Will there be a huge turf war between PA and NP?

babyNP., APRN · Mar 7, 2018

I don't know the answer to your question, but I did read a disturbing account of someone who worked as a women's health NP and her place of employment has replaced their NPs with PAs because NPs were more expensive and in a nursing union. I was so shocked to see that at first... Since NPs are a smaller part of the workforce, I don't know what or if anything the nursing union did to support them.

This was in Boston and the place was a teaching facility, according to the poster.

Advanced Practice Columnist / Guide · Mar 7, 2018

The usual answer is there is room for both types of provider and I tend to agree with that based on my personal experience with the caveat that role bias toward one provider versus the other will always exist in some specialties and geographic locations. NP's claim that the existence of states with Full Practice Autonomy works to our advantage especially in securing primary care roles but some data actually show that the percentage of PA's in primary care are higher than NPs.

I think that what can work to our disadvantage overall is our larger number compared to PA's and the even larger number of routes to an NP career with some being perceived as too easy (i.e., for profit programs, distance learning routes). However, there are specific NP specialties with lower numbers overall such as NNP's and PMHNP's who fill a niche role where the market isn't saturated.

The Number of Nurse Practitioners and Physician Assistants Practicing Primary Care in the United States | Agency for Healthcare Research & Quality

FullGlass, BSN, MSN, NP · Mar 7, 2018

When looking for a job as a primary care NP, most of the job postings stated "NP or PA." In primary care, it appears FNP and PA are pretty interchangeable. In more remote areas in full practice authority states, an FNP would be preferred for primary care, as they can operate without physician supervision and many of these areas don't have physicians.

I agree that the PMHNP would be preferred for mental health care, as a PMHNP has much more mental health education and training than a PA.

Riburn3, BSN, MSN, APRN, NP · Mar 7, 2018

I think there is room for both in the market and Juan made some excellent points.

I also think state laws will play a huge role going forward and a lot will depend on how PA's position themselves and whether or not they start to lobby for independent practice.

I have a specific example of how state laws will impact both our fields going forward:

I work in New Mexico where NP's have full autonomy, and my job as a hospitalist is open only to NP's for that reason. PA's in New Mexico still require physician supervision. Our partner hospital 45 minutes down the road in Texas hires both NP's and PA's since both require a physician looking in on them. When one of the PA's from there tried to join us, he wasn't able to since none of the physician's wanted to take the responsibility.

The reality is in states that require supervision or collaboration with physicians, both NP's and PA's are usually seen as being the same thing in the eyes of physicians and employers, so there isn't a turf war. Until PA's start getting independent practice themselves, I doubt we see much of a change, and even if they do, I doubt hey change much and could even see more collaboration between NP's and PA's, not turf wars.

guest769224 · Mar 7, 2018

There is a big push from the PA profession to gain independence and they are gaining ground.

Riburn3, BSN, MSN, APRN, NP · Mar 7, 2018

There is a big push from the PA profession to gain independence and they are gaining ground.

As long as the data backs them up like it does us, more power to them.

I would imagine it might be a tougher uphill climb since the position is more closely aligned with physicians, and their title itself implies inferiority/subservience to a physician. I'm sure the physician lobby will argue even more strongly against PA's than they do NP's.

allnurses Guide · Mar 8, 2018

Having watched (and on the NP side been actively involved with legislation) independent practice evolve over the past decade I have come to consider a few very important points:

1. All providers (MD, DO, PA, NP along with PTs/OTs/DPMs/PharmDs/etc) should practice collaboratively. No provider in this day in age should be practicing without any collaboration. I fear sometimes when this issue is discussed that independent practice is pitted against collaborative practice, and that really is not the issue. The breadth and complexity of medicine requires collaboration with our colleagues and peers.

2. The "turf war" (though I hate to think of it in those terms because it need not be) is going to be fought on two distinct fronts: NPs vs physicians and physicians vs PAs.

3. This "turf war" is purely based on money. While both sides debate the patient care aspect of it, the entire thing is only an issue because of money.

4. This could be a mutually beneficial arrangement for everyone involved if both sides could let go of the control issue and focus on meaningful reform.

5. The "rules" of physician-mandated supervision are not followed by anyone; they are largely a farce.

Riburn3, BSN, MSN, APRN, NP · Mar 8, 2018

Perfect post Boston. I don't think there's a single person in healthcare that would argue against the importance of interdisciplinary collaboration.

Unfortunately, "physician collaboration" or "physician supervision" have become synonyms in the debate, which is a shame when they mean different things.

Oldmahubbard · Mar 8, 2018

I started a thread a few weeks back, asking NPs if they are fully in compliance with their collaborative or supervisory regs.

I got almost no replies. I can't imagine why!

People do not want to admit the truth.

Very few are really in compliance, and the regs are a big fat farce.

Jules A, MSN · Mar 8, 2018

I started a thread a few weeks back, asking NPs if they are fully in compliance with their collaborative or supervisory regs.
I got almost no replies. I can't imagine why!
People do not want to admit the truth.
Very few are really in compliance, and the regs are a big fat farce.

When our state required it the "collaborating" physician didn't even have to sign the form! I could have googled anyone's medical license number and submitted the form. There were no guidelines, required hours etc. Another instance of nursing taking the easy way out.

SopranoKris, MSN, RN, NP · Mar 11, 2018

Then you have a state like Michigan, where PAs actually have more authority than NPs. It's pretty dismal right now. PAs have their own DEA # and can prescribe without physician oversight (must still practice under supervision, though). NPs can't have a DEA # and can only prescribe non-schedule drugs independently. Everything else requires the physicians signature. NPs have to work under direct supervision (no collaborative agreement). NPs also are not recognized as providers and must bill their services under the supervising physician. This is why I want to locum tenens in other states after I get some experience as an NP.