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?
My understanding was that they admitted 80 PA students per year until 2005? when they reduced to 35. Which would be 30 X 80 (2,400)+ 5 X 35 (165) or 2,565. Which would be closer to 2%. As I understand the UND program Distant Ed wasn't part of the program until the last few years.
My understanding is that it has been around 35 for a quite a while. The one PA that I know went there about 8 years ago and had 32 in her class. I think the confusion is that they interview for 80 but spread across two years (if I understand the process). Currently part of the interview process is that they go to your preceptor and interview both you and the preceptor. This makes more sense if you can batch a bunch of interviews together in one geographic area.
Also remember that the size of most PA programs have only increased in the last few years. Duke had 4 students in its first class. They were at 24 until about 10 years ago. Similarly the first CU class was 6. They were also about 20 until about 9 years ago when they went to 40. Most PAs that are out there have actually graduated in the last 11 years (if I remember where the 50% mark is).
my understanding is that it has been around 35 for a quite a while. the one pa that i know went there about 8 years ago and had 32 in her class. i think the confusion is that they interview for 80 but spread across two years (if i understand the process). currently part of the interview process is that they go to your preceptor and interview both you and the preceptor. this makes more sense if you can batch a bunch of interviews together in one geographic area.
also remember that the size of most pa programs have only increased in the last few years. duke had 4 students in its first class. they were at 24 until about 10 years ago. similarly the first cu class was 6. they were also about 20 until about 9 years ago when they went to 40. most pas that are out there have actually graduated in the last 11 years (if i remember where the 50% mark is).
david carpenter, pa-c
the pa i talked to had 80 students in her class in 1997, her alumni news listed 80 graduates in 98-2001, with 2001 the last time i saw a alumni publication. which means i don't have any accurate information other than those few years i saw the alumni news.
the size of np and pa programs were all small in those early years, i had 5 students in my class in the early 80s. i am guessing the # of new nps over the past 10-11 years is about = to % of pas. everybody trying to expand education numbers to keep costs down. less cost to the program if they can have 10-20 students tuition as compared to 5-10.
the pa i talked to had 80 students in her class in 1997, her alumni news listed 80 graduates in 98-2001, with 2001 the last time i saw a alumni publication. which means i don't have any accurate information other than those few years i saw the alumni news.
the size of np and pa programs were all small in those early years, i had 5 students in my class in the early 80s. i am guessing the # of new nps over the past 10-11 years is about = to % of pas. everybody trying to expand education numbers to keep costs down. less cost to the program if they can have 10-20 students tuition as compared to 5-10.
the person i talked to said she had 40 in her class in 1999. she said they admitted 80 for a two year cycle. not really sure what their numbers are. very hard to pin down. she said the numbers in the class before were much larger, the class after was smaller. it may be they go up and down depending on resources. she did most of the course self study and then went there for four one month rotations. she was an icu nurse so they let her arrange her specialty rotations in the hospital also. this was just before internet learning came out. she thought that the dropout rate was 25-30%. overall she was not very impressed with the education compared to the other pas she works with. her perception was that she had to figure out what was important instead of having people who had worked in the profession go over what they thought was important. the main advantage was that it allowed her to stay at home with her kids.
as far as the classes, this is definitely true. the first pa class was 4 people. the first np class had 1 person. for pas the classes really didn't expand until the 90's. thats when the colleges figured out the dollar signs were there.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
The person I talked to said she had 40 in her class in 1999. She said they admitted 80 for a two year cycle.
*** I just talked to a person at UND. She said that they have been admitting 35 PA students per year since it became a graduate program. She also said that they were planning on admitting 60 students in 2008 and do an all in-all out program were there is only one class of PA students at a time.
I have been thinking that with their first two semesters of didactic instruction online and with students working with a preceptor in their home town the size of their class could be almost unlimited.
The person I spoke with thought the idea that UND would lose their accreditation absurd and said their program has been accredited since 1970.
I am disappointed that PA instruction seems to be going the way of nursing and some other fields towards degree inflation.
*** I just talked to a person at UND. She said that they have been admitting 35 PA students per year since it became a graduate program. She also said that they were planning on admitting 60 students in 2008 and do an all in-all out program were there is only one class of PA students at a time.
I have been thinking that with their first two semesters of didactic instruction online and with students working with a preceptor in their home town the size of their class could be almost unlimited.
The person I spoke with thought the idea that UND would lose their accreditation absurd and said their program has been accredited since 1970.
I am disappointed that PA instruction seems to be going the way of nursing and some other fields towards degree inflation.
