PA/NP/DNP: filling the "education gap" re: medical model

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I already have a BS in chemistry and a masters in engineering, so I have pursued PA school. I've been waitlisted and have accepted that I may not make it off that waitlist. I was, however, accepted to an accelerated BSN program here.

I know subjects around this issue has been beat to death a bit, and in my state, i've been told they are "the same". Neither NPs or PAs have heavily encouraged or discouraged one or the other. However, Missouri is *heavy* NP, particularly the St. Louis region, which is reflected in the job posts I scour. I don't plan on relocating when I graduate, either (husband's career is here, family...we have two young children, 2 and 4. And i will not be moving away for my schooling and leave my family behind). I have a strong science background and a penchant for picking stuff like that up.

The most common complaint I see is that NP's lack the medical model education that PAs get. And that PAs are preferred in procedural type roles, which is what I found appealing. I think my interests lie in acute care/procedural work. I like to do things (engineer brain and all). I also know there's an RNFA role I can look into. I have also been told that I will be "bored to tears" with the lack of science education (which is surely offensive to nurses and NPs but only you can tell me how much of scientific based education you feel like you received)

Do you feel there is an education gap here or not re: the medical model versus nursing model? I have not been able to pinpoint what this means. Or do you not feel that you are lacking an educational component in this regard as an NP/DNP?

To me, it makes the most sense to go to PA school if I get in, since I already have the BS and MS. Otherwise, it makes sense to do the NP/DNP route because i can continue the education while working, after getting the BSN.

Thoughts? Thanks!

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All nursing is evidence based. People draw dramatic conclusions about the difference in education between PA and NP. Realistic differences:

In PA you'll have a large number of brief clinical experiences across multiple specialties and will be trained as a generalist who can then work under any physician willing to hire/train you in pretty much any specialty. You will not have a license and will have no option to practice autonomously anywhere in the US.

In NP school you will receive additional training in primary care to augment your RN training, but your education will be mainly focused on your specialty area. There is more of a societal/holistic approach to education in NP school than PA, so be prepared to discuss poverty/healthcare policy/societal issues in great depth. You will not have the practice mobility of a PA, even as an FNP you will still technically be a "primary care" specialist, and will be more limited in where you can practice. You will be a licensed healthcare provider with more autonomy and the option to practice independent of physician supervision in about half the country.

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Thank you for your response. Unfortunately in Missouri, NPs have a restricted license, so they work under physicians in the same manner PAs do. Hopefully that will change soon, though.

It sounds like, if you figure out what you want to do with your career, NP is an excellent route to take, because you can specialize more (which makes you a more competent provider, I'd think). But thanks for clarifying the societal/holistic approach. I've never really known for sure what that entails other than "treat the whole person".

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Specializes in Family Medicine, Medical Intensive Care.

If the medical model of training is what you prefer, then I would lean towards reapplying to PA school. PA school will also better prepare you for the acute care and surgical roles you might enjoy. Plus, there is always the option to switch specialties if you learn that acute care is not for you. You would have to attend an ACNP program if you wanted to practice acute care as an NP. The majority of those programs require prior RN experience, usually critical care.

As someone with a background in Biochemistry, I did not enjoy my entry-level BSN program at all. The scientific focus was replaced by a more practical one, in my opinion. I did not find the depth of instruction that I was looking for. Graduate school has been almost an entirely different experience for me. I still had to take those "fluff" courses (e.g., nursing theory, leadership, finance, policy, etc.), but my core FNP classes have been rooted in the medical model of care with a family medicine focus. I have only taken one course on nursing theory, and it hasn't appeared at all in any subsequent classes. I wish that we had separate courses in the basic medical sciences instead of having to learn them "on-the-go" as I study for classes. There is a lot of independent, supplemental learning that we are expected to do. For example, when we were covering inborn errors of metabolism in Pediatrics, I had to consult a biochemistry textbook to get a stronger grasp on the pathophysiology as the required textbook seemed to assume that the reader already had an understanding of the altered metabolic pathways.

Overall, NP school with my independent study of the basic medical sciences has done a satisfactory job of satiating my thirst for medical knowledge. If I had the opportunity to do it all over again, I would have chosen medical school as I prefer the more formal, structured education that medical students receive plus a formal residency after graduation.

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Thank you. If i was 22 again, I'd be looking at medical school, but it's not an option at this point in my life! I'm still debating re-applying to PA school, since I won't have had any significant changes on my application.

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