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.
Psychiatric MD is the only way for me. The scope of practice is the main reason but I must say the pay isn't too shabby (custom made range rover goals). All the sacrifice will be worth it. Staying a nurse won't cut it for me. Good luck to you.
The problem with all of these people wanting to enter NP school because of its lax standards is that they only think of themselves and not what is best for advanced practice or the patients. It also somewhat arrogant to think that one would be competent to practice advanced nursing without having mastered the basics.
I understand where you are coming from, OP. But it is a slap in the face to many NPs who actually took the time to learn on the bedside while others feel entitled to NP positions because they are older and have kids and want to skip through thr important experience that bedside and years on the job give.
Plus, many MD and PAs speak lowly of NPs for that particular reason. NP schooling shouldn't cater to convenience but to ambition.
Not to speak for the poster you were responding to but the remark wasn't a criticism of those who decide on becoming an NP or PA instead of a physician but was really to bemoan the fact that the NP route is now perceived as the "easy" path to a provider role. As a practicing NP myself, it doesn't bode well for our profession to be regarded as the easy route.
But that's not really your fault either. As proud as I am of the beginnings of the NP profession and our achievements through the years, I am bothered by the lack of standards in how NP programs can be set up so that we now have programs springing up even in virtual classrooms with a handful of faculty that are housed in a corporate office somewhere while students are asked to find their own clinical placement. I am appalled at how programs get accredited and how candidate selection criteria in some programs are all over the place.
Your post is unfortunately, the kind of story these "opportunistic" NP programs want to hear. You will be a target of their aggressive marketing. My advise is that if you are someone committed to becoming a competent provider in the future, spend some time as a nurse at the bedside to figure out what specialty you are passionate about if you plan to start with a BSN first. The NP field is not a one size fits all. We have various tracks that prepare you as a specialist from the get go unlike the PA route which is more of a generalist training. Pick a reputable NP program and that may mean having to compete with other applicants who have stellar credentials in order to get in. That's OK, not everyone should be admitted.
I appreciate your feedback and advice, many thanks.
Psychiatric MD is the only way for me. The scope of practice is the main reason but I must say the pay isn't too shabby (custom made range rover goals). All the sacrifice will be worth it. Staying a nurse won't cut it for me. Good luck to you.
I found your criticisms (maybe not that strong...down sides?) of the PA profession to be suprising. From what I heard, MDs prefer to work with PAs since they have similar educational background and training philosophies. Advance practice nursing has been quite nebulous in its educational standards and defining practice. In my market area, there are probably more opportunities for PAs than NPs for advance practice. I do not see them fading out at all.
I chose NP over PA because I saw more opportunities in organizational development. I could also teach, should I ever get burned out of clinical practice. To each their own.
My intention with the op was to list the reasons why I chose to, as the title says, quit the pa school rat race. I mean no offense to PAs, students, applicants, or hopefuls. I just found that it is not the path for me. I don't see PAs fading out either, but with PA residencies becoming more commonplace, it may be in the future that the PA career path is less flexible than what we see today. Couple this with what I perceive as a relatively weaker lobbying power, and I come up with a reason to seek nursing instead.
In my experience, I have found that MDs tend to have no preference over which advanced practitioner they work with, and that the jobs posted tend to reflect the personal preferences of upper level administration (ie, the people who won't have to work with the new hire). As a matter of practice, I have seen that PAs tend to get hired into specialty services and NPs tend to be hired into primary care and, increasingly, emergency/acute care. My preferences lean toward the latter, hence my initial interest.
In my opinion, while NP programs have tended toward retention by means of "lowering the bar" as it were, PA and MD programs have gone the opposite direction and have focused increasingly on applicant stats. Some newer PA programs (eg Western University) prefer applicants to have no experience at all. Yes, you read that correctly. For pre-meds and pre-PAs, it's all about racking up volunteering hours, medical missions, research, getting your name on published research, and of course GPA/GRE/MCAT. To be honest, I have no intention on spending any amount of time chasing application bullet points just because that's what everyone else is doing to bolster their applications.
As an undergrad, I had two once-in-a-lifetime opportunities that would have given me awesome application cred. One was to be a scribe with Dr. Leonard Bailey at Loma Linda University (pioneer of infant heart transplant), and the other was to room with and work for a scientist at Bayer in Germany. Despite both being awesome opportunities, I passed on both because my heart wasn't in it. I have no passion for research and I have no desire to be a scribe (had plenty of that in the military).
