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The economics of PA vs. NP

Specializes in CRNA, Finally retired.

DizzyJ DHSc PA-C

Specializes in DHSc, PA-C.

Overall, accurate depiction of the problem. There is absolutely no reason PAs shouldn't gain independence as well.

umbdude, MSN, NP

Specializes in Psych/Mental Health.

Unfortunately, PAs comparing themselves to NPs doesn't make a strong argument for independent practice. NPs have years of evidence and experience as independent providers, and PA has to show that they can do the same with solid evidence while diligently pushing for legislative efforts and strategies rather than saying, "if NPs can do it with less training or capability, why can't we?" Else, it will just turn into a fruitless finger-pointing debate between two professions.

Of course PAs can practice independently. There's no question about it. But the reality is that PAs are incredibly entrenched in medicine and most PA programs are housed within medical schools. On the other hand, nursing has always been a separate model and housed under its own school. Furthermore, I'm not sure that majority of PAs are even on board with independent practice.

DizzyJ DHSc PA-C

Specializes in DHSc, PA-C.

58 minutes ago, umbdude said:

Unfortunately, PAs comparing themselves to NPs doesn't make a strong argument for independent practice. NPs have years of evidence and experience as independent providers, and PA has to show that they can do the same with solid evidence while diligently pushing for legislative efforts and strategies rather than saying, "if NPs can do it with less training or capability, why can't we?" Else, it will just turn into a fruitless finger-pointing debate between two professions.

Of course PAs can practice independently. There's no question about it. But the reality is that PAs are incredibly entrenched in medicine and most PA programs are housed within medical schools. On the other hand, nursing has always been a separate model and housed under its own school. Furthermore, I'm not sure that majority of PAs are even on board with independent practice.

Many think it makes a very strong argument. Clearly providers can be made independent with less training then a PA. What many don’t realize is that a lot of PAs already practice independently in reality. Having a doc say they looked at 10 charts a year (varies by state) isn’t exactly supervision.

subee, MSN, CRNA

Specializes in CRNA, Finally retired.

1 hour ago, umbdude said:

Unfortunately, PAs comparing themselves to NPs doesn't make a strong argument for independent practice. NPs have years of evidence and experience as independent providers, and PA has to show that they can do the same with solid evidence while diligently pushing for legislative efforts and strategies rather than saying, "if NPs can do it with less training or capability, why can't we?" Else, it will just turn into a fruitless finger-pointing debate between two professions.

Of course PAs can practice independently. There's no question about it. But the reality is that PAs are incredibly entrenched in medicine and most PA programs are housed within medical schools. On the other hand, nursing has always been a separate model and housed under its own school. Furthermore, I'm not sure that majority of PAs are even on board with independent practice.

I think this is disengenuous because we have no uniform practice requirements for NP programs and so people are graduated from programs with absolutely no nursing experience. The entrance requirements for NP are a joke compared to PA school. If every NP were experienced before starting grad school, the argument that our experience gives us credibility would be more attractive to me. Until clinical nurses control their educational standards we will never win the education war. There is no low to which our graduate pre-prequiremments will fall to. Our bad.

umbdude, MSN, NP

Specializes in Psych/Mental Health.

2 hours ago, subee said:

I think this is disengenuous because we have no uniform practice requirements for NP programs and so people are graduated from programs with absolutely no nursing experience. The entrance requirements for NP are a joke compared to PA school. If every NP were experienced before starting grad school, the argument that our experience gives us credibility would be more attractive to me. Until clinical nurses control their educational standards we will never win the education war. There is no low to which our graduate pre-prequiremments will fall to. Our bad.

I don't entirely disagree, but it has nothing to do with the PA profession. I was saying that putting down the NP profession (as the author did in that article) will not do much in moving forward PA independence.

umbdude, MSN, NP

Specializes in Psych/Mental Health.

