Noreaster

That's a pretty sweet find by MacD for an NP ortho fellowship. I'd guess there aren't too many of those in ortho for NPs. Keep also in mind: if it's ortho you want, you should try to get into something like that Fellowship or something b/c most times, the generic training for NP does't otherwise offer training in surgery, perisurgical skills, injections, aspirations, surgical skills, like suturing, and procedures, etc... I've a friend, who entered into a job in plastic surgery to be just clinic. It was very overwhelming, even in the clinic and then they wanted her to start doing first assist but she can't. To do first assist, she now has to go and get extra formal training. Just something to think about. I know of an ortho practice that has 2 PAs and one NP. The 2 PAs do everything, surgical assist, rounding, autonomousely see all kinds of patients in clinic and the NP does nothing but pre-op H&Ps, and that's it. Just be careful when making your choice. If you go NP, make sure your big picture plan includes training that would allow you to do all of ortho, which includes surgery, etc... like that Fellowship. Or, PA would be an other option. In PA school, you get surgical rotations and training and could likely do an ortho elective rotation as well. Coming out of a 2-year PA program, you'd have everything you'd need to find a job in ortho, with little restrictions--if any. (There are some PA residencies, but it wouldn't be needed). Oh, in case somebody brings up the ol' independence thing... don't worry about that in ortho. NPs and PAs are extremely likely to be hired by the surgeons to work pretty much the same way in a given office. ...meaning, indipendence isn't really an issue in a subspecialty like this, and if the NP has proper cert. in surgical first assist. Either one would work with the same expected amount of autonomy in a given practice. Some ortho surgeons don't have mid-levels work with much autonomy in a clinic setting, while some ortho offices allow the mid-levels to work with a lot of autonomy. It depends on the given office and the desire of the surgon(s) and not if one is NP vs. PA.

Where did I say that a PA can be independent all the time? I did not. In my last post, I think I made it pretty clear on the proper and real dynamics--at least in my state. Please don't misunderstand my post b/c I am not--repeat--not interested in the old "Independence" battle. There is some level of independence with a PA, for sure, but my last post pretty much spells that out and it does, in fact, vary from job-to-job and state-to-state. Oh, and, by the way, the government has mis-spoken about this topic before so, don't be too naive--although this one is pretty much on the money, with the exception that a lot of PAs, nowadays, are getting Master's degrees.

Here's a point of contention: The above sentance is quite true. It is, however, often misinturpreted and misunderstood. Many seem to think that having a supervising physician, (SP), means that every thing must be okay'd, run past, approved by, checked, and/or singed off, by the SP. This is often not the case. It does depend upon what state one is in, however. A lot of the times, as it is in my case, PAs work autonomously and collaborate with a SP, whenever questions arise, or as needed. It actually takes good judgement skills to do this because most SPs don't want everything brought to them. In my practice, my SP has expressed confidence in my skills and his attitude is that I will work autonomously and when I have a question, I'll ask. He instills that confidence to patients as well, which goes a long way. I'm also in a surgical subspecialty and sometimes need to ask the surgeon to come in to meet my patient, whom I've worked up and surgery looks like a next viable option. For the record: In my state, no charts need to be co-signed. In NH, where I am, the NH Board of Medicine (of which I'm licensed to practice), lets the SP & PA relationship come up with their own plan of how supervising works. In a lot of cases (and mine) the SP is fine with the natural dynamic of how things work becuase there's a regular dialog with at least 1 patient a day and a dialog of all in-house patients I've rounded on, which keeps the SP pretty well-aware of things. Personally, I wish the term supervising physician was not chosen because it is often misunderstood. I am enveous of the term collaborative physician, that NPs have because the word much-better describes what is taking place. That is an excellent choice in terminology in practice dynamics.

huh, didn't know that about Australia. Right now, PAs are being initiated in England. Many PAs have gone over there to help things get started; I've a friend, who has gone over for a few months. Too bad about NPs in Aussie only being "initiators" in getting tests going; it sounds like a pretty restrictive place for a NP to be.

In my Master's PA program, I had 12 full months of rotations with like 1 week off (and a holiday or 2) for 40-50 hours per week. The numbers that were origionally quoted weren't too far off, really. The clinical rotations were typically 5 days a week; some took some call with their preceptors, only adding to those hours.

The differences in both should be spelled out, thus it is good getting both NPs' and PAs' viewpoints on these professions, as the OP'er requested. I often see nurses and NPs on the popular PA forum I often visit and it is entirly welcomed, as should be other professions on this site too--negativeity aside. JI'm a PA and work very autonomously. I do not need to "run everything" past the doc nor have everything okayed by nor signed by a doc. I ask whenever I have a question, which is a good thing for the patient, right? I write all my own scrips and fully diagnose, order tests, and interpret them, and make medical decisions, and carry out treatment plans, etc, etc... I think your preception of PAs is a little off. The indipendence thing isn't something that is as much of an issue as some make it out to be because many mid-levels, both NPs and PAs often work practically very much the same--practically speaking.

