Hello. I am considering NP and PA school. I have a few years of experience as an ED Tech in a Level 3 Trauma Center in California (busy, but not too intense). Our ED is staffed with PA's no NP's.
I have a few questions about clinical differences between NP's and PA's. I know that PA's seem to have a great ability to work in surgery specialties like ortho, neuro, peds, and cardio surgery. They do pre and post surgery exams, order interprets tests, and prescribe meds (at least in 47-49 states). Are there any NP's on this forum who do this? Are there any in California who can comment?
Second. I know that most PA schools have a much longer clinical component than do NP schools. I have been told it is because NP's already have so much clinical experience as nurses. But can you really compare the two? In our ED, the nurses are not making differential diagnoses, determining etiology of disease, etc. etc., they are monitoring the pt's overall state and response to the treatment ordered by the Physician (or sometimes PA). Therefore, does this experience compare to the rigorous training PA's get in diagnosing?
Part of my interest in medicine is the actual procedures themselves. I want to do chest tubes, central lines, suturing, first assistant surgery, etc. etc. Are there any NP's out there who are doing this?
Finally, I know some people (including some nurses) who deride the "nursing diagnosis" concept. Can anyone offer up a brief rationale for how nursing diagnoses are of value to an NP in clinical practice?
Each state will be different, read your state statutes! In Missouri, the doctor MUST be IN THE OFFICE (not over at the hospital, not available electronically etc)
the doctor does not have to be on duty. In all states that I have read the laws of, the physical presense of the doc is not required. however, they must be able to be contacted by electronic means.
PAs are a very popular choice that surgeons make. You will find mostly PAs in surgery although NPs are starting to be used. RNFA would also be a good thing to look into. There are two surgically focused PA programs in the country, cornell and university of alabama. I would look into those programs as they prepare you VERY well to work in surgery. You can also do one of many post-graduate PA residencies at instutions like yale, duke, or john's hopkins. These usually are 1 year long and almost exactly like the 1st year of physician residency. I hope this was helpful. Always research what people tell you because you will hear a LOT of inacurate information about PAs, and NPs too.
Each state will be different, read your state statutes! In Missouri, the doctor MUST be IN THE OFFICE (not over at the hospital, not available electronically etc)
even in missouri certain clinics and facilities are exempt from that rule. Look it up.
You are right though, it does vary state to state as is common for both NPs and PAs.
so what's the differnce of NP and PA and lets say family doc in terms of job description, what are the limitations or focus of np or pa.. what's the depth of the diseases coverage (if i'm asking this the right way)? thx
**oops sorry, i didn't see the "clinical difference" thread.. i'm going to read that first :)
I would like to clarify the differences between PA's and NP's. There are several differences, and after viewing this post, it is my hope that you will have a better understanding as well as appreciation for the benefits of an NP over a PA.
1. The PA is only educated at the bachelors level. Some programs do indeed go through to a masters level, but they are only required to have a 4 year degree.
2.Most PA's enter the program without any clinical experience previously. This is a clear disadvantage to the NP, most of who have several years and a variety of clinical experiences.
3. The PA is educated on a MEDICAL model. This means they are trained to evaluate, diagnose and treat a medical problem. This is a very valuable skill set.
4. The NP is educated according to a nursing model within a medical model context. This means that in addition to evaluating, diagnosing and treating a medical condition, they are also able to provide extensive education and preventative medical advice...this is an even more valuable skill set.
5. PA's are not able to work without the direct supervision of their supervising physician. This means they work along side of the doc, and that the doc then needs to essentially do the same work as the PA.
6. The NP is able to work independently (in many states) of the collaborating doc, making his/her services a most valuable commodity, as the work the NP does SAVES time and makes money for the practice.
7. The PA cannot prescribe any scheduled drugs classes II - V.
8. The NP has full prescriptive privilege in many states, has his/her own DEA number, and is able to perform this task independently.
8. The NP is educated at the MASTERS level, and may soon become a doctorate required program.
9. Yes - the NP is able to assist in surgery.
I hope this helps to clarify the value of an NP over that of a PA. PA's provide a great service, and they are important in many areas of medicine, but NP's have more versatility, a better satisfaction rating, more effective and thorough care of the patient, and generally more experience going into the clinical arena.
i would like to clarify the differences between pa's and np's. there are several differences, and after viewing this post, it is my hope that you will have a better understanding as well as appreciation for the benefits of an np over a pa.
clarifying what pa's can do.
