From a civilian (non-medical) point of view, I don’t see any difference. Can anyone enlighten me on the differences in the two titles, training, privileges, etc.?
Just curious I guess.
From a civilian (non-medical) point of view, I don’t see any difference. Can anyone enlighten me on the differences in the two titles, training, privileges, etc.?
Just curious I guess.
PAs are required to work under the supervision of a doctor.
What does “supervision” mean? I have seen both NPs and PAs, neither with a doctor anywhere in sight.
As I understand it, an NP can work independently and specialize. We had an NP at the embassy in Uganda. There was a regional doctor in Kenya, but the NP worked on her own. From what I read, a PA has to have direct supervision somewhere on site (hospital, clinic, whatever). Their duties seem to be pretty much identical, but I think NPs have more latitude regarding having someone looking over their shoulders.
Hopefully, one of our medical folks will pop in and clarify things.
I gather that, in many cases, the “supervision” that a PA is subject to is largely nominal. In other words, the PA can pretty much do as they feel is most prudent and the supervising MD is there to make sure that the PA isn’t a complete fuckup, and, of course, to take the fall if the PA in fact turns out to be a complete fuckup and kills someone or something. Is this anywhere near the case? Does it vary a lot from jurisdiction to jurisdiction or MD to MD? E.g. some MD’s will mostly leave you alone except for a few nominal “review” sessions every few months, while other MD’s look over your shoulder every hour, demand justification for everything you do on the spot, in writing, with proper APA citations for everything, and still end up vetoing about a third of what you want to do. You were going to prescribe Amoxicillin for that sinus infection? NO! The MD wanders in suddenly and tells you Cipro or hit the road.
I thought about applying to a program for one or the other a few years ago so I went to an open house at Boston College where they have a NP program and someone asked this question. The head of the program hemmed and hawed badly someone else said that they didn’t understand and asked the question a few more times in different ways.
The best that they could answer was that nurse practitioners receive their training under the nursing teaching model and most students were other types of nurses before they become NP’s. Physicians Assistants receive their training under the pure medical teaching model (the same model that trains MD’s just not as intensely). The implied difference was that NP’s receive more training in holistic medicine, caring for the whole patient, bedside manner and other nursing type skills. Physicians Assistants are more like a primary care doctor lite that sees the patient as collection of parts and symptoms. I don’t know how true that is. It is my understanding that their actual job responsibilities are usually indistinguishable.
You may be wondering why there are two separate training programs for what becomes essentially the same job. It is my understanding that the Physicians Assistant model was created because many military medics wanted to stay in the same type of work as a civilian after they got out but most of them couldn’t just enroll in medical school. Rather than loose their valuable skills, they created the Physicians Assistant. Likewise, many nurses found that they wanted to practice more advanced and autonomous medicine than they were allowed to even as an RN. The Nurse Practitioner model was created to allow that career path.
However, you don’t have to be a military medic or even be a nurse to be accepted into either program. Anyone is free to apply as long as they meet the undergraduate prerequisites as well as a few requirements.
Meh. In my day, the term for “physician’s assistant” was “registered nurse”.
Harrumph.
Oh, and: What, no discussion of medical judgment versus nursing judgment, especially as regards nurses having prescriptive authority?
My regular doctor’s office is operated by two NPs, who have a PA that reports to them.
Go figure.
PAs and NPs can write prescriptions, diagnose patients and plan treatments. This is significantly more independence than an RN has.
PAs get board certified across all specialities and have to re certify every 6 years. They are dependent meaning they must have (nominal )supervision by an MD who does periodic chart checks and is ultimately responsible for any malpractice. MDs do not have to co-sign Rx or lab orders and in many states do not even have to be on site. PAs cannot own practices. NPs are independent but are specialists. They can own practices and have no supervision by an MD. However, a PA can switch fields (ER to Peds, for example) whereas an NP must stay within their certification (they get certified in a speciality, like on/gym or ER).
PA positions were originally designed for return army medics from Vietnam who had tons of field experience but little didactic training. The PA programs then made up for then classroom work and expanded their clinical skills. There is some movement to rename Physician Assistants to Physician Associate to better indicate the high degree (if not absolute) autonomy and breadth of training they have.
On/gym? OB/gyn. Stoopid autocorrect.
Do either PA’s or NP’s have a fast track route to MD? I know that there used to be (and maybe still is) a LPN to RN “fast track” program that allowed LPN nurses to “step up” to the more complex and challenging RN curriculum without going all the way back to Day 1 and doing all the intro courses all over again. Can PA or NP’s take advantage of something like this and graduate with an MD in less time than a straight-out of undergrad student with no clinical experience, or would they have to start with Day 1 of med school along with everyone else?
There are three-year fast track programs out there for PAs to get MD or DO degree.
