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.

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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

9 minutes ago, MentalKlarity said:

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.

Considering the first PA program was established in 1965 and the first NP Program was announced in 1967 clearly the PA profession was a response to the Original NP Program that would be established in 2 years. The rest of your information is equally valid. 

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Specializes in Anesthesia, Pain, Emergency Medicine.

 

In 1965, one of these leaders, Loretta Ford, partnered with a physician, Henry Silver, to create the very first training program for Nurse Practitioners. Their program, offered at the University of Colorado, focused on family health, disease prevention, and the promotion of health.

If you include CRNAs then it was 1909. ?

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3 minutes ago, core0 said:

Considering the first PA program was established in 1965 and the first NP Program was announced in 1967 clearly the PA profession was a response to the Original NP Program that would be established in 2 years. The rest of your information is equally valid. 

Probably debatable dates. First NP Program is said to have been conceived in 1965 as well. In league with a physician no less. Could probably argue nurses were doing similar roles by nature of their license even before official programs were chartered where PAs weren’t even a part of the healthcare equation. 

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Specializes in CRNA, Finally retired.

If people don't want to be called midlevel....go to medical school.  In educational prequirements, are are MID level.  I take no offense to it because I was paid very well and given a lot of discretion and respect from surgeons, etc.  

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Specializes in Anesthesia, Pain, Emergency Medicine.
Just now, subee said:

If people don't want to be called midlevel....go to medical school.  In educational prequirements, are are MID level.  I take no offense to it because I was paid very well and given a lot of discretion and respect from surgeons, etc.  

I have no words. We a truly our own worst enemy. You realize that the AANA has also come out with a statement about how derogatory the term mid level is?
I'm sorry your program was subpar but mine and many others were not.

I'm sorry you felt you practiced beneath or less than physicians. I and many others practice at the same level and are judged at the same level.

I'm sorry your care was "mid level" and less than our physician counterparts.

I'm sorry you feel RNs are low level. I feel they are part of the team and bring knowledge and perspective that may differer from mine.

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Specializes in DHSc, PA-C.
13 hours ago, MentalKlarity said:

So a few points:

  • 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.

PAs have independent practice in North Dakota and fairly close to it in Michigan (no supervision/delegation by a physician, defined as independent prescribers, require a participating physician agreement).....more to come over the next 1-2 years.  A couple states eliminated supervision requirements, temporarily, for COVID.  

"developed to be an NP counter"??? What is an NP counter? 

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Specializes in Anesthesia, Pain, Emergency Medicine.
Just now, DizzyJ DHSc PA-C said:

PAs have independent practice in North Dakota and fairly close to it in Michigan (no supervision/delegation by a physician, defined as independent prescribers, require a participating physician agreement).....more to come over the next 1-2 years.  A couple states eliminated supervision requirements, temporarily, for COVID.  

"developed to be an NP counter"??? What is an NP counter? 

Agreed.
No reason for PAs to not have independent practice as well.
We need to get over the NP vs PA crap. There is no functional difference. I've found the FP physicians, NPs and PAs are pretty much interchangeable for the most part. It's not the initials but the person.

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Specializes in CRNA, Finally retired.
10 minutes ago, nomadcrna said:

I have no words. We a truly our own worst enemy. You realize that the AANA has also come out with a statement about how derogatory the term mid level is?
I'm sorry your program was subpar but mine and many others were not.

I'm sorry you felt you practiced beneath or less than physicians. I and many others practice at the same level and are judged at the same level.

I'm sorry your care was "mid level" and less than our physician counterparts.

I'm sorry you feel RNs are low level. I feel they are part of the team and bring knowledge and perspective that may differer from mine.

Your ego is interferening with your judgement?  When did I call RN's low-level.  I just explained that mid-level is an educational term...not a functional term.  The AANA might better spend it's time on requireing anesthesia instruction to actually come from the school's instructors and not to people who actually don't have any expertise of interest in teaching.