1. the pa is only educated at the bachelors level. some programs do indeed go through to a masters level, but they are only required to have a 4 year degree.
there is no requirement for a degree. just like the first np's the first pa's received certificates. approximately 75% of pa programs award master's degrees. most associates degree programs also award a master's degrees through distance learning programs.
2.most pa's enter the program without any clinical experience previously. this is a clear disadvantage to the np, most of who have several years and a variety of clinical experiences
on the average pa's entering the profession have 40 months of health care experience. there are several np programs that are direct entry and require no previous experience. there are also on line nurse practitioner programs:o.
3. the pa is educated on a medical model. this means they are trained to evaluate, diagnose and treat a medical problem. this is a very valuable skill set.
good point.
4. the np is educated according to a nursing model within a medical model context. this means that in addition to evaluating, diagnosing and treating a medical condition, they are also able to provide extensive education and preventative medical advice...this is an even more valuable skill set.
umm preventive medical advice and education is part of the medical skill set. i'm not sure when nursing copyrighted this.
5. pa's are not able to work without the direct supervision of their supervising physician. this means they work along side of the doc, and that the doc then needs to essentially do the same work as the pa.
pa's work as dependent providers. they operate under the supervision of a physician. there are 4 states that require some element of direct supervision. three of those require this only at the beginning of employment. missouri requires that the physician be present in the same building.
6. the np is able to work independently (in many states) of the collaborating doc, making his/her services a most valuable commodity, as the work the np does saves time and makes money for the practice.
hmm functions essentially the same as the pa in most states. if the np is working for a practice the liability of the supervising physicians is the same. on the average np's function the same as pa's except they see less patients (makes less money for the practice). np's do have the advantage in some states that they can practice independently. for pa's to own a practice they have to hire a supervising physician.
7. the pa cannot prescribe any scheduled drugs classes ii - v.
pa's can prescribe schedule drugs in all but 5 states (authority at all in indiana). the latest information i can see is that np's can't prescribe schedule drugs in 4 states (both groups have restrictions in some states on schedule ii).
8. the np has full prescriptive privilege in many states, has his/her own dea number, and is able to perform this task independently.
see above.
8. the np is educated at the masters level, and may soon become a doctorate required program.
see above. you forgot to mention that on average the np program has about 1/2 the clinical and didactic content of the average pa program. the doctorate level is not particulary welcomed by all np's (check out this site).
9. yes - the np is able to assist in surgery.
yep. they can also bill for it. good luck in getting credentialled unless you have your rnfa.
i hope this helps to clarify the value of an np over that of a pa. pa's provide a great service, and they are important in many areas of medicine, but np's have more versatility, a better satisfaction rating, more effective and thorough care of the patient, and generally more experience going into the clinical arena.
beth
np's and pa's work in many of the same positions and along side each other with no problems. however lets look at you last paragraph
1. pa trained in all aspects of medicine including surgery, pediatrics, family and internal medicine. np's trained in a specific area of nursing. check to the pa for versatility.
2. better satisfaction rating, more effective and thorough care of the patient. no studies show this. most studies show that both np's and pa's give care equivalent to residents or new physicians.
3. see above. while there is good data on pa students. there seem to be little published data on how much experience np students have prior to school. published data ranges from an average of 2-3 years to an average of 7-9 years for older studies. i would guess that like the pa profession the students are getting younger and have less experience.
in general i get along with np's and work closely with them. when asked whether we should hire an np or pa i usually reply that we should hire the best provider, regardless of the credentialls. posts like yours only serve to incite problems between the groups.
I would like to clarify the differences between PA's and NP's. There are several differences, and after viewing this post, it is my hope that you will have a better understanding as well as appreciation for the benefits of an NP over a PA.
1. The PA is only educated at the bachelors level. Some programs do indeed go through to a masters level, but they are only required to have a 4 year degree.
2.Most PA's enter the program without any clinical experience previously. This is a clear disadvantage to the NP, most of who have several years and a variety of clinical experiences.
3. The PA is educated on a MEDICAL model. This means they are trained to evaluate, diagnose and treat a medical problem. This is a very valuable skill set.
4. The NP is educated according to a nursing model within a medical model context. This means that in addition to evaluating, diagnosing and treating a medical condition, they are also able to provide extensive education and preventative medical advice...this is an even more valuable skill set.