Thanks for info. I see some info about DEAs and about co-signing charts but was specifically wondering about the scenario of if one were to open a practice, with own building, staff, and complete facilities. Which states can this be done in where there is no collaborative physician, whatsoever, no contracts, agreenments with any physician, or anything--just working alone in an office without ever collaborating at all.

I don't think the OP'er was "missing" the fact of what NPs are designed to do in the nature of working in their scope, necessarily... The point was simply that some seem to think more highly of themselves than they ought. The OP'er is a NP, right? I didn't see the OP'er missing anything of NPs working in their scope missing; if anything, the OP'er seems to be promoting this concept. The more somebody humbly recognizes their scope of practice and level of training--keeping a sober judgement, and is the first to be humbly open to any input, likely makes a great practitioner.

Oh, thanks. So, in other words, there are certain states, where collaborative doc is not needed for a NP to run a completely independant practice? Does anybody know which states allow this?

Quick question: for those few entirely NP-run clinics out there, is there any need for a collaborative doc at all, whatsoever, or can the NP in this situation run entirely solo with no collaboration with any doc whatsoever?

Again, let's please end the battle, shall we? Some people would rather see a physician; some people would rather see an NP; some people would rather see their PA. I'd hope we, as adults, can reason in our minds enough to understand that we shouldn't ever generalize or make blanket statements; certainly not all people, all of the time, would rather see any one type of provider. Some wouldn't want anything less than a physician, while some would love the care they get from their NP and would be happy to not change that, while still others love and would prefer to see their PA.

Great post! I, personally, wish we'd all get over the semantics and terminology: working under a physician; supervising phsician; collaborative physician. When a mid-level provider works among physicians, who wouldn't fully utilize their extensive training, expertise, and knowledge to the fullest degree? It is beyond my understanding that all mid-level practitioners don't view collaborating with physicians (and/or collegues), as a really good thing, which only helps to provide care--perhaps to a fuller/better degree--for the patient. A later post in this thread comments on why he/she would not want to be a PA b/c of apparently some kind of significance. Let me make it clear: In so many cases, and all the one's I've worked in, PAs and NPs work essentially the same. The NPs need collaborative activity and PAs need a supervising physician, (SP). Let me tell you that the PA/SP relationships I've ever seen, is nothing different than 2 practitioners collaborating about a patient. Some grossly misunderstand the term SP and think that everything needs to be run past that SP. All PAs I know work autonomously and run either questions by, or review some cases by, and other like collaborating when they think it's appropriate and know their limitations. The PAs I know are not viwed by their patients as "the doctor's assistant" as a poster on this thread has mentioned. To be honest, when I'm seeing a physician and he/she tells me that they want to talk with their partner too about something, I certainly am glad that they're open to other's medical collaboration. It also shows a level of humility that I certainly appreciate in ANY medical provider, be it, NP, PA, MD, DO, etc...

If you ever wanted to check out the physician assistant profession--an other mid-level practitioner position, a good site for that would be: www.physicianassociate.net Best of luck with whatever you choose

amen to that! it didn't sound like the op'er was questioning advocating, just raising a concern of some "thinking more highly of themselves then they aught" kind of arrogance, which is--in some places--more prevelent than some may know or think.

The original post raises a valid concern/issue. I really appreciate the OP's humble attitude but also loving and not short-changing being an NP. PNP2005, keep that heart and mindset!!! Working among a good number of NPs I see different attitudes. My favorite NP where I work has a very similar attitude as PNP2005; she is a joy to be around, is well-respected, and is very strong at what she does. For some reason, some NPs feel either threatened, prideful, presumptuous, or any combonation, while others feel secure in what they do, while able to admit other's differing training, strengths and weaknesses, and are the first to recognize an other's training--without feeling defesive. In other words: this quote that the OP'er quoted is not necessarily a rare thing. I hear things like this on a regular basis, unfortunately. It creates a closed mindset and a defensive stance, and is frankly hard to work with. If ANY mid-level feels pridefull enough to not collaborate and practice like that, they are only setting themself up for trouble. As a mid-level practitioner, I, too, must keep this in check. Just listen to the OP'er. He/she has first-hand experience with his/her brother physician and simply raises factual info of the differences--without bias, feeling threatened, defensiveness, or the like. So, PNP2005, you are not alone in your observations. Please keep that humble mindset; I'm sure you make an amazing practitioner!