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?
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.
The most recent data doesn't seem to show this. MGMA data from 2005 shows the NP salary at 70k and PA salary at 75-80k. The AAPA data shows the average PA salary at 80k. The real problem with this is what the data doesn't include. Many surgical practices are not in MGMA so they don't report the data. The data also doesn't show NP owned practices which are probably the most lucrative.
As far as PA and NP income they probably follow the same patterns. In a situation where both NP's and PA's are employees why would one level off and one not. One of the problem with NP and PA salaries is that you cap out very quickly. PA salaries for new grads are about 68k and you hit the max for a given situation within two to three years. This is similar to what happens with employee physicians.
Primary care PA salaries are the lowest and are not changing much. There is only so much relative efficency that you can gain that will allow you to bill more. The primary driver for PA salaries is the increase in specialty care and surgery. For example the average PA salary in GI is 80k for new grads and the 75th% is 100k after 3 years. Much higher than primary care practice. The average salary for CVSPA's is close to 125k.
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.
David Carpenter, PA-C
The best universities in the country have online courses. I prefer any didactic course online versus actually sitting in class. The time spent driving, parking, stupid people in class wasting your time, etc (I once found 40 benefits to online learning from googling) makes traditional learning inefficient. Some people have to be spoonfed in a classroom setting, but I think online learnng attracts those who function better in the workplace because they know how to find info. I've had both traditional and online education and prefer the online.
The best universities in the country have online courses. I prefer any didactic course online versus actually sitting in class. The time spent driving, parking, stupid people in class wasting your time, etc (I once found 40 benefits to online learning from googling) makes traditional learning inefficient. Some people have to be spoonfed in a classroom setting, but I think online learnng attracts those who function better in the workplace because they know how to find info. I've had both traditional and online education and prefer the online.
I agree that some of the best universities in the country have online courses. However, it is relatively rare in well known graduate course and it is pretty much unheard of in medical education. Like it or not online courses have a certain perception that is hard to overcome. In a high volume field like medicine I think it is important to have that face to face contact. Put this in medical context - my doctor got his degree online. How is that going to go with the patient population. I would like to see some studies to show that the learning and retention is equivalent. I think that there is a very small subset of people that can do well with difficult subjects such as those involved in graduate nursing.
I agree that some of the best universities in the country have online courses. However, it is relatively rare in well known graduate course and it is pretty much unheard of in medical education. Like it or not online courses have a certain perception that is hard to overcome. In a high volume field like medicine I think it is important to have that face to face contact. Put this in medical context - my doctor got his degree online. How is that going to go with the patient population. I would like to see some studies to show that the learning and retention is equivalent. I think that there is a very small subset of people that can do well with difficult subjects such as those involved in graduate nursing.
David Carpenter, PA-C
My understanding is many PAs with a BS seek their MS online at Nebraska (and others) because of the low cost and ease. I also thought that 35% of PA programs currently grant a MS degree, not 75% as you noted on a prevous post.
Specializes in Education, FP, LNC, Forensics, ED, OB.
From the AAPA:
The typical PA program is 24-27 months long and requires at least two years of college and some health care experience prior to admission. The majority of students have a BA/BS degree and just under 40 months of health care experience before admission to a PA program. While all programs recognize the professional component of PA education with a document of completion for the professional credential (PA), seventy-five percent of the programs award a master's degree. [102 award master's degrees, 24 award bachelor's degrees, 4 award associate degrees, and 5 award certificates.
PRESCRIBING - Forty-nine states, the District of Columbia, and Guam have enacted laws that authorize PA prescribing. (Indiana does not yet authorize prescribing by PAs.)
STATE LAWS - All states plus the District of Columbia, the Commonwealth of the Northern Mariana Islands, Guam and the United States Virgin Islands have laws or regulations authorizing PA practice.
CERTIFICATION AND CME - PAs receive their national certification from the National Commission on Certification of Physician Assistants (NCCPA). Only graduates of an accredited PA program are eligible to take the Physician Assistant National Certifying Examination (PANCE). Once a PA is certified, he/she must complete a continuous six-year cycle to keep her/his certificate current. Every two years, a PA must earn and log 100 CME hours and reregister her/his certificate with the NCCPA (second and fourth years), and by the end of the sixth year, recertify by successfully completing either the Physician Assistant National Recertifying Examination (PANRE) or Pathway II. All states require passage of the PANCE for state licensure. Forty-five states have provisions for new graduates to practice prior to passage of PANCE.
