PA-C or NP? What would you do?

[Guttercat]

I am an ADN, with many years under my belt in nephrology, ICU, ER, and M/S.

In my current role, I function quite independently/autonomously and I'm quite good at it clinically. One thing this role has taught me, I really, really, reeeeallly enjoy the medical science and application side of things, being able to use my knowledge to make more autonomous decisions, and having a high degree of contact and collaboration with nearly all departments (and docs) in the hospital.

Healthcare politics, business, and trends interest me a great deal, but my primary talent and enjoyment comes from assessing patients and problem-solving.

I am currently in the research phase of deciding between pursuing RN->BSN->ANP or becoming a PA.

>Both roles while similar, have different challenges not just in practice, but on the political scene as well. PA's (at app 85,000 in number) are terribly underrepresented at the State and Fed levels as opposed to RN's (millions strong).

>I like the heavy, medical-model of PA school, yet I like the fact that NP's can function under their own license.

>I dislike the fact that ANP scope of practice varies so wildly from state to state. The barriers to true autonomy are numerous. This issue I realize, is being heavily studied and lobbied.

>I've ruled out CRNA and perfusionist as options (had enough machine-management, thank you :) ).

>I like that PA's are considered "generalists" yet they have so many options in specializing. As one of the docs I work with put it, "you can write your own ticket."

One thought is to just finish my BSN and decide from there, but...PA programs can have different reqs...i.e, it's been so long, that I have to take some chemistry, English, and A/P again...sigh.

Any thoughts from those that have faced this conundrum (or otherwise) I'd greatly appreciate it.

[Guttercat, ASN, RN]

I sincerely appreciate everyone's thoughts.

I have no fear of "independent practice" as an ANP degree would afford, so that's not an issue. I also don't mind working under/with MD's when those MD's are of a collaborative nature, so the PA route (medical model which is very enticing) doesn't raise a flag either.

The issue for me specifically at this point, is trying to determine the future markets, where and how NP's vs. PA's will be in most demand, and future scope of practice. Both options coud lead to entirely different outcomes, especially in the context of HCR, market saturation, and political lobbying clout.

Thanks again.

[LagunaB]

Hello and thanks for starting this thread. I am in a similar situation, as I was recently accepted into an entry level MSN-FNP program and also was accepted to PA school. I have done a lot of research on the whole NP/PA thing and really went back and forth for a while. It really seems like they are 2 different paths to a similar outcome.

I chose PA because I am not an RN already, so PA school is 2 years versus 3 1/2 for NP. Also, I like the notion of learning under the medical model and PA school is said to be about 75% of Med School. Also, the clinical rotational hours are almost double for a PA vs NP. I wanted more hands on clinical training and thought that I would be better prepared as a diagnostician after attending a rigorous PA program. Also, it seems like ERs and Surgeons tend to hire more PAs, whereas NPs seem to work a lot in primary care (I could be wrong about this, it just seems to be the case in CA...correct me if I'm wrong!).

I may end up in primary care (and actually that is where I feel most led), but wanted the option to specialize, which seems more viable for a PA vs. NP. This is just my opinion. I am sure there are many excellent and challenging NP programs, and I am sure that NPs do specialize, but it just seems that more is required of a Physician Assistant. Also, I was accepted in to FNP program and I am still not sure of the specializing options for Family Nurse Practitioners. I just thought that I would be mostly doing primary care.

I understand that NPs do have more autonomy in California, yet it seems that most NPs work under a doctor anyways. I would be curious to know how many NPs actually do work independently. Supposedly the education requirements for NPs are changing in 2015. All new NPs will be required to get their DNP, which may add some clinical hours and obviously...more school!! I think that students who enter the program now or soon will be grandfathered in, which made me think that I should get the NP before they add more and more requirements. Also, I was leaning towards the NP because I though I might have better job prospects. Yet, nearly every job posting I've come across asks for either an NP or a PA. Not to mention that PA school is 50K cheaper in tuition alone. The notion that I could finish my education slightly faster and considerably cheaper, and to have the same job prospects, duties and responsibilities really appealed to me. So as of today, I will be attending PA school in the fall!

[Tinabeanrn]

Wow Laguna B. 50k less! That is amazing :). Good luck with school in the fall. It will go by so quick

[TraceyMarino]

Hi! Something to consider....I too looked at PA vs. NP, and as an RN already, it was a wash time and money wise.

