Interesting Physician Perspective On NPs

[PMFB-RN]

I am not an NP. I am a full time rapid response nurse at a teaching hospital. This morning I stopped in to residents office to update the night residents on what had happened with their patients and what I had done. They were in the middel of sign out to the day team including several interns, residents, the chief resident and the attending. After I was done an intern speaks up and says "PMFB you should become a PA!". This was met with a rousing round of "NOooos" & "no way!" from the residents and attending. The intern looked confused. The chief resident leans over to her and says "PAs are at the bottom of the medical word. PMFB should become and NP, they are at the top of the nursing world".

The attending and other residents all readily agreed. I thought it was an interesting insight into physician thoughts about mid levels.

[treejay]

*** I believe you but don't see that information in the link you provied. I had already found that site as well but without goig to each school's website I didn't see how you could determine what kind of program they were. They used to list them by state with degree listed after. I notice they don't do that anymore.

What has been the motivation for more and more programs going to the masters degree? Were PAs prepared at other levels shows to inadiquatly prepared?

I don't know a single listing that lists all programs and what degrees are offered. The one core0 provided has all the info, it just takes longer to get at because you'd need to click on each state individually. Take, for example my state of Texas. click on it, and you'll see each PA program in texas and which degree it offers (M, B, or C). In that case, there is one program offering a C, or B which is the program for those in the Army.

As for why the motivation for more programs to go for masters degree, i can't say definitively since i haven't read discussions of those decisions, however I'd venture to say it is in sync with all heatlhcare fields who have had degree creep. ask why NPs have chosen to go to DNP. answer is probably the same.

[PMFB-RN, RN]

I don't know a single listing that lists all programs and what degrees are offered.

*** I don't either anymore. The site coreO listed used to a few years ago when I frist started looking into it and was the site I was thinking of in my previous statements.

The one core0 provided has all the info, it just takes longer to get at because you'd need to click on each state individually. Take, for example my state of Texas. click on it, and you'll see each PA program in texas and which degree it offers (M, B, or C). In that case, there is one program offering a C, or B which is the program for those in the Army.

*** Yes I see that. When I look at the state of PA I see 21 programs listed with 6 having a "B" and one not saying. CA lists 9 programs with 3 having an "A", though "C" & "M" are also listed for those schools. NY lists 23 programs with 8 of them having a "B" listed. Even though masters program have now become the majority it would seem a sizable minority are still below the masters level. I find this to be a real shame.

As for why the motivation for more programs to go for masters degree, i can't say definitively since i haven't read discussions of those decisions, however I'd venture to say it is in sync with all heatlhcare fields who have had degree creep. ask why NPs have chosen to go to DNP. answer is probably the same.

*** Well NPs haven't chosen to go to the DNP. The AACN recomends it but it is far from being a requirement. In my opinion the recomendation for DNP is a symptom of nursing's lack of self esteem as a profession combined with the desire for colleges of nursing to be able to charge far more for thier NP programs than they can with a masters level program.

I hate to see this needless degree creep in both fields. The PA and NP are supposed to be cost effective providers of health care. I can't see where any good can come of drasticaly increasing the cost and time required to train them. Since neither's move twords higher degrees for the same training has resulted in higher pay for them it becomes even more confusing to me. NP is already on a tenious cost of training vs potential income plane. Most people I know who went to NP school went to get a better schedual since they are unlikely to make more than they were making as staff RNs. Several I know have taken pay cuts to be NPs. However I am sure in places with lower RN pay than we enjoy that might not be the case.

[AbeFrohman, BSN, RN]

Glad to see so many defending PAs on here. We need to realize that PAs and NPs can do so much more together. They both have their faults and points of excellence in different places, which culminate in equal care by both. If we come together, we can much more easily overcome scope of practice issues, prescriptive authority problems, ect. We can look at each others educational models and instill the best from both, we can look at how each of our lobbying efforts are successful and mimic it, and we can be 250,000 strong when speaking to elected officials and contributing money to their campaign funds. There are 100,000 PAs and 150,000 NPs. There are nearly 1 million physicians. If we want to stand up to that kind of power, we need to be together.

If you want to see what NPs, CRNAs, PAs are truly capable of, look no further than the military. All three act independently, especially in combat zones.

[treejay]

Glad to see so many defending PAs on here. We need to realize that PAs and NPs can do so much more together. They both have their faults and points of excellence in different places, which culminate in equal care by both. If we come together, we can much more easily overcome scope of practice issues, prescriptive authority problems, ect. We can look at each others educational models and instill the best from both, we can look at how each of our lobbying efforts are successful and mimic it, and we can be 250,000 strong when speaking to elected officials and contributing money to their campaign funds. There are 100,000 PAs and 150,000 NPs. There are nearly 1 million physicians. If we want to stand up to that kind of power, we need to be together.

If you want to see what NPs, CRNAs, PAs are truly capable of, look no further than the military. All three act independently, especially in combat zones.

