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?
In eigIn eight states, including Oregon, Washington DC, Washington state, New Hampshire, and many Mountain/Pacific Time Zone states NPs work totally autonomously, and many choose to open their own clinical practice. PA's CAN NOT.
I work in air medical transport as a BSN and a NURSE/NURSE configuration is considered a higher level of care than a NURSE/MEDIC configuration for transport. Also as a transport RN, mind you not even an advanced practice nurse,use medical diagnosis when communicating to our medical control, and not nursing diagnosis. The PA profession was initially developed to use combat medics from the Vietnam war as healthcare providers under a physicians guidence, and they do an invaluble service, but like I said nurse/nurse is a higher level of care.
Just enroll in an FNP/PA program at Stanford University or UCDavis. They have combined both into one program. That is how similar their roles are so don't let some nit picker confuse you. Choose the program that you believe will give you the greatest advantage in being a health care provider in the future, and I wish you the best of luck in your future.
Nurses use medical dx when communicating with other nurses not just transport RNs.
The Davis program now has a separate FNP program as well as an option for RNs in the PA program to get their FNP with additional classwork (due to the requirement for an MSN to be licensed as an FNP.
Welcome to allnurses.com
David Carpenter, PA-C
David do you ever sleep? I have a hard enough time keeping up on the reading I need just to stay current, much less read everything that you do. :) Again thanks for all your input. If everyone (including me) put as much time and effort into their postings here, things would be better for everyong.
David do you ever sleep? I have a hard enough time keeping up on the reading I need just to stay current, much less read everything that you do. :) Again thanks for all your input. If everyone (including me) put as much time and effort into their postings here, things would be better for everyong.
One of the joys of working in surgery is the odd hours. That and the ability to work on little sleep.
Specializes in Stepdown/IMU, full-time Night shift charge.
David, I want to add my thanks for the info you give and the passion you show in your posts. I follow your posts here and in the PA forum, so I feel I've grown to "know" your online persona.
Everywhere I've lurked, most PAs and NPs agree that with 2-3 years of experience both professions are on the same footing in what they do and their competence when they do it. Online, some in both professions become a bit territorial, and they say things they would not say in person. The didatic and clinical training may be different, but in the "real world" PAs and NPs seem to function quite well together.
David, I want to add my thanks for the info you give and the passion you show in your posts. I follow your posts here and in the PA forum, so I feel I've grown to "know" your online persona.
Everywhere I've lurked, most PAs and NPs agree that with 2-3 years of experience both professions are on the same footing in what they do and their competence when they do it. Online, some in both professions become a bit territorial, and they say things they would not say in person. The didatic and clinical training may be different, but in the "real world" PAs and NPs seem to function quite well together.
I would tend to agree. There are some institutional issues that can be involved but generally on a personal level PAs and NPs get along.
I would tend to agree. There are some institutional issues that can be involved but generally on a personal level PAs and NPs get along.
David Carpenter, PA-C
I would add MDs to the mix. Generally, if a NP, PA or MD isn't getting along with the other providers they don't really get along with a whole of lot of other people.
Specializes in Emergency, Critical Care Transport.
I applied to both PA and NP programs. I work with both in a family planning clinic.
I can honestly say that the PAs and FNPs that I work with are highly intelligent, personable people whom I respect greatly.
At this juncture in my life, I'm working on entering a MEPN program, mostly because I want to be an ACNP, but also because I think earning an RN will give me greater flexibility in my career path. If I want to also be a PA, I can do so at a later date. Right now, I'm working on getting knee-deep into trauma (love the ED).
From my understanding and from my discussions with some fabulous representatives of both PA and NP folk...
PAs are trained very well, but must work under a licensed physician. NPs are able to work under their own license. That kind of autonomy is important to me.
Both are able to diagnose patients. Scope of practice seems very similar, although regulated differently. It seems like underlying philosophies might be different (ie Nursing philosophy vs physician philosophy?).