As far a class size you still have to supply the same support to the students wether they are at the school or not. That is part and parcel of the PA education process. That was recently codified in the guidelines. A typical PA program with 40 or so students will have 3-4 academic coordinators to secure new sites and to check on students while on rotations. This is magnified if you have students spread out all over the place. The uneveness of student arranged rotations is supposedly the reason that ARC-PA is doing this. The rules on this are probably going to get stricter. A lot of the top tier programs are cutting down on student arranged rotations and are getting rid of any that don't give good experience.
The other issue is that the students still have to do their other required rotations such as surgery and ER. My understanding is that most of these are done in North Dakota. If you double the class size you have to find twice as many slots. They are also increasing the medical school size if I remember correctly so that will be more competition there. Adding students is not as simple as adding seats in the class. You also have to have good sites for them. Nationwide there is a tremendous problem finding OB slots for male students for example. Some of the programs have resorted to paying the practice site for the slots.
As far as the degree issue, I think that the Masters is the appropriate degree. The knowledge is taught at the graduate level. The trick is to keep the certification competency based. There are a few schools that funnel a lot of PAs to underserved areas that are based at community colleges. It would be a shame to lose those programs that really go back to the roots of the PA profession. That being said there are at least two states that require a Masters to practice so that is probably the future. (the cynic in me sees the higher $$$$ for graduate school as the motivating force).
as far as the degree issue, i think that the masters is the appropriate degree. the knowledge is taught at the graduate level. the trick is to keep the certification competency based. there are a few schools that funnel a lot of pas to underserved areas that are based at community colleges. it would be a shame to lose those programs that really go back to the roots of the pa profession. that being said there are at least two states that require a masters to practice so that is probably the future. (the cynic in me sees the higher $$$$ for graduate school as the motivating force).
david carpenter, pa-c
i often wonder where is the $$$ going? we know np and pa faculty are not high $$$$ jobs, they do it because they like to teach. costs vary greatly between individual np programs and individual pa programs. i would think if the $$$ were so good for teaching, the jobs would be hard to get. my understanding is that teaching jobs are confusing, in that (at least np) are seeking the phd prepared np, of which very few exist. i haven't heard that pa faculty are making a lot money either. so we have a lot of students who want to be nps or pas and a significant faculty shortage. i know the nursing faculty shortage is scary, and isn't getting better. not sure what the answer is, the more we compare the np and pa the more similarities are found.
i often wonder where is the $$$ going? we know np and pa faculty are not high $$$$ jobs, they do it because they like to teach. costs vary greatly between individual np programs and individual pa programs. i would think if the $$$ were so good for teaching, the jobs would be hard to get. my understanding is that teaching jobs are confusing, in that (at least np) are seeking the phd prepared np, of which very few exist. i haven't heard that pa faculty are making a lot money either. so we have a lot of students who want to be nps or pas and a significant faculty shortage. i know the nursing faculty shortage is scary, and isn't getting better. not sure what the answer is, the more we compare the np and pa the more similarities are found.
in a lot of schools the money goes to subsidize other programs. in my program the money subsidized the undergrad students. i will give you the example i know best. 50 students per class at $24k per year (so 100 students total per year). that works out to $2.4 million per year. we had a 3 administrators, 6 faculty, 4 academic coordinators and a program director (who was also faculty). in addition there are part time instructors that supervise students in their first year rotations and visiting instructors that are paid for lectures (if i remember that was about $100 per lecture). so lets be generous and say that salary + benefits are $100k (i would bet that it is less than that). that would be $1.3 million or so. add another $300k for the building and stuff and you still have a nice profit. i was told that the graduate programs (pa/ot/pt) with 150 students paid about 40% of the colleges expenses while the undergrad with 900 students paid the rest.
now what you get for that money is a top 10 school with a lot of contacts that is able to get you a rotation almost anywhere in the us. another program that i know fairly well has 24 students with 4 faculty, program director, 2 coordinators and a secretary. they pay their lecturers less but tuition is $12k. so there you have a budget of about $550k per year which won't cover expenses without state aid and a grant. so not all programs make a ton of money.
there isn't really a big shortage of pa educators as far as i know. there is a shortage of program directors, but that is a function of the growth in the profession. a good program director can do really well. the one issue is that a lot of older pas don't have a masters so have a hard time getting academic appointments. if you are coming from primary care the salary is probably a wash. if you are cominig from specialty you are going to take a hit. in the end you don't teach for the money.
as far as nps they are mostly looking for the phd which limits the job market. this is one driver for the dnp (at least from my understanding). at least locally the np instructors don't take a heavy course load so some of the tuition goes to subsidize their research.
graduate education is a very complex topic. there are some schools that make a frightening amount of money off it (university of phoenix comes to mind). overall most of the programs break even or subsidize other graduate programs.
as far as nps they are mostly looking for the phd which limits the job market. this is one driver for the dnp (at least from my understanding). at least locally the np instructors don't take a heavy course load so some of the tuition goes to subsidize their research.
