The economics of PA vs. NP

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

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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

Specializes in Former NP now Internal medicine PGY-3.
7 minutes ago, myoglobin said:

We can argue studies all day. Bottom line NP IP is growing and is unlikely to slow let alone reverse.  Thus, we are winning and that is a good thing for NP's and probably also for patients.

I’m not arguing against but it’s disingenuous to state something that is not found in a study and just causes the viewpoint to lose credibility. IP doesn’t change much in light of medicine. There is very little difference in roles of physician and NP  in IP vs most non IP states hence why I’m not against it. Plus I don’t want to sign mid level charts It’s  just more liability 

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Specializes in ICU, trauma, neuro.
12 minutes ago, Tegridy said:

I’m not arguing against but it’s disingenuous to state something that is not found in a study and just causes the viewpoint to lose credibility. IP doesn’t change much in light of medicine. There is very little difference in roles of physician and NP  in IP vs most non IP states hence why I’m not against it. Plus I don’t want to sign mid level charts It’s  just more liability 

Again, even in non IP states like Florida (well we technically just became IP) even as a first year NP I found no less than four MD's willing to "sign my charts" for anywhere from 5-10% of gross revenues (they wouldn't have signed my charts just been my collaborator per state law).  Thus, even in non IP states supervised practice is largely a fallacy since it is in essence a "fee" for service arrangement where the NP pays a fee and gets to "check off the box" so they can practice with little or no actual supervision.  Note, even for a job in New York State where I interviewed the Psychiatrist said we would "chat" for about an hour per month. The same was true in Mass and for a different job in Rhode Island.  

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Specializes in Former NP now Internal medicine PGY-3.
Just now, myoglobin said:

Again, even in non IP states like Florida (well we technically just became IP) even as a first year NP I found no less than four MD's willing to "sign my charts" for anywhere from 5-10% of gross revenues (they wouldn't have signed my charts just been my collaborator per state law).  Thus, even in non IP states supervised practice is largely a fallacy since it is in essence a "fee" for service arrangement where the NP pays a fee and gets to "check off the box" so they can practice with little or no actual supervision.  Note, even for a job in New York State where I interviewed the Psychiatrist said we would "chat" for about an hour per month. The same was true in Mass and for a different job in Rhode Island.  

We all know this hence why it doesn’t make any diff really. I’m all for free market as long as the marketing is fair

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Specializes in ICU, trauma, neuro.
4 minutes ago, Tegridy said:

We all know this hence why it doesn’t make any diff really. I’m all for free market as long as the marketing is fair

Well, in Washington state where I practice IP I advertise CAM approaches and lifestyle interventions. One could not be much more outside the mainstream unless I started doing energy field manipulation or something. Probably, 70% of my clients balk when I even suggest an intervention that requires an RX.

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Specializes in Former NP now Internal medicine PGY-3.

? let me know if they need some OMM. I don’t really believe in it but maybe I will for the right price 

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Specializes in CRNA, Finally retired.
13 hours ago, myoglobin said:

We can argue studies all day. Bottom line NP IP is growing and is unlikely to slow let alone reverse.  Thus, we are winning and that is a good thing for NP's and probably also for patients.

Results: Although some questions remain, a review of the literature suggests that NPs can reduce wait times for the ED, lead to high patient satisfaction and provide a quality of care equal to that of a mid-grade resident. Cost, when compared with resident physicians, is higher; however, data comparing to the hiring additional medical professionals is lacking.  This quote is from the NIH study listed above.  I don't have any doubt that any NP with previous ER experience and a vigorous experience can perform well in the ER setting.  However, that is not the situation for new grads who don't have experience signing up for an online NP Program.  It sounds like (from what I read on AN) that some NP programs are tightening up but we still don't have consistent standards which would apply to ALL NP students.  One attribute of a profession is setting it's own educational standards and I don't believe we have met that criteria in a fashion that gives all NP's credibility.

 

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Specializes in ICU, trauma, neuro.

My assertion for NP quality equivalence is limited to primary care. I believe that the data (even for Psych where I practice) is limited and lacking overall. However, in any case without regard to the data IP practice (or de facto IP practice where the supervision is effectively paying a fee to an MD and maybe having a conversation once a month) is the effective rule in essentially every state.  Also, states like Washington where I practice have had IP for NP's for many, many years.  This train has left the station and even new higher standards are likely to "grandfather" in people who met the older, lower thresholds.  For example I know several NP's who have a Masters in "nursing education" (didn't have to take the three P's) but they took the boards back when they could (I believe until the late 1990's early 2000's) and they do not have to meet the new higher standards (having programs that require a certain number of clinical hours and the so called advanced 3 P's courses).  

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Specializes in Anesthesia, Pain, Emergency Medicine.
On 6/20/2020 at 5:14 AM, 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.

Nice insult. This is where the problem lays. Calling us "midlevel". 

 

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Specializes in psych/medical-surgical.
12 hours ago, nomadcrna said:

Nice insult. This is where the problem lays. Calling us "midlevel". 

 

Well to be fair, it's not just him. Many state statues and credentialing applications refer to us as "mid-level" including the DEA. I think it's just easier to separate the application processes. Instead of lumping us all under "provider."

But yeah, midlevel I don't really agree with... considering, we aren't. Nursing was not originally derived from the medical model. PA on the other hand falls under the medical model and there for with respect to MD would be "mid level" as they can not be independent.

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Specializes in Anesthesia, Pain, Emergency Medicine.
1 hour ago, DrCOVID said:

Well to be fair, it's not just him. Many state statues and credentialing applications refer to us as "mid-level" including the DEA. I think it's just easier to separate the application processes. Instead of lumping us all under "provider."

But yeah, midlevel I don't really agree with... considering, we aren't. Nursing was not originally derived from the medical model. PA on the other hand falls under the medical model and there for with respect to MD would be "mid level" as they can not be independent.

All the NP organizations came out literally YEARS ago against the term "midlevel"? I push back every time I hear it.

I don't agree that PAs are mid levels either. They do function independently, they just need xx number of chart reviews.

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Mid level provider, advanced practice provider, at the end of the day in most states you’re still forced to maintain a collaborator. People need to get over (moderator edit) about what they’re called.  Your title doesn’t define you.  The care you provide does. 

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Specializes in Psychiatry.

So a few points:

  • NP programs should have more clinical hours, definitely. You can never have too many.
  • Comparing PA programs to NP programs is apples and oranges because we SPECIALIZE. A PA may have 2000 hours to our 700 or so, but we do all 700 in our chosen population and they do everything. In the end we may have more hours in our given field than a new grad PA. Does a new graduate PA have more pediatric clinical hours than a new grad pediatric NP? Does a new PA have more psychiatric clinical experience than a new PMHNP? The answer in almost all cases is no. Even for an FNP, it's 600-700 hours in PRIMARY care, not specialties like surgery that won't lend as much knowledge about that subject. In reality, PAs have fewer clinical hours in the field they eventually end up practicing in compared to an NP trained for the same field specifically.
  • Lastly, PAs will never be independent because they were basically developed to be an NP counter who is required to be under the thumb of physicians. It was the physician answer to the threat of independent NP practice.
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