This is not true in most states. I’m not sure it’s true in any states. In some, an MD has to review a certain percentage of the NPs charts weekly, biweekly or monthly. In some they have to be on the premises a certain percentage of the workweek, in some they have to see the patient within 2 weeks or 30 days of a major care plan change or new prescription made by the NP. Many states allow NPs prescribing authority for many drugs, but not controlled substances, so the NP has to have a supervising physician for those orders. NPs are most often covered under their supervising physician’s malpractice insurance, which is a big benefit to the NP, but also means they’re accountable and supervised by the MD. NPs are not generally *legally *independent, although that’s usually not visible to the patient.
I have to admit, in three years of working with NPs and PAs as an RN, I’ll be damned if I can tell you a real difference (other than regulatory ones) between NPs and PAs. Or, for that matter, between NPs, PAs and MDs, except for breadth of knowledge. Within their specialty, I couldn’t tell an NP or PA from an MD. I often don’t even know that the “doctor” I’m speaking with on the phone is an NP or PA until I ask them if the patient can get another Norco script, and it takes three rounds of phone tag to get it because they can’t do it themselves.
CNMs (Certified Nurse Midwives) excepted. They’re a special breed, bless their hearts. Outside of a hospital setting, it’s easy to spot the CNMs. Too often once they get in the hospital, though, they get just as bad as the MDs.
Here is a map showing NP supervision requirements. While you’re correct that I was generalizing for the purposes of this thread, (some states do require some supervision), a large number require none. And NPs as a whole are considered more independent than PAs. Where I used to teach these students (CT) it’s fully independent. NY, where I am now, it’s not.
Here it is: I knew NY just went independent. http://www.modernhealthcare.com/article/20140407/NEWS/304079964
http://www.aanp.org/legislation-regulation/state-legislation-regulation/state-practice-environment
Bolding mine. Disclaimer: I’m a doctor and not a nurse, but AFAIK, this is not true. One of the prerequisites for entry into a nurse practitioner training program is that one already be an RN. I’m open to being shown any counterexamples to this.
Also, physician assistants who advocate for increasing autonomy for PAs will be quick to correct you about their professional title: it’s Physician Assistant, not Physician**'s** Assistant.
One important distinction is that PAs and their scope of practice is regulated by state medical boards–in other words, doctors are ultimately in charge–while NPs fall under state nursing boards. So technically a state nursing board could declare tomorrow that independently performing brain surgery falls within the scope of nursing practice, and doctors would be powerless to do anything about it. Though state laws probably would not allow them to actually do it.
Nurse practitioner programs have in recent years exercised “degree inflation” and are trying to transition to a universal DNP (Doctor of Nursing Practice) degree instead of a masters-level degree. Also, nurse practitioner advocates will be quick to correct you on the use of the term “supervision.” The arrangements vary by state and some states may use that term, but the world of nursing is very sensitive to this idea of being seen as having doctors as their bosses. That is not what they want. In my own state, in order to practice, an NP has to sign what is called a “collaborative agreement” with a physician, but AFAIK there is no requirement that the MD review or sign a certain number of the NP’s charts nor that the NP discuss a certain number of cases with the MD.
In general, everyone wants a bigger piece of the doctors’ pie.
Ask and you shall receive.
Master’s entry option for non-nurses.
“The master’s entry route to entry prepares those with a baccalaureate degree or higher in non-nursing fields for advanced practice nursing.”
http://www.bc.edu/schools/son/programs/masters/masters-entry.html
UIC used to do this, although I see on their website that they’re in the middle of changing the program to require an RN before entry.
The way it worked up until this year was that a person with a Bachelor’s Degree in a non nursing field would enroll and take nursing classes and after the first year, sit for the NCLEX. They would then be an RN, but not have a degree in Nursing. They’d keep going seamlessly and 18 months or 2 years (I can’t recall) later would have their Master’s Degree and sit for their specialty exam to become an NP.
If a non-clinician wanted to become a NP as their career goal, what would be the typical path? Would they first go to “regular” nursing school to become an RN and then immediately apply to a NP school, or would they be expected to get some amount of experience as a “regular” RN first? There’s a lot of debate along these lines in other fields - some have observed that an MBA is much more valuable for people with several years of white-collar “Dilbert” life than it is for someone with “too much education, no experience”. And we know you can’t get a job without experience…
It’s interesting that it used to be very common to be allowed to practice medicine with just a bachelor’s degree!
Weird question. Could someone be both a PA and a NP and use both at the same time in order to do more with less supervision? Would they have to pick a “hat” to wear for each patient, or could they swap at will and effectively practice anything from either field at will? “Oops, the care I’ve been giving you has been mostly under my PA authorization, but I need to sign this prescription with my NP certificate number because I can’t prescribe that as a PA. One moment… Now, that physical therapy we were going to do is back in PA-land, so let me switch back <head jerks slightly>. There, now lie down, I am now a PA again.”