Abe Frohman ?? The sauage king of Chicago ?? :)

Couldn't agree more. I'm with your vision.

treejay, PA-S2

[treejay]

*** Yes I see that. When I look at the state of PA I see 21 programs listed with 6 having a "B" and one not saying. CA lists 9 programs with 3 having an "A", though "C" & "M" are also listed for those schools. NY lists 23 programs with 8 of them having a "B" listed. Even though masters program have now become the majority it would seem a sizable minority are still below the masters level. I find this to be a real shame.

I don't know if I agree that it's a real shame. How it's setup by the accrediting agency, PA programs are competency based, not degree based. Graduates of any PA program, associates or master's need to meet the same competencies, and those competencies are stringent. I think this is one of the strengths of the PA education model.

With all due respect, and not intended to flame, and as discussed in other threads here, shameful might be the online NP program requiring in the ballpark of 500 clinical hours which may vary widely in quality. Theoretically, and i bet it has been done, not just in theory, one can obtain a BSN (or an accelerated BSN in 12 months if already have another bachelors), work very briefly as an RN if at all, then move on to an online NP program and practice after completion of the 500 hours of clinical hours. Granted, I have never met anyone or know anyone first hand who has done this. But it seems like the system is there to do it if one wanted to. And please understand, I point this out not to compare good vs bad, us vs them. I believe it's a fair critique of NP educational model. There are outstanding NP programs and from what I have read here, there seem to be some poor ones too. Huge variance if you will. I think PA education has a leg up in this issue. The standards for accreditation are stringent, well defined, and enforced. It's been discussed elsewhere in this forum. Just curiously, for my knowledge, who accredits NP schools? And what are the standards?

Don't take me wrong. I'm a uniter of the two professions, not a divider. But even with a vision of unification, there will always be room for critique on both sides. "constructive feedback" so to speak

[PMFB-RN, RN]

I don't know if I agree that it's a real shame. How it's setup by the accrediting agency, PA programs are competency based, not degree based. Graduates of any PA program, associates or master's need to meet the same competencies, and those competencies are stringent. I think this is one of the strengths of the PA education model.

*** Yes I know and I agree with you.

With all due respect, and not intended to flame, and as discussed in other threads here, shameful might be the online NP program requiring in the ballpark of 500 clinical hours which may vary widely in quality. Theoretically, and i bet it has been done, not just in theory, one can obtain a BSN (or an accelerated BSN in 12 months if already have another bachelors), work very briefly as an RN if at all, then move on to an online NP program and practice after completion of the 500 hours of clinical hours.

*** It's actually worse than that. Several universities in the state I work in have direct entry masters programs for advanced practice. A person with a bachelors degree in another field can become and RN and then NP in 2.5 years without ever practicing as an RN. The 500 hours of clinical might have been appropiate for the very experienced RN who has worked in a variety of area of nursing and brings that expereince to the NP program but not (IMO) for a person without high level heathcare experience.

Granted, I have never met anyone or know anyone first hand who has done this.

*** Students of the program I describe above do clinicals at my hospital. I find them easy to spot. They are usually the ones who haven't figured out that the physicians also make mistakes on occasion, and the ones wanting to know why their patient was put on O2 without an order.

But it seems like the system is there to do it if one wanted to. And please understand, I point this out not to compare good vs bad, us vs them. I believe it's a fair critique of NP educational model. There are outstanding NP programs and from what I have read here, there seem to be some poor ones too. Huge variance if you will. I think PA education has a leg up in this issue. The standards for accreditation are stringent, well defined, and enforced.

*** I couldn't agree more. Based on my observation of working with both PA and direct entry students when they get their chance to respond to RRTs the PA students have it all ocer the direct entry NP students and both look pale and weak next to the NP student who spent 10 years working as trauma center ER RN before NP school.

[goofeegirl]

I don't believe PAs have prescriptive authority in GA or NY.

[VICEDRN, BSN, RN]

Sorry, all advance practice nurses are created equally. None of them is superior to any other, and I don't know anyone who thinks otherwise except students who don't know any better. We think of ourselves, along with our PA brethren, as well as MDs and DOs, as colleagues. We have different specialties and backgrounds, but we are all peers. This constant need to "rank" people is jejune, and only diffident people feel the need to play that game. Everyone brings something unique to the table. When you are working within a group, you quickly learn how to work together toward everyone's strengths and all that ego nonsense falls away. Grown ups do not discuss their salaries, how gauche.I've got news, the coding police, practice managers and risk mangers ultimately out "rank" us all.

This entire post bewilders me. I have met other dnp types who believe the same line of malarkey but they all work in academics as it is so entirely and utterly not true. Mds are obviously at the top of the food chain as they set they control the entire formulary (and can use it too!), who gets hired and in what number and what protocols exist for any given patient population.On top of that, I think, as a practicing rn and future graduate student, I absolutely see a huge difference and I care because I will one day be among the graduate students. Of course, I want to pick the right role for me and of course, they are all different. And another thought...absolutely everyone know exactly what the food chain looks like, right downtown who gets what computer or chair. This "team work" nonsense is not real and yes, I think we need some kind of leadership role and structure.