5. PA's are not able to work without the direct supervision of their supervising physician. This means they work along side of the doc, and that the doc then needs to essentially do the same work as the PA.
6. The NP is able to work independently (in many states) of the collaborating doc, making his/her services a most valuable commodity, as the work the NP does SAVES time and makes money for the practice.
7. The PA cannot prescribe any scheduled drugs classes II - V.
8. The NP has full prescriptive privilege in many states, has his/her own DEA number, and is able to perform this task independently.
8. The NP is educated at the MASTERS level, and may soon become a doctorate required program.
9. Yes - the NP is able to assist in surgery.
I hope this helps to clarify the value of an NP over that of a PA. PA's provide a great service, and they are important in many areas of medicine, but NP's have more versatility, a better satisfaction rating, more effective and thorough care of the patient, and generally more experience going into the clinical arena.
Beth
I want to clarify that not all NP have masters, I work with 4 PA with atleast one masters degree while the one FNP does not have not have there masters. All of these providers are equally well trained and you couldnt tell what degree they have. In California there are many FNP that dont even have a BS, this will change as of 2008. It is foolish to state that one NP/PA is better than the other, there are pros and cons of both. #5 is so false its irritating!
apparently you have concerns that warranted your obvious defensive stance re: my posting. my information was correct. keep in mind please that each state has different requirements for certain practice function. in response to some of your additional info:
there are also on line nurse practitioner programs.
np programs are not typically online. please do not mislead other readers into thinking that a np student can earn a degree without entering a clinical arena.
according to drexel et al, nurse practitioner programs do have the ability to have online class components. the pa programs do as well. many of the classes that form the basis for the degrees, such as role/concept classes and the liberal arts components can effectively be taught online. the clinical classes such as health assessment, pathophys, micro etc are done on campus. there is no one program that awards a degree that is suitable for sitting through the ancc exam that is held 100% online.
you forgot to mention that on average the np program has about 1/2 the clinical and didactic content of the average pa program.
this is not always true. when you combine the education required to obtain the rn licensure that is required to enter the np program with the graduate level work, the semester hours exceed that of a pa program.
the doctorate level is not particulary welcomed by all np's
you are totally correct. i do not welcome it either, despite the fact that i will be grandfathered by the time the 2015 recommendation is enacted. i think there are several drawbacks for the np as well as the profession as a whole. looking at it in this aspect, np's can actually be considered undercredentialled in many ways now.
yes - the np is able to assist in surgery.
yep. they can also bill for it. good luck in getting credentialled unless you have your rnfa.
in nys, many np's are found in surgery without the rnfa and do indeed get paid/bill for service. this may be different elsewhere, so i apologize for this potential error.
pa's can prescribe schedule drugs in all but 5 states (authority at all in indiana). the latest information i can see is that np's can't prescribe schedule drugs in 4 states (both groups have restrictions in some states on schedule ii).
not exactly. while the pa certainly has the ability to write the rx, the supervising physician must have either delegated the duty to the pa, or have authorized the rx. in some states the pa can write for a 72 hour supply, this much is true. in other instances where a pa can write for a scheduled drug, the chart must be cosigned within a certain amount of time. the np can write for scheduled drugs in most states without this requirement.
umm preventive medical advice and education is part of the medical skill set. i'm not sure when nursing copyrighted this.
i did not imply that np's solely provide preventative care. the issue is though, that under the medical model of practice, preventative care is not the main focus. there is not a whole lot of health teaching that goes on in the med schools, and i am sure you know that to be true. i don't believe there is a focus on nutrition classes in most of the programs at all. nursing is notorious for providing this type of care, and yes, the research does show that np's are preferred by patients in this regard.
if the np is working for a practice the liability of the supervising physicians is the same.
this is not correct. if the np is considered an employee, then yes, the liability is the same. this is considered incident ii criteria. in this instance you are correcxt that np's are functioning the same as a pa, and in this instance the practice is reimbursed at 100% md rate. most np's however bill under their own medicare numbers, of which the pa does not have and this takes the liability away from the md.
on the average np's function the same as pa's except they see fewer patients (makes less money for the practice). np's do have the advantage in some states that they can practice independently.
this is again, not an accurate reflection of the np. in many states, the np not only functions as a pcp independently, performs specialized services independently, takes call, and sees patients in the hospital, but the np also has the ability to see as many or more patients in a session than the pa, because the doc does not have to follow behind. if you look at it in that way, the doc may not have office hours at all on a particular day. the np can independently run that practice, and is reimbursed at 85% of the md rate. this is 85% more than would have been earned that day if the doc had only a pa. again, the np brings in $$ where there would have been none.
