Just a note on the NP vs PA debate...

RNPATL, DNP, RN · May 2, 2004

pa's are assistants, they always have been, and always will be...they assist doctors with all the scut work
my my, such arrogence and anger towards the pa's! maybe if they are just for "scut work" and are merely "assistants", then can you tell me why they receive much more education and training? namely, on average the pa will complete nearly 2200 hours of clinical vs. the np's barely sufficient 300-700 hours? why do pa's do 5-12 weeks of rotations vs. np's only completing a pathetic 40 hours?
as far as "anyone" getting a pa, more and more programs demand a master's degree in order to practice, something not seen in the np training. oh! and the majority of pa schools of medicine require 500 hours of direct helath care experience before admission where the nursing schools do not require any direct care experience.
maybe you should actually learn a little bit about what you're railing against. it's obvious you're uniformed but it's admirable that you are so proud of your little profession. it's always been my experience that it is those who yell the most who are the least competent.

first of all, half the information you are quoting here is not true. in order to be accepted into a post graduate level np programs, you have to have demonstrated at least 2 years of practical experience as a registered nurse. in addition to this, most, if not all the np programs that i am aware of require a masters degree in nursing. some programs for fnp, etc, require post graduate education.

having just stumbled on to this thread, i am amazed at all the discussion (heated, i might add) about np v. pa. i had no idea there was such a power struggle between the two.

i can only speak to the nursing end of this as i have been researching np education and have finally made a decision to become an fnp. i will go into independent practice once i have completed my education, and have completed my board certification. i do not understand why more np are not in independent practice. my whole goal for becoing an fnp is to provide health care to rural areas that do not have the benefit of having enough physicians or other health care providers in the area. hopefully, i can also take some time to teach.

as far as the debate between pa's and np's ... isn't there enough room in our industryfor everyone? i know that nurses have been shoved around by medicine for many, many years. now that advance practice nursing is being recognized as a viable health care alternative, many people in medicine do not like the fact that nurses can actually practice independently. perhaps this is the reason that np's protect their "turf," because it is the first time in nursing history that we have ever had any "turf" to protect. but, lets go easy on one another because there is room for everyone.

smk1, LPN · May 3, 2004

pa's are assistants, they always have been, and always will be...they assist doctors with all the scut work
my my, such arrogence and anger towards the pa's! maybe if they are just for "scut work" and are merely "assistants", then can you tell me why they receive much more education and training? namely, on average the pa will complete nearly 2200 hours of clinical vs. the np's barely sufficient 300-700 hours? why do pa's do 5-12 weeks of rotations vs. np's only completing a pathetic 40 hours?
as far as "anyone" getting a pa, more and more programs demand a master's degree in order to practice, something not seen in the np training. oh! and the majority of pa schools of medicine require 500 hours of direct helath care experience before admission where the nursing schools do not require any direct care experience.

i'm pretty sure all np programs are masters level and have been for a few years. some are post-graduate level as well, and rn experience is also required (someone i think mentioned the hours needed) for admission into many schools. it's nice of you to come stick up for pa-c's in this thread but don't down the np's to do it. totally unneccessary! both are well educated practitioners. :)

lalaxton · May 3, 2004

Interesting thread as I've been internally debating the PA/NP path for a few days now. I received a PA flyer from MidWestern University and it states that PAs need to sit for a recertification exam every 6 years. I have yet to hear anything similar for NPs.

Kabin,

To maintain certification NP's must either rewrite the certification exam or show significant amount of CME's with other activities such as precepting students, teaching a class etc. The complete requirements can be found at ANCC or AANP. Certification needs to be renewed every 5 years.

Kabin · May 3, 2004

Thanks for clearing that up.

I checked out the AANP website and it describes recertification with the two options: 1) take a recertification test, 2) 1000 hours of clinical experience and 75 continuing education hours. So option 1 may be needed for those NPs that let cliinical experience lapse. Whereas PAs need to recertify regardless every 6 years as well as do 50 hours/year or so of CMEs.

Alnamvet · May 3, 2004

pa's are assistants, they always have been, and always will be...they assist doctors with all the scut work
my my, such arrogence and anger towards the pa's! maybe if they are just for "scut work" and are merely "assistants", then can you tell me why they receive much more education and training? namely, on average the pa will complete nearly 2200 hours of clinical vs. the np's barely sufficient 300-700 hours? why do pa's do 5-12 weeks of rotations vs. np's only completing a pathetic 40 hours?
as far as "anyone" getting a pa, more and more programs demand a master's degree in order to practice, something not seen in the np training. oh! and the majority of pa schools of medicine require 500 hours of direct helath care experience before admission where the nursing schools do not require any direct care experience.
maybe you should actually learn a little bit about what you're railing against. it's obvious you're uniformed but it's admirable that you are so proud of your little profession. it's always been my experience that it is those who yell the most who are the least competent.