The other day, a new volunteer came through the ER, and the first words out of the senior MD's mouth was "and what is he wanting out of this?" That sums it up quite succinctly for me, and it's not a rat race in which I care to run. The AMA has utterly failed to appropriately address the growing physician shortages and gaps in care, instead supporting the efforts of schools to seize on the opportunity of growing numbers of applicants to raise tuition exorbitantly and discourage med students from pursuing things like rural primary care because it pays beans and rice compared to specialties like cardio, ortho, derm, etc. There are other factors as well, but the AMA is complicit in this problem. As a result, society has put PAs and NPs in the gap, and I've chosen to embark on the NP route. I completely comprehend the argument against this, that it's a shame someone like me would choose the path of least resistance - I held the same opinion until I actually started working in healthcare for a living and found that paradigm to be somewhat elitist and contrived. I mean to convey no offense by that, I only say it to illustrate my own thought process.
Regardless, I respect your position and appreciate your honest feedback.
The problem with all of these people wanting to enter NP school because of its lax standards is that they only think of themselves and not what is best for advanced practice or the patients. It also somewhat arrogant to think that one would be competent to practice advanced nursing without having mastered the basics.
I understand where you are coming from, OP. But it is a slap in the face to many NPs who actually took the time to learn on the bedside while others feel entitled to NP positions because they are older and have kids and want to skip through thr important experience that bedside and years on the job give.
Plus, many MD and PAs speak lowly of NPs for that particular reason. NP schooling shouldn't cater to convenience but to ambition.
Please remember that the same physicians who speak lowly of NPs, also speak lowly of some of their own colleagues. As an NP, I have heard some of the conversations. MDs do not spend any time at bedside nursing, so that clearly is not a requirement. But they do get a lot of clinical rotations, and residencies in an acadmeic model. This is how they hone their skills. NP do not always receive the best clinical training due to the shortage of preceptors willing to actually teach. The best way to improve skills is to find strong preceptors who enjoy teaching. Also get as many hours of clinicals as possible. If at the bedside, read all the MD notes and research topics to enhance learning. I have seen PA students in clinical rotation who were unfortunate to be with a preceptor who did not pay much attention to them or teach them. Their experience ended as it began.
I've come from a background where the odds are stacked against me to quite a degree - first gen college student, born on a reservation to parents who currently qualify for welfare, served in Iraq as a medic in a unit who threatened to kill the person I replaced, was a very troubled youth, etc etc. Instead of quitting when I was initially rejected for military service I persisted. I persisted through college in the top 10% of my class, marriage at a time and place where about 65% of marriages end in divorce within 10 years, and continue to persist in the face of people who deny my heritage as a registered tribal member because my skin isn't dark enough. However, persisting through to med/pa school isn't worth it. I've got stuff going on in my life that I enjoy and am not willing to give up. I'm producing an album, building a microbrewery with my dad, I'm a cyclist 5 days a week, and most importantly I'm raising my two boys. I just can't give any of that up, especially the latter.
You and I both had odds stacked against us - I can really appreciate and respect your situation and think it's great you are actively committed to making sure your sons grow up in different conditions than what you experienced. I grew up among poverty, drugs, alcohol and mental health issues. I was also a troubled kid and it took many years to feel comfortable in my own skin. To compound this, I have a lot of chronic medical problems that have proven to be difficult as well, though I am also active and love to run. I am now married and in my dream job, with the goal of getting pregnant in 6 months. I think it takes a lot of strength to realize what's important to you and not settle. You are embracing who you are and living your life unapologetically and I have nothing but respect for that!
I honestly think the rivalry among doctors and the different types of mid-level practitioners is ridiculous. Do your research (which you've done) and then do what you want to do. Who cares if a PA or NP looks down on you for choosing a path that gave you more time to spend with your family? At the end of your schooling, you'll be in a field that you like (I'm hoping), you'll be able to provide for your family, and you'll have been able to continue building relationships with your family through the process.
The problem with all of these people wanting to enter NP school because of its lax standards is that they only think of themselves and not what is best for advanced practice or the patients. It also somewhat arrogant to think that one would be competent to practice advanced nursing without having mastered the basics.
I understand where you are coming from, OP. But it is a slap in the face to many NPs who actually took the time to learn on the bedside while others feel entitled to NP positions because they are older and have kids and want to skip through thr important experience that bedside and years on the job give.
Plus, many MD and PAs speak lowly of NPs for that particular reason. NP schooling shouldn't cater to convenience but to ambition.
I tend to agree with you for the most part. I've met some people who are eager to spend as little time as possible at the bedside before starting their NP careers. As a new grad, the thought of doing this myself is horrifying! When I see how much I still have to learn....it'll be a few years before I consider the NP/PA route myself.
However, the OP did state that he's planning on spending 4-6 years in school while working at the bedside. That's 4-6 years of acute care experience before starting his NP career, and I would say that's enough. Much better than a BSN signing up for an accelerated NP program and making advanced clinical decisions after just a couple of years at the bedside (imo anyways).
Workitinurfava, BSN, RN
1,160 Posts
Psychiatric MD is the only way for me. The scope of practice is the main reason but I must say the pay isn't too shabby (custom made range rover goals). All the sacrifice will be worth it. Staying a nurse won't cut it for me. Good luck to you.