also note that np's have further training in which they are specialized into different care areas such as acute care, women's health, psych, etc, where the pa does not have the ability to specialize. while a pa may work in a specialty area, (this being one of the pa's greatest strengths and benefit, as most specialist docs wants their hands on every patient anyway), they are not specifically trained for a specialized degree.
now for the record, some of my best friends and colleagues are pa's. i supervise pa's, and i precept them in primary care as well. i think pa's are a huge benefit in most situations. however, when posed with the difference between the two degrees, i think the benefits and positive aspects of both need to be considered. the np is without question more autonomous in most states and in more areas of practice. that was my point.
apparently you have concerns that warranted your obvious defensive stance re: my posting. my information was correct. keep in mind please that each state has different requirements for certain practice function. in response to some of your additional info:
my first post was rather intemperate and edited by siri. i have a big problem with your misrepresentation of the pa profession. it is customary when posting in a thread to read the thread. had you done so you would have seen a significant amount of your "correct" is directly contradicted by earlier posts. to address your other issues.
there are also on line nurse practitioner programs.
np programs are not typically online. please do not mislead other readers into thinking that a np student can earn a degree without entering a clinical arena.
according to drexel et al, nurse practitioner programs do have the ability to have online class components. the pa programs do as well. many of the classes that form the basis for the degrees, such as role/concept classes and the liberal arts components can effectively be taught online. the clinical classes such as health assessment, pathophys, micro etc are done on campus. there is no one program that awards a degree that is suitable for sitting through the ancc exam that is held 100% online.
i never said that an np can enter a degree without entering the clinical area. however there are np courses that are completely online for the didactic portion:
i have a problem with graduate courses being done online. when dealing with something this important and this difficult i would rather the student be face to face with their teachers so they can be evaluated. there are a few pa courses and even med school courses that are done online. it is even possible to get a master's in pa studies online. however, no one graduates from a pa program or sits for the boards without doing at least 90% of their classwork in a classroom setting.
you forgot to mention that on average the np program has about 1/2 the clinical and didactic content of the average pa program.
this is not always true. when you combine the education required to obtain the rn licensure that is required to enter the np program with the graduate level work, the semester hours exceed that of a pa program.
apples to apples. we are talking graduate medical or nursing hours. i don't count my undergraduate degree or paramedic degree. what we are looking at is the contact hours spent in didactic and clinical work. also do not confuse contact with semester hours. i had 2300 didactic hours. by traditional measurement i have 127 semester hours that year. i got credit for 40 since otherwise i would have to pay 127 x $420 per hour. for most postgraduate clinical programs the didactic and clinical hours have no relationship to the semester hours.
the minimum requirement for most np's is 500 clinical hours. most programs are raising this to 600 or so hours. pa programs have no set hours, only areas that the pa must have a minimum exposure to. on the average pa students have more than 1600 didactic and 2100 clinical hours.
the doctorate level is not particulary welcomed by all np's
you are totally correct. i do not welcome it either, despite the fact that i will be grandfathered by the time the 2015 recommendation is enacted. i think there are several drawbacks for the np as well as the profession as a whole. looking at it in this aspect, np’s can actually be considered undercredentialled in many ways now.
yes - the np is able to assist in surgery.
yep. they can also bill for it. good luck in getting credentialled unless you have your rnfa.
in nys, many np’s are found in surgery without the rnfa and do indeed get paid/bill for service. this may be different elsewhere, so i apologize for this potential error.
this is actually a national issue pushed by aorn. there is a requirement for documented or competency to meet jhaco standars. some aorn member are taking this to mean that nurses need an rnfa to work in the or. nurses that have documented experience can usually be grandfathered. new grad nurses are having significant problems.
pa's can prescribe schedule drugs in all but 5 states (authority at all in indiana). the latest information i can see is that np's can't prescribe schedule drugs in 4 states (both groups have restrictions in some states on schedule ii).
not exactly. while the pa certainly has the ability to write the rx, the supervising physician must have either delegated the duty to the pa, or have authorized the rx. in some states the pa can write for a 72 hour supply, this much is true. in other instances where a pa can write for a scheduled drug, the chart must be cosigned within a certain amount of time. the np can write for scheduled drugs in most states without this requirement.
