I have been following your discussions here on the recent media coverage of the primary gap, and NPs place in it. I posted this on another forum that I moderate, and felt it was only fair to give you all a chance to chime in. I hope it doesn't come across as an attack, but rather a clinician of a different stripe with some real questions about how we market ourselves. The text below is addressed to PAs, so read in that context:
I have been reading the coverage of the recent articles from CNN and Time that we discuss here, in particular the responses on allnurses.
Of course I have to provide my PA disclaimer.....I work with NPs.....about a dozen of them at my institution. I have never had a negative experience with any of them, and have no need to write a "hit piece". We confer, they give medical feedback, I give surgical, etc....collegial and pleasant.
That being said, I have read over and over again about the presumed advantage NPs provide over docs (this is in their words) becuase they offer a "nursing perspective", "treat the patient, not the disease", "look at the patient as a whole", "offer prevention as well as treatment", etc.....
I really don't see this as NP bashing, but I see these comments as somewhat elitist....or at least "leading the argument". The NPs I work with practice the same medicine (!) as the rest of us, PAs, MDs, etc. Their preop cardiac workups look just like any other. And they're good. A clinic NP treating OM...are they really offering that much of an edge over a non-NP due to their nursing background? What does the nursing backgroud teach about listening, empathy, and thinking about interdependent body systems that our medical model education does not?
This all seems like a phoney selling point that is SO subjective that there is no way to argue it, putting NPs in a position which is easy to defend and impossible to refute.
Thoughts?
Do you feel like you treat your patients any less holistically b/c you were trained in the medical model?
I will be a bedside nurse for at least a few years before becoming a PA so I guess I will be the best provider ever, trained as a mid-level in the medical model with a heavier science and clinical background plus my superior bedside manner and outstanding compassionate whole-person care :) Yay for me!
One thing many might not consider is what kind of patients they want to see. Do you need a heavy science load to treat all patients? Is science curing all our ills?
Rhetoric is right! I'm soooo tired of this endless debate. I'm also surprised by the pro-PA individuals that post to a NP forum looking for support. NPs have been around as long as PAs. From the posts here, you'd think patients would be dropping dead all around NPs (unless a PA could get to them first). Just isn't happening, folks. You can continue with the same old talking points. NPs aren't going away. The field is, in fact, thriving. I've posted the list of studies from major MEDICAL journals showing the competency and effectiveness of NPs. You people haven't posted anything but the same old rhetoric. I suggest heading over to the PA Forum for an audience that sees things your way.
Rhetoric is right! I'm soooo tired of this endless debate. I'm also surprised by the pro-PA individuals that post to a NP forum looking for support. NPs have been around as long as PAs. From the posts here, you'd think patients would be dropping dead all around NPs (unless a PA could get to them first). Just isn't happening, folks. You can continue with the same old talking points. NPs aren't going away. The field is, in fact, thriving. I've posted the list of studies from major MEDICAL journals showing the competency and effectiveness of NPs. You people haven't posted anything but the same old rhetoric. I suggest heading over to the PA Forum for an audience that sees things your way.
I would hope that this forum is welcoming to all viewpoints, even those that appear oppositional from some.
My intent with the OP was NOT to state that NPs provide inferior care, but to draw out what NPs felt about the common dogma that "holistic care", well, really means anything in today's era of EBM and strict data tracking. We have a few NPs and RNs who post over at PA Forum and it is not uncommon (more often the majority) who feel that the (forgive the term) feel-good nurse theory doesn't add much to their practice; additionally there are those that feel that those components of their education perhaps distract from more applied clinical sciences that could help make them better practitioners. THIS SENTIMENT IS COMING FROM FOLKS W/ NURSING BACKGROUND, not PAs.
Is it ironic that PAs are considering a Doctorate program of their own? Blasphemy!!
They have one already, at Baylor, a DHSc. There are non clinical doctorates for PAs as well (education), and I just read that Wake Forest is developing a PhD track.
The intent of the Baylor program, through the military, is partly used as a retention tool for officer status. In general doctorate PAs are geared towards education, program administration, etc, less so clinical.
The AAPA had its Clinical Doctorate Summit in April. The outcome was (w/ my boldface):
1. The PA profession opposes the entry-level doctorate for physician assistants.
2. The PA profession endorses the master's degree as the entry-level and terminal degree
for the profession. As of 2012 the degree conferred upon completion of a PA program
will be a singular degree entitled the Master of Physician Assistant Practice (MPAP).
3. The PA profession supports colleges and universities offering postgraduate, nonprofession-
specific clinical doctorates (e.g., doctorate of medical science, doctorate of
health science, or other non-PA-specific clinical doctorates) as options available to PAs.
4. The PA profession should explore the development of a model for advanced standing for
PAs who desire to become physicians (sometimes called a "bridge program").