[treejay]

I don't believe PAs have prescriptive authority in GA or NY.

wrong. why not simply type a few words into google for your quick answer?

[Patti_RN]

BlueDevil's comments are fairly accurate--advanced practice practioners are fairly similar, but there tend to be differences. The most significant difference is the ability, aptitude, and skills of the individual. There are good and bad nurses good and bad doctors and good and bad mid-level practitioners; whether an individual is competent or not does not reflect on others of similar training. The next important criterion is the quality of education--there is a HUGE difference in academic rigor between the most demanding and the 'easiest' schools--and the demanding schools generally produce more competent practioners--first, because those admitted to competitive schools are the gifted students already at the top of the class, and second, because those programs are more challenging. This is not to say every single grad of a top-tier program is more skilled than every student at poorly ranked schools--but there is definitely a correlation. In my area, there are three fairly good NP programs and the grads of each are well respected. There is one local PA school with a poor ranking, low pass rate on boards, and the grads are generally thought of as being less competent and not as well prepared. This doesn't mean 'all NPs' are better/ smarter/ more skilled than 'all PAs'; but in our area it's generally true. The inverse could hold in an area where there is a strong PA program and weak NP program, so some opinions may be based on anecdotal information. This could be a great topic for research, but it's probably a subject too charged with ego, emotion, prejudice, and lack of meaningful information to be discussed and determined here.

[core0]

I don't believe PAs have prescriptive authority in GA or NY.

You would be incorrect.

http://www.aapa.org/uploadedFiles/content/The_PA_Profession/Federal_and_State_Affairs/Resource_Items/Rx%20Chart%201-12.pdf

PAs and NPs have prescriptive authority in all 50 states. PAs do not have schedule authority in FL and KY. NPs do not have schedule authority in Alabama and Florida.

[core0]

I don't know a single listing that lists all programs and what degrees are offered.

*** I don't either anymore. The site coreO listed used to a few years ago when I frist started looking into it and was the site I was thinking of in my previous statements.

The one core0 provided has all the info, it just takes longer to get at because you'd need to click on each state individually. Take, for example my state of Texas. click on it, and you'll see each PA program in texas and which degree it offers (M, B, or C). In that case, there is one program offering a C, or B which is the program for those in the Army.

*** Yes I see that. When I look at the state of PA I see 21 programs listed with 6 having a "B" and one not saying. CA lists 9 programs with 3 having an "A", though "C" & "M" are also listed for those schools. NY lists 23 programs with 8 of them having a "B" listed. Even though masters program have now become the majority it would seem a sizable minority are still below the masters level. I find this to be a real shame.

As for why the motivation for more programs to go for masters degree, i can't say definitively since i haven't read discussions of those decisions, however I'd venture to say it is in sync with all heatlhcare fields who have had degree creep. ask why NPs have chosen to go to DNP. answer is probably the same.

*** Well NPs haven't chosen to go to the DNP. The AACN recomends it but it is far from being a requirement. In my opinion the recomendation for DNP is a symptom of nursing's lack of self esteem as a profession combined with the desire for colleges of nursing to be able to charge far more for thier NP programs than they can with a masters level program.

I hate to see this needless degree creep in both fields. The PA and NP are supposed to be cost effective providers of health care. I can't see where any good can come of drasticaly increasing the cost and time required to train them. Since neither's move twords higher degrees for the same training has resulted in higher pay for them it becomes even more confusing to me. NP is already on a tenious cost of training vs potential income plane. Most people I know who went to NP school went to get a better schedual since they are unlikely to make more than they were making as staff RNs. Several I know have taken pay cuts to be NPs. However I am sure in places with lower RN pay than we enjoy that might not be the case.

There is a listing but its password protected and costs $35 per year:

Physician Assistant Programs Directory

As for what the letter mean take for example NY. There are a number of entry level program in NY. You enter as a freshman get your bachelors after four years and Masters after five years. Essentially undergrad and grad school in the same program. There are also programs that offer a bachelors but also offer a distance learning masters. For example RCC in California is listed as A, B, M. They are a community college and offer a associates. They also offer a Masters through Saint Francis University. They also offer a bachelors from another program.

The degree creep is largely in my opinion led by money. Graduate programs charge more than non graduate programs. The other issue is student loans. With the prerequisites for even the CC programs most students have a bachelors already. So from a financial aid standpoint it makes sense to go to a masters so as not to limit loan amounts (and tuition charged).

The profession is always been competency based with all students learning the same material. In that way its somewhat similar to nursing. ADN, BSN and MSN are all RNs and perform the same basic function. Despite what magnet attempts to show there is no real correlation between education and outcomes. PAs are held to the same standard and training regardless of the degree. The programs are accredited the same regardless of the degree. In the end everyone is PA-C. There are three states no that require a Masters and one that requires a bachelors. Its a shame because it misses the original target which is returning military medics with life experience but not necessarily a degree.