The students pay a HUGE tuition fee (I went to an ivy and paid the same as the med students) but my instructors followed me through the whole program.  That is what I was paying for - not to be farmed out to a department in another institution that wasn't there for the student's interest.  We have much larger issues that being "offended" at being called midlevel.  In educational terms, it's just what we ARE.  I had to work alone right out of school so I know what it took for my mentors to get me ready for a central line and spinals by myself from the getgo.  My value was dictated by the quality of my work.  But hey, in those days the term mid-level wasn't even formed on anyone's lips now.  I don't really care what the AANA thinks since they think it's OK to farm students out far from instructors.

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Specializes in Anesthesia, Pain, Emergency Medicine.

Your comments are telling.
You "HAD to work alone out of school"?
You were graduated without knowing how to do central lines and spinals? Seriously?
A spinal is such a basic part of our practice that I fail to see how your program to fail you so hard.
I assume you also did not do PNBs as well.
Your retort is pretty much word salad. It makes little sense.

My "ego" has nothing to do with my post. My anesthesia care is absolutely no different than an MD anesthesiologist.
My ER care of patients is no different than an FP physician. In fact, I find it much better due to also being a Nurse Anesthesiologist (CRNA).

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Specializes in CRNA, Finally retired.
18 hours ago, nomadcrna said:

Your comments are telling.
You "HAD to work alone out of school"?
You were graduated without knowing how to do central lines and spinals? Seriously?
A spinal is such a basic part of our practice that I fail to see how your program to fail you so hard.
I assume you also did not do PNBs as well.
Your retort is pretty much word salad. It makes little sense.

My "ego" has nothing to do with my post. My anesthesia care is absolutely no different than an MD anesthesiologist.
My ER care of patients is no different than an FP physician. In fact, I find it much better due to also being a Nurse Anesthesiologist (CRNA).

I do not see students doing their own spinals nor central lines in the students that come to the inpatient facility where I worked.  They are very unprepared for working independently and prefer to work in the "team" model.  No your care isn't any different ( I like to think that we have to be better:) but your education isn't medical school, internship and residency.   It just isn't.  Do I believe that we are better educated in anesthesia than MDA's.  Ours is more anesthesia focused but I don't see students doing pain medicine rotations (they aren't even allowed to do their own spinals), intensive care rotations, etc.  Our educations are theoretically good enough to do the large majority of cases in this country but I'm just not seeing students getting the SAME educational intensity in clinical sites.  If the students from my institution are getting out into the world with what we provided them, then the AANA is not fulfilling their function.  Try to convince the entities that don't pay us that we are interchangeable with doctors and they will always come back to we aren't doctors.  I know that we ARE interchangeable (for the large majority) but we haven't convinced the payors that we are interchangeable.  The way the system is set up may be disgraceful and wasteful but I've been around for four and a half decades and we are still fighting the same old battles we were in 1982.   BTW, you are missing my point in my last post and I know this should have started my message.  I thought I was making it clear that I WAS prepared to work on my own because of my university fulfilling it's obligation to me to give me the best education...I was paying for the best and I got it.  I just don't think students are getting what they are paying for anymore.   

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Specializes in Anesthesia, Pain, Emergency Medicine.

You can't graduate unless you have the minimum spinals, epidurals and central lines.
You are way wrong assuming physician education is somehow better, it's not.
In any case, I'm done with you. Hopefully readers will see through your blather.

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Specializes in CRNA, Finally retired.
15 hours ago, nomadcrna said:

You can't graduate unless you have the minimum spinals, epidurals and central lines.
You are way wrong assuming physician education is somehow better, it's not.
In any case, I'm done with you. Hopefully readers will see through your blather.

 

 

Saying that students are competent to work alone after doing the "minimum" standards is blather.  If what I see in my institution is common, then we are not giving students the skill sets they need.  I know my old program is just cranking them out to work in the ACT model.  We are in a wealthy part of the country where anesthesiologists are tripping over themselves and the salary between an experienced CRNA and a jr. level MDA aren't very different.   Those MDA's keep a tight rein over the students and aren't interested in helping them develop to work independently.  It's a problem.  There are no instructors from the university onsite in the hospital.  That's a problem.  We even had a student who was working in a room with an MDA and that doc left the room.  And then the student left the room and went out in the hallway to find help.  Neither party suffered more than a slight violence of the tongue.

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