Any Thoughts on why Orthopedics Hire PA more than APN

shibaowner, MSN, RN, NP · Aug 6, 2017

What are you basing this opinion on? If you see a job that look interesting, but it says PA, go ahead and apply. MDs and DOs might not be aware that NPs can specialize in Ortho. My last MSN clinical rotation was for a ortho/sports med practice and they wanted to hire an NP (1st choice) or PA (2nd choice.)

Jules A, MSN · Aug 6, 2017

I agree and have no qualms about applying for something that looks interesting if I'm qualified to do it regardless of what the ad says. I will usually scour my personal contacts and attempt to get an intro from someone but have also done it via the cold call technique. Some times it works, some times it doesn't. Basically just a numbers game.

The worst that can happen is to hear NO, which for some reason is seemingly insufferable for many now a days lol. If thats the case I simply thank them for their time and move it along. Making contacts and getting to know people even briefly is a huge plus in the professional networking game. I've had amazing offers as the result of some strange unrelated encounters.

Sandybear · Aug 6, 2017

Shibaowner, and Jules

I'm in school for APN with Orthopedic specialty and as I was looking for possible preceptors. I'm finding that they hire a great deal more PA's than NP's. I was just wondering if there may be a reason for it.

Dodongo, APRN, NP · Aug 6, 2017

My guess would be that a lot of orthopedic surgeons want a first assist in the OR. NPs by and large are not trained/qualified in that role, whereas PAs are.

nomadcrna, DNP, CRNA, NP · Aug 6, 2017

Lots of NPs first assist in the OR. PAs are not trained either but receive OJT.

A nice benefit of an NP is that in many states they are indepedent.

Dodongo, APRN, NP · Aug 6, 2017

Lots of NPs first assist in the OR. PAs are not trained either but receive OJT.
A nice benefit of an NP is that in many states they are indepedent.

?? Every PA program in the country has a didactic component for surgical skills and at least 1 clinical rotation first assisting in the OR as a requirement of their accrediting body. There is 1 NP program in the country that does this. Any NPs that desire formal training as a first assist must attend a separate RNFA program (as I am doing).

NPs that act as FA were, by and large, given OJT. In my hospital system you will not find one single NP that functions as a first assist in the OR across any of the facilities. They are all PAs. In my region PAs vastly outnumber NPs in the OR across the board. NPs on surgical services, for the most part, are in the clinic or round pre/post op.

nomadcrna, DNP, CRNA, NP · Aug 7, 2017

Do you really think 6 or 8 weeks is enough to learn to be a first assist? LOL

NPs are not required to do a FA program for billing and payment. You really can't think that because YOUR hospital and area do it one way mean that it's done that way all over the country?

Are you an NP? Have you worked anywhere else besides your hospital system? If you did, you would see many different approaches.

There is a big difference between an NP who already knows how to suture, does minor surgical procedures and can treat disease processes and and RN. Very easy to OJT a NP and nothing wrong with it.

Dodongo, APRN, NP · Aug 7, 2017

Do you really think 6 or 8 weeks is enough to learn to be a first assist? LOL
NPs are not required to do a FA program for billing and payment. You really can't think that because YOUR hospital and area do it one way mean that it's done that way all over the country?
Are you an NP? Have you worked anywhere else besides your hospital system? If you did, you would see many different approaches.
There is a big difference between an NP who already knows how to suture, does minor surgical procedures and can treat disease processes and and RN. Very easy to OJT a NP and nothing wrong with it.

I suppose I'm just not following your logic on this. Is 6 or 8 weeks long enough to learn to be a first assist? I think it's the difference between understanding the basics and having no understanding at all. An entire semester learning surgical skills plus another semester of clinical. Knowing the most common instruments used, basic suturing techniques, sterile technique, handling tissue, etc. Which do you think a surgeon prefers? Also, with your logic, no NP has learned to do anything. One class on pharm. One class on pathophysiology. 6-8 weeks comprising half of their entire clinical training. I mean come on. What kind of argument is that.

Are you seriously telling me that PAs and NPs are represented evenly in the OR environment? I'd be willing to bet that PAs having some surgical training in their programs, compared to NPs with no training at all, is what tips the scales in their favor here. Further, there is a large percentage of NP programs that do not have any sort of skills training. No suturing, no I&D, no line insertion, no excisions, nothing. So taking a PA who has at least thrown a few sutures, vs an NP who has not, makes a bit of a difference.

I have worked in 3 systems and I'll say it, again, that PAs completely eclipse NPs in the OR environment. NPs can be found working on surgical services to be certain, but PAs win by far in the OR. And I have to think it's because NPs do not receive training in this role. And because of this, I would think NPs are much more hesitant to apply for those jobs, and hiring surgeons/hospitals won't entertain them nearly as much as a PA. It would be naive to think that this does not play a role.

And I don't recall ever talking about RNs doing this so I'm not sure why that was mentioned. Both RNs and NPs have to attend an RNFA program for any formalized (read: not OTJ) training if that is what you were referring to there. The only NP program that includes OR training (that I know of) is UAB. Otherwise, good luck even getting basic procedural training.

AND, in many states/hospital systems, yes they are required to complete an RNFA for credentialing/billing.

I think you have some generalized ideas about this but haven't really looked into it. Maybe where you work they have a high number of NPs in the OR, rivaling or even surpassing the number of PAs. If so, I'd love to know where you live so I can move there.

allnurses Guide · Aug 7, 2017

Honestly, I think more PAs are interested in working OR/surgery than NPs are. People that are interested in operating probably gravitate more to the PA model than to becoming a nurse/NP. I know I work in a surgical specialty, but have no desire to go to the OR, which is what I have seen a lot of in my area.

I agree though, regarding job ads - my job was advertised as PA but I applied and was hired as an NP.

nomadcrna, DNP, CRNA, NP · Aug 7, 2017

LOL, I'm done. But you keep trying to put words in my mouth. You may gain a greater understanding when you get more experience.

Dodongo, APRN, NP · Aug 7, 2017

Honestly, I think more PAs are interested in working OR/surgery than NPs are. People that are interested in operating probably gravitate more to the PA model than to becoming a nurse/NP. I know I work in a surgical specialty, but have no desire to go to the OR, which is what I have seen a lot of in my area.
I agree though, regarding job ads - my job was advertised as PA but I applied and was hired as an NP.

I absolutely agree with this. People who are interested in working in OR/surgery attend PA programs so that they can receive training in it, versus an NP program that has no surgical training component. I'm sure this is a huge part of it. If I were ineligible to attend an RNFA program I would have attended a PA program.

LOL, I'm done. But you keep trying to put words in my mouth. You may gain a greater understanding when you get more experience.

LOL, doubt it. I don't think that someday I'll magically think there are more NPs working in the OR than there actually are.