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 can assure you that I know plenty of PA's who are practicing with an associate's or bachlor's degree only. So, that's MORE education than a NP with a Master's degree? That doesn't even make sense!
Why don't you go to the Physician Assistant Forum site and read about all the NP bashing - this site doesn't even begin to compare!
So what about those NPs that have a bachelors, associates or heaven help them a certificate? Around 10% in the last Nursing census. Are they less "educated" than the Master's NPs? Education is more than a degree.
The PA and NP were not employees, but independent contractors. The doctors had a problem with the PA being an "independent contractor," yet the practice was having to pay the PA upfront and do the billing themselves. The NP has a contract with the physicians and she bills Medicare directly and then pays the doctors their share whe she is reimbused, which I believe is 50%.
That makes sense. The PA was unwilling to participate in an illegal billing scheme and the NP was. Read the antikickback laws very carefully. A 1099 employee cannot reimburse a percentage of a job from a physician where the payment was directed:
"(1) whoever knowingly and willfully solicits or receives any remuneration (including any kickback, bribe or rebate (directly or indirectly, overtly or covertly, in cash or in kind - (A) in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under [Medicare] or a State health care program, or "
A contract employee is similar to any other employee. You can pay them on a per case basis, salary or other means but they have to be paid for the work done. This used to be a common problem for PAs in surgery. The physician would demand a percentage of the first assist fee for sending the work this way. After a few people went to jail it largely stopped.
Responding to Sir I Staff: I'm going to ask that from here on out, the responses stay neutral, ie, no making replies pointed to a certain member especially if the replies might derail the conversation or place each other on the defensive. Nothing is gained by that. Please, we are all professionals with one goal in mind and that is to provide the best possible care for our patients.
There are many avenues to achieve this goal, Physician, NP, PA.........so, let's conduct ourselves professionally on the boards without bashing, name-calling, devaluing each other, etc.
It would be a sincere shame to shut down this thread after all this time and effort to educate about the educative/clinical differences between NP and PA.
I agree. We really need to be professional. It's not about titles- absolutely NO ONE ON THIS EARTH IS BETTER THAN ANYONE ELSE-no doctors, not the President, no actors, etc. Everyone has a job to do and our goal is to do it to the best of our abilities. Remember, we choose our profession. Our profession doesn't choose us so let's NOT get caught up in titles, who education makes them better, etc. Physican, PA, NPs and others HCPs must work in collaboration with one another in the best interest of the patient. Let us not forget, there are strenous exams we must pass to practice in our discipline. And, if you are currently working- I'm sure you have knowledge. And, the level of knowledge comes with exposure. Let us not forget that. Not to go spiritual on everyone, but we are all GOD's children and we came into this earth the same way and when we die, we will return to dirt. God gave all of us a talent and our talents are different; this is what makes us special. So, if you see, hear, read about someone who makes a false statement, enlighten them by referring them to the correct source. And, it's okay to disagree with some one, but it's a way to disagree. Always, think about or refer to a source before responding. This is something that I have been working on and I have found that it makes things easier....I have accomplished much. So, let us not bash each other. And, those who are APNs, PA or MDs, let us set good example for those who wishes to pursue the medical field....NOT put in their mind- go to Medical School because you will be looked at as better, instead go to medical school because you have the desire to help save people or encourage them to go to nursing school b/c they also want to help save people and have a nurturing character. Or, whatever the case is, let us be encouraging b/c I'm sure many people w/ various background has viewed this site. Think about it, who want anyone treating them if they're attending a facility where workers do not respect their coworkers ability to practice.
I am not aware of any state that directly bars PA ownership of practices. There are at least four states that prohibit direct employment of physicians by PAs but there are others that prohibit any non-physician employing a physician.
David Carpenter, PA-C
I'm still trying to find the regs, but in California, as I understand, a PA can't own more than 49%. I'm not sure if this is a PA regulation or a board of corporation deal.
I'm still trying to find the regs, but in California, as I understand, a PA can't own more than 49%. I'm not sure if this is a PA regulation or a board of corporation deal.
I'm not an expert on California, but from the lecture that I went to from the lawyer that sets up most of the PA owned practices in California this is only true for a Medical Professional Corporation. Other business ownership structures are legal and common. These permit the PA to own up to 99% of the practice. The same prohibition applies to NPs in California. For a Medical Professional Corporation physician(s) must own controlling interest.
That makes sense. The PA was unwilling to participate in an illegal billing scheme and the NP was. Read the antikickback laws very carefully. A 1099 employee cannot reimburse a percentage of a job from a physician where the payment was directed:
"(1) whoever knowingly and willfully solicits or receives any remuneration (including any kickback, bribe or rebate (directly or indirectly, overtly or covertly, in cash or in kind - (A) in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under [Medicare] or a State health care program, or "
A contract employee is similar to any other employee. You can pay them on a per case basis, salary or other means but they have to be paid for the work done. This used to be a common problem for PAs in surgery. The physician would demand a percentage of the first assist fee for sending the work this way. After a few people went to jail it largely stopped.
David Carpenter, PA-C
Only a physician can admit patients to nursing homes in this state, so there isn't a kickback scheme going on. The NP has her own company and the doctors have contracted with her to see their nursing home patients. They each get a percentage...the nurse for seeing the patients and the doctor for "supervising."
I am a 36 year old Business Analyst employed by a Banking Software Company. I am looking to change careers and I am very much interested in the healthcare field. I have no healthcare experience at all. Although I do have college credits, I do not have a 4 yr degree nor have I taken any science classes. Basically, it'll be like starting all over again. I am trying to decide which is better for me studying to become a PA or an NP. I see that both are well respected fields. I am interested in specializing in the areas of geriatrics and women's health. I realize that working in either profession will provide exposure in both areas, but given my individual sitiuation, one has to be better suited than the other.