3 hours ago, DizzyJ DHSc PA-C said:

Many think it makes a very strong argument. Clearly providers can be made independent with less training then a PA. What many don’t realize is that a lot of PAs already practice independently in reality. Having a doc say they looked at 10 charts a year (varies by state) isn’t exactly supervision.

Yet the two training models are different and factors that influence NP performance might not apply to PAs. Your definition of "less trained" is purely based on certain coursework and number of hours, but doesn't take into other aspects of nursing. I do not believe NPs are less trained in many specialties.

Not here for a debate...I think PAs should be able to practice independently and I'm all for it. But if PAs want independent practice, they have to have something to show for and be ready to push hard. If PAs already have de-facto autonomy in some states where there's no limit on how many PAs a physician can supervise, then maybe that's the approach to take in Utah.

Dragging the NP profession down in an attempt to boost your own is simply unprofessional and not useful.

Neuro Guy NP, DNP, PhD, APRN

Specializes in Vascular Neurology and Neurocritical Care.

11 hours ago, umbdude said:

Yet the two training models are different and factors that influence NP performance might not apply to PAs. Your definition of "less trained" is purely based on certain coursework and number of hours, but doesn't take into other aspects of nursing. I do not believe NPs are less trained in many specialties.

Not here for a debate...I think PAs should be able to practice independently and I'm all for it. But if PAs want independent practice, they have to have something to show for and be ready to push hard. If PAs already have de-facto autonomy in some states where there's no limit on how many PAs a physician can supervise, then maybe that's the approach to take in Utah.

Dragging the NP profession down in an attempt to boost your own is simply unprofessional and not useful.

And says a lot about those sinking to those levels, namely feeling threatened. At least that's the behavior I've seen in other situations where people feel threatened, so I think it can be extrapolated here.

11 hours ago, umbdude said:

Yet the two training models are different and factors that influence NP performance might not apply to PAs. Your definition of "less trained" is purely based on certain coursework and number of hours, but doesn't take into other aspects of nursing. I do not believe NPs are less trained in many specialties.

Not here for a debate...I think PAs should be able to practice independently and I'm all for it. But if PAs want independent practice, they have to have something to show for and be ready to push hard. If PAs already have de-facto autonomy in some states where there's no limit on how many PAs a physician can supervise, then maybe that's the approach to take in Utah.

Dragging the NP profession down in an attempt to boost your own is simply unprofessional and not useful.

I have to agree that a comparison of the two educations cannot be accurately made. The point must be made that NPs train in a specific specialty and thus their clinical hours are spent becoming competent in that specialty.

I am a primary care FNP. I entered and graduated from a program that required over 1000 hours clinical experience. These included rotations in pediatrics and women’s health. While it’s true that I had no clinical rotations in ED, ICU, or surgery I am prohibited from seeking jobs in those areas as they are outside my scope of practice.

If a NP desired to have the same flexibility in career choices that is afforded to PAs they would have to attend multiple programs and take multiple certification exams. This would far exceed the training and clinical hours of current PA programs.

Tegridy

Specializes in Former NP now Internal medicine PGY-1.

On 6/15/2020 at 4:23 PM, umbdude said:

Unfortunately, PAs comparing themselves to NPs doesn't make a strong argument for independent practice. NPs have years of evidence and experience as independent providers, and PA has to show that they can do the same with solid evidence while diligently pushing for legislative efforts and strategies rather than saying, "if NPs can do it with less training or capability, why can't we?" Else, it will just turn into a fruitless finger-pointing debate between two professions.

Of course PAs can practice independently. There's no question about it. But the reality is that PAs are incredibly entrenched in medicine and most PA programs are housed within medical schools. On the other hand, nursing has always been a separate model and housed under its own school. Furthermore, I'm not sure that majority of PAs are even on board with independent practice.

I always chuckle when new grad mid levels come out and insinuate medical school is unneeded.

Back to the topic though, issue with PAs is they are generalists. So technically an independent PA could do "everything" (Derm, ortho, neuro, cardio, etc) and nothing would be there to restrict him or her. Not so sure I am on board with that. Physicians can't even do that since we have board specific specialties.