Thank you Siri. I also know that at least two of the 4 associates program have agreements with Masters programs that allow their students to get a Masters with that program. The concept of the Masters is controversial within the community. On one hand it properly gives the students credit for the work they do which is post graduate medical education. On the other hand it moves us away from our roots. The PA education has always been competency based and grew out of a desire to extend the training of Navy Corpsman trained in Vietnam.
The reality of the move to the Master's is to exclude those who have extensive experience, but insufficent college to get a Master's. The consequence is that the PA student population is becoming younger and on the average has less medical experience. While I generally agree with the concept of experience for PA's, I will admit that there are no studies that show that PA's without experience do any worse in any aspect of patient care. Indeed, PA's without experience do as well on the certifying exam as PA's with experience.
I think the strength of the PA training is that it does not rely on your previous education, but on what you are taught as a PA. We had nurses, med techs, pharmacists and paramedics in my class. No student was given any credit for previous experience. We all got the same lectures, took the same classes etc. Did the Pharmacist have an easier time with pharmacology, yes. However, they still had to do the clinical medicine part and understand why the drugs were prescribed.
The main problem that I have with the NP training is the direction that it is moving. If you compare the PA training and NP training they were very similar in length when they started. The first PNP program was 4 months of full time instruction followed by a 20 month period of continuous training in the community. The original PA program included a year of didactic instruction and a year of clinical training. Over the years the PA programs have stayed roughly the same or expanded slightly (average is now around 25 months). This is full time work for 1200+ hours of didactic and 2000 clinical hours. The NP programs have regressed. I have been unable to find published data on the average NP program but most information that I have reviewed shows about 400 didactic hour and around 500 clinical hours. I think that this is an insufficent amount of training to acheive good clinical results.
I think that this is reflected (at least in respect for pharmacology) with the requirements in some states for additional training in pharmacology and additional clinical experience before NPs can get prescriptive authority. The DNP may be a response to this (the genesis of this is unclear to me). This problem is compounded by the advent of direct entry NP programs. I will also point out that the other two advanced practice nursing fields (CRNA and Nurse midwife) follow this 1+1 program and are similar in didactic and clinical hours to the PA programs.
I would fully agree with the statement that in almost any field the difference between an NP and a PA will be indistinguishable within one to two years. I think before that time the NP will be more reliant on previous experience while the PA will be more reliant on their training as a PA.
In answer to the original question posed on this thread, there are state by state differences in what an NP or a PA is allowed to do. However, in the end both professions do an excellent job in what they are trained to do - provide quality healthcare.
I want to do more surgery-type, so are they in surgery as well, or is that completely different!? (There seems like SO many different jobs in a hospital!)
Typically, PAs are known to work more in the OR, however NPs can also work in surgery. My background was as a RN, then RNFA (Registered Nurse First Assistant), then FNP. I continue to assist in the OR. Both professions work in hospitals as well. I am a NP and I work in both office and hospital settings as well as the OR.
The main difference is two-fold. If you do not have a nursing background, or are an ADN, it is generally faster to become a PA. If you have your BSN, it is generally a 2 year MSN program to get your NP.
The only other difference between NPs and PAs is that PAs are required to work under a physician, where in many states, NPs need to have a colaborative physician, or none at all to work. So if the idea of working in a solo practice appeals to you and is allowed in your state, then becoming a NP may be the better path to take.
Typically, PAs are known to work more in the OR, however NPs can also work in surgery. My background was as a RN, then RNFA (Registered Nurse First Assistant), then FNP. I continue to assist in the OR. Both professions work in hospitals as well. I am a NP and I work in both office and hospital settings as well as the OR.
The main difference is two-fold. If you do not have a nursing background, or are an ADN, it is generally faster to become a PA. If you have your BSN, it is generally a 2 year MSN program to get your NP.
The only other difference between NPs and PAs is that PAs are required to work under a physician, where in many states, NPs need to have a colaborative physician, or none at all to work. So if the idea of working in a solo practice appeals to you and is allowed in your state, then becoming a NP may be the better path to take.
Both are awesome fields to be involved in!
Good points. Part of the reason that more PA's are involved in surgery is that all surgery is function of training. After 2007 all PA students must have surgical experience with operative experience. NP's do not necessarily have that experience and depending on the nursing credentialling may be required to take the RNFA which usually requires one year of OR experience (see the circular pattern here). That being said I have seen MD's that really valued a particular NP's experience get them credentialled.
