[Cyndee, MSN, NP]

[quote=MrBob]

Originally Posted by Jayla

Jayla...you are way beyond your years in wisdom regarding this matter....the fact is there is no CLINICAL difference....the difference is philosphical, pure and simple....I have been a PA for 25 years and at the grassroots level we all get along (at least in my state) I precept NP students in my clinic and was asked by the NP programs to do this.....My PA students are precepted by NP's ( I teach in one of the programs)....the difference is a topic sought out by those small PA's and NP's who think they are the only ones who exist.....those of us who really work for a living don't see the point in arguing small stuff and those of us who agree with you about joining forces have joined the American College of Clinicians...an organization born out of the same concerns you make....why don't we just stick together???

When the tomatoes come...just duck you are a bigger person for your insight and ability to look beyond the idiocy of that argument!! good luck on your journey to NP school!!

Robert Hollingworth MS, PA-C

I wish I knew more PA's like you. I used to work as a pharmaceutical rep (worked as RN on the side) and when I told my PA's I was going to go back and get my Master's to become a NP, they just about tore my head off! They kept telling me to enter a PA program because "PA's were trained by doctors and NP's were trained by nurses". That was totally not the case in my situation. I shadowed a NP for a month and then spent all my clinical rotations with internists/gerontologists. That may be the exception though, because most of the NP's I know did all their clinical rotations with NP's. Maybe it just depends on where one goes to school(?).

p.s. I'm not sure why those PA's thought that doctors (in general) were better at training students.

[Cyndee, MSN, NP]

[quote=siri]

Originally Posted by Cyndee, MSN, NP

PNP's can now practice independently in 7 states. quote]

Actually, Cyndee, NPs can practice independently in 21 states. With the exception of Georgia, all NPs have some ability to prescribe. And, in 10 states, NPs can prescribe independently.

I understand what you're getting at, but if you go to the Texas Board of Nursing website you will find that we practice independently, BUT in order for us to have our own clinic we STILL have to have a physician audit 10% of our charts plus they have to be available to answer any questions. So, we really aren't practicing independently after all. However, in New Mexico and a few other states, a physician does not have to audit our charts and we are truly independent. Unfortunately, hospitals are still controlled by physicians and they come up with all kinds of rules that limit what NP's can do in the hospital.

[Papadoc]

Originally Posted by Cyndee, MSN, NP

I graduated from Vanderbilt and they have just about every NP specialty there is with the exception of anesthesia. I am certified in Adult & Geriatric Health and I work as an independent contractor. I'm going to begin working a couple of days a week with a pain management specialist and we have discussed my scope of practice. I do not know of any states that allow NP's or PA's to do lumbar punctures, but they can perform intra-articular and trigger point injections. PA's can work in surgery, but a NP must complete a "first assist" course (9 hours online, 6 full days of training and then assist with 15 surgeries). I do not know of any NP programs that include the "first assist" courses in their programs, but all PA programs do. As far as lumbar injections, you would have to become a nurse anesthetist to perform those and it would depend on your state's laws as to whether you could actually practice independently and bill for those services.

If I were you I would go the PA route, otherwise you will have to go back and take that first assist course.

Thanks for your repply,Cyndee,MSN,NP!
I've considered PA route also after leaving the med school. With all my pre-med prereqs, and NO BSN, PA could be a faster route, but I gather not neccessarily a better one.I've been an RN for 15 yrs now. "Crossing over" to another profession, rather than advancing one I'm in now, and basically starting from scratch..... . And all for the first assist thing.I'm a lot more interested in PM&R, cronic pain and fatique, fibromyalgia type of patients, rather than slicing someone open. I'm quite happy with what I do with acupuncture, but I haven't been able to truely blend it with my RN. So I thought may be NP would give me that edge of the decision making.
Thanks again

[mango-lo-maniac]

Originally Posted by Cyndee, MSN, NP

I do not know of any states that allow NP's or PA's to do lumbar punctures, but they can perform intra-articular and trigger point injections. PA's can work in surgery, but a NP must complete a "first assist" course (9 hours online, 6 full days of training and then assist with 15 surgeries). I do not know of any NP programs that include the "first assist" courses in their programs, but all PA programs do. As far as lumbar injections, you would have to become a nurse anesthetist to perform those and it would depend on your state's laws as to whether you could actually practice independently and bill for those services.

