The economics of PA vs. NP

myoglobin, ASN, BSN, MSN · Jun 29, 2020

On 6/26/2020 at 10:45 PM, DizzyJ DHSc PA-C said:
Obviously, you have no understanding of the PA profession and no literature to support your outrageous statement. Endangering patients?!?! A provider who does 500 hours of clinicals, they scheduled on their own, is endangering patients.

I was engaging in sarcasm to make fun of MD’s who lobby against NP’s and hospital systems that have subverted the ANA in to opposing nursing ratio laws. Of course I support PA being treated in a like manner with NP’s.

FiremedicMike, RN, EMT-P · Jun 29, 2020

14 hours ago, myoglobin said:
I was engaging in sarcasm to make fun of MD’s who lobby against NP’s and hospital systems that have subverted the ANA in to opposing nursing ratio laws. Of course I support PA being treated in a like manner with NP’s.

I caught on about halfway down, but for the first half I was like "holy cow are you serious??"

?

subee, MSN, CRNA · Jul 4, 2020

On 6/22/2020 at 10:55 AM, 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.

All of the studies I have seen are done by NP's. It's a start but it's not good enough. We need independent studies because without them, MD's will always point out to the bias done by studies done by NP's. They MAY be equivalent, but let's get our ammunition from independent researchers.

FullGlass, BSN, MSN, NP · Jul 4, 2020

39 minutes ago, subee said:
All of the studies I have seen are done by NP's. It's a start but it's not good enough. We need independent studies because without them, MD's will always point out to the bias done by studies done by NP's. They MAY be equivalent, but let's get our ammunition from independent researchers.

There have been studies in which the researchers included MDs. Most MDs are OK with FPA for NPs. It's a loud subset that are causing problems.

DrCOVID, DNP · Jul 4, 2020

2 hours ago, subee said:
All of the studies I have seen are done by NP's.

Nope:

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/614872

https://pubmed.ncbi.nlm.nih.gov/17626694/

https://www.cbo.gov/sites/default/files/96th-congress-1979-1980/reports/79doc633.pdf

https://journals.lww.com/ccmjournal/Abstract/2008/10000/Nurse_practitioners_and_physician_assistants_in.25.aspx

https://pubmed.ncbi.nlm.nih.gov/16495196/

https://journals.lww.com/jncqjournal/Abstract/2008/10000/Critical_Care_Nurse_Practitioners_Improve.9.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC100791/

https://www.CDC.gov/pcd/issues/2014/13_0175.htm

https://ota.fas.org/reports/8615.pdf

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.855.177&rep=rep1&type=pdf

https://www.sciencedirect.com/science/article/pii/S0735109715048640?via%3Dihub

You gotta go to med school to be a good provider, everyone knows that!

subee, MSN, CRNA · Jul 5, 2020

18 hours ago, adammRN said:
Nope:
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/614872
https://pubmed.ncbi.nlm.nih.gov/17626694/
https://www.cbo.gov/sites/default/files/96th-congress-1979-1980/reports/79doc633.pdf
https://journals.lww.com/ccmjournal/Abstract/2008/10000/Nurse_practitioners_and_physician_assistants_in.25.aspx
https://pubmed.ncbi.nlm.nih.gov/16495196/
https://journals.lww.com/jncqjournal/Abstract/2008/10000/Critical_Care_Nurse_Practitioners_Improve.9.aspx
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC100791/
https://www.CDC.gov/pcd/issues/2014/13_0175.htm
https://ota.fas.org/reports/8615.pdf
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.855.177&rep=rep1&type=pdf
https://www.sciencedirect.com/science/article/pii/S0735109715048640?via%3Dihub
You gotta go to med school to be a good provider, everyone knows that!

No, I actually don't believe that NP's can't provide equivalent care but that we have to have proof that we can. Thank you for this list and I haven't gone through it all but the studies that I did open were done (I think so) long before online programs were offered. I believe that NP's should have education as stringent as CRNA's. We have a tiny armamentarium compared to what you guys need. One of the studies was also about critical care (and 20 years old) but these aren't people coming from "the street" and up and running without acute care experience.

myoglobin, ASN, BSN, MSN · Jul 5, 2020

My point all sarcasm aside is that above all "most" humans are above all "self interested". That is to say we are unlikely to support policies that have the net effect of increasing the challenges we face in gaining employment, and earning a high salary. Thus, many MD's will likely oppose expanded IP's for NP's because at the end of the day it means that they will earn less money. In a like manner it is likely that some NP's will oppose expanded scope for PA's because it means that they (in a like manner) will also face more competition and less income (or slower increases in pay) than would otherwise be the case. One "selling point" for expanded PA autonomy might be that the added "political push" from PA advocacy groups might be enough to expand independent practice in states where it might not otherwise be possible. Thus, if adding PA's to our "political camp" were enough to push Texas, and California into independent practice then that would be a huge expansion in opportunity for NP's and PA's. that would overcome the extra supply considerations (from also competing against PA's). I am primarily an advocate first of all for myself, my family, and other nurses. I make no apologies for this and all of my points will be subject to those biases. Again that is why at the end of the day we need government(s) that make rational laws that regulate things based upon the best science and the public interest possible (subject of course to our constitutional rights).

FullGlass, BSN, MSN, NP · Jul 5, 2020

1 hour ago, subee said:
No, I actually don't believe that NP's can't provide equivalent care but that we have to have proof that we can. Thank you for this list and I haven't gone through it all but the studies that I did open were done (I think so) long before online programs were offered. I believe that NP's should have education as stringent as CRNA's. We have a tiny armamentarium compared to what you guys need. One of the studies was also about critical care (and 20 years old) but these aren't people coming from "the street" and up and running without acute care experience.

