AGNP vs AG-ACNP - am I wrong?

Posted
by Polly Peptide Polly Peptide, BSN, RN Member

Specializes in Hospice, Med/Surg. Has 3 years experience.

Hello all - first allow me to say I'm sure some version of this question is out there, however I have done a ton of research and also read these forums extensively and am still having difficulty really ascertaining the answer.

I am applying to a direct-entry MSN program this fall and am trying to get a handle on how these specialties really look in practice. I've read the consensus model and understand to an extent how this will impact it (with the most obvious difference being the hospitalist role). But still, I am struggling.

I am not currently an RN (have been working on the business end of healthcare for 15 years), which is a limitation in my full understanding of the scopes of the role. Yet, I have to choose my specialty when applying for the direct-entry program.

I've thought for years that I desired to work with more complex patients, so I envisioned myself in an outpatient specialty clinic, with the ability to round in the hospital. It might be nice to have the flexibility to work as a hospitalist, thus I thought the ACNP track would be a good option. When I read the descriptions of ACNP, it is not all "ICU" focused, rather it COULD be that, but can also be well-suited for OP specialty. This seems to be a good fit for me.

However a recent personal experience has called all of this into question.

A close family member was just diagnosed with stage 4 pancreatic cancer. We have bounced from hospital to hospital, doctor to doctor, from one emergency procedure to the next. I witnessed an astonishing lack of continuity of care and personally wanted to step in to help them navigate and facilitate all of the communication and movements from one place to the next. Balls were dropped and unfortunate errors were made, delays in receiving proper treatment because of some of these issues. I just began to think that I didn't want to pop in and out of someone's life in such an episodic way...that maybe I am more suited to helping people navigate the system and coordinate their care.

And that makes me wonder if primary care is a better choice for me.

The problem is, I always thought "primary care" meant you caught the strep throats and hypertensions and handed the interesting stuff off to everyone else.

PLEASE forgive me if that sounds insulting...I do not mean it to be. I would love to be corrected if I'm wrong.

Do I have the wrong perception of primary care? I am wondering if that is actually my place after all?

Thank you for getting this far and any advice you may provide!

sirI, MSN, APRN, NP

Specializes in Education, FP, LNC, Forensics, ED, OB. 18 Articles; 13,654 Posts

Welcome to allnurses.com

We moved your thread to the Student NP forum where Students and NPs will reply.

Riburn3, BSN, MSN, APRN, NP

Specializes in Internal Medicine. Has 15 years experience. 3 Articles; 551 Posts

Primary care means you are taking the responsibility for the day to day healthcare of your patients. I equate it to being the point guard on the basketball team, you control the flow of the ball. You can pass the ball to a teammate or you can be the one to shoot. As a PCP, you can manage a patient for as much as your feel comfortable with, or if something more complex arises, you can refer it out. In our healthcare system, the buck stops with the PCP as they are the primary coordinator of all the healthcare a patient is to receive, and it is a vitally important role.

For example, I work for an Internal Medicine practice as a PCP, where we deal with a wide variety of patients from very basic to very complex healthcare issues. Some patients will be low acuity cough/sore throat basic things, others will be patients with renal failure, DM2, COPD, CAD, S/P transplant all in one. Sometimes your renal failure patients will come in with a sore throat and you have lots of things to consider when treating them. You can manage chronic conditions if you wish to your point of comfort, or if you feel the patient would benefit from more specialized care, you can refer them. Either way though, the ball is always in your hands, and the patients care runs through your hands and clinical determination.

Polly Peptide

Polly Peptide, BSN, RN

Specializes in Hospice, Med/Surg. Has 3 years experience. 219 Posts

Thank you, @Riburn3. May I ask, are you an FNP or AGNP?

I am not choosing the FNP route, as I don't desire to work with children and I also know that the school I am applying to gets an overwhelming number of applicants for that specialty.

The way you describe it makes me think that primary care is probably where I belong. Actually, I am getting excited because I really think I can make a difference there. And working in an internal medicine practice does give you the opportunity to see a fairly wide variety of presentations, I would think.

Polly Peptide

Polly Peptide, BSN, RN

Specializes in Hospice, Med/Surg. Has 3 years experience. 219 Posts

I'll add - I've been told by some nurse friends who have gone back to school that one thing to consider is, of course, The Money. It is difficult to find salary information differentiated by "ACNP" versus "AGNP", at least not categorized like that. Is it really that different? Do ACNPs make more if they are working in a hospital setting? If there is a difference, how much is it really?

WKShadowNP, DNP, APRN

Specializes in Hospital medicine; NP precepting; staff education. Has 21 years experience. 1 Article; 2,077 Posts

This is an interesting discussion. I look forward to further replies. I chose the FNP route because I wanted to see all ages (because my ideal location is the ER and it's a given I'll see all ages.)

