Physician assistant or Nurse practicioner

Career and education discussion for nurses and nursing students. LPN/LVN, BSN, RN, MSN, Doctor of Nursing.

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Postby 8ML » Tue Jun 13, 2006 8:06 am

This is a problem that I have been struggling with for the past couple of years. I’m 33, married, and still working on an associate’s degree. Needless to say, I believe I have missed my window for becoming a MD. So the struggle has been either to pursue P.A. or N.P. I work with several of each here so I have had the opportunity to see both in their natural habitat.

I have decided on P.A. for several reasons. My personal view is that the medical community as we know it is about to change drastically. It cannot continue to operate in the model that it has for so long with the advent of such a litigious and pessimistic society. Medicare and private insurance continue to lowball the medical community and this places hospitals of the “for profit” nature in a real pickle. How do you make a profit when insurance has essentially predefined the price?

The answer, as I see it, is the switch to more and more mid-level practitioners. For instance my hospital has recently had one of the MD’s resign. He was quickly replaced with two P.A.’s. The P.A. educational model was designed to be the didactic years of medical school model. Basically you have two minds on a case, the MD and the PA, who will integrate nicely. The deficit here is that the PA will need to practice under the supervision of a MD. However, in practice, this supervision is minimal and usually consists of the PA calling for the MD on only the most challenging cases. The upside to this is that malpractice insurance is considerably cheaper for a PA.

NP’s have a higher degree requirement. Also keep in mind that the third largest lobbying group in my state is that of the RN community. Anyone who has worked in a hospital will have certainly noticed that the RN’s are well defined in their scope of practice, and very protective of their jobs. The joke around this hospital is that they are the Nurse Mafioso. Another words, you do not want to piss off “the family”.

One of the reasons I had considered NP was to have the leverage of the community on my side. They have successfully lobbied to have their scope of practice expanded and today perform tasks that were traditionally performed by MD’s just 20 years ago. I also liked the idea of working autonomously. It has been made clear that the NP world has set its sights on the PA territory. The first shot across the bow was requiring all NP’s to be a Masters program. The PA community retaliated by requiring all PA programs become Masters level in the not too distant future. Then the NP’s decided that they needed Doctorates. On it goes…

Here is the problem; the whole point to mid level practitioners was low cost. You cannot ask an MD to work for 70k a year when his malpractice insurance is 100k, and he has to write a check each month for 3k just for student loans. NP’s have just about completely educated themselves out of a job! I work with 7 NP’s. Two work with private practice physicians as basically PA’s who take call. They are both miserable because of pay, hours, and respect issues. Both have expressed that they “should have gone to med school”. The other NP’s work as CCU nurses and NOT as NP’s. They say they make better money as critical care nurses and their overhead costs are minimal. Not one has encouraged me to pursue NP. There is a respect issue that seems to stem from them being “just RN’s” in the eyes of the rest of the nursing staff. Obviously this is not true. They are very highly trained and skilled parishioners.

The last issue that killed NP for me was this encroachment into autonomous practice. They have now successfully expanded their scope into the areas