Advantages/Disadvantages of NP vs PA

allnurses Guide · Dec 3, 2007

None really. The difference is going to be whether the local area hires PAs or NPs. There are only about 200 Psych NPs and CNS produced each year.

This is just pure FYI: The number of pysch NPs produced each year is about to increase. The military is opening its' own Psych NP program starting Summer '08.

By the way I think the one year NP programs are after you have completed all/most the MSN core courses ....

I am glad to hear that some of the PA programs are 15-months. I will be sure to let my med-techs know in the future, since quite a few of them intend on pursuing this option.

core0 · Dec 3, 2007

this is just pure fyi: the number of pysch nps produced each year is about to increase. the military is opening its' own psych np program starting summer '08.
by the way i think the one year np programs are after you have completed all/most the msn core courses ....
here is the thread:
https://allnurses.com/forums/f34/1-year-np-programs-262921.html
13 credits a semester for three semesters (including summer).
i am glad to hear that some of the pa programs are 15-months. i will be sure to let my med-techs know in the future, since quite a few of them intend on pursuing this option.

there are only two programs that do this:

stanford and uc/davis. both give a very limited exposure to surgery, em and im. so if you are interested in doing one of these specialties you are going to be limited in your options. they are designed as primary care pa programs (what used to be the pa/fnp programs).

david carpenter. pa-c

ILoveIceCream · Dec 3, 2007

None really. The difference is going to be whether the local area hires PAs or NPs. There are only about 200 Psych NPs and CNS produced each year. On the other hand there are only about 400 PAs working in psychiatry plus another 120 or so working in addiction medicine. So I would guess if all the NPs found jobs there is more opportunity as an NP. But there are definitely areas that being a PA is an advantage just as there are areas that being an NP is an advantage.
Peds is very similar. It is a little more confused now there is a acute care and primary care NP certifications. There are some programs that do both but most make you choose. Also NNP is a separate certification so there is not much overlap. If you wanted to work peds and neonatal critical care you would need two NP certifications. Once again it depends on your local situation. When I was in Denver two hospitals used only PAs in the NICU while the others used only NNPs. Part of the reason that the two hospitals use PAs is they can use them to cross cover the peds ER and PICU. Part of it is institutional memory.
In my mind this is actually the advantage of the generalist educational model. The ability to shift between specialties. I have moved between Peds GI, adult GI, and now peds and adult liver transplant. This would be very difficult under the NP process.
David Carpenter, PA-C

If, for example, a PA and a WHNP were competing for the same job in an OB/GYN office, might the hiring physician desire the WHNP over the PA since the WHNP would have had more extensive specific training in that particular area of healthcare?

ILoveIceCream · Dec 3, 2007

Thanks for the info. I guess I'll see what I like when I get out in the field. I hope I don't regret getting a second degree BSN, when I could have probably went strait into PA school. I just thought that there were some advantages to the NP path. Now I've invested a lot of money and time in the BSN program and it sounds like being an RN wouldn't be ideal for me, since I want to do more of the med diagnosis part with a more holistic/humanistic perspective. I want to learn more about non-western medicine too, if just in books. Anyway, I'm hoping that I didn't make the wrong choice. Thanks again for the info,
J

I think by getting your BSN you've kept some doors open for yourself. If you decide down the road that you'd like to be a Nurse Anesthetist or a Nurse Midwife (non-PA specialties), you will be equipped to do so.

caldje · Dec 4, 2007

If, for example, a PA and a WHNP were competing for the same job in an OB/GYN office, might the hiring physician desire the WHNP over the PA since the WHNP would have had more extensive specific training in that particular area of healthcare?

It depends on the two people applying. If the PA did the OB/GYN residency at arrowhead for PAs then obviously the PA would have more extensive training. It depends on the two people applying, not just their letters.

ILoveIceCream · Dec 4, 2007

That's a pretty obscure example. I believe the fellowship mentioned is the only one of its kind, and accepts only 2 PAs per year. I meant to compare your average PA with your average WHNP. On average, I think WHNPs have more extensive training in Women's Health, just as psych NPs have more extensive training in psych, and GNPs have more extensive training in Gerontology.

core0 · Dec 4, 2007

That's a pretty obscure example. I believe the fellowship mentioned is the only one of its kind, and accepts only 2 PAs per year. I meant to compare your average PA with your average WHNP. On average, I think WHNPs have more extensive training in Women's Health, just as psych NPs have more extensive training in psych, and GNPs have more extensive training in Gerontology.

WHNPs may have more extensive training in Womens health, but there are a number of reasons that a OB/GYN may choose a PA. The most appropriate comparison and competitor for PA jobs is actually the CNM. The primary reason that PAs would be used instead of WHNP is that there are elements of the job description outside the WHNP scope of practice. The primary issues that I can think of are delivering babies and surgical assisting. There are about 900-1000 PAs that designate OB/GYN as their specialty. There are a number of others working in other areas that have a strong GYN component such as fertility, GYN-ONC, and GYN surgery. Most CNMs from what I understand mostly do deliveries and OB management (there are some that assist at C-sections). So if you have a strong surgical component to your OB/GYN practice, or have a component outside the normal training of WHNP such as GYN Onc then a PA may be your only choice.

