Comments on: The Difference Between a Nurse Practitioner (NP) and a Physician Assistant (PA)

By: Blake

Blake — Wed, 11 Jan 2012 20:23:20 +0000

Dan, respectfully, im not sure where you get your information. my clinical requirement from my NP program was 1000 hrs. You are also not mentioning the 4 years of nursing school and clinical training before i ever stepped into NP school. Not mentioning other training gained in nursing pracitice such as “CEN, ACLS, TNCC, ATLS, PALS,ITLS, BLS, PEPP,and last but not least CCRN”, all achieved prior to advanced practice training and actually used in pt care situations. My graduate program also required at least 1 year of critical care experience prior to admission and was a 3 year program. 7 years of school and 1 year of critical care minimum, and you say that a buisness degree and 2 years of school is better training? your comments appear to be enclusive at times but are clearly inflammatory in nature. PA’s are well trained and i love working side by side with them and the MD, i choose not to degrade any of them. however…..i think that this discussion may be better served by those of us who acutally touch patients. i would never attempt to determine how well a pharmacist counts pills because i am not a pharmacist.

By: dan

dan — Mon, 02 Jan 2012 22:12:44 +0000

I have read the entire thread. There is a level of truth in most of the comments posted. A quick glance at the comments and you can quickly pick up on the bias view. The facts are the facts. And I will point them out. I have an association with both groups and well informed about intent, practice parameters for both. First thing to understand, the nursing board is independent, it is as easy for the board to declare medical independence as it is for it to declare nurse practioners as rockets scientist. The meaning of this there is no check and balance with respect the credential they pass out. And although some PAs have private practice via hiring a physician part time to collaborate with, the fact is on paper NPs are the independent practioner of the two under the law… In the real world, all hospital treat mid-level care practioners equally, that is regardless of the groups the doctor is the final check off.. As for education, facts are the facts… the didactics associated with diagnosis and treatment it is clear, PAs has much more class room and clinical rotation time. Just for a quick illustration, the guidelines for NP education dictates 700 clinical hours which may be done sparingly, 700 clinical hours amounts to ~ about little than 3months of rotation. Looking at PA training, each rotation is about 2months long. The real, true on average coming right out of school a PA will be better informed then a NP but that edge quickly disappear within the first two years of working… Intent, both groups want to be independent, which is concerning as a healthcare consumer. One comment said, they will be the new primary care providers, really? Truth is neither profession rise to the level of training and education necessary to be completely independent. Whether PAs change the name to physician associates, or whether NPs, add another credential to the same thing they’ve been doing (DNP), none of it can make up for the standard set for medical practice. The good, both are highly skilled profession with a lot to offer the medical community. My suggestion dont do either if you believe its a short cut to acting like a doctor. In the end, when push come to shove, there will be signs notifying patient to specify whether you want to be treated by a medical doctor, MD, a nurse practioner, who practice medicine in a nursing model, or Physician assistant… It goes that route you will be looking for a job. Ironic enough PAs and NPs I have talked to, refuse to see anyone other than a the medical doctor do you think the rest of the public will feel differently..? Im a pharmacist so it doesnt matter to me. What i see, is that, NPs are ever trying to be viewed like doctors, and you think its a good move, but it will end up biting you in the future when push come to shove… If you want to be a doctor go do it, if you want to be a mid level care do it.. , but whatever you do stay in your lane. We all in healthcare, so no need for PAs n NPs to bicker about 1st, 2nd, or 3rd place… The ultimate choice rest with the patient. If you’re a patient what would you choose.

By: Oksana

Oksana — Sat, 31 Dec 2011 20:05:51 +0000

one more point:
On a federal level, Medicare allows PAs to get their own NPIs, however, their practice act stipulates that payment for PA services “shall be made to his or her employer….” This is because PAs are “supervised” by physicians, versus the collaborative agreement that NPs have with physicians.
With Nurse-Midwives becoming independent practitioners and not requiring collaborative agreements anymore, it is possible that the entire NP profession will acquire the same independence soon. Independent practice, anybody? What is your American Dream?

