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?
One of the major differences is the certification exam required every 6 years for PAs.
As I was thinking about this I have started to wonder how difficult can this test be? All PAs take the same exam offered every 6 years. A family practice PA, a dermatology PA, every PA no matter what their current practice setting. The PAs I know take a review course just before the exam and they all pass even though they have spent the past 20 years in orthopedics. What am I missing? Aren't these exams covering all the content areas from their PA education.
Now I hear that the the exam every 6 years isn't the PANCE, but a PANRE? From what I have noted everybody passes the PANRE? If everybody passes, why not just have CME. This is really interesting.
Now I hear that the the exam every 6 years isn't the PANCE, but a PANRE? From what I have noted everybody passes the PANRE? If everybody passes, why not just have CME. This is really interesting.
Actually the pass rate is about 91%. Good not perfect. The PANRE is validated against practice standards and the test questions reflect this. There was a Pathway II which was a self paced test which had a higher rate. You had to get more than 90% of the questions right, but it was completely open book. The NCCPA did away with it this year.
Overall it is a good reflection about what we do. Even if you work in specialty care you should be knowledgeable about the basics of medicine. Fortunately for me 16% of the questions are on GI which is my specialty. I feel for people that are really specialized like reproductive endocrinology. The normal way is to take the test about a year prior to when you recert so you have a couple of chances if you blow it. This is the direction that most physicians are moving. Almost all physicians have to recertify every 5-10 years. Our physcians have to recertify in internal medicine and gastroenterology. One of our physicians has to recertify in IM, GI, and transplant hepatology.
One of the major differences is the certification exam required every 6 years for PAs.
As I was thinking about this I have started to wonder how difficult can this test be? All PAs take the same exam offered every 6 years. A family practice PA, a dermatology PA, every PA no matter what their current practice setting. The PAs I know take a review course just before the exam and they all pass even though they have spent the past 20 years in orthopedics. What am I missing? Aren't these exams covering all the content areas from their PA education.
its harder than the one NPs have to take..
and we've all been to CME events, there is a huge diference in having to recertify every 6 years, WITH your job on the line, and having to go to cancun for 4 half days of lecture and the rest of the time spent at pharm dinners and on the beach. The recertification thing is a pain, but it ensure a competency that is the halmark of the PA profession. It also holds all PAs accountable for a broad base of knowledge at any given time in their career, something that could be seen as good in most people's eyes.
Now I hear that the the exam every 6 years isn't the PANCE, but a PANRE? From what I have noted everybody passes the PANRE? If everybody passes, why not just have CME. This is really interesting.
PANCE = initial certifying exam
PANRE= Recertifying exam, the C is switched to a R. You must pass the initial test to receive your PA-C and able to initially practice. In california if you fail the PANRE you can still work but must drop the -C. Not everyone passes the PANRE. I have ran into a few that have dropped the -C.
A recertifying exams is a great way to insure that PAs keep the core knowledge of Primary Care and keep the ability to lateral into different fields. I suppose this is similar to board certified Docs who also must recertify.
As for the PANCE being harder than FNP exam, one would have to take both exams to be able to state that claim. Come feburary of next year I will give you that answer;)
and we've all been to CME events, there is a huge diference in having to recertify every 6 years, WITH your job on the line, and having to go to cancun for 4 half days of lecture and the rest of the time spent at pharm dinners and on the beach. The recertification thing is a pain, but it ensure a competency that is the halmark of the PA profession. It also holds all PAs accountable for a broad base of knowledge at any given time in their career, something that could be seen as good in most people's eyes.
Caldje, how do you know the exam is harder? Is there an analysis that you can use to reference? I am not sure how you can say one is harder than the other. In the the old days when a new graduate NP could take the PA exam those that passed the NP passed the PA. Even when an exam (NP or PA) is harder the "curve" always makes things balanced.
PANRE= Recertifying exam, the C is switched to a R. You must pass the initial test to receive your PA-C and able to initially practice. In california if you fail the PANRE you can still work but must drop the -C. Not everyone passes the PANRE. I have ran into a few that have dropped the -C.
A recertifying exams is a great way to insure that PAs keep the core knowledge of Primary Care and keep the ability to lateral into different fields. I suppose this is similar to board certified Docs who also must recertify.