Actually, learning to do lumbar punctures is standard in most PA programs. I don't know for certain, but I imagine that NPs who work in emergency med do LPs as well.

Also, depending on the setting, PAs (maybe NPs, too??) can do lumbar injections. "BlocDoc" at the PA forum is an RN/PA who works in pain management. I think he's a member here too, but less active. Anyways, he's a really approachable guy and could elaborate much more than I ever could on the topic.

Originally Posted by Cyndee, MSN, NP

Physicians DO have ownership of PA's. PA's will NEVER be able to practice independently because the State Medical Boards will never allow it!

I certainly don't foresee independent PA practice, but I wouldn't say that PAs are "owned" by physicians. Like "collaboration", "supervision" has many different interpretations. Indiana is to PAs what Georgia is to NPs. We can't prescribe there, and while a doc doesn't have to be physically present during PA practice the physician must review every chart within 24 hours. But North Carolina is PA-progressive, somewhat analogous to New Mexico and NP practice. NC PAs prescribe schedule II-V (30-day limit for Sch II), and supervision is a meeting once every 6 months. PAs can also own their practice in NC.
summary of PA practice regulations

[Osiris55]

Originally Posted by mango-lo-maniac

I certainly don't foresee independent PA practice, but I wouldn't say that PAs are "owned" by physicians. Like "collaboration", "supervision" has many different interpretations. Indiana is to PAs what Georgia is to NPs. We can't prescribe there, and while a doc doesn't have to be physically present during PA practice the physician must review every chart within 24 hours. But North Carolina is PA-progressive, somewhat analogous to New Mexico and NP practice. NC PAs prescribe schedule II-V (30-day limit for Sch II), and supervision is a meeting once every 6 months. PAs can also own their practice in NC.
summary of PA practice regulations

Personally, looking at it from a pt. perspective I'd be a little worried about seeing an NP that doesn't have ANY physician oversight at all. I've looked very hard at NP programs and such and have been very drawn to them, but I can't see how a mid-level would be able to practice without a physician going over a sampling of charts every x months. I don't understand why that is a bad thing.

One of the reasons I was turned off by PA programs was that I had always thought they had a greater degree of oversight then NPs. It just seemed silly to me to train someone to do all this stuff that allows you to be a physician extender but requires you to go running to the physician every 10 minutes. It is interesting to learn that there are states with less oversight. In fact I just checked with that link and I see my own state, NH, has what seems to be almost the exact same regulations as NC.

Now I'm really thinking about which one would be better for what I want to eventually do. Not that I'm anywhere near the point of entering either type of program, but what before was a one sided decision (If I wanted any independence I'd need to be an NP) has been given a new, and very intresting, dynamic.

[brownrice]

Mango-Lo-Maniac:

Can you please share the address of the PA forum website?
Thanks.

[mango-lo-maniac]

The main PA forum is www.physicianassociate.net. The sister site, for PAs and NPs to discuss issues of mutual concern, is www.clinicanforum.com.

[Danielle4]

osiris55
I am glad to hear that you have decided to consider PA school which will give you another option. I think it is really smart to consider several options.
I agree with you 100% when also when you say about being worried about seeing an NP with no supervision. I agree ANY mid-level trying to practice medicine without it is bad news. I don't think a NP/PA should have to carry all that legal strain on them in the long run the doc is the only one that went to med school and they get more paid for it- let them do it. I think NP and PA's are completely capable of handing medical cases and all, but they should have a doctor to consult when needed for sure. It does not hurt to have someone check your charts- the medical field should have tons of checks and balences just like our government. I think it makes the healthcare TEAM better.