I would disagree that it is faster to get an NP than a PA degree if you have a BSN. Some programs may make you take coursework in excess of the BSN, but they are both two year programs generally. If you want the best of both worlds consider the Stanford program. Graduates of this program get an NP degree and a PA degree if they have their BSN.
The supervision issue is real, but I would question how much it really matters. In surgery you will never work without supervision and most providers work for a practice one way or another. If you really intend to strike out on your own then the NP is the only way to go.
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
I would disagree that it is faster to get an NP than a PA degree if you have a BSN. Some programs may make you take coursework in excess of the BSN, but they are both two year programs generally.
What Trube wrote was that it's easier to become a PA if you do not have a nursing background or if you have an ADN. That's probably true in areas where PA programs are not at the Master's degree level. But I do agree with you that in many cases, it will take longer to go through the PA route. Where I am at, the PA programs are all Master's degree. It would have actually taken me longer with a BSN to finish a PA track because most programs here in my state even require prerequisite courses before actually being admitted.
Independent NP practice does attract a lot to the field. However, there are still many barriers to total independent practice for NP's even in states where the law seems to indicate that an NP can practice without physician involvement. The American Academy of NP's lists Michigan as one of the states where no physician involvement is required. However, in our state prescriptive authority is a delegated role so that makes it hard to prescribe without indicating a physician's name. Many private insurances do not recognize an NP's independent practice so that's another barrier unless the NP goes through the insurance company's credentialing process. In my state, not many NP's have been able to accomplish that.
I remember being told in NP school that being an NP is a political statement in itself. That's because there are many barriers to meeting our full potential to practice and we have to constantly strive to erase these barriers. One way to do that is be involved in NP organizations at the state and national level.
I remember being told in NP school that being an NP is a political statement in itself. That's because there are many barriers to meeting our full potential to practice and we have to constantly strive to erase these barriers. One way to do that is be involved in NP organizations at the state and national level.
I'll agree with that. What I find maddening is that when trying to research NP's there is no single organization that represents them. With PA's, it is really well defined. We have the AAPA that represents us on a national level. We have state academies that represent us on a local level and we have specialty congresses and caucuses that represent us from a specialty or viewpoint level.
As far as a can tell no such organization exists for NP's. You can be part of ANA and there is the ACNP and a number of other organizations. However, they don't seem to speak with a unified voice (I'll admit there is a fair amount of disagreement in the PA profession but not to the extent that I see in the NP profession). Also the NP academics seem to be working at cross purposes with the NP's that actually work with patients. There seems to be little or no care about how their policies effect working NP's. There are also multiple certification organizations including two different organizations for FNP. All of this makes it hard to participate (I would imagine, but also hard to make your voice heard.
core0, you've just described nursing in general with all the fractionated areas........
Agreed, NPs need a unified voice.
Can I tweek that last statement a little bit and say that "NPs and PAs need to come together and create a large unified voice." The american college of clinicians attempted that but doesnt seem to have worked out all that well. If we all worked together, recognizing the strengths and weaknesses of both professions and working together to standardize training and certification by getting rid of the collective bad and promoting collective good NPs and PAs alike, as "midlevels" could really improve public health by doing what they both do best. oh well. it will never hapen.
core0
1,831 Posts
The most recent data doesn't seem to show this. MGMA data from 2005 shows the NP salary at 70k and PA salary at 75-80k. The AAPA data shows the average PA salary at 80k. The real problem with this is what the data doesn't include. Many surgical practices are not in MGMA so they don't report the data. The data also doesn't show NP owned practices which are probably the most lucrative.
As far as PA and NP income they probably follow the same patterns. In a situation where both NP's and PA's are employees why would one level off and one not. One of the problem with NP and PA salaries is that you cap out very quickly. PA salaries for new grads are about 68k and you hit the max for a given situation within two to three years. This is similar to what happens with employee physicians.
Primary care PA salaries are the lowest and are not changing much. There is only so much relative efficency that you can gain that will allow you to bill more. The primary driver for PA salaries is the increase in specialty care and surgery. For example the average PA salary in GI is 80k for new grads and the 75th% is 100k after 3 years. Much higher than primary care practice. The average salary for CVSPA's is close to 125k.
David Carpenter, PA-C