Edited by Tegridy

DizzyJ DHSc PA-C

Specializes in DHSc, PA-C.

35 minutes ago, Tegridy said:

I always chuckle when new grad mid levels come out and insinuate medical school is unneeded.

Back to the topic though, issue with PAs is they are generalists. So technically an independent PA could do "everything" (Derm, ortho, neuro, cardio, etc) and nothing would be there to restrict him or her. Not so sure I am on board with that. Physicians can't even do that since we have board specific specialties.

I always feel both professions are set back decades when someone says “mid level”.

PAs are “generalists”. However, we only practice within our scope of experience, training, and education. So, if one is practicing in derm, then they would have to show their experience, training and education in that speciality. Continued up to date CME in that specialty. It would be malpractice if they just one day decided to practice neuro. While technically they could, they couldn’t show current competence and training. It would be beyond their Current scope. An FNP and PCP could attempt the same with non-surgical specialities.

umbdude, MSN, NP

Specializes in Psych/Mental Health.

10 hours ago, Tegridy said:

I always chuckle when new grad mid levels come out and insinuate medical school is unneeded.

I chuckle when a supposedly educated professional makes personal attacks rather than making a logical argument.

A little off topic, but nursing programs should all have the same requirements and offer high quality curriculums. The low standards of some of the programs that I’ve encountered are shocking. On another note, I heard an NP argue that staff nursing is not comparable to the advanced care NPs are trained to give, and lack of RN experience is inconsequential. Is this true NPs?

KatieMI, BSN, MSN, RN

Specializes in ICU, LTACH, Internal Medicine.

58 minutes ago, Queen Tiye said:

A little off topic, but nursing programs should all have the same requirements and offer high quality curriculums. The low standards of some of the programs that I’ve encountered are shocking. On another note, I heard an NP argue that staff nursing is not comparable to the advanced care NPs are trained to give, and lack of RN experience is inconsequential. Is this true NPs?

Bedside nursing as it most commonly practiced has very little to do with advanced practice nursing. Bedside nurses are frequently not stimulated to develop qualities necessary to advanced nursing practice such as critical and analytical thinking, constant widening of the base of knowledge and independence/autonomy and instead pushed into blindly following absolutely senseless policies and forced into formation of working habits which are detrimental for their development as clinicians such as "calling instead of thinking" and following protocols instead of applying analytical skills. Nurses who are smart and open-minded and not "task-oriented" are targeted by their peers and administration as "know-alls", "bookish" and "unsafe" and experience lateral violence and workplace bullying just because they are smarter. Anti-intellectualism runs rampant at bedside even in specialties where clinical/analytical skills are paramount for safe nursing practices.

Being a provider, I honestly can tell that one of the greatest mistakes in my nursing career was spending almost 3 years at bedside. All benefits I got as a result are freedom from student debt and a few really good friends, which is all good but won't make it up for what I endured as a new grad only guilty of knowing more than the rest of the pack.

And, yes, I think that bedside experience can be beneficial but is not mandatory for making a good advanced practice nurse. Smart, independent and knowledge-thirsty should not suffer for what they are just because there is some general opinion without any data supporting it.

subee, MSN, CRNA

Specializes in CRNA, Finally retired.

23 hours ago, KatieMI said:

Bedside nursing as it most commonly practiced has very little to do with advanced practice nursing. Bedside nurses are frequently not stimulated to develop qualities necessary to advanced nursing practice such as critical and analytical thinking, constant widening of the base of knowledge and independence/autonomy and instead pushed into blindly following absolutely senseless policies and forced into formation of working habits which are detrimental for their development as clinicians such as "calling instead of thinking" and following protocols instead of applying analytical skills. Nurses who are smart and open-minded and not "task-oriented" are targeted by their peers and administration as "know-alls", "bookish" and "unsafe" and experience lateral violence and workplace bullying just because they are smarter. Anti-intellectualism runs rampant at bedside even in specialties where clinical/analytical skills are paramount for safe nursing practices.