FYI, I am in nursing school and am not pro PA and anti-NP. I am just saying like others who are in nursing and have pursued PA over NP that advanced nursing is a lot of fluff classes that do not add to their ability to assess, diagnose, and treat illness because the science classes are just not there in large quantity like they are for PA. You can have experience all you want but if you did not have an extensive education in the sciences (which is what I thought you based treating illness and disease on) you are going to be lacking compared to someone that does. No matter how independent a mid-level whether PA or NP think they are, and how they may have caught something a doctor missed and so on, a doctor is superior in the respect that their scope of practice and expertise exceeds that of mid-levels based solely on the fact they have more education and clinical training. This is the reason I debated going to med school versus becoming a mid-level, I was worried I would be disappointed when I hit the EVENTUAL wall all mid-levels will hit in only being able to treat and practice so far because you simply did not get the additional education. People are always asking on both NP and PA forums about how far can they go with their skills and how much autonomy they will have and so on. The fact is you will hit a wall no matter what at some point in your career as a mid-level because you are not a doctor with even near the amount of education.
Everyone brings something of value to the table whether NP or PA. Bottom line, I believe PA's have more science curriculum and clinical hours in their programs compared to NP's and I want that type of training over what is offerred from NP programs. It is my belief and my decision about what I value more in what I need to provide good care to patients and for me I want more science and more clinical hours. My opinion and others in the nursing field pursuing PA agree with me. They would have wanted more science and less fluff.
If you're questioning whether to pursue MD vs.midlevel, then yes, I can see where you would be concerned about "hitting the wall" when treating pts. However, even as a physician, you would find a limit to your skills/training and have to refer that pt on to a specialist.
NPs and PAs have different training tracks, as you and others have pointed out. My position still stands, fluff classes or not, relevence of prior nursing experience/school or not, "holistic care" or not, NPs are providing competent care equivalent to that given by PAs. How would you explain that?
I don't know. I just see the curriculum for NP programs and see a ton of classes that don't pertain to what mid-levels do in terms of treating patients. Then I see PA programs and see all the classes in advanced sciences. I don't know what I am saying about NP's. I work with them and see them personally and have always loved the care they provide. I looked forward to becoming one after nursing school. I have just been in school a long time and have spent so much time and money on classes that don't apply to what the heck I am doing except for taking my money and time. Maybe I am wrong. I just see on the descriptions of these classes things I don't desire to know and will not help me take care of my patients physical and mental needs. I see more of those classes in PA school programs. Agaain, maybe I am wrong. Personally, I am sick of all of it. It would be nice to not worry or question the education base when all of us contribute so much of ourselves to the healthcare system. It would be nice to see all of us trained in similar ways so collaboration instead of retaliation and mockery were the result.
Sounds like the PA pogram is the way to go for you. Its a long road in either program, from application through to board exams, to dislike or distrust what you're being taught.
I don't know. I just see the curriculum for NP programs and see a ton of classes that don't pertain to what mid-levels do in terms of treating patients. Then I see PA programs and see all the classes in advanced sciences.
I did my CNS program back in the early 80s and don't remember being unduly stressed by "fluff" courses. Now, as a post-masters student, I don't have to repeat any of those courses, but I did go look at Rush's FNP curriculum. Here's what I see as the courses some might consider fluff:
2 Theoretical Perspectives for Nursing Science and Practice
2 Issues in APN Role Development
2 Transition to the APN Role
3 Introduction to Applied Biostatistics
3 Research and Evidence-Based Practice : Impacting Clinical Outcomes
3 Health Promotion and Disease Prevention Across Diverse Populations
2 Interdisciplinary Studies in Palliative Care
1 MSN Capstone
18 hrs
Do you...or anyone...think that these courses will not only help you in treating patients and understanding where you fit in the health care arena...or should they all just be dropped?
They have one already, at Baylor, a DHSc. There are non clinical doctorates for PAs as well (education), and I just read that Wake Forest is developing a PhD track.
The intent of the Baylor program, through the military, is partly used as a retention tool for officer status. In general doctorate PAs are geared towards education, program administration, etc, less so clinical.
The AAPA had its Clinical Doctorate Summit in April. The outcome was (w/ my boldface):
1. The PA profession opposes the entry-level doctorate for physician assistants.
2. The PA profession endorses the master's degree as the entry-level and terminal degree
for the profession. As of 2012 the degree conferred upon completion of a PA program
will be a singular degree entitled the Master of Physician Assistant Practice (MPAP).
3. The PA profession supports colleges and universities offering postgraduate, nonprofession-
specific clinical doctorates (e.g., doctorate of medical science, doctorate of
health science, or other non-PA-specific clinical doctorates) as options available to PAs.
4. The PA profession should explore the development of a model for advanced standing for
PAs who desire to become physicians (sometimes called a "bridge program").
Not to quibble but:
"The summit was financially supported by AAPA and PAEA but the activities of the summit were independent of either organization. The summit was facilitated by Innovation Labs, a consulting firm with a wealth of experience in using creative and interactive activities to produce deliverables from group discussion processes."
This is what happens when you put a bunch of people with an agenda in the same room. There were very specific directions and the mandatory masters went beyond those directions. It represents the wishes of some of the academics. Fortunately there is no requirement for anyone to listen to this.
? Where's my popcorn smiley? At least it makes for good entertainment. 
zenman
1 Article; 2,806 Posts
One thing many might not consider is what kind of patients they want to see. Do you need a heavy science load to treat all patients? Is science curing all our ills?