Correct me if I'm wrong, and apologies if this is redundant, as I haven't spent the past 3 hours reading all of the posts here.
i applied to both pa and np programs. i work with both in a family planning clinic.
i can honestly say that the pas and fnps that i work with are highly intelligent, personable people whom i respect greatly.
at this juncture in my life, i'm working on entering a mepn program, mostly because i want to be an acnp, but also because i think earning an rn will give me greater flexibility in my career path. if i want to also be a pa, i can do so at a later date. right now, i'm working on getting knee-deep into trauma (love the ed).
the opportunity cost for pa after you have an np certificate is too high in my opinion. outside of the one remaining dual cert program i am not aware of anybody who has gone back and gotten a pa after getting their np or vice versa. realistically you have to pick one career path or the other (unless you choose the ucdavis route).
from my understanding and from my discussions with some fabulous representatives of both pa and np folk...
pas are trained very well, but must work under a licensed physician. nps are able to work under their own license. that kind of autonomy is important to me.
both are able to diagnose patients. scope of practice seems very similar, although regulated differently. it seems like underlying philosophies might be different (ie nursing philosophy vs physician philosophy?).
correct me if i'm wrong, and apologies if this is redundant, as i haven't spent the past 3 hours reading all of the posts here.
pa work under their own license but have a supervising physician. nps also work under their own license but in most states do not have a supervisory physician (and in some states do not have collaborating physicians).
as far as scope, i think that this is now becoming the biggest difference clinically between the two professions. as noted multiple times the pa scope of practice is defined by the supervising physician. in pretty much all states the np scope of practice is defined by the certification, training as an np and bon direction. if you had asked the question a when this thread started i would have stated that an fnp and pa scope of practice were essentially identical. in the last year i have seen the fnp scope dramatically narrowed in a number of states. the acnp seems to be the preferred certification for inpatient (and increasingly specialty) work. how the np profession will deal with the pediatric component of many specialties remains to be seen.
Specializes in Critical Care, Emergency, Education, Informatics.
IThat kind of autonomy is important to me.
My question is why is that autonomy important to you? I've found over the years that a lot of people really don't understand what they mean by autonomy. I've worked in places as a staff nurse were I had enough autonomy to get my self in a lot of trouble if I wasn't careful.
Even Doc's don't have as much autonomy as people think they do. They are governed by "standards of Care", There are clinical pathways that direct how a given disease process is handled,The pharmacy committee dictates what antibiotics will be available in any given facility, insurance companies have more control over things than people think they do sometimes, and the economics of the the patient limits what a doc can and can not do. And I bet if you looked at the numbers, a large percentage of Docs actually work for someone.
Is it the opportunity to open your own practice? Dave help me on this, but from what I know about practice management, it's a LOT of work and not as much patient care as you would like. Plus it's expensive, salaries, equipment, rent. Just way to much like work for me.
I admit that part of my opinion is based on what is rapidly approaching 32 years in this business and I'm pretty cynical about a lot of things.
My question is why is that autonomy important to you? I've found over the years that a lot of people really don't understand what they mean by autonomy. I've worked in places as a staff nurse were I had enough autonomy to get my self in a lot of trouble if I wasn't careful.
Even Doc's don't have as much autonomy as people think they do. They are governed by "standards of Care", There are clinical pathways that direct how a given disease process is handled,The pharmacy committee dictates what antibiotics will be available in any given facility, insurance companies have more control over things than people think they do sometimes, and the economics of the the patient limits what a doc can and can not do. And I bet if you looked at the numbers, a large percentage of Docs actually work for someone.
Is it the opportunity to open your own practice? Dave help me on this, but from what I know about practice management, it's a LOT of work and not as much patient care as you would like. Plus it's expensive, salaries, equipment, rent. Just way to much like work for me.
I admit that part of my opinion is based on what is rapidly approaching 32 years in this business and I'm pretty cynical about a lot of things.
Actually the physician ownership issue has waxed and waned. It probably hit its low point in the late 1990s when hospitals were buying up many physician practices in order to steer patients to particular hospitals. As most people would expect hospitals proved to be spectacularly bad at running physician practices. I saw one study that showed hospitals lost on average almost $100k per physician in practices that were purchased by hospitals.
On the other hand there has been a increase in either publicly or privately held firms entering as medical management firms. These are very common among hospitalists, EM, and anesthesia. There are still a number of hospital owned practices in the East but seem to be less popular in the west.
