could use some advice

You can do ANYTHING as an FNP. An FNP is like a general practitioner. The other specialties are what are limited. You also can work in OB as an FNP, you simply cannot deliver babies. (In fact, I work in a family practice that sees OB patients at this very moment). However, I do not think that PAs can deliver babies either unless they are a midwife also. Now it is true that you won't get as much training in any particular specialty as you would if you were in a program that was for a particular specialty. For instance, you will get peds training and will be certified to work with peds as an FNP, but a PNP will, of course, have more training than an FNP in pediatrics. When you graduate, however, you will legally be able to see any child that a PNP will see. It sounds like FNP would be the best choice for you since you do not have a specific area that you are passionate about (at this point). The only people that I would recommend a specialty area to are those that KNOW that they ONLY want to work in women's health or peds. Remember, the FNP programs are longer than the specialty programs are. Hope this helps!

Thanks for your reply. It is reassuring, and it makes sense for me to choose something that will allow me to decide after I've had more experience exactly which area to work in.

I guess it's just hard because all of the options in front of me have pros and cons, but I won't know for sure until I'm in school and/or working if I definitely made the right choice.

pas do deliver babies and there is also a post-grad residency for ob/gyn pas that specifically trains in deliveies/intra-partum care. good luck on your decision.

arrowhead ob/gyn pa residency program

arrowhead regional medical center

dept. of women's health

400 n. pepper ave. colton, ca. 92324

colton, ca 92324

program director: christine sims, pa-c, mms

[email protected]

909-580-6320

length of program12 monthsclass size4-6application deadlinejune 1 (flexibility permitted)interviews:june through august (flexibility permitted)starting date:august 1st, october 1st, january 1st

program description:

this is a 12-month full-time postgraduate residency program offering intensive training in inpatient and outpatient obstetrics and gynecology. the program is housed at arrowhead regional medical center which is one of southern california¹s premier teaching hospitals with 373 beds, approximately 3,600 obstetrical deliveries per year, and more than 30,000 visit encounters to the hospital¹s outpatient women¹s health center annually. the pa residents are trained along with the ob/gyn physician residents, working 70-80 hours per week, and are exposed to the management of complicated and non-complicated antepartum, intrapartum, postpartum, postoperative, acutely ill, and well ob and gyn patients. upon completion of this residency, the pa should be competent in performing lady partsl deliveries, 1st assisting in cesarean deliveries and gynecological surgeries, and performing colposcopies and other common gynecological procedures.

curriculum:

the didactic portion consists of daily morning rounds, biweekly lectures by attending physicians, monthly journal clubs, morbidity and mortality conferences, assigned readings, and self-directed learning. the clinical portion consists of training and experience in labor and delivery, obstetrical ultrasound, l&d triage, er consults, or assisting, and the management of high and low risk obstetrical and gynecological patients.

costs/benefits:

there is no fee or tuition for the program. benefits include a stipend, malpractice insurance, medical insurance, 15 days vacation, and 50 hours of category i cme. housing and the initial on-site interview expense are the responsibility of the resident.

credentials awarded:

upon graduation from the residency, the physician assistant receives a certificate of completion of a postgraduate ob/gyn residency from arrowhead regional medical center. an option to obtain a master of science in health sciences-health professions education concomitantly at western university of health sciences is available, but admissions, tuition, and coursework are independent from the ob/gyn pa residency (for more information, please call 909-469-5540).

applicant qualifications:

graduate from arc-pa accredited physician assistant program

california state licensure or eligible for california state licensure

nccpa certification

admission requirements:

completed application

curriculum vitae

personal statement

three letters of recommendation

national certifying examination scores

copy of pa program diploma/certificate

copy of pa education transcript

copy of current cpr certification

copy of california state licensure

on-site interview

for more information and an application packet, please contact:

jasmine cervenka, dept. of women's health

400 n. pepper ave.

colton, ca 92324

909-580-6320

[email protected]

Also, here is the link to the organization for PAs in OB/GYN.

http://www.paobgyn.org/faq.html#babies

also understand that many places who have both NPs and PAs assign them the same responsibilities and group them together, such as this one.

https://www.urmc.edu/obgyn/residency/womensHealth.aspx

this is the society for PAs in pediatrics.

http://www.aapa.org/spec/SPAP/

and an issue brief.

http://www.aapa.org/gandp/issuebrief/pediatrics.pdf

once again, good luck and PM me for any further info if you'd like. The good thing about your situation is there is essentially no wrong choice. they are all great careers.

And - if you can't FIND a job - there is always the possiblitly of CREATING one.

Surely some doctor in your area would like to partner up and make some money!

Thanks for the encouraging replies. They're just what I needed; I'm feeling more excited than anxious about my career change again now.

Cladje - thanks for those links. I'm going to look into what the PA role in OB looks like more I think. I like that PAs have access to formalized residency training.

Does anyone know if there are programs like that for new NPs?