Being a provider, I honestly can tell that one of the greatest mistakes in my nursing career was spending almost 3 years at bedside. All benefits I got as a result are freedom from student debt and a few really good friends, which is all good but won't make it up for what I endured as a new grad only guilty of knowing more than the rest of the pack.

And, yes, I think that bedside experience can be beneficial but is not mandatory for making a good advanced practice nurse. Smart, independent and knowledge-thirsty should not suffer for what they are just because there is some general opinion without any data supporting it.

Has anyone done a study comparing results from NP's without nursing experience and nurses with no nursing experience? Gives me a headache how you would even design it but it could give a more definitive answer. But, even my own doc just goes through the prompters on the computer to ask me any questions. Since I'm healthy, a robot could do that for me and we are already up to our knees in cookbook practice. Despite the fact that 90% of patients who get penicillin tested because someone told them that they were, are in fact not allergic to penicillin, it was never my practice to push Vancomycin into a patient when they were pen "allergic" when a less problematic alternative was available. It was an on going war with the surgeons for decades until VRSA evolved. So, if we are doomed to the cookbook, I suppose NP with no previous experience would do. But we will never win the the PR war as long as we allow non-practiced, online trained NP's out in the market.

KatieMI, BSN, MSN, RN

Specializes in ICU, LTACH, Internal Medicine.

19 minutes ago, subee said:

Has anyone done a study comparing results from NP's without nursing experience and nurses with no nursing experience? Gives me a headache how you would even design it but it could give a more definitive answer. But, even my own doc just goes through the prompters on the computer to ask me any questions. Since I'm healthy, a robot could do that for me and we are already up to our knees in cookbook practice. Despite the fact that 90% of patients who get penicillin tested because someone told them that they were, are in fact not allergic to penicillin, it was never my practice to push Vancomycin into a patient when they were pen "allergic" when a less problematic alternative was available. It was an on going war with the surgeons for decades until VRSA evolved. So, if we are doomed to the cookbook, I suppose NP with no previous experience would do. But we will never win the the PR war as long as we allow non-practiced, online trained NP's out in the market.

I was also interested. There are no such studies, and I have access to one of the best searching systems in the world.

Yale did a study in the 1980s and there are a few more out there. There are some studies- they aren't very rigorous but none of the NP comparison studies are.

subee, MSN, CRNA

Specializes in CRNA, Finally retired.

4 hours ago, egg122 NP said:

Yale did a study in the 1980s and there are a few more out there. There are some studies- they aren't very rigorous but none of the NP comparison studies are.

Calling all future DNP students - what a great topic for research. Of course, now the issue becomes muddled with MSN vs DNP. I will by six feet under by the time this has any answers:)

FullGlass, BSN, MSN, NP

Specializes in Adult and Geriatric Primary Care.

On 6/22/2020 at 6:49 AM, subee said:

But we will never win the the PR war as long as we allow non-practiced, online trained NP's out in the market.

The question of whether or not NPs should have RN experience has been beaten to death already on this forum. While additional research might be interesting, there have been a few studies that found no difference between NPs with or w/o RN experience. Get over it.

Currently, almost all ACNP programs do require RN experience. That makes sense.

Primary care NP programs do not require RN experience, because RN experience isn't really relevant to the outpatient environment.

RN experience is not going to impress critics of NPs. What we need are NP residencies. For an NP, NP experience trumps RN experience.

adammRN

Specializes in DNP/PMHNP student.

On 6/22/2020 at 2:00 PM, subee said:

Calling all future DNP students - what a great topic for research. Of course, now the issue becomes muddled with MSN vs DNP. I will by six feet under by the time this has any answers:)

PhD***... DNP are supposed to be integrating research to practice and facilitate change/nursing leadership, not conducting research experiments. My cohort picked DNP because we wanna be terminally educated providers. None of us wanted to be "in research." DNP is meant to be clinically focused and needs a more beefy clinical/scientific curriculum.

Edited by adammRN

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