The economics of PA vs. NP

[subee, MSN, CRNA]

A PA asserts that their futures may be limited by supervising requirements despite lower educational requirements for NP's.

https://www.kevinmd.com/blog/2020/03/whats-the-future-of-the-physician-assistant.html

[DizzyJ DHSc PA-C]

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

[umbdude, MSN, APRN]

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]

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]

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, APRN]

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, APRN]

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]

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.

[203bravo, MSN, APRN]

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]

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.

[DizzyJ 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, APRN]

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.