Nurse Practitioner

NPs can work independently and are generally more broadly scoped.

Yes they will be in more demand. More so DNPs will be in more demand but there is a whole bucket of jobs under the DNP title.

You find out which type does what job through tons of research.

In some states NPs work independently. In reality the vast majority work for health care organizations or physician practices. The best data shows the same percentage of PAs as NPs own their own practice (if you call that the true measure of independence).

As for scope I would disagree. Its going to largely depend on your state for nursing. NPs practice a specific area of advanced practice nursing. In some states this will allow you to see any patient (work in an ICU with an FNP for example). In other states you will restricted to what your training is in (in Maryland for example only ACNPs can work in a monitored unit). Also you may be restricted in age depending on your training (ACNPs in our hospital cannot see patients under 18).

PAs are trained broadly in medicine and surgery. Their scope of practice is defined by the scope of practice of their supervising physician. This means that you will find PAs in all areas of medicine and surgery. It also allows PAs to move easily among any area of medicine or surgery.

In practice the NPs and PAs in our unit are utilized exactly the same. We have a lot of autonomy which is earned by a close working relationship with the physicians.

David Carpenter, PA-C

Not true at all. I worked on a tele-neurosurgery program where the PA and doctor communicated via phone and a teleconferencing set up.

"Supervision" does not mean standing over the shoulder of the PA. You are perpetuating a common misunderstanding of the role of PA's.

Correct. There are a few states that require the physician to be present in the building a certain percent of the time (just as some states do for NPs). All states allow general supervision (physician must be reachable by some method of communication).

As for the DNP there is a thread in the NP section. Its a recommendation but no agency is requiring the DNP by a specific date.

David Carpenter, PA-C

i was under the impression that pas must practice under the scope of practice of their supervising mds. over the past several years i have seen pas seeing all age groups while the supervising md will only see adults. now the pa is qualified to see all ages, but if they are practicing within the scope of practice of a supervising md who does not see anyone under 18 is there an issue? if this is an issue, this is one area where the np in the same practice would be allowed to see all ages as the np is not restricted to the md scope of practice. i am interested in your interpretation, thanks

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it gets a little more twisted than this. generally physicians have an unlimited license to practice medicine and surgery. in theory this allows them to see any patient and do any procedure. in reality most physicians self limit themselves to what they are trained for in residency and fellowship. in the case above the physician may decide that they will limit themselves to adults simply for convenience. as long as they are able to see the pediatric patients and be a resource if the pa has a question then the supervisory requirements are met. if they state they are unable to see the patient because they don't have the knowledge then they shouldn't be supervising the pa seeing the patients (in my opinion).

where this most often applies is procedures. lets say i work for a pain service and learn to do facet blocks. if i go work for an ortho service where the physicians can do facet blocks then i can do them. however, if i go work for a fp practice where the physicians are not trained to do facet blocks then i can't do them. this comes up frequently with cosmetic procedures in primary care. usually the physician takes a course to satisfy the knowledge requirements. finally these are general guidelines.there are two states that i can think about that don't specifically limit pa procedures or patient population to those the physician can do.

as far as the difference for nps its really going to depend on the practice. depending on the state, in theory a np could see patients that the physician didn't see. in reality unless there was a broad multispecialty practice its unlikely. someone has to take call on the patients and see them when the np isn't there. if the physician's can't it substantially reduces the value of having a provider in the practice.

usually the problem i see is where medical practices cross age groups. for example where i work we occasionally take patients under 18 into the icu. our physicians are fine treating them. however, hospital policy limits acnp to 18 and above (state rules and regulations are unclear). usually that means the pas or the residents see them because of the broader age range. you see the same thing in orthopedics for example. many orthopedics practices have a substantial pediatric practice.this would necessarily limit an acnp. em is another area that can be a problem.

david carpenter, pa-c

What is the difference between a NP and a PA?

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There's already a sticky here called "Differences (Educative/Clinical) between NP & PA."