Why do some practices prefer PAs to NPs?

OllieW, DNP, PhD, NP · Apr 12, 2018

i think all the online for profit NP programs are weakening the quality of NPs entering the workforce. I have seen way too many horrible NPs recently...I am embarrassed for them...So maybe the overall quality of the PA program makes them a safer investment

cayenne06, MSN, CNM · Apr 12, 2018

i think all the online for profit NP programs are weakening the quality of NPs entering the workforce. I have seen way too many horrible NPs recently...I am embarrassed for them...So maybe the overall quality of the PA program makes them a safer investment

Agreed. I just had a new NP grad orient with me and i was...kinda shocked. She was let go during her orientation but i feel it cheapens our credential, that it is so easy to become an APRN. And its just as easy to get a DNP! Why are we lowering the bar so much?!

But on the flip side, an NP usually specializes from day 1 of their program, as opposed to the generalist model of PA education. So they may be more prepared right out of school. However i do wish APRNs had to generalize before entering the specialized portion of their training. I am *lost* outside of women's health. Which is annoying as heck.

Jules A, MSN · Apr 12, 2018

Three potential solutions I see:
1) NPs assume leadership roles, remind people we're highly trained, that we can all work together. Advocate.
2) Demonstrate we're highly trained every day. This involves getting the job first.
3) NP schools to quit it with the sub-par programs who take anyone with a pulse.

I feel the pain and agree with #3 but disagree with your references to being "highly trained". Really we aren't. Our minimal clinical hours, lack of RN experience and need for extensive orientation upon graduation doesn't leave anyone thinking we are highly trained.

guest769224 · Apr 12, 2018

Why are we lowering the bar so much?!

Because schools have realized APRN is a desirable profession and a lot of people are applying to become one. So requirements are far and few and admission is given to anybody. Basically, it's a huge cash grab for schools. Ultimately, in the future, it will be the profession's downfall, for not regulating admission.

Compare CRNA's. High barrier to entry, far fewer people admitted, employment prospects look excellent for this group. Similar story for MD's, because they control admission rates and it actually takes hard work to get into these two programs.

djmatte, ADN, MSN, RN, NP · Apr 13, 2018

Because schools have realized APRN is a desirable profession and a lot of people are applying to become one. So requirements are far and few and admission is given to anybody. Basically, it's a huge cash grab for schools. Ultimately, in the future, it will be the profession's downfall, for not regulating admission.
Compare CRNA's. High barrier to entry, far fewer people admitted, employment prospects look excellent for this group. Similar story for MD's, because they control admission rates and it actually takes hard work to get into these two programs.

I don't think CRNA is as desirable as one might hope. While there is a higher bar of entry, there are still a lot of people going through the programs. In my area hospitals are starting to no longer employ them straight up and turning to anesthesia groups to handle it. In the process, CRNAs are losing money and getting more limited opportunity for work. While many of them don't have the same criticisms of a low bar of every, they still worry about the glut of CRNAs going through school.

guest769224 · Apr 13, 2018

Many of the CRNA workforce are retiring in the near future. Salary and demand will remain high. However, you are correct that some local areas have more of a glut. Florida for example. Salaries for CRNAs have stagnated there.

But overall, a much healthier outlook (in my opinion) than that of NP's.

BlondieMSNRN · Apr 14, 2018

I feel the pain and agree with #3 but disagree with your references to being "highly trained". Really we aren't. Our minimal clinical hours, lack of RN experience and need for extensive orientation upon graduation doesn't leave anyone thinking we are highly trained.

Sorry: I meant we need better training and this dovetails w #3. We need much better training bc depending on the NPs I meet I am embarrassed to be one sometimes. . And if NPs are going to continue to tout that we have nursing experience as if that's a positive we better actually HAVE IT.

Dodongo, APRN, NP · Apr 15, 2018

I think (opinion) that we as NPs need to take control of the educational pathway of our profession and strengthen and secure it. We are at an all time low here. 1. Very few programs require RN experience - and yet any time independence is addressed we love citing that RN experience. I was just watching a debate in Georgia for NP independence and the NPs looooooved throwing that out there. "Most RNs build on their nursing experience... blah blah". NPs lost that fight BTW. And it was embarrassing to watch. The MDs that spoke tore NP education to shreds - and it was easy for them.

2. Very, very few programs require an appropriate amount of clinical time. 500-800 hours is the average from what I've seen.

3. Do we want programs that are 100% online - no campus time required?

4. No interviews prior to acceptance.

When there are 3 provider level pathways, do we really want to be the quickest/easiest? These poorly executed, tenuous, biased "research" articles that NPs used to show that NPs are trained well are garbage.

LCC6133 · Apr 27, 2018

The hospital I work uses PA's more than NP's in the ED. As for the other areas, NP's far out number PA's. The majority are women in both cases.

blixkanaan, MSN, APRN · Jun 25, 2018

I believe we do get trained well (assuming you go to a brick and mortar school & have strong RN experience; and BSN or bachelors in other related field). I would also like to point out that as independent practitioners, I dont necessarily agree that we should be trained as generalist. I think it makes sense for PAs because they are supervised in every area. But for NPs, I dont believe that would work, or be appropriate. It should be noted that NPs focus on specific populations and for us to formally specialize actually requires way more formal education than that of a PA. Like for me, as an FNP, to be able to practice in the specialties of psych and/or neonatology, I would need an additional 1 year + of formal education and clinical rotations, and then would need to take a separate board in each of those disciplines to be certified. PAs don't have that much stringency with switching specialties, and maybe they should, if they want to be independent practioners, like many are fighting for. NP education is more focused (i.e., on specific populations, not specialty areas), and I think it should remain that way, because we are independent practitioners in nearly half the country. You cant possibly learn all specialties of medicine in 2 years, and be proficient in all areas. Look, PAs do cover a lot of material in each specialty, but everything they do cover is in just 2 years and in 2000 hours of clinical rotations. Also, PA candidates have more variablitly regarding prior medical or healthcare experience. Some were experienced paramedics while others were maybe home health aids...While I do agree with all of you that we need better controls in our education, realize that still, the vast majority of NPs are highly skilled, experienced, and qualified. Our training is not just 2 years. It starts from day 1 with RN school and extends through that 6th or 7th year when you graduate NP school.

I would also ask (and I'm sincerely wondering), how can we make our voices heard and demand for higher acceptance standards for our NP programs? It's one thing to complain about it. But what can we actually do to fix it?

FullGlass, BSN, MSN, NP · Jun 28, 2018

Preference for PA vs NP is based on the hiring managers' experiences and provider availability. I worked with an MD who only wanted to hire NPs because he was "burned" by a few PAs. The primary care system I work doesn't have a preference, but employs almost all NPs because we haven't been able to recruit PAs for some reason. The nursing emphasis on the whole person vs the allopathic model is also a factor. Many of my patients are poor and appreciate that I will do a lot to find them the least expensive meds, print out information for them, etc. Most of the MDs in the clinic are just focused on the patient's illness.