graduate education is a very complex topic. there are some schools that make a frightening amount of money off it (university of phoenix comes to mind). overall most of the programs break even or subsidize other graduate programs.
david carpenter, pa-c
the phd is the gold standard for any master's program faculty not in a medical school. faculty degrees are compared to english and math. the dnp has not been considered on the same level at the phd or imho should it. research is an expectation for graduate faculty, as is grant writing and publications. this is where the rub happens, faculty who like clinical don't often have time for the academic requirements. faculty who like research don't have time for the clinical requirements. faculty in english or math are not expected to see patients and maintain a clinical practice. the dnp is the clinical expert and not an academic. i suspect the majority of "state" nursing programs both undergraduate and graduate lose $$$$. the undergraduate program i was affiliated with was always on the chopping block as too expensive. too many faculty for too few students. not like a biology class with 300 students. those clinical rotations are expensive.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
As far as the degree issue, I think that the Masters is the appropriate degree. The knowledge is taught at the graduate level. The trick is to keep the certification competency based. There are a few schools that funnel a lot of PAs to underserved areas that are based at community colleges. It would be a shame to lose those programs that really go back to the roots of the PA profession. That being said there are at least two states that require a Masters to practice so that is probably the future. (the cynic in me sees the higher $$$$ for graduate school as the motivating force).
David Carpenter, PA-C
*** The cynic in my agrees with the cynic in you :) I wouldn't have a problem with masters as the appropriate degree, IF those with master were paid commiserate with their education. From what I can see in the nursing and PA fields they are not. Masters prepared PAs and nurses don't make much more than the associates degree prepared RN, or for that matter my buddy with an AA degree in golf course management, or those with AA in mortuary science (probably the second best deal in education after the ADN) or those with AAs in tech fields. In my community college's graduate report the highest paid graduates are those from the stone and brick masons program. They average $90K/year. Seems to me that in order to make a masters degree pay one needs to make over $100K, or at least that's what it would take to make it pay for me.
I am dead set against the DNP idea as entry level for NPs and CRNAs. I think that the DPT and similar are silly.
I have started to note a disturbing trend between NPs and PAs. Over the past 6 months I have had several PAs who happen to be in the same clinic as a couple of NP students become more and more critical of the NP education. Specifically these FNP students don't have enough clinical in the hospital and ED like "they" did, thus making their educational process inadequate. At first I attributed this attitude to these PAs as either ignorance or jealousy. As I investigated further and started "lurking" on the PA forum I found this attitude as a recurrent theme amongst PAs who post and discuss (criticize) NPs and NP education. Has anyone else noted this? I have not noted the same consistency among my NP peers being critical of the PA education. I have noted several negative PA posts on this forum from NPs (usually new NPs or students), but they are usually quickly corrected by Siri or another reasonable member of the forum (CoreO). I have also noted when a NP speaks up in the PA forum they are quickly stomped on, and reminded that the PA forum is for PAs. Am I seeing this issue with rose colored glasses?
I think it all depends on how the NP approaches the situation. NPs certainly are welcomed on the PA forum. But, as you know, there has been a long history of NPs fighting against PAs in much bigger battles than a silly forum post. Things like getting Rx privaleges in ohio, etc. So, I think the issue is alive and well there... because NPs prevent PA schools from being opened up, and i have often heard plenty of misinformation being spread, not only on forums.
I DO think, though, that we should all be more willing to take the people.. who have enough interest to spend time on other's forums, and educate them in a non antagonistic way regarding our beliefs and where we are coming from. I don't think a post, pointing fingers, does any good at all. Nobody wastes their time somewhere if they arent trying to learn and its sad to not take that obvious opportunity and do well with it INSTEAD of trying to point fingers.
Specializes in Pulmonology/Critical Care, Internal Med.
Okey so after reading all of these pages. I think I have an idea about what NP/PA's can do can't do compared to one another. But then again the posts went all over the place so I'm not quite sure. Just to make sure I have this right. Basically, there isn't anything a NP/PA can do that their counterpart can't do interms of procedure. Is that correct?
core0
1,831 Posts
My understanding is that it has been around 35 for a quite a while. The one PA that I know went there about 8 years ago and had 32 in her class. I think the confusion is that they interview for 80 but spread across two years (if I understand the process). Currently part of the interview process is that they go to your preceptor and interview both you and the preceptor. This makes more sense if you can batch a bunch of interviews together in one geographic area.
Also remember that the size of most PA programs have only increased in the last few years. Duke had 4 students in its first class. They were at 24 until about 10 years ago. Similarly the first CU class was 6. They were also about 20 until about 9 years ago when they went to 40. Most PAs that are out there have actually graduated in the last 11 years (if I remember where the 50% mark is).
David Carpenter, PA-C