Riburn3, BSN, MSN, APRN, NP

Specializes in Internal Medicine. Has 15 years experience. 3 Articles; 551 Posts

I'm an FNP. I spent my entire RN career working in critical care in some form or another, and thought I wanted to do ACNP. I eventually realized I didn't care to spend the bulk of my career in a hospital dealing with nothing but the sickest of the sick. Managing patients before they get that way is much more rewarding to me, and I feel like it is much more proactive. This versus working in acute care settings where you're trying to stop something serious from getting more serious. After so many years of that, I decided I wanted to be on the front lines and go the FNP route. It got draining.

Although like you I had no desire to treat children or do women's health, I chose the FNP because of the versatility. If 20 years down the road I get tired of adults, I have the option of working with kids. I also actually loved my pediatrics rotation even though it terrified me, and once a month grab a 5 hour shift at a friends pediatric night clinic just to keep my brain somewhat fresh. I never ever thought I would like working with kids, but I enjoy being a jack of all trades so to speak.

I also still get to round in the hospital here and there when my boss goes out of town, which keeps my brain sharp in that arena. You can't do everything with an FNP degree, but it entitles you to be a good primary care provider while being less restrictive in scope than other APRN disciplines.

Riburn3, BSN, MSN, APRN, NP

Specializes in Internal Medicine. Has 15 years experience. 3 Articles; 551 Posts

I'll add - I've been told by some nurse friends who have gone back to school that one thing to consider is, of course, The Money. It is difficult to find salary information differentiated by "ACNP" versus "AGNP", at least not categorized like that. Is it really that different? Do ACNPs make more if they are working in a hospital setting? If there is a difference, how much is it really?

Depends on location. I know several ACNP's fresh out of school here in Texas that work for a hospitalist group making money in the 130's salary with full benefits. I also know a few working with a local pulmonary group where their base salary isn't that high, but their bonus incentive package rewards you for keeping busy to the point that you can double or triple your salary if you bill enough.

For primary care providers salaries are going to run all over the place. If you look at what new NP's are making here on various threads, it seems to start in the high 70's to the low 100's. Again region is a huge, huge factor.

Polly Peptide

Polly Peptide, BSN, RN

Specializes in Hospice, Med/Surg. Has 3 years experience. 219 Posts

I am in the Nashville, TN area and will be staying here for the foreseeable future (specifying Nashville because it is truly different than west TN compared to middle compared to east TN). I hear that PCP NPs are starting in the $85k range.

It would seem to make sense, if I settled on primary care, that I go the FNP route for the flexibility. However the school I am applying to has essentially discouraged me from applying to the FNP program. Not "me" per se, but when I've been to orientation sessions there, every time somebody asks the question, they say that the FNP specialty is one of their most popular and, in so many words, I hear that if you want a better chance of getting in at all, DON'T APPLY TO FNP. So I had pretty much written it off.

Because it's direct-entry, all of the tracks are competitive. So FNP gets around 120 applicants for 20 spots; ACNP gets about 100 applicants for 20 spots; and AGNP gets about 80 for 20. I'm just trying to balance this information with what I think I'd like to do, where I'll fit best, and make the right call...

It feels like a big deal when it's something I've wanted to do for 20 years and am finally making it happen!

WKShadowNP, DNP, APRN

Specializes in Hospital medicine; NP precepting; staff education. Has 21 years experience. 1 Article; 2,077 Posts

It is a very big deal. I put in about 2 years of research in to find the schools to which I wanted to apply. I had tables/spreadsheets with the schools' names, requirements, cost, expectations, et cetera et cetera.

Then I got turned down by my top two choices and went with Walden. I'm still learning and getting the end goal. I really wanted the dual certification of ACNP and FNP, but for now I'm getting the FNP. I may do a DNP with the ACNP part but we'll see.

Polly Peptide

Polly Peptide, BSN, RN

Specializes in Hospice, Med/Surg. Has 3 years experience. 219 Posts

Yes, WKShadowRN, I know what you mean. I am somewhat limited in my options...I can't move, so don't have a ton of options to apply to. My most limiting issue is the fact that I am not currently an RN. I can certainly do that first (there are second degree BSN options here, and I am applying to those as well as a back-up plan), however I know without a doubt that my goal is to be an NP. So I just feel like I want to go ahead and do it...especially considering I am older and this is "mid-career" for me anyway. The direct-entry program here is very good, reputable. I've been to their orientation sessions probably 3 times in 6 or 7 years! I took the GRE two years ago, thinking I was going to do it then. I'm finally pulling the trigger.

WKShadowNP, DNP, APRN

Specializes in Hospital medicine; NP precepting; staff education. Has 21 years experience. 1 Article; 2,077 Posts

Go for it! I'm loving this rigorous program. I'm having fun in clinicals and already have a prospect for work lined up. Reach for the stars!