I quit the PA rat race.

[Non Sequitir]

I'm not new here, but my profile is. I'm posting for feedback - at the risk of criticism of course - from folks who are currently in the field as practitioners. I'd fish for feedback with colleagues in real life, but to be honest I'd rather not reveal my thoughts so honestly with those among whom I work. Take that for what you will. Also - as a premise for this post, based on my observations, it is assumed that, despite differences in education and philosophy of practice, PAs and NPs are essentially clinically equivalent.

I'm a former military combat medic. I got out, got a bs in biology, then went to work for a very large hospital network in health admin to feed my family while figuring out my next move. I considered medical school until deterred by the reality of spending the next 10-15 years of my life sacrificing time with my family. So I applied to and interviewed for pa school. What I learned during my time in that rat race was that the vast majority of my competition was actually well suited to sit for the mcat and apply for med school. The pa applicant pool is saturated with overqualified young professionals who made my combat medic experience and top-10% bio degree grades look inadequate.

Over a year later, I've changed my tune and am going into nursing, with the purpose of getting into an np program as soon as I can. I found a scholarship program that will pay my tuition and give me a living stipend so I can make my mortgage and feed my wife and kids. Here are the reasons I decided to on this path:

- First and foremost (given the anonymous nature of the internet I can say this, otherwise I would never mention it), this is the route of least resistance to becoming a provider. My local university's np program is part time over a 4-6 year period while working as an rn. The two big benefits here are 1) not sacrificing as much time with my young kids and 2) I don't have to move (no local pa program).

- I don't care about the money, I have relatively little school debt and it will all be forgiven anyways before it's paid off

- I don't care about clinical prestige. Working as an administrator who approves interhospital transfers has demystified the average physician, revealing that many lack a lot of common sense and/or are very narrow minded and can't understand very basic tenets of authorization and eligibility.

- As mentioned above, the pa applicant pool is saturated with young adults who are otherwise well suited to study and sit for the mcat. Were I to re-apply as a more competitive applicant, I would need more classes and more volunteering and application bullet points...at which point I may as well spend that time studying and sitting for the mcat. I interviewed at average/below average pa schools whose rates of acceptance were less than 6%. That's Harvard and Mayo med territory.

- A common theme on the pa forums is comparing the pa lobby to the nursing lobby, the latter of which is consistently deemed to have much more weight and heft. This to me bodes well for advanced practice nurses because the pa profession is essentially owned by the AMA, and why would physicians lobby to give the pa profession more autonomy, thereby replacing themselves in the clinic? Oversimplification but I state this to highlight the overall philosophy of comparing the two lobbies and potential futures with respect to autonomy.

- The largest hospital network in the country (the world?), the VA, is increasingly eschewing state restrictions for NPs and granting more autonomy of practice, albeit mostly for primary care and mental health. Pay still lags slightly behind PAs as can be seen in the private/public sector, but again I don't care about money (to a degree). The state I live in, for example, is restrictive regarding NPs prescribing controlled substances, but NPs at the local VA do not have this restriction.

- The longer I spend reading the opinions of and conversing with older PAs, the more grim the outlook is relative to NPs, and this is considering the aforementioned pay advantage. Though this could change in the future as non-physician practitioners are more heavily relied upon to fill the huge gaps in care with respect to the baby boomers, I would choose the profession with the better lobby at the moment which is nursing.

I completely understand the criticisms against my premise, and have no problem hearing out those who think that taking the path of least resistance is deplorable. I get it; but society has opened up and endorsed this pathway to practicing medicine and I plan on taking advantage of it. Feedback of those deep in the profession is greatly appreciated.

Edit for clarity: my bsn application is under review right now, I am not currently a nurse and hope to start during the fall '17 semester.

[HouTx, BSN, MSN, EdD]

You've obviously done a lot of background investigation and arrived at the right pathway for your needs. Best wishes on your nursing education. I look forward to reading your future posts.

[jaderook01, BSN, RN]

OP: Good luck to you in nursing school. I hope you enjoy nursing and that everything works out for you. I also hope you achieve your career goals. You certainly sound motivated, at this stage.

[MIRN923]

Very well thought-out. I appreciate your insights to the world of PA and how they relate to NP, both now and in the foreseeable future.

Best of luck to you.

[Pachinko]

Non Sequitir, you would look much better with some soft curls, and lay off the neck exercises.

Your rationale for NP school is good. Working bedside is where you will receive your real education. Start with whatever unit interests you most and will hire you, but shoot for ICU at some point, especialy cardiothoracic if possible. This will teach you to think critically and prepare you for the advanced practitioner role. It will also help you determine which kind of NP you want to be.

I would only add that one of your main reasons for not pursuing your PA, market saturation, is also an issue for NPs in some areas. It's hard to know where it will be in 5-6 years, but NPs are not necessarily better positioned than PAs in that regard.

ETA: yes, NPs do have more freedom than PAs. We can practice independently in some states. I don't think that there is much difference in pay, I recall salary surveys showing a difference of 2-3K in annual income, with PAs having the slight advantage. In my experience (underserved primary care), there is no different between what PAs, NPs, and MDs do. What makes the better practitioner is how dedicated and interested in helping the provider is, not education level. Have seen this repeatedly. I will say that MDs are less likely to miss major issues, though. That's why you need solid hospital experience before you practice. Nurses also have a lot of good will from the public, which is nice.

[ProperlySeasoned]

Bravo for posting an NP/PA comparison that does not resort to the usual who is better, who works harder, who is more respected by MD's banter. Seems like you will succeed in either role.

[Jules A, MSN]

I would only add that one of your main reasons for not pursuing your PA, market saturation, is also an issue for NPs in some areas. It's hard to know where it will be in 5-6 years, but NPs are not necessarily better positioned than PAs in that regard.

I agree about the job market but OPs point about the the ability to get into PA school which is highly competitive as compared to NP school where anyone with the funds can get in is both true and also a sad commentary on our profession.

[Wile E Coyote, ASN, RN]

Stellar post, amigo. I'm picking up what you're laying down.

I agree that although sound in reasoning, it reads like a sad indictment of nursing's state of affairs.

[Rachaelk, BSN, RN]

This is such a great comparison. I have applied twice to PA school, had two interviews and was turned down/wait listed by both schools. I can't tell you how many people I interviewed with who were the young,just graduated, typical premed student. I'm 30 and have two friends who had very minimal to no hands on patient experience who just got into PA school on their first round.

I recently found out about direct entry MSN/NP programs that I will be applying to this year. If this avenue doesn't work out I will most likely pursue my BSN to eventually pursue an NP education.

Good luck in your endeavours and thank you for your genuine comments!

[Jules A, MSN]

I recently found out about direct entry MSN/NP programs that I will be applying to this year. If this avenue doesn't work out I will most likely pursue my BSN to eventually pursue an NP education.

No worries and absolutely no reflection on you personally but if you can pay the tuition you are in! Congratulations!

[CrunchRN, ADN, RN]

I think you are making a very smart decision. At my work we have an MD school and PA program and you are right about many things mentioned. Also, this way you will get and always have your RN so if life changes and delays your ultimate plan you will still have a way to make a good living and be there for your family.

[Workitinurfava, BSN, RN]

You have to do what is best for you but I am a stubborn person, and I don't quit until I succeed, if it is something I really want. I take the roads less traveled. I make sure things are in order for me to make great sacrifices. I am in the process of going back to school to become an MD in psychiatry. My husband is supportive and shows it. I spend time with my family when I can. They will have to understand. The outcome is worth it for me. I want to look at my life years from now and be okay with the decisions I have made. I want to work for myself at some point. Nursing has its own set of sacrifices.