I talked to a public health nurse I work with yesterday, and she knows some of the professors in the nursing school here and will put me in touch with them so I can find out more detail about the masters entry program. This will help a lot. I guess I'll be weighing my options for awhile still, but it is true that they're all good options. :)

There are a few midwife/FNP programs out there. I know that Vanderbilt does (in Nashville) and I know that the Frontier Nursing School in Kentucky does also. I know about these programs because they are both close to where I went to school in Knoxville, TN. I think that they are usually geared toward NPs that practice out in the middle of nowhere- like where that particular NP is the only (healthcare) game in town. If the NP school where you live does not offer a midwife program, then you can just go to a midwife program at another school after finishing your FNP. When you get another specialty after getting your NP, it does not take as long as getting the inital NP degree. Also, I wanted you to think about some things, and I don't mean to rain on your parade. I just wanted you to think about things from a different perspective....

If you are seriously considering getting into a situation where you deliver babies, either as a PA or as an NP, you need to realize some things. It all sounds very neat when you think about it in theory, but there are some serous downsides to delivering. For one, your malpractice insurance is considerably higher. The practice you work for may take care of this for you, but sometimes they don't. It would be good to get in contact with an insurance company and see what the difference is. Also, remember that the number one reason for a malpractice lawsuit in this country is because of a 'bad baby'. Getting sued would be a real risk for you everyday. It sounds like you have small children and a family. Is that a risk that you and your family can deal with? Don't get me wrong, it may be worth it, if delivering babies is really your passion, but it is still something I would think about. I used to work in wound care (which is also a lawsuit-happy field). This may sound weird, but I always really loved wounds- I really loved helping them heal, etc. I wasn't prepared for the non-compliance of patients in this field and that their non-compliance could result in an amputated limb. Even if I knew that I did everything right, it was still enough of a risk of getting sued that I had trouble sleeping at night. As much as I liked the field, I left it because I just wasn't willing to live under that cloud. Now, I am an overly anxious person, and I know that about myself. You may not be. I just wanted you to think about that.

The other thing is that you need to find out about practice laws of both NPs and PAs in your state. Are they both allowed to write prescriptions? Are they both allowed to practice when an MD is not on site? What are the limitations? This can make a big difference. Also, when you look up jobs in the paper-who has more jobs advertised-NPs or PAs? That is probably the most important thing to consider. The point of going back to school is to get a better paying job in both the geographical area and the specialty area that you want to get it. Anyway, hope this helps. If you have any more questions I would be happy to hlep you.

Yes, those are some very good points. I do have quite a bit of concern about the liability one takes on when delivering babies. It's a little awkward for me to even say it, but my father is a medical malpractice lawyer who has prosecuted plenty of OB/GYNs and midwives. He held his tounge for the most part about my using a midwife and having a birth center birth, but I know it bothered him. I think my becoming a midwife would be a big issue. My sister is on her way to becoming an OB/GYN, so we've been talking about the malpractice insurance costs, but I suppose neither one of us can really imagine what the personal and professional costs of defending a lawsuit would be. It is a complicating factor and adds to my feeling that it is probably best that I get a good broad base of training and experience before I decide if delivering babies in any capacity is something I want to pursue.

As for the PA vs. NP part, it seems that both have generous practice laws in the states I'd like to live in. NPs do have more options for independent practice, but I can't predict with any certainty if I'd ever want to excercise that option. I think that I will likely choose to do the FNP program at my local university because it fits in very well with other aspects of my life. My reservations have been/are about whether the coursework and # of clinical hours will be sufficient to prepare me to practice competently soon after finishing school. I'm realizing though that I've been wanting to rely on a degree or program to make me a good clinician. I can't do that. I have to use whatever education I am getting to my full advantage but also recognize that it will be my effort, dedication, and gathering of experience that will develop me into a good clinician. I am confident that I'll get there - I've been a very good clinician in my current field - and I could take it slow and stretch out the time I'm in my NP program so that I can work more hours as an RN if that will help me be ready for work after school. Also, it occurred to me that if after my pre-licensure year rotations, I feel certain that there is a specialty that I want to concentrate my schooling in, I could stop, work as an RN in that area for a couple years, and then move to a specialty NP program.

Thanks for the input on my situation; it is helping me think through all the implications of my different options. Life has certainly gotten more complicated. I don't think this decision would have been easy when I was fresh out of college either, but as my husband said, at that point, everything we owned fit in a small truck, we had no pets (not to mention no child), we had no mortgage, we were still on our parents' health insurance plans, and we were ready for adventure. I still want adventure, but now there's more to lose if things don't go as planned.

i didnt realize you are already an RN. You should look into stanford's and UC Davis' PA programs. After you graduate from the you can also take the FNP boards. PA training, NP politics. Its a good deal.

caldje- no, I'm not already an RN. If I do a masters entry NP program, I'll be an RN after the first year of training and then could do the rest of the program more slowly so that I could work part-time as an RN to gain experience before graduation. I'm looking at that as a way to balance the relatively small number of clinical hours required to graduate.

oops, double post.