By: Oksana

Oksana — Sat, 31 Dec 2011 14:12:28 +0000

Very interesting points made by the proponents of both professions. I am an Adult NP, certified by AANP. As an RN I was able to specialize in the areas of nurisng/medicine I was mostly interested in: med-surg, oncology, wound/ostomy care. My clinical experiences during both Master’s and post-Master’s education gave me an opportunity to become clinically solid and practice with healthy confidence after graduation as an NP (BTW, I’ve had over 2000 clinical hours combined by the end of NP education – it’s required to be certified). My preceptors were both MDs and NPs – they were all fantastic! As in any profession, you must have the drive and the ambition to become the best, and to continue to grow. Medical field is highly competetive; if you want to be a practitioner that can truly collaborate with an MD – you need the ambition. That said, the surgeon I currently work with, specifically was looking for an NP, “because of the nursing background and the educational background”. Other than surgical mandatory module, the NP education is not really that different didactically from the PAs’. I see the benefit of a “Nightingale factor” though – nursing tought me to see the whole person, not just a system/organ – the PERSON, family included. Believe me, it makes a measurable difference. Nursing takes the WHO definition of “health” in hand and goes to work
As far as the practical side of things. There is no significant difference in the salary or the hours – depends on the setting. as an NP w/hospital privileges, I can admit and discharge patients; PAs cannot.
there are 2 certifying bodies for NPs; each has somewhat different requirements: mandatory CMEs +/- professional development (teaching, etc.), OR you can get re-certified every 5 years.
Master’s degree is not mandatory for entry into practice for PAs, unlike for NPs. However, both professions are facing the potential higher requirements for entry into practice.
I think, both professions are great, and can be a good fit for a specific individual.

By: Scott

Scott — Wed, 21 Dec 2011 07:34:31 +0000

I hate to be a jerk but I see an abdundance of comments related to pay. If you folks are overly concerned with that then the healthcare industry is not for you. I work with both PA’s and NP’s and the overwhelming complaint is about money and hours when compared to their physician counterparts. I’ve worked in family medicine, urgent care and ER. These were all physician driven practices and believe me when I tell you the doc’s are just happy to have the help. Most now days couldn’t give a rat’s ass what you are as long as you don’t kill somebody or piss off the staff. For those of you just coming out of college with a science related degree or nursing please volunteer somewhere for a year or so in the third world. You will have a completely different outlook when you return. If you still want to be a NP or PA after that GO FOR IT! You’ll be a much better clinician….

By: rebecca

rebecca — Sat, 03 Dec 2011 00:02:28 +0000

‘ Don’t forget to mention that by 2015 those going to be NP’s will have to get their DNP and not just MSN’

This is a FAQ from the AACN website:

16) Does implementation of the DNP mean advanced practice nurses will no longer be permitted to practice without a doctorate?

No, nurses with master’s degrees will continue to practice in their current capacities. Recommendations are included in the Roadmap Task Force report on how to facilitate rapid transition to the DNP for master’s-level nurses seeking this credential.

By: Tman

Tman — Thu, 01 Dec 2011 01:35:04 +0000

A few question, Would you want to see someone trained by nurses in the nursing model or someone trained by MDs? Wouldn’t you want to see someone that has gone through training side by side with residents, fellows, and med students? Would you want to see someone who does not have to take a national board exam to make sure they are competent? Would you want to see someone who does not have to take their board exam every 6 years? The Answer is Clear. PERIOD. SEE YOUR PA….