I do a lot of medical mission trips, and travel extensively. If you are interested in any international work, PA's are only recognized in the US and Canada, where NP's are recognized pretty much world wide. An NP can work in Mexico, Australia, Canada, and all over Europe. PA's are an American invention, where NP's and advanced practice nurses and midwives have been around forever in many other countries. In Australia, the lion's share of healthcare providers are NP's and midwives, not doctors.

I think PA and nurse practitioner are both a great way to go. There will always be struggle for autonomy, as the AMA and doctors as a whole are lobbying very hard against all midlevels, midwives, NP's, PA's, and CRNA's. They are instrumental in creating the limitations outlined in the ACO language, and will continue to try and thwart the progress of PA's and nurse practitioners.

Go where you will get a great education, in the least amount of time, for the least amount of money. Then, practice where they appreciate you and treat you well.

[ghillbert, MSN, NP]

The clinical education advantage of PA seems to be that they do more hours and more varied rotations, but I did extra clinical hours in my MSN (more than required) and was able to choose a variety of areas - I do not feel my clinical experience was limited. Just make sure you choose a program that gives you some flexibility. I do feel that your experience as an RN really makes a difference to potential NP employers - I am interviewing at the moment and my years of ICU experience as a CCRN mean a lot more to them than my 850 hours of clinical during my MSN.

Edit to say: RE lobbying power, PAs and NPs need to work together and join forces!! The employment outlook is fantastic for advanced practice providers, and there are enough jobs for both types of APP. We are still being lowballed on pay though - many of my graduating class will start at just about the same or even less as a new grad NP than they were as experienced RNs in senior positions.

At the end of the day, choose a program that suits your needs, and an education model NP/PA that is most marketable in your area, since that varies.

[Corey Narry, MSN, RN, NP]

I understand that NPs do have more autonomy in California, yet it seems that most NPs work under a doctor anyways.

Well, California isn't really known for NP autonomy. There are restrictive laws here...one, NP's need a Standardized Procedure laid out with a physician prior to starting a practice and two, NP's do not prescribe, we "furnish" and a Furnishing License is required prior to being able to furnish therapies and pharmacologic agents.

In its true sense, the number of nurse practitioners who own a practice with no physician oversight are low compared to the overall number of NP's: http://www.aanp.org/NR/rdonlyres/F7E4A2F4-7597-4BF7-8D0F-97C56BD7FC2D/0/2011AANPNationalNPCompensationSurvey.pdf

The states where true NP independent practice exist are seen in this map in pink:

http://championnursing.org/sites/default/files/aprnmap.6.11.branded.pdf

[ProgressiveThinking, MSN, CRNA]

This is something I've been thinking about as well. Although there are a lot of factors that will come into play, I intend to apply to grad school, but leaving the VA would be difficult (we have the greatest benefits ever). The community college that I did my RN at offers a PA program with a price tag of $3000. If you have a bachelor's degree, they award you a master's degree from a university in Pennsylvania. Not too shabby. The only downside if you CANNOT work during the program. A cal-state about 2 hours away from where I currently live has an FNP program for about 20k, which is not too shabby either considering there are other local schools that run for 60k+. You can also go part-time if needed.

[Akewataru]

Not to mention, if you go the PA-C route and you want to further your education and become an DO you can go to Lake Erie College of Medicine and do their PA to DO bridge program in three years. I don't know of any physician bridge program for NPs. Correct me if I'm wrong, cause' I learn more when I'm wrong!

[Tinabeanrn]

Wow. .. that's amazing! I wish I could become a DO in 3 years. I would jump all over that!

[Conqueror+, BSN, RN]

I believe that as APN's gain more autonomy that physicians will start looking for ways to regain ground (read $$). Since they cannot control the wave of NP's their only option will be to focus on scaling back the PA's because they control PA practice. It may sound silly but it's what I would do and I'm a pretty good strategist. PA's will be at a disadvantage because their jobs are literally tied to the physician's. Ours is not.

[core0]

I believe that as APN's gain more autonomy that physicians will start looking for ways to regain ground (read $$). Since they cannot control the wave of NP's their only option will be to focus on scaling back the PA's because they control PA practice. It may sound silly but it's what I would do and I'm a pretty good strategist. PA's will be at a disadvantage because their jobs are literally tied to the physician's. Ours is not.

So how do physicians control PA practice if you are such a good strategist?

[Conqueror+, BSN, RN]

Well my being a good strategist has nothing to do with Physician's controlling PA practice they just do. My rationale is pretty basic. Let's say your family's drinking water was in a large container inside your home and one day you saw two holes in it. You couldn't reach one of the holes but you could reach the other. What would you do?