so much mis/disinformation has been provided by your post, it is obvious who needs to do his research; after 30+ years in the business of healthcare, i think i know of what i speak...do yourself a favor, and leave this discussion to the pros who are in the business, and really know what the programs are out their, who qualifies, what the requirements are, the degrees, if any, offered, and what each state has legislated regarding the scope of practice for mid-level providers. there is a load of info out their, and so far, only ~1% of whats been posted in this thread is accurate...i am sorry to say that you get a 0% (zero) for your effort :stone

bobbiesal · May 4, 2004

Interesting thread as I've been internally debating the PA/NP path for a few days now. I received a PA flyer from MidWestern University and it states that PAs need to sit for a recertification exam every 6 years. I have yet to hear anything similar for NPs.

As a Pediatric NP, I have to take a recertification exam every year! Now...I could choose to opt out with practice hours or CEU, however, we are on a 6 year cycle, and out of that 6 years, at least 2 of the years must be exams. So, now you've heard.

I'm thinking that neither field knows enough about the other to throw stones. I considered going to PA school prior to going to graduate school, actually took all the prepratory classes to do so. (1 extra year of chemistry, 4 extra cedits of microbiology) However, when it came down to it, the university I attended strongly discouraged nurses from applying to their program. Fact is, they would have to "unteach" the nursing perspective & try to instill the medical way of thinking - a difficult prospect for an instructor...

Is there a difference in practice? Absolutely. NPs are hands down better at teaching, and better at seeing the bigger picture. The teaching part comes from what we are taught in every program from LPN on up, the bigger picture is what nursing is all about. And altho some PA programs offer graduate degrees, most are very minimal on research.

I am, however, very encouraged that NPs & PAs are working together to forma a new organization to tackle the legislative issues that continue to threaten autonomy. And as far as practicing autonomously, that comes from experience, not from degree....

RNPATL, DNP, RN · May 4, 2004

There was a question posted earlier as to why many NP are not in independent practice. This was a question that I was also curious about. Perhaps some of the NP's on this thread can give their perspective. I talked with several of the NP's at work and there common response was due to reimbursement. One of the NP's said that rural clinics see many Medicaid patients and the resimbursement from Mediciad is very low. Apparently Medicare is either not reimbursing for NP services or the reimbursement is pretty poor. I know that there are many HMO's that reimburse for NP as a Primary Care Provider, but would like to know if any of the NP's here are in independent practice and if not, why.

This will also help me as I move toward my graduate degree and finish my FNP.

Thanks.

HU_nurse · May 5, 2004

I too was interested in this. I want to obtain a PNP degree and open up a small private practice clinic in Southern California. So what's the deal with this reimbursment issue?

Kabin · May 7, 2004

I've heard NPs sometimes get paid at 80% of the doc's rate. If this is the point, it doesn't seem to be a show stopper. :confused:

RP2001PAC · May 28, 2004

youre absolutely correct Nurse Practitioner do not need to retest in order to keep their certification. If you pass once you are golden.

RP2001PAC · May 28, 2004

You are slightly mistaken in your representation. IF you are not a Physician Assistant yourself I think that you should stop providing false representation of what a Physician Assistant actually does. I have a great amount of autonomy. I see my own patients in a clinic and the physician works the other end of the hall. Sometimes we dont even cross paths in a day. I know my limitations. I am NOT a physician and likewise nurses are NOT physicians either. You portray PA's to be incompetant little assistants who follow the doc around all day long picking up after him. You could not be further from the truth if you live near my area...I invite you to spend a day with me in the office. I am highly respected by my patients, and colleagues alike (yes including my nurses and supervising physician) On top of that I make EXCELLENT money (40/hour + profit sharing, have EXCELLENT benefits and great working hours (7:30-3:00 M thru F) No Call. great working environment. I dont know where your misconstrued ideas are generated from. Either way I am not going to add anymore fuel to your fire. This message is for those out there reading the rubbish that you write.

cgfnp · May 28, 2004

There was a question posted earlier as to why many NP are not in independent practice. This was a question that I was also curious about. Perhaps some of the NP's on this thread can give their perspective. I talked with several of the NP's at work and there common response was due to reimbursement. One of the NP's said that rural clinics see many Medicaid patients and the resimbursement from Mediciad is very low. Apparently Medicare is either not reimbursing for NP services or the reimbursement is pretty poor. I know that there are many HMO's that reimburse for NP as a Primary Care Provider, but would like to know if any of the NP's here are in independent practice and if not, why.
This will also help me as I move toward my graduate degree and finish my FNP.
Thanks.

Depends on the state as far as independent practice. You can make it happen just about anywhere just have to make the paperwork right for the laws. Medicare reimburses 85% of the physician rate if the doc isn't on site. Everything else is same. (and HMO reimbursement is rediculous no matter what you are)