you have taken the ny laws and applied them to all pa's. the new york laws are very restrictive. here is the appropriate part of the law:
"in an outpatient setting, the pa may prescribe all medications including schedule iii - v (excluding schedule ii) controlled substances if delegated by the supervising physician. pas may apply to the dea to obtain their own, individual registration numbers as "mid-level practitioners." once duly registered by the dea, they may write schedules iii, iv and v drugs subject to any limitations imposed by the supervising physician and/or clinic or hospital where such prescribing activity may occur. such prescriptions are to be written on the supervising physician's prescription form. the prescription form must include: the imprinted name of the pa; the imprinted name of the supervising physician; the practice address and phone number; the pa's signature followed by the designation rpa; the pa's new york state registration number; and the physician's license number."
the nursing act is different however it appears that the np is limited by the collaboration agreement with the physician. it does appear that np's can prescribe schedule ii. now for example let me quote the colorado law:
"a. a physician assistant may issue a prescription order for any drug or controlled substance provided that:
1. each prescription and refill order is entered on the patient’s chart.
2. each written prescription order shall be signed by the physician assistant and shall contain in legible form the name, address and telephone number of the supervising physician and the name of the physician assistant.
3. nothing in this section 3 of these rules shall prohibit a physician supervisor from restricting the ability of a supervised physician assistant to prescribe drugs or controlled substances.
4. a physician assistant may not issue a prescription order for any controlled substance unless the physician assistant has received a registration from the united states drug enforcement administration.
b. physician assistants shall not write or sign prescriptions or perform any servicesthat the supervising physician for that particular patient is not qualified or authorized to prescribe or perform.
c. no drug that a physician assistant is authorized to prescribe, dispense, administer or deliver shall be obtained by said physician assistant from a source other than a supervising physician, pharmacist or pharmaceutical representative.
d. no device that a physician assistant is authorized to prescribe, dispense, administer or deliver shall be obtained by said physician assistant from a source other than a supervising physician, pharmacist or pharmaceutical representative."
show me cosignature, authorization, or delegation. ny pa laws are generally regarded as poor and antiquated. it is just as easy to show np laws that are as or more restrictive. most pa laws generally let the pa prescribe as long as the prescription is within the supervising physicians purview and not prohibited by the supervising physician. probably the same limitations that np's face under their collaboration agreement.
umm preventive medical advice and education is part of the medical skill set. i'm not sure when nursing copyrighted this.
i did not imply that np’s solely provide preventative care. the issue is though, that under the medical model of practice, preventative care is not the main focus. there is not a whole lot of health teaching that goes on in the med schools, and i am sure you know that to be true. i don’t believe there is a focus on nutrition classes in most of the programs at all. nursing is notorious for providing this type of care, and yes, the research does show that np’s are preferred by patients in this regard.
actually you need to look at more modern medical programs. yes 10-15 years ago preventive health was ignored. however most practice standards now heavily emphasize preventative medicine. most pa schools and medical schools teach to this standard. please show the research that shows that np's are preferred in this regard.
if the np is working for a practice the liability of the supervising physicians is the same.
this is not correct. if the np is considered an employee, then yes, the liability is the same. this is considered incident ii criteria. in this instance you are correcxt that np’s are functioning the same as a pa, and in this instance the practice is reimbursed at 100% md rate. most np’s however bill under their own medicare numbers, of which the pa does not have and this takes the liability away from the md.
umm you really go back and understand practice mechanics. incident to is a medicare term that allows a np or pa to bill 100% of medicare rate for following conditions originally evaluated by the physician. as far as medicare both np's and pa's bill under their own medicare numbers (yes pa's have medicare numbers) unless billing incident to. failure to do so is fraud.
billing has nothing to do with liability. if the np or pa is an employee liability will fall to the company and ultimately the supervising physician. as far as np liability, at least 6 states require supervision by the physician. in these states the liability is the same as for a pa. other states require a collaboration agreement. in most cases the np has the liability unless they have consulted the physician on the case. there is mixed case law on physician liability if the np goes outside of the collaboration agreement or the collaboration agreement allows the np to exceed their scope of practice. here is a rather nice article:
realistically this is a stalking horse. if the np is practicing completely independently in the states that allow that, there is no physician liability. if the np is practicing in states that require supervision or collaboration then there is some degree of liability. if the np is an employee the liability is identical as far as the corporation is concerned.