As for the PANCE being harder than FNP exam, one would have to take both exams to be able to state that claim. Come feburary of next year I will give you that answer;)
I am not you can compare to an IM recert as they are recert in IM, as are all the other speciality areas. I am still trying to figure out how you can practice in derm for 17 years take a week review course and pass at 91% rate? AS I understand PA areas, most are in speciality areas, GI, Surg, EM. which would not prepare for PANRE. Now if there was a speciality PANRE you would have more credit.
I am not you can compare to an IM recert as they are recert in IM, as are all the other speciality areas. I am still trying to figure out how you can practice in derm for 17 years take a week review course and pass at 91% rate? AS I understand PA areas, most are in speciality areas, GI, Surg, EM. which would not prepare for PANRE. Now if there was a speciality PANRE you would have more credit.
38% of PA's are in primary care. Another 10% are in Emergency medicine. So about half are in a position where they deal with general medical problems every day. 25% are in surgery and they have the biggest problem. Of the specialty care cardiology and GI are probably the biggest specialties and those questions account for almost 35% of the test. So there is a big advantage there.
The other thing that you have to remember is that this is not just show up and take the test. It is a continous process. We have to log 100 CME hours every 2 years. If you are smart you do not log all your hours in your specialty. I usually log about 160 hours per cycle. I log 1/2 in GI and liver disease and the other half in general medicine. This helps you stay current. Also if you are in a specialty you are still responsible for medical problems that present to you. Someone like derm probably does have the hardest time, but if you are well trained from the get go it comes back.
The other thing to realize is that the first time pass rate is 91% but the all comers pass rate is in the 80%. So if you don't pass the first time you are going to have a hard time passing. At that point you really need to study your butt off.
Finally a number of PA's work more than one job. I do some free clinic stuff to keep my hand in and if you are in an IM subspecialty then you have to deal with general IM stuff as well as your specialty. Overall there are probably about 20-30% of PA's that do little "medicine" in thier daily jobs. They should realize they are going to have to work harder to recertify and need more work to keep current. Also there are a few states that do not require current certification. The state BOM's are working to bring them into line.
Caldje, how do you know the exam is harder? Is there an analysis that you can use to reference? I am not sure how you can say one is harder than the other. In the the old days when a new graduate NP could take the PA exam those that passed the NP passed the PA. Even when an exam (NP or PA) is harder the "curve" always makes things balanced.
I have heard that in the past NP's could take the PA exam as could informally trained PA's. However that has not happened for at least 25 years and possible more. The exam has dramatically changed in the last 25 years (it has changed dramatically in the last 10 years). The process is very involved but it essentially uses a competency assessment by following primary care PA's then developing questions based on those competencies. The questions are then tested on a sample of students. For example the PANCE will have 360 questions. Only 300 of those count, the other 60 are exam questions that are being evaluated. For the PANRE there are 300 questions 250 of which count. Here is a link that talks about functional areas and test development:
Speaking with Stanford grads that have taken both the PANCE and the FNP exam, they all agree the FNP (both versions) is much easier (n is small here). However, they are trained as PA's so its not exactly apples=apples for a FNP grad. An interesting experiment would be to develop a combined FNP/PA test using questions from both exams and administer this to a group of new grads from both professions. I have also heard from NP faculty that they are frustrated by the FNP exams. One refers to the dumbing down of the exam. There are two exams and students will naturally take the one that they percieve as easiest. This has led to a "race to the bottom" in the opinion of some faculty. The final problems is that seems to be no or little tracking of pass fail results for NP programs. There is very little data at all on what happens to graduates. On the other hand there is a wealth of data on PA pass fail rates (as a matter of fact all PA programs must publish thier first time pass rates).
Speaking with Stanford grads that have taken both the PANCE and the FNP exam, they all agree the FNP (both versions) is much easier (n is small here). However, they are trained as PA's so its not exactly apples=apples for a FNP grad. An interesting experiment would be to develop a combined FNP/PA test using questions from both exams and administer this to a group of new grads from both professions. I have also heard from NP faculty that they are frustrated by the FNP exams. One refers to the dumbing down of the exam. There are two exams and students will naturally take the one that they percieve as easiest. This has led to a "race to the bottom" in the opinion of some faculty. The final problems is that seems to be no or little tracking of pass fail results for NP programs. There is very little data at all on what happens to graduates. On the other hand there is a wealth of data on PA pass fail rates (as a matter of fact all PA programs must publish thier first time pass rates).
