RuralNP

I have trained both NP and PA students (not to mention medical residents) and seen so much variation in both programs that I always fall back on the statement.."Good is as good as you want to be". Good programs don't make good providers but bad programs give you a lot to overcome. Overall, and this is my personal experience, if you have an extensive, critical care, clinical background, consider NP. If you have little, pick a good, well established PA program. I learned a lot of ER medicine when I was working as an ER RN. I read the journals and the text books between patients. I ordered the tests for the MDs and followed through on them. ERs are great places to learn how to do the job, even if you start as a tech. You just have to take advantage of the opportunity. In the end you become the provider that you make yourself regardless of title. I've been doing solo ER and family practice for over 10 years, and some of my regional competition are solo, NP owned practices. Whether this is legally constrained by states or not, as a matter of reality it happens de facto in every state. The only thing that matters is the quality of the product.

This is a really big topic, but you can bypass a lot of wasted bandwith by skipping the arrogance and false assumptions. A big threat to our patients is the assumption you know what you're talking about when you really don't. I've seen some huge knowledge vacancies filled with incorrect information in this thread. If you can do that, you can make big medical mistakes and think you're doing the right thing. NP's often catch MD mistakes and vice versa. Has much less to do with training, a lot to do with how good you want to be and how much attention you're paying. If you have specialty experience even as a staff RN, you're going to run circles around a newly minted family practice MD in your area of expertise. And don't forget, everyone makes mistakes. On top of that, to arrogantly assume that any training protects you from being outdiagnosed is incorrect. There's not enough room in your brain for everything you really need to know to do this job right all the time. Somebody always knows something you don't, sometimes it's the orderly. After a few years in practice the field levels out and whatever you've learned in the past becomes less important that the character of your practice, how hard your working to keep up on the new stuff, and how hard you try not to forget the old stuff. There are many more mistakes made by lack of attention than lack of training. That's why NPs and PAs do so well in head to head comparisons with MDs. AND by the way the literature has some REALLY good studies that measure objective medical endpoints in RANDOMIZED, controlled trials that have been published in well respected peer-review magazine including the REAL medical journals. I remember one local doc that picked up a Erythema Nodosum that I missed as a new grad (I thought it was bug bites), the next week I picked up a Ramsay-Hunt Syndrome that he missed (he was treating for simple otitis). That was in the old days when there were more of us around. Now I hardly ever talk to anyone who's not a specialist. I haven't worked side by side with an MD in the office or the ER in over 5 years. Fact of the matter is, out in the jungle it doesn't matter what you call yourself. If the system sets you up to be a primary provider, you either do it or you don't. There are good and bad PCPs and the title doesn't tell you which is which. But make no mistake, NPs and PAs are real, autonomous PCPs all over this country. As far as Optometrists go, in my fine state, they don't prescribe so there's a real wall to their practice. You could hardly call them comprehensive providers. They examine, diagnose (some things), and make glasses. Any medical problems they send to a Opthomologist. If they could prescribe, I bet many would be just as good as Opthomologists in office practice. Just like NPs and PAs showed that they could be just as good as family practice docs.