By: Sean H

Sean H — Wed, 30 Nov 2011 19:06:39 +0000

A very brief “side-by-side” view of federal laws governing compliance for PAs and APNs, now together known as Non-Physician Providers (NPPs), can be seen here:
https://www.cms.gov/mlnproducts/70_apnpa.asp
See the PDF “Medicare information…”
Even here the list is not quite complete, but relatively simple and correct.
It will reveal they are equivalent from a billing standoint as far as the governement is concerned. Where the gov’t goes, often private insurance will follow.
Regarding differences from a PA perspective:
1) Education – Yes APN’s need a nursing degree, then a master’s degree and with further degree inflation, a doctoral degree. Yes they have a national board and specialize earlier. There are very few PA schools that still offer a certificate or even BS any longer. >80% are now Master’s programs requiring a BS first. Does not have to be science, but surely helps and you will need the grades, prerequisites and prior medical experience. I was a military EMT. A classmate of mine was a band major with years of experience as a CNA, go figure. Degree inflation in time will likely require a doctoral as well, as PTs have moved there too. There is a national board with every 6 year recert. PA education is focused mainly as a generalist for primary care setting, but does follow a medical block-training model with courses taught by MD’s or PA’s. Some lectures are the same lecture provided to medical students, only condensed. I’m sure NP training is rigorous. Only look at the website for various schools and you can see coursework for either. I would not discount a nursing backround, but experience and maturity on both parts helps. PAs historically are older and do have prior medical experience of some sort.
2) Work – all will take time to be proficient and feel secure enough to act independent. As stated, it would be dangerous if you though otherwise. I cannot speak to how independently NPs act in the outpatient setting. In the inpatient setting, PAs and NPs are often indistinguishable. They work side by side in pulmonary, cardiac, ICU and ER settings, among others. It is rare to see NPs in the OR, though. All charts are being cosigned by supervision/collaborating docs, regardless of state laws, as far as I can tell, and I’ve worked in two states. This is because hospital credentialing and privileging requirements mandate this due to our litigious society. And with electronic records, it is automatic that charts are cosigned. Neither NPs nor PAs need scripts cosigned by their doctor. In the outpatient setting, I know PAs that are functionally independent. The doc is not coming in to see patients with them. They may cosign charts, but it is a percentage and usually only if prescriptions were provided. It varies state by state and doc to doc, and laws change for all as both professions seek more “autonomy.” In a primary care setting, be it family medicine or emergency medicine, oversight will likely not be great. There are varying degress of oversight in the hospital. I have yet to see an APN function independently in the hospital.
3) Specialty- This will vary as stated numerous times. APNs tend to focus on women’s/children’s/family practices. But I see them in many specialties around the hospital. They are rare to see in the OR, but some do. Not to say they haven’t worked as an OR nurse. I have seen some going to surgical assist courses to compensate. CRNAs of course are OR oriented by training.
PAs work in women’s/ped’s/family practices. I have seen them in every specialty in the hospital I can think of, including morgue. They are utilized well in the OR, with didactic and surgical rotations as part of their training. I cannot speak to APN OR training.

4)Licensing – For PAs, you are not limited to your state. If you wish to change, you need to apply for a license for that state. You do not need to retake the national board, unless the state has a board exam, and some do. I imagine APNs have at a minimum to reapply for a license as well.

5) Compensation – Pay for both will likely vary greatly by specialty. Last APAA census data showed mean salary for PAs at 90K. I know PAs that have made >150K, depends on call schedule and this would be a surgery specialty. CRNAs are making this, and have an excellent lifestyle. New grad in primary care, there is census data for all of these, but among PAs/APNs is likely not too dissimilar and is at the lower end of the pay scale. Higher for experience and production pay.

6) Travel – many foreign gov’ts do not recognize PAs or APNs, so for NGOs, PAs have a difficult time and APNs function in a RN capacity, from what I’ve seen/read. I’m sure exceptions exist. US gov’t organizations do, and both can work oversees as a US gov’t employee. For PAs, they do legally work in Canada, UK and Australia, Guam/Phillipines. There may be others. APNs likely have some legal status in other countires too.

7)Demographic – Both are majority women and white at this point, variants among specialty.

8)Which to decide – Both are respected fields, both should be proud and both are in demand. As stated, look at your state. Some are more bent toward APNs and some PAs. Laws are more and more making them quite indistinguishable Specialties look to both in many applications, or if you apply when they seek one, they will likely consider you if the experience is there. As I said, reimbursement is the same. I think both are great and have equal respect for my APN collegues. If I could do it over again…I might look into a CRNA. It means more schooling/money, but I personally think the return is worth the investment.

Surely missed some things, but you get the idea.

Good luck.

By: Linda

Linda — Wed, 16 Nov 2011 04:04:31 +0000

If you’re talking about income, the median income for PA’s is 89,40 and for NP’s is 90,121. PA usually start out 10K higher than NP’s but money wise it ends up being the same. It’s really about what and how you want to practice. NP’s will be the new general practice doctors. PA’s are more likely to assist Dr’s in cardiology, oncology or some other speciality. NP’s have specialities to but they tend to be more in the line of women’s health, pediatics and family practice. Most people that opt for NP I think do so because they want to be able to practice on there own and being nurses to begin with feel more connected to with their patients. It is true PA’s can take a test and be admitted without a medical background. A friend recieved 1000 hrs clinical credit toward admission for being a massage therapist. But the escelerated PA 2 yr program was rigiorous. A nurse that has completed a four year program and graduate school has a lot to offer. They have years of clinicals and patient experience. You can’t do either of these without working hard and being smart. NP’s can practice on there own. PA’s have to work under a doctor. It’s what’s best for you.

By: Steph

Steph — Mon, 31 Oct 2011 20:56:50 +0000

You could major in communications if you wanted to, as long as your prerequisites are taken care of. Just be prepared to tell the admissions people how that will help you in medicine. Also, be sure to have great grades and rock the GRE. Some PA schools are nearly as competitive as medical schools.