired, which should also be doable with the right school/employer."

 

I never even considered this as an option. On paper it sounds extremely doable/realistic. I will definitely contact UIC and see if they allow something of this nature. And sorry, this is a stupid question, but do you mean radiology when you say "rads"?

 

UpRegulated, have you ever received backlash/stereotype comments for being a male in a women-dominant profession? I was just curious if it has ever happened to you at all and how you responded to it.

[2234leej]

If you want ortho PA would be a better route. In 2 hospital systems in my state they won't allow NPs in the OR without a separate first assist certification. So it isn't only based on the state laws but the hospital policies.

 

 

If you don't mind me asking where are you located? And would you happen to know where I could find additional information regarding this topic?

[LT_Oneal_PAC]

That's not true. It is state dependent and to my knowledge (correct me if I'm wrong), the overwhelming majority of states do not require RNFA (maybe Texas?). And in those that do, that could be picked up by the OP in a year or two after graduation.

 

You don't have to be an RNFA to a first assist, but you do to be able to bill as one.

[UpRegulated]

UPREGULATED: thank you so much!

 

Your situation is considerable to mine so I can definitely relate to you. And according to EMEDPA, Illinois is a more NP friendly state compared to PA's (never knew that until now).

I never even considered this as an option. On paper it sounds extremely doable/realistic. I will definitely contact UIC and see if they allow something of this nature. And sorry, this is a stupid question, but do you mean radiology when you say "rads"?

 

UpRegulated, have you ever received backlash/stereotype comments for being a male in a women-dominant profession? I was just curious if it has ever happened to you at all and how you responded to it.

 

Yeah, do a lot of research in your state as well as the schools before you pull any triggers.

 

Yes, radiology.

 

Backlash/stereoptype? Almost none. When I was in my previous career and they found out I was quitting to be an NP, one dude said something about being a "male nurse." He was a super nice guy and a good friend, but kinda' dumb honestly. That's it. In the medical community and nursing school, I've gotten zero. My fellow nursing students, nursing instructors, fellow nurses, residents, physicians (especially), RT's, PT's, OT's, lab tech, rad techs, etc., if anything, have been more respectful to me than my female counterparts. I had the exact same concerns (I'm a male!), but my concerns were completely unwarranted. At my hospital/unit, the dudes tend to be the hot shots and the "go to" nurses for lots of things (patho questions, med questions, IV starts, etc.). The lady nurses love us. :)

[Jonathan Yoder]

"If I were to go the NP route I will definitely do FNP or ACNP (considering FNP more though)."

 

Among nursing educators/national leadership there is a growing push for nurse practitioners to work within the scope we are trained (e.g. FNP should see primary care problems/ACNP see in-patient acute/specialty problems; search Consensus Model for APRN Regulation). Obviously, lots of FNPs (including myself) are working for specialty practices and in inpatient settings, but I think there will be growing pressure at both the state board level (Texas is a good example) and the individual institutional level for NPs to have the degree that matches their population focus. Similar/related push is developing for PAs with specialty certification, but they are much better positioned as generalists than NPs who are trained with a specialty focus.

 

One way to get a feel for nursing school would be to enroll in a nursing pathophysiology or pharmacology course as a non-degree student (online would work, preferably graduate level, see if they'll work with you since you're a PT, don't tell them you're debating NP/PA). Nursing curricula vary significantly in emphasis and content, but those courses tend to be on the heavier end of the content for most programs. In other words that's about as intense as it gets. That might help to inform your decision, you'll likely have a definite sense after a course about your interest in pursuing an NP program.

 

Overall, I think the PAs I work with were better trained when they graduated than I was when I graduated, especially as acute/inpatient providers.

 

The caveat is that ultimately you will be responsible for what kind of clinician you become. PA vs NP is an important decision, but seeing patients (lots and lots of patients), finding mentoring, being honest, asking questions, and engaging in persistent self-directed learning all matter a lot, and are ultimately (I hope) more determinative of your skill set than your initial training program (within the regulatory issues outlined above).