David Carpenter, PA-C
First I have to say, I dont always agree with your posts. But you are classy! Rarely personal, usually well referenced. With that said...
Explain to me some of these currently certified PAs I work with, these are not smart people. I want to be clear, I am only referring to three out of 20+ I have worked with in the past. But, these three, in different clinics are all very poor providers. In fact, I won't allow any of them to see any of my primary patients. They almost always cause more trouble than its worth.
So how do they pass every 6 years? If the test is so difficult, and they have passed every 6 years at least 3-4 times as I recall, how did they do it? I also want to be clear, several NPs have made me wonder how on earth they passed the exam the first time.
First I have to say, I dont always agree with your posts. But you are classy! Rarely personal, usually well referenced. With that said...
Explain to me some of these currently certified PAs I work with, these are not smart people. I want to be clear, I am only referring to three out of 20+ I have worked with in the past. But, these three, in different clinics are all very poor providers. In fact, I won't allow any of them to see any of my primary patients. They almost always cause more trouble than its worth.
So how do they pass every 6 years? If the test is so difficult, and they have passed every 6 years at least 3-4 times as I recall, how did they do it? I also want to be clear, several NPs have made me wonder how on earth they passed the exam the first time.
Well I will say that every profession is defined by a bell curve. The test tries to measure clinical competency, it does not gaurantee competency. I am sure we all know providers (MD, PA, NP) that test well, but you wouldn't let near a patient. For the most part I have no problem referring to the NP's in our medical community. When I refer I send my patients to practitioners that know what they are doing. I will not refer to a number of MD's that I feel are subpar. That doesnt mean that they are not proficent at what they do, it means that there is someone better or that they have a poor bedside manner. All things considered I will take bedside manner if the other skills are equal.
One thing that I am unclear about is are your referring people for specialty care? If these are the PA's you are talking about then I will also point out that this does not measure competency in specialty care. This is one of the big debates in the PA world. Wether we pursue specialty certification or not. Since the scope of practice is defined by the supervising physician any additional certifications can be a barrier to practice. So far Derm, CV surg and EM have specialty exams. How this will play out is unknown.
As far as the test is concerned it is very difficult to compare to anything else. It is a difficult test and MD's have compared it favorably to step II. The process has been vetted by the AMA and the BOM's. The board is composed not only of PA's but representatives from the AMA and various medical specialties.
I think the true test would be to ask NP and PA's who have gone on to med school how they compare. You could potentially use these responses but the N would be small and you would have not only observer bias but recollection bias.
Caldje, how do you know the exam is harder? Is there an analysis that you can use to reference? I am not sure how you can say one is harder than the other. In the the old days when a new graduate NP could take the PA exam those that passed the NP passed the PA. Even when an exam (NP or PA) is harder the "curve" always makes things balanced.
my point was that NPs dont have to recertify at all. not necessarily trying to implicate any differences in difficulty. I have, however, used both USMLE step 2ck study guides, pance study guides, and taken some FNP practice tests. I won't say any is harder than the other because i am just not a fair judge of that, i dont know enough. However, I will say that the FNP practice exams dont even touch on most of the medical subjects covered in the other tests. It really is just different.
my point was that nps dont have to recertify at all. not necessarily trying to implicate any differences in difficulty. i have, however, used both usmle step 2ck study guides, pance study guides, and taken some fnp practice tests. i won't say any is harder than the other because i am just not a fair judge of that, i dont know enough. however, i will say that the fnp practice exams dont even touch on most of the medical subjects covered in the other tests. it really is just different.
i don't disagree that the fnp exam may be "easier" . what if the passing score for the fnp exam was 75% and the passing score on the pance was 50%. my point is, one may be more difficult, you still have a high passing rate. 90% pass the panre with a week review course? and yet we hear how nps and pas are all about the same after a few years. my point is, the panre is more hype than anything else. i have been listening to the pas say for years how they have more credibility because they take an exam every 6 years. it wasn't until the past couple of weeks that i understood what the panre really was and how "everybody passed" . read the thread on the pance in the pa forum http://www.physicianassistantforum.com/forums/showthread.php?t=6580
prairienp
315 Posts
Now I hear that the the exam every 6 years isn't the PANCE, but a PANRE? From what I have noted everybody passes the PANRE? If everybody passes, why not just have CME. This is really interesting.