Published Sep 8, 2003
I am currently a nursing student and recently did my OR rotation. I was able to see a skin graft and a knee replacement surgery (very interesting). Well throughout the entire skin grafting I watch as the person who I thought was the physician talk to the patient about what was being done. He removed the skin from his leg and sewed it onto his arm. When the procedure was over and the nurse was talking to him about post op meds he told her what he wanted given. I also couldn't seem to figure out why there was another physician in the room who was doing nothing but anytime someone asked a question he'd tell them ask the other guy. Well low and behold the person who did all the work was a physicians assistant and the person sitting back doing nothing was the physician. I am confused as to what the role of the physicians assistant is? This also made me think well these guys must be making as much as the physician since they are doing just as much work. Well I went to http://www.salary.com and in my area (NC) they are making on average about $69,000. This just seems like pennies with all the responsibility that they have (I feel the same way about nurses also). I just don't understand why there is a need for a physicians assistant and was hoping someone could clarify this for me?
Nurse Practitioners predated Physician Assistants. Nurse Practitioners were created BY nurses to fulfill a need for the underserved; a side effect was, despite the fact that they operated with a supervising physician, doctors wanted control of their education, not trusting nursing education. MDs then created the Physician Assistant program, a two year program. These professionals seem to be a true "Physician Extender", a term utilized for NPs as well, but a NP must have a four year nursing education and at least two year NP education,this only after two years minimum practice...a total of 6 years education and two years practice. PAs are usually hired by a private MD practise or MD practise consortium and are predominantly male. They are usually employed by MDs, though some are hired by hospitals to serve certain departments. What you may have witnessed was a testing or reinforcement of a PAs job for the physician or consortium for which he was employed..it is telling that those in the OR asked the physician, only to be told to ask the PA-it indicates that those present knew exactly who was the physician and who the PA- and sought first direction from the MD. There is a political aspect to the differentiation of NP and PA which has to do with MD desire, stronger, perhaps in the mid 90s, to promote the PA role over that of NP [predominantly female, but this is an aside, and ALWAYS an offshoot of nursing]. What you saw seems to be a supervised PA. Most PAs with whom I have worked operate [pun implied] as first year residents ...that is, their role corresponds to that of a PGY1 . An intern also does what you described, while supervised. As to what they should earn...well, remember that the MDs created them, the Nurses created the NP, they are mostly male, NPs are mostly female. While I have serious objection to the indocrination of NPs in NP school [first lesson, often repeated is "You are not just a nurse anymore"...first lesson should be, "You are not a traditional nurse anymore because traditional nurses had great insight, created and continue to support your role"] , my own sentinment lies with the NP exactly because they ARE the creation of my profession's insight and creativity. .What you probably saw was a nurse anethesist and a PA doing a surgery supported by the paperwork done by nurses and signed off by a doctor. It isn't that the PA should make more [ they were created to offset the cost of MDs/Surgeons in this regard and to bolster the MD salary by proper resourcing]. Let the MDs and PAs slug it out regarding their salaries-the MD is signing off on that PA, who is doing hands on work so that the MD can sign more paperwork generated by nurses to ensure continued income. Concentrate on nursing salaries. That's where your concern should lie. What you didn't mention was what the nurses were asking. What they asked, or commented on, were the things that really gave the flow to the work...that is..they directed, by their concern , the attention of the highly skilled technicians[surgeon and PA] to the patient status and so developed the outcome of that surgery.
I don't want to start the PA vs. NP debate, but I do want to clear up some misconceptions. I support both PA's and NP's. There are advantages and disadvantages to both.
Most PA's are actually women and not men. Yes, it does take a total of six years to become an NP, but only two of those are specific to NP education. PA's also go to school for 6 years, with two of those specific to PA education. Yes, most NP's have clinical experience as RN's and I do feel that is helpful, but clinical experience as an NP is what counts because the role of the RN and NP is quite different.
Just my 2 cents
PAs have more than two year's education. Some PA programs are run through two years, but that does not count the bachelor's degree they need first.
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