on the average np's function the same as pa's except they see fewer patients (makes less money for the practice). np's do have the advantage in some states that they can practice independently.
this is again, not an accurate reflection of the np. in many states, the np not only functions as a pcp independently, performs specialized services independently, takes call, and sees patients in the hospital, but the np also has the ability to see as many or more patients in a session than the pa, because the doc does not have to follow behind. if you look at it in that way, the doc may not have office hours at all on a particular day. the np can independently run that practice, and is reimbursed at 85% of the md rate. this is 85% more than would have been earned that day if the doc had only a pa. again, the np brings in $$ where there would have been none.
you have a poor understanding on how a pa functions. in all studies that look at pa and np preformance (n=2) the pa's see more patient per fulltime equivalent. here is the data from kaiser and mgma:
yearly encounters pa np
kaiser (1990) 4,500 3,800
mgma (2005) 3,186 2,429
either way pa's in these two studies see more patients than np's this equals more dollars. this is also borne out in the mgma studies on cost effectiveness. this measures the ratio of compensation to production (compensation/production). for pa's it is .24 for np's .27 for md's it is .33. what this means is that for every 24cents in compensation the pa brings in one dollar. under any of these measures the pa is the most productive health care provider.
i'm not sure where you work, but my md does not follow behind me at any time. there is no requirement that the md cosign my note in clinic (our practice does anyway). in the hospital both the np and pa note have to be signed within 48 hours. i can run a practice in a collaborative manner and see patients on my own. you seem to have a very narrow view on what pa's can do.
also note that np’s have further training in which they are specialized into different care areas such as acute care, women’s health, psych, etc, where the pa does not have the ability to specialize. while a pa may work in a specialty area, (this being one of the pa’s greatest strengths and benefit, as most specialist docs wants their hands on every patient anyway), they are not specifically trained for a specialized degree.
pa's are trained in medicine. we get the whole experience including surgery, psych, family practice, internal medicine, pediatrics and emergency medicine. we also have to the ability to do clinical rotations in specialties during school. the "specialties" that you mention are actually broad categories of nursing that limit np's to those specialties. depending on the state that you practice in you may be limited by this. for example in texas the nursing board has this to say:
q: "my office practice employs two advanced practice nurses who are approved in different specialties. i understand that there is overlap in their scopes of practice. [an example of such a situation is an ob/gyn setting in which both a family nurse practitioner (fnp) and a women’s health nurse practitioner (whnp) practice]. does this mean both advanced practice nurses have the same scope of practice in this setting?
a: although both programs included content related to a particular specialty or sub-specialty, the depth of the content included in each program varies significantly. as in the example of ob/gyn specialty content for the fnp and whnp, the fnp educational program provided some content related to ob/gyn. it did not, however, include ob/gyn specialty
content to the same depth that the whnp’s program did. therefore, although there will be overlap in the scope of the services each advanced practice nurse provides in this setting, there may be procedures or patient care activities that are within the whnp’s scope of practice that are not within the fnp’s scope of practice in this particular setting. each advanced practice nurse is responsible for practicing within the role and specialty
authorized by the board and appropriate to his/her educational preparation. additionally, each advanced practice nurse is responsible for recognizing when he/she is in danger of exceeding his/her personal and professional scope of practice.
in addition anp's may not see pediatrics and vice versa, a problem in practices that cover multiple age groups such as allergy. acute care np's may not see clinic patients. np's are restricted by their nursing training. on the other hand the pa is restricted only by what their supervising physician allows and what their supervising physician can do.
now for the record, some of my best friends and colleagues are pa’s. i supervise pa’s, and i precept them in primary care as well. i think pa’s are a huge benefit in most situations. however, when posed with the difference between the two degrees, i think the benefits and positive aspects of both need to be considered. the np is without question more autonomous in most states and in more areas of practice. that was my point.
i'm really glad for you that you have friends that are pa's. i wonder why they have not helped you with your many misconceptions about pa's. i hope that you are not passing on the same bad information when you precept them. yes in certain states np's can practice independently. if that is what you want good for you. for the most part np's and pa's practice identically. if you wish to educate yourself more about pa's please follow the links in my first post.
I've also heard that the income gap between NP's and PA's is decreasing and I've also heard at some point the PA's income levels off, whereas the NP's have more opportunities to advance.
caldje
177 Posts
Easily confused. I understand. I didnt mean to be so abrupt in my response. :-D