Center for Health System Change has data (relatively small N but reasonable for trends) that tracks physician practice data for the last 10 years or so. It can be found here:
MGMA data is similar here. So I think that around 50% ownership is about right. If you look at the salary data for physicians, almost without exception those practices that are owned by physicians are the most lucrative. In addition specialists are less likely to be in non-physician owned practices (which tend to be the most lucrative practices). Surgery is also less likely to be non-physician owned. The caveat here is that hyper specialties (ie neurosurgery subspecialties) tend to be university employees.
To be honest one of the primary reasons that I chose not to go to medical school is that I had no desire to run a business. I have had the opportunity to work in three different practices in the course of my career and observe many more. There are a few physicians that are good at business (and a similar number of PAs and NPs). I think intrinsically it is hard to be good at both. Invariably the physicians that go into business do less and less medicine (look at the recent CEOs of almost any large insurance company). The best practices put someone schooled in business in charge of the business affairs which allows them to practice medicine. The worst try to manage the business affairs like they do medicine (my first rule is never take a job where the physicians wife or husband is the office manager). The reason that half the physicians do not have ownership of their own practice is that they have no desire to run a business, they have no talent run a business or they have already failed at running a business (or a combination of the three). So over half the physicians have given up the "autonomy" of running their own business.
Next lets consider the original quote. What defines autonomy? It is classically defined as personal independence. Most definitions talk about self direction and self reliance. Under that definition there is a lot of autonomy in medicine (in the case of self direction) and very little (in the case of self reliance). If you doubt this try to order a CT. The CT is very easy write an order and it will generally get done. On the other hand from a self reliance standpoint you would have to buy a CT, get a license to run it, hire the people to maintain it, learn how to read CTs .... you get the idea. Medicine is by definition a team sport.
As far as self direction in medicine as Craig-B stated there are a number of guidelines and clinical pathways that may or may not influence what you do. Standards of care are also a "drag" on self direction. As an employee the practice will have an interest in making sure that you do not put the practice at risk. An employee (be it physician or NPP) will be more restrained than an owner but even owners are not allowed to put the practice at risk. The consequences of action here are more severe than that of an employee (loss of ownership).
Finally consider the other costs of "autonomy". Lets say you define autonomy as owning your own practice. One way of doing this is to do everything yourself. You make appointments, room the patients, bill for the visits etc. At this point you are in charge of your destiny but you are probably spending more than 1/2 your time doing non medical things. That is the price of independence (although there are a number of physicians practicing this type of Concierge medicine).
The other way is to open your own practice. In the standard model you have at least an MA and a front desk person. Now you have two people depending on you to bring in the bucks as well as pay the rent keep the lights on etc. Now lets say you band together with some other practitioners to gain efficiency. Oops there went the autonomy.
Bottom line as CraigB stated running a business is hard work. There are few people that are good at it. There are less that are also good at medicine. Remembering that less than 50% of new small businesses are around in 5 years helps bring this point home.
In my mind autonomy is finding an environment that allows me to utilize my knowledge, improve my skills with minimal distraction and good support. This is my way of looking at things. Of course I've always been about the journey not the prize;).
As my usual standard of desperately trying to make this somewhat pertinent of the actual title of the thread. I am assuming the comment by Star77 was a reference to more perceived clinical autonomy for NPs vs. PAs. If you look at the number this is not supported. The number of PAs in independent practice is pretty reliably put at around 2% (independent practice defined as ownership of the practice). The data for NPs is not as good but the Advance for NP survey put the number of NPs at exactly the same percentage (it will be interesting to see what the AANP data set says). So there is no real advantage from a clinical standpoint (defining automony as practice ownership). Based on my own definition of autonomy I think that autonomy is more based on the practice environment than type of certification (NP or PA). Given that in most practices PAs and NPs that work in the same practice usually have identical duties (at least anecdotally) this is further supported.
In regards to practicing medicine vs nursing, I think thats a little assinine. If I can diagnose, prescribe, and treat, that's medicine.
You do realize that your state nursing boards defines "diagnosing, prescribing, and treating" as the practice of nursing, right?
The reason they do that is because if they defined it as the practice of medicine they would be sued by the state medical board for practicing medicine without a license.
So you can call it whatever you want, but your state nursing board defines what you are doing as "nursing" not medicine. They are very clear on that point.
tiredfeetED
171 Posts
Nurses use medical dx when communicating with other nurses not just transport RNs.
tiredfeetED FNP-S/PA-S