David Carpenter, PA-C

ILoveIceCream · Dec 4, 2007

I'm betting most of those PAs working in GYN-ONC and Fertility received on the job training. As far as I can tell, there's nothing stopping a WHNP from receiving that same OJT and working in the same settings.

As far as first-assisting for C-sections, aren't all Registered Nurses eligible to become first-assists? WHNPs are RNs, too.

I still maintain that, in general, specialized NPs are better trained in their specific specialty than generalist PAs.

core0 · Dec 5, 2007

I'm betting most of those PAs working in GYN-ONC and Fertility received on the job training. As far as I can tell, there's nothing stopping a WHNP from receiving that same OJT and working in the same settings.
As far as first-assisting for C-sections, aren't all Registered Nurses eligible to become first-assists? WHNPs are RNs, too.
I still maintain that, in general, specialized NPs are better trained in their specific specialty than generalist PAs.

I would agree that most PAs working in those roles received on the job training. There is nothing stopping the WHNP for receiving training for those roles. Similarly the WHNP is eligible to get certified as an RNFA. However this requires CNOR which requires 2400 hours of perioperative nursing (waived for NPs) and 2000 hours of first assist experience. This is a pretty high standard to meet, however since it is a nursing standard most hospitals require this to be credentialled. This is the primary reason that so few nurses work in the OR. The other issue is that for those specialties that cross multiple nursing domains there is the question of which NP specialty covers that. Is GYN Onc within the specialty of Onc NP or WHNP?

While in General specialty NPs may be better trained in a specific specialty than PAs, especially for medical fields that cross multiple NP boundaries, the PA may have better integrated training and will not have to deal with scope of practice issues that an NP would have to deal with.

David Carpenter, PA-C

caldje · Dec 5, 2007

Please don't forget that the typical PA program involves pediatrics, internal medicine, family practice, ob/gyn, surgical, emergency medicine, etc. rotations.

So, even though it may 'seem' like a PA didnt have much exposure to peds. They actually were exposed to peds in multiple different settings, ER/FP/Peds and maybe surgery.

I have sat down and compared a PA program to a PNP program and noticed that the difference in exposure to peds is actually very minimal. Depending on the programs you are comparing and how many kids were seen in FP/ER/surgery the difference may be one class and no clinical time or it may be at worse 250-300 clinical hours and 2 classes. Either way, that time is QUICKLY recovered on the job (2 months at 40 hours a week=320 hours).

My point is, PAs are exposed and have the basic training needed to work in any specialty. The "on the job training" required if a PA were to work in peds and women's health is not as much as one might think. It is not like taking a WHNP and trying to teach them inpatient cardiac management. A PA already has the didactice and clinical basics of all specialties so that the OJT can be short and sweet.

The residency was just an example that there will always be exceptions. That you cant simply say that a WHNP is better trained or a PA is better trained. It is dependent on the person and ridiculous to think that one will always be better than the other or 'usually' better than the other.

westcoastgirl · Dec 6, 2007

it really depends on the personal situation of the applicant, I work with several PAs some at a sister clinic others as locums and we pretty much do the same job in our primary care practice.

PAs are not limited by scope of practice as much as NPs, I learned if a doc will teach you a PA can do it, but that may not true for a NP, and Psych is a good example.

A lot of foreign doctors I know go for the PA, I think it works for them to not deal with the whole getting an RN first then NP, too convoluted! However for others the NP works well, because even if you had to drop out you're still a RN and can easily find a job to pay the bills. I also know RNs who choose to go to PA school instead. Research the local job market is what I would tell applicants.

With DNP becoming the only way to be NP, I think we will lose many good applicants to PA schools.

amzyRN · Dec 6, 2007

it really depends on the personal situation of the applicant, I work with several PAs some at a sister clinic others as locums and we pretty much do the same job in our primary care practice.
PAs are not limited by scope of practice as much as NPs, I learned if a doc will teach you a PA can do it, but that may not true for a NP, and Psych is a good example.
A lot of foreign doctors I know go for the PA, I think it works for them to not deal with the whole getting an RN first then NP, too convoluted! However for others the NP works well, because even if you had to drop out you're still a RN and can easily find a job to pay the bills. I also know RNs who choose to go to PA school instead. Research the local job market is what I would tell applicants.
With DNP becoming the only way to be NP, I think we will lose many good applicants to PA schools.

Yeah, I think you're right about loosing applicants. Right now, I'm looking into non nursing options for graduate study. I'm considering naturopathic medical school. I've already committed myself to a second degree BSN program though, because I wanted to check out nursing. I really hope experience as an RN will be helpful in my future studies,

J