Originally Posted by ashfost
Thanks for the input. When you say the NP has no input, are you saying that the NP sees the "usuals" and takes care of just those patients? Hmm....I was talking to a CNS today and she was telling me that alot of NP's are dissatisfied with their career because they say its mundane and repetitive. If I interpreted your statement correctly, I can see their point. But it still sounds like a rewarding career. I love nursing but I feel that it being heavily task oriented will get on my nerves really quickly. I'd like a bit more autonomy and independence. I am on the road for CRNA but just looking into other options. Like I said, I am also interested in GI so I was just seeing what was out there. Thanks for the replies!
I can't speak for NP practice, but what I like is the variety. We have 8 docs and 4 PA's so you are exposed to a lot of different practice styles. It helps that they are all decent people. We do see a lot of "usuals" but we also see patients that need to be seen immediately. These are great learning experiences since you start the work up but then usually get input from the physician and execute the plan. I personally like the variety when moving back and forth between the hospital and the clinic. The clinic is where you develop relationships with patients and the hospital is where you get immediate feedback.
I will say that one of the differnences that I see locally between NP's and PA's in GI is that the PA's tend to move around while the NP's tend to stay in one place. We have a group of cardiology NP's that we work with that have been with the group on average more than 10 years. On the other hand PA's nationally change jobs every 5 years. Of the PA's in our practice I came from Peds GI, one from hospitalist, one from neurosurgery and one from plastic surgery. Our group looks for hospital experience since they feel that area has the highest risk and liability.
On the subject of autonomy, in specialty practice this is different. You will never be in independent practice, and your autonomy will be determined by the confidence that the physicians have in you and the amount of control they are willing to give up. Within those limits you have a lot of opportunity for growth and the ability to sub-specialize within the specialty. A great opportunity is to look for patients that require a lot of time and teaching and adopt these. The physicians will be happy for you to take an interest and to unload their schedules. On of my coworkers does a lot of IBS. The practice allows her extra time to deal with these patients and the patients appreciate the extra attention. I do a lot of liver disease and am doing some work in transplant medicine. The opportunities are out there.
As far as mundane and repetitive you have to understand what you are getting into. In GI you consider something mundane, then you are not looking hard. Somtimes the unusual is found in the mudane. I saw two patients in a row that both had polio in 1941 that affected the right foot last week. Figure the odds. I also had to tell three patients they had cancer
. You take the good with the bad. Prior to becoming a PA I was a CST. This is a very technical job, which I enjoyed, but I like to see the whole picture. Surgery is just a snapshot in time. I like to be able to follow the patient, good or bad. Speaking of technical, while I appreciate the job they do, there is no way that I could be a CRNA. A friend described the Army (pre Iraq) as long periods of boredom interspersed by short periods of pure panic. This describes a CRNA to me. I like my action a little more spread out and I am past the time when I like to do procedures.
GI is a great profession. It straddles the border between cerebral medicine like ID and procedure based medicine such as urology. Ultimately your ability to get a job is going to depend a lot on the local market.
David Carpenter, PA-C
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