Just a note on the NP vs PA debate...

[TMnurse]

I did not want to fuel this debate. In fact, I hadn't realized there was this much NP-PA hostility until I found this board. Honestly, I think it a trivial debate in the grand scheme of things.... HOWEVER... NPR (National Public Radio) covered a story 3/5/04 in Chicago on the US prision system and new lobbying to eliminate unlicensed persons (PAs) to provide health care for the inmates. The lobbying focus is that since there are no actual physicians to supervise PAs (unlicensed to practice independently) they should not be seeing state or federal inmates. As most would know on this board, I wonder who will replace those providers... hmmmm? I realize that there are plenty of NPs already working in the prison system but I think this would be a bold statement by the feds.

[Noreaster]

Sean,

I agree with a lot of what you said but just have to clarify one of the things, just to be correct. Most (if not all, but I cannot confirm the all part) PA programs involve one year of full time clinicals. That is 12 month, usually about 50 weeks. These rotations are almost always 40 plus hours per week (my ER and surgery, 2 months each, were many more than that ). So, adding that all up is where people get the 2000+ hours thing. It is correct, likely more like 2500 hours.

I am not quite sure where you got the 12-1600 thing?

Bottom line, we have different training but compete for the same jobs. There most certainly are enough jobs for all of us. If you are unsure about that, check out the US BLS website and look at their projections.

People choose NP or PA for a variety of reasons, some good, some not. Regardless, our goal should be to make both professions better at serving the patient.

Also, all PA programs will be Masters degree granting shortly.

Check out American College of Clinicians and Clinican Forum for ways we are trying to become united.

Best Wishes,

Pat, RN, PA-C, MPAS

In my Master's PA program, I had 12 full months of rotations with like 1 week off (and a holiday or 2) for 40-50 hours per week. The numbers that were origionally quoted weren't too far off, really. The clinical rotations were typically 5 days a week; some took some call with their preceptors, only adding to those hours.

[alkaleidi]

Ok, I hate to bring a somewhat dead topic out of the grave, but I have a question, and would like any answers that are as unbiased as possible.

I was speaking to a PA student who is an RN today, and asked why choose PA instead of NP. He said that he chose PA because of the specialty. He said that (at least in IL) the bulk of NP jobs are in dr's offices, making rounds, etc. More "boring" jobs for lack of a better word to describe it. Not saying being an NP is boring, but the tasks they are typically assigned to are more consistent, repetitive, and in the same areas.

One example he used was surgery. He said (and I agree that I personally have never seen it) that rarely would a surgeon hire an NP; they frequently use PAs. The reason behind that being the difference in billing. Nurses are considered ancillary staff and the surgeon isn't able to bill more by using an NP to assist. But PAs are considered as a different role (I don't remember what he called it), therefore the surgeon is able to tack on something like 17% as a billing fee for the PA.

My questions are (1) how often do you see NPs assisting in a surgical setting and (2) is the billing statement accurate?

[core0]

ok, i hate to bring a somewhat dead topic out of the grave, but i have a question, and would like any answers that are as unbiased as possible.

i was speaking to a pa student who is an rn today, and asked why choose pa instead of np. he said that he chose pa because of the specialty. he said that (at least in il) the bulk of np jobs are in dr's offices, making rounds, etc. more "boring" jobs for lack of a better word to describe it. not saying being an np is boring, but the tasks they are typically assigned to are more consistent, repetitive, and in the same areas.

the bulk of pa jobs are in the boring category;). as a surgical pa a lot of what we do and a lot of the value that we bring to the practice is the boring stuff. making rounds is just as important (and requires more medical decision making than assisting). there are a few pas that only assist and move between different surgeons, but the majority of pas that work in surgery see patients in the office, round and assist.

one example he used was surgery. he said (and i agree that i personally have never seen it) that rarely would a surgeon hire an np; they frequently use pas. the reason behind that being the difference in billing. nurses are considered ancillary staff and the surgeon isn't able to bill more by using an np to assist. but pas are considered as a different role (i don't remember what he called it), therefore the surgeon is able to tack on something like 17% as a billing fee for the pa.

rns are considered ancillary staff and you cannot bill for them. nps are considered non-physician providers (as are pas) and you can bill for them. both nps and pas can collect 14.5% of the surgeons fee (85% of 18% if you care) for first assist or second assist where allowed (not all surgery allows an assist). for a liver transplant for example that works out to about $1000. the big money is in cardiac where the vein harvest is considered a separate surgery and the pa gets 85% of the physicians fee.

note that these billing rules only apply for medicare. most insurance generally follows them but may allow other providers such as rnfas or sas to bill. the payment for other providers is hopefully above medicare.

my questions are (1) how often do you see nps assisting in a surgical setting and (2) is the billing statement accurate?

(1) in four years working in the or i saw two nps that first assisted. one in pediatric urology and the other in general surgery. on the other hand i probably worked with more than 100 pas. in my current job the department of surgery has 100 or so pas and no nps as far as i can tell.

(2) the billing statement is not accurate. the reason that you don't see nps in the or is twofold. one is that surgeons are used to pas. pas have been assisting in surgery since the start of the profession. one of the first pa programs (uab) was a surgical pa program.

the other is that while some rnfas consider themselves apns by all the other defiintions they are not. either because of the rnfa or for other reasons there has not been a np program that covers surgery. the uab program recently started but i do not believe has graduated a student yet.

the credentialing requirements for surgery require you to demonstrate that you are no what you are doing before you enter the operating room. in the old days surgeons would train scrubs (or other providers such as nps or rns) on the job to assist. this is no longer allowed. this is one of the reason that all pa students are required to have a surgery rotation with operative experience.

the problem with a program such as the uab program is that it is trying to fit a nursing domain onto a medical profession. besides the fact that it is longer and more expensive than the pa program with less clinical and didactic time it also suffers from the inherent problem of basing it on the acnp. many practices work across age groups. for example i see pediatric and adult liver transplant patients. if you work for an ortho group then you may be expected to take er call and set an arm or a five year old. all outside the scope of practice of an acnp.

david carpenter, pa-c