My doctor employs 3 PAs who all work independantly (all work when she is not in the office) but they all have pagers, etc and can always contact the doctor. I have complete confidence in all my healthcare providers in that respect and I trust them. I also trust them in that if they don't know what to do they will ask the doctor and as a patient I feel I trust them with my life and I feel that a midlevel practitioner owes it to their pts to feel like they can go to a doc if need be.

mango-lo-maniac thank you for enlightening us with your knowledge. I was really interested to read your posts.

I agree DocBloc is a really nice guy who is very approachable! He is very knowledgable about his field. He even has his doctorate and has done a fellowship that only usually doctors do because he is such a brilliant PA-C. I have not talked to him much but from what I know about him he is genuinely very nice. you should definitely ask him questions if you are interested in pain management.

[Josh L.Ac.]

Originally Posted by Papadoc

Thanks for your repply,Cyndee,MSN,NP!
I've considered PA route also after leaving the med school. With all my pre-med prereqs, and NO BSN, PA could be a faster route, but I gather not neccessarily a better one.I've been an RN for 15 yrs now. "Crossing over" to another profession, rather than advancing one I'm in now, and basically starting from scratch..... . And all for the first assist thing.I'm a lot more interested in PM&R, cronic pain and fatique, fibromyalgia type of patients, rather than slicing someone open. I'm quite happy with what I do with acupuncture, but I haven't been able to truely blend it with my RN. So I thought may be NP would give me that edge of the decision making.
Thanks again

I finished my acupuncture master's degree a year and a half ago, and I felt like to practice I really needed to know more conventional medicine, so I am going to an accelerated BSN then NP school.

I know it is off-topic, but I am curious how long you have been doing acupuncture and what problems you had attempting to integrate it with your RN. Thanks.

[Papadoc]

Originally Posted by Josh L.Ac.

I finished my acupuncture master's degree a year and a half ago, and I felt like to practice I really needed to know more conventional medicine, so I am going to an accelerated BSN then NP school.

I know it is off-topic, but I am curious how long you have been doing acupuncture and what problems you had attempting to integrate it with your RN. Thanks.

Hi Josh,L.Ac!
I've been practicing OM since 2001. At first I wasn't trying to blend two professions. Then more and more patients started to ask me something like..."you rae such a bright guy, why don't you go all the way to be a doc?"etc.I was already an RN for a while, and finally it got me. I've applied to 3 major off-shore schools (in the Caribbean), got accepted to all 3 (much to my surprise).Another thing that triggered this shift was interacting with too many doctors who were certified in Acupuncture with 200 hours or less of some home-video training. I've gotten many patients from these who went to these doctors, "tried" acupuncture and "it didn't work" for them .What was more troubling for the business aspect is that many insurance companies would reimburse "certified" acupuncturists (MD/DO), but they wouldn't consider a licensed acupuncturist (L.Ac) with more then 4000 hrs training (core, electives, herbology,outside externships with Master-Practitioners).So you get the picture. The only gratifying experience was that if patients did come to me and tried real acupuncture (and different styles I'm trained in) they usually did "180" on "it doesn't work" I guess I decided to become a part of the system rather than trying to fight it, and off I went to the med school.But that's a whole different story. In retrospect, IMHO if you want to do Acupuncture ond OM only you really don't need to have more of the Western medicine training, provided that you had basic bioscience credits, requiered for licensure by your State.I already had my RN for 10 yrs by the time I've got my M.S. in A&OM.But I don't want to tell you the wrong thing...like "don't do NP training." If that's what you want to do, then by all means go right ahead.But just like in my case becoming an MD, so I could incorporate acupuncture better than my compitition does...simply silly. The truth is there is only so much time, and as you become busy, and a better practitioner, you simply won't be able to concetrate on so many things in your practice. I can see it now. Doing it for a sake of "blending" something that doesn't really mix would be a mistake, IMHO.
Have a good one
Happy New Year!