It appears the downside of the P.A program for me is that all P.A programs strongly discourage students form working as the program is so rigorous and intense. I am living solo and my income is the sole source of income in my household. I really cannot afford to not work. The NP program seems like it would take longer to complete, but the huge benefit that I see is not having the requirement to supervised by a physcian. That is attractive to me. Also, it appears that one can maintain employment while in the NP program.. a big plus for me. I believe to enter the PA program,one does NOT have to be a RN. However, you must be an RN to enter NP programs, is this correct? To be an NP, you must have a MSN degree, is this correct too? So for me to become an NP, I need to go to school and become an RN which is a 2yr degree. Then what? Enter a 4 yr program for NP? Not really clear on this. The PA seems like less schooling, but the NP appears to allow one to specialize in a particular area of medicine.
The PA program does not REQUIRE previous healthcare exp although they recommend it. What about NP? Do you have to have so many hours of working as a nurse to be considered??? Any thoughts? Can you pros share some insight on the above? Or am I too old and tired and need to consider another career?? LOL
It appears the downside of the P.A program for me is that all P.A programs strongly discourage students form working as the program is so rigorous and intense. I am living solo and my income is the sole source of income in my household. I really cannot afford to not work. The NP program seems like it would take longer to complete, but the huge benefit that I see is not having the requirement to supervised by a physcian. That is attractive to me. Also, it appears that one can maintain employment while in the NP program.. a big plus for me. I believe to enter the PA program,one does NOT have to be a RN. However, you must be an RN to enter NP programs, is this correct? To be an NP, you must have a MSN degree, is this correct too? So for me to become an NP, I need to go to school and become an RN which is a 2yr degree. Then what? Enter a 4 yr program for NP? Not really clear on this. The PA seems like less schooling, but the NP appears to allow one to specialize in a particular area of medicine.
The PA program does not REQUIRE previous healthcare exp although they recommend it. What about NP? Do you have to have so many hours of working as a nurse to be considered??? Any thoughts? Can you pros share some insight on the above? Or am I too old and tired and need to consider another career?? LOL
PA programs can be certificates, associates, bachelors, or masters. The education you receive is 100% identical, but the degree you get varies. The PA program was founded on the principle of being a second career with substantial health care experience beforehand. That is becoming less and less common, although some exposure is very helpful. You could always work or volunteer part-time in a hospital or nursing home to get some exposure. A PA program is basically completing 2/3 of medical school in 1/2 the time, so it is very intense.
An NP has to have a master's degree and you must have your bachelor's of science in nursing (BSN) before you can start. There are some RN-MSN programs (for those nurses with an associates or certificate) and there are direct entry MSN programs for those with a non-nursing bachelors degree. Previous RN experience is highly recommended before entering a MSN program and for some specialties, it is required (CRNA, ACNP). I don't believe any is required for women's health, but I'm not sure. One of the majror reasons is because NP school is only 600-700 clinical hours, where most PA students can get that many hours in a certain area, plus get exposure in all other areas of medicine as well. MSN programs tend to build on previous nursing experience where PA program start from scratch.
PA is a general medical education, like medical school. You don't specialize. You receive on the job training for the area you want to work in, or you can complete a 1 year residency, like medical school graduates do. NPs specialize and you must go back to school for 1 year if you want to change specialties. You would have to choose between women's health and geriatrics or go back and do both. Your best bet at this point, since you want to maintain employment and do not have a college degree, would be to find an associate degree RN program. They have lots of evening and weekend programs available for those who wish to maintain employment. You could then do your RN-BSN online while working full-time as a nurse. You can also do the MSN online and complete clinicals locally so you could continue to work.
Another thing to keep in mind... starting in 2015, all NPs are supposedly going to be required to have a doctorate degree as the minimum (DNP) so that could prolong the amount of education you will get and the time until you can actually be an NP.
You should do some research on the differences between medicine and nursing. They have their similarities and differences. Typically, people can't be entirely happy in both fields.
foreverlaur .. thank you for taking the time to respond. lots to think about.. especially the mention of np's being required to have a doctorate in 2015.. was not aware of that...
Don't worry about not having any experience for PA school. Some schools don't consider medical experience at all. I applied to a fairly well known school with a ton of healthcare experience, about 10 years worth and they totally did not consider that. The thing they look for more than anything else is your GPA. It's kind of like trying to get into med school only not as cut throat competitive. Some of the people that interviewed with me at this one PA school had NO experience. One girl was 21 and still in college and had no healthcare background at all.
What school is this? I researched many programs. There is often no written requirement for clinical experience, so those 4.0 undergrads can slide in to their master's program right away, but after talking to advisors, it became clear that experience is weighted very heavily along with GPA and GRE/MCAT scores. My #1 choice of schools accepts about 10% of their applicants. Two thirds don't even get an interview. Another program even requires 3000 hours of clinical experience up front before you can apply. The admissions staff I spoke to said I would be very competitive if I had some clinical experience, but without it, I probably wouldn't even get an interview. I got my undergraduate degree in an unrelated field 10 years ago with a 3.6 GPA, so that's a factor too.
The number of PA schools that don't require health care experience are about the same as the number of NP programs that don't require any RN experience. Just because it isn't required doesn't mean it isn't highly factored in.
Great grades and great test scores don't always mean you get in either, just like health care experience doesn't guarantee you will get in. Things like letters of recommendation and essays pay a large role too. Even then, there are a lot of applicants with great everything and schools still have to pick between the cream of the crop. Even amazing applicants get denied every year.
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So what about those NPs that have a bachelors, associates or heaven help them a certificate? Around 10% in the last Nursing census. Are they less "educated" than the Master's NPs? Education is more than a degree.
David Carpenter, PA-C