I am baffled as to what evidence you think you need. There were numerous studies done with author panels that include MDs and DOs. If you want to do a research study, then go ahead.

With regard to quality of education, please provide evidence that current NPs are not as well-prepared as NPs 10 or 20 years ago.

Whether or not NPs should have RN or acute care experience has been beaten to death already. The studies that have been done indicate RN experience does NOT benefit NPs in outpatient specialties.

Acute care NP programs REQUIRE RN experience. Please reread that carefully. Acute care NP programs REQUIRE RN experience. Any hospital that hires an FNP (which is an outpatient specialty) has no one but themselves to blame for hiring an NP that is incapable of working in an ER or elsewhere in the hospital.

The best NP schools have been moving to online education for some years now - Johns Hopkins, Vanderbilt, etc. There is no reason for didactic education to be in-person, especially in the age of COVID. Provisions are made for in-person skills courses and exams.

Most of us agree NP education could use improvement. What we really need are NP residencies and more and more of these are now available.

It appears that no amount of studies will convince certain doctors, nurses, and evidently NPs, that NPs provide safe, quality care. However, that ship has sailed, as more and more states are providing FPA to NPs.

subee, MSN, CRNA · Jul 6, 2020

21 hours ago, FullGlass said:
I am baffled as to what evidence you think you need. There were numerous studies done with author panels that include MDs and DOs. If you want to do a research study, then go ahead.
With regard to quality of education, please provide evidence that current NPs are not as well-prepared as NPs 10 or 20 years ago.
Whether or not NPs should have RN or acute care experience has been beaten to death already. The studies that have been done indicate RN experience does NOT benefit NPs in outpatient specialties.
Acute care NP programs REQUIRE RN experience. Please reread that carefully. Acute care NP programs REQUIRE RN experience. Any hospital that hires an FNP (which is an outpatient specialty) has no one but themselves to blame for hiring an NP that is incapable of working in an ER or elsewhere in the hospital.
The best NP schools have been moving to online education for some years now - Johns Hopkins, Vanderbilt, etc. There is no reason for didactic education to be in-person, especially in the age of COVID. Provisions are made for in-person skills courses and exams.
Most of us agree NP education could use improvement. What we really need are NP residencies and more and more of these are now available.
It appears that no amount of studies will convince certain doctors, nurses, and evidently NPs, that NPs provide safe, quality care. However, that ship has sailed, as more and more states are providing FPA to NPs.

Well, the thought was in my HEAD to mention the the acute care nurses do not come into programs without critical care experience...but somehow I failed to add that in my post. I have no problem with the acute care NP model. I do have a problems with programs that charge students for instruction but, in fact, make students find their own instructors, some of whom never follow the students through their programs. Even anesthesia is doing this now. Any program that wants me to be an instructor isn't much of a program:) No one is getting the global picture on any particular student and yet they charge them the same high fees as if that student were mentored by the program's own faculty. IMHO the students are being cheated.

KatieMI, BSN, MSN, RN · Jul 6, 2020

24 minutes ago, subee said:
Well, the thought was in my HEAD to mention the the acute care nurses do not come into programs without critical care experience...but somehow I failed to add that in my post. I have no problem with the acute care NP model. I do have a problems with programs that charge students for instruction but, in fact, make students find their own instructors, some of whom never follow the students through their programs. Even anesthesia is doing this now. Any program that wants me to be an instructor isn't much of a program:) No one is getting the global picture on any particular student and yet they charge them the same high fees as if that student were mentored by the program's own faculty. IMHO the students are being cheated.

1). Acute care NP programs usually (not always) ask for any inpatient experience, not ICU. And there are at least a few diploma-mills type which do not require any experience at all, as well as direct ASN/BSN to DNP Acute Care programs.

Only CRNA programs expressively require ICU experience.

2). I had to arrange my own preceptorships and was more than happy with that. I knew those were people who would be able to live at peace with my accent, my quirks and my base of knowledge and won't use preceptorship as their power ride holiday. I suffered enough from the aforementioned type already at that point.

APP programs are just as effective for every single student as the student puts into them. In this sense, they are similar with residency. There are residents who manage to mostly sit on their butts all the time after intern year and get busy with "relation competencies" (read: licking the right people's behinds) and yet they pass Boards and become similarly lazy and uncaring docs. Physicians, just like advanced providers, must shape themselves in order to become competent professionals

DrCOVID, DNP · Aug 3, 2020

On 6/25/2020 at 6:32 PM, KatieMI said:
I am really sorry, but when I read current guidelines/search Uptodate/find and read articles about a subject/sit in committee and offer solution for a problem based on available research and implement all that in my current practice, doesn't it mean that I am "integrating research into practice", or what? I do not need additonal year or two in school and $$$$ spent to know how to do that. I already know how to do it with just MSN.

No need to be sorry Katie! You should write a letter to the AACN and tell them that their idea for the DNP is stupid and worthless because you don't need the DNP to do what you do as an MSN.

Also, tell them the extra clinical time is worthless and just because every other clinical practice based discipline is doctoral level doesn't mean we should make our professional require more of nurses! Either way, your mentality will hold our profession back. Regressive, not progressive. That is the way we make the world better!

Here;

https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf

That way you don't have to strain yourself looking for what you don't know!

yourgoodneighbor · Aug 4, 2020

We are all lobbying for our interests!