NP or PA for ER w/ some primary practice

Specialties NP

Published

Greetings all,

Forgive me in advance for this question as I have not found my answer yet despite a plethora of trolling. Basically, I'd like to be in a position to do two things: 1) practice in an ER where I can perform surgical procedures and 2) also have a practice involved in community health/primary care. Would the NP or PA route be better or am I too broad in my intention for future practice? Thanks in advance for any insight.:bow:

Specializes in Critical Care, Emergency, Education, Informatics.

I think if you've ben reading the posting your going to find the answer is "It Depends" It depends on were you are. I know there are lots of rurual places in the midwest that you can do both with either. You have to research your specific market.

Specializes in family, internal, pediatric.

If you would like to divide your time between ER/office, the NP track would be a better choice. The NP track focuses on primary care, no procedures, my school had one session on suturing. The PA track seems to be more procedures since you are assisting the physician and not working independently. The PAs are the providers in the OR with the MD, there are very few NPs doing this kind of work.

The post from CraigB-RN is correct, in rural health you can do everything since the closest ER may be miles away. You could also practice independently if your state allows. I worked in a rural setting and had my supervising MD in another city.

If you would like to divide your time between ER/office, the NP track would be a better choice. The NP track focuses on primary care, no procedures, my school had one session on suturing. The PA track seems to be more procedures since you are assisting the physician and not working independently. The PAs are the providers in the OR with the MD, there are very few NPs doing this kind of work.

The post from CraigB-RN is correct, in rural health you can do everything since the closest ER may be miles away. You could also practice independently if your state allows. I worked in a rural setting and had my supervising MD in another city.

I will disagree. If you actually want to be trained in both emergency medicine and family practice PA would be the way to go. As a student you will be heavily involved in procedures in both your EM and surgery rotations. There will be more than enough opportunity to suture (and most programs teach this pretty well). In primary care there still is opportunity to do procedures (many FP do joint injections and other procedures). PAs in FP probably have the most autonomy of any medical specialty. They generally carry their own panel of patients and consult with the physician as necessary. The majority of PA owned practices are in FP with minimal physician prescence.

In the ER the amount of autonomy that you have will vary considerably. There are a lot of rural ERs that are staffed by PAs with no onsite physician. If you work in a bigger ER there may be a seperate fast track where PAs handle less acute cases or you may work in the bay where you just take the next chart up.

There is also urgent care and occupational medicine which are more espisodic but provide a lot of opportunity for procedures.

David Carpenter, PA-C

Thanks for the replies as it gives me more guidance on how to look at the next several years. Question for David, do you know how much impact the ER/Trauma residency programs have on how much a PA is allowed to do regarding procedures? Thanks again!

Thanks for the replies as it gives me more guidance on how to look at the next several years. Question for David, do you know how much impact the ER/Trauma residency programs have on how much a PA is allowed to do regarding procedures? Thanks again!

It really depends on the program. Where I trained we had no surgical residency and a limited ER residency. There was a trauma fellowship, but the fellows main job is to manage and operate so there was little overlap. The trauma service was run by the PAs. The ER had a PA run fast track, a peds ER with 1-2 PAs depending on the time, and 2-3 in the main. This gave me a lot of opportunity to do procedures if I wanted (although I had sutured for three years as an Army medic). During my surgical rotation I concentrated mostly on inpatient management and trauma management. Other places may vary with mostly fast track and little main ER experience. The advice I usually give to PA students is either look for a level one trauma center with a lot of PAs in the ER or a level 2 with no EM residency if you want a lot of ER experience. I worked between 100-120 hours per week on my surgery rotation and 80-90 on EM so I got a lot of experience.

David Carpenter, PA-C

+ Add a Comment