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.

[Skippingtowork]

Good luck to you. You have done a lot of research. Your nursing degree will serve you well. I wonder if one of the reasons it's harder to get into PA school is that there aren't as many programs and the required rotations are more stringent than NP programs.

Just a note: critical thinking is required in all areas of nursing. There is a high need for primary care providers and you need general medicine knowledge. Cross train as much as possible. It appears that you will do well, no matter what path you choose.

[NanaPoo]

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

I must agree with this.

[klcarrut]

I've been a PA for nearly 20 years in 3 different states. Whatever program is in the area determines which profession saturates the field. Both professions are not changing for the better I do not believe. I'm thankful that I have my experience and work ethic that continues to make me marketable and able to earn top wages. I no longer work grueling hours or take call, and this is because of years of hard work, mastering skills and earning respect-none of which can easily replaced by another. An astounding number of our bright hospital nurses are now working part time because they are enrolled in a NP program. Some do it for the professional enrichment or challenge, but many young women are doing it because they don't want to work weekends, don't want to work full time, want more money, etc. Even more importantly, they are not discreet about their desires for more pay and less work. This is embarrassing to me. I don't want this type of practitioner for my partner. Physicians around the country are seeing this trend and it reflects poorly on all PAs/NPs. One surgeon said recently at a conference that his NPs want all the glory, the pay, the vacation, the prescribing rights, and even go to the Capital to protest for MORE, but if you call their phone at 5:01 PM, you get a voicemail. I'm not saying we have to work our fingers to the bone, but pay your dues, let your colleagues see that they can count on you, that you are an invaluable member of the team. This is not a strike against NPs-but I work in a NP rich environment and have so for the last 7 years, so this is my most recent perspective. As for pay, more PA's take call and work in surgical settings; therefore, higher wages in general. I say Go For It, never stop reading, work hard and it will pay off for your and your fellow PAs/NPs.

[smartassmommy]

I love your plan. The VA is a seriously underserved population. Best of luck. May you have nothing but success in this endeavor.

[lasvegasnurs]

I think you are on the right track. I dropped out of med school and was considering my options a few years ago. After taking a couple years to work I looked at my options of return to med school, PA, or NP. Ultimately my biology degree wasnt worth much alone. A biology degree doesnt provide much in job opportunities especially ones that pay well so I decided the nursing route was the best since it right out of school provides a decent salary and good experience. Where I lived they had an accelerated program for those with a degree already if you met certain requirements which having a biology degree covered it all. NP programs are defiantly abundant and much easier to get into and can be done while working (another huge bonus). I went into nursing still not sure what exactly I would do but planned on graduate education. I ultimately decided not to do the NP route and am in a CRNA program but looking back nursing was the best choice and is a good career with the most options and experience's available compared to other routes in the medical field.

[Skippingtowork]

I think you are on the right track. I dropped out of med school and was considering my options a few years ago. After taking a couple years to work I looked at my options of return to med school, PA, or NP. Ultimately my biology degree wasnt worth much alone. A biology degree doesnt provide much in job opportunities especially ones that pay well so I decided the nursing route was the best since it right out of school provides a decent salary and good experience. Where I lived they had an accelerated program for those with a degree already if you met certain requirements which having a biology degree covered it all. NP programs are defiantly abundant and much easier to get into and can be done while working (another huge bonus). I went into nursing still not sure what exactly I would do but planned on graduate education. I ultimately decided not to do the NP route and am in a CRNA program but looking back nursing was the best choice and is a good career with the most options and experience's available compared to other routes in the medical field.

And later, if you still have energy, you can still go back to med school if your heart desires it. Nursing offers flexibility that very few professional fields offer - Go this way or go that way. It's a great field. I do both bedside and NP and love both worlds.

[foggnm]

Don't take 4-6 years to do an NP program. Two of my friends did theirs as full time RNs, then just had to take a little time/coordination at the end of their program for clinicals. Almost all the rest was online and took less than 3 years. Stretching school out over 6 years will be exhausting. You put a lot of thought in the PA vs NP thing, I hope you put equal amount of thought in to why you want to be a provider.

[elkpark]

Oh goodie, someone else who wants to go into advanced practice nursing because the educational process is easier and less competitive than what the person actually wants to do ...

[Jules A, MSN]

Oh goodie, someone else who wants to go into advanced practice nursing because the educational process is easier and less competitive than what the person actually wants to do ...

Unfortunately we have only ourselves and perhaps the greedy schools to blame for this predicament.

[elkpark]

Unfortunately we have only ourselves and perhaps the greedy schools to blame for this predicament.

I know, but it still makes me sad ... I hate us being the "sloppy seconds" for so many other healthcare professions. Y'know, nursing used to have some real self-respect, that actually meant something.

[malenurse69, MSN, NP]

Pretty much agree with OP. Nursing was a cold calculated decision I made career wise. Looking at the pros and cons, nursing just has way too much going for it wether you're single or married with kids to pass it up.

[tommyb87]

Agreed. I'd love to go to med school or a PA program, but being the sole provider for my wife and three little ones tends to complicate things. So NP is the end game for me, not because it's easy, not because I'm lazy, but because it's the smartest decision. I don't want to live in poverty until my kids are in high school because of med school/residency and you'd have to be moronic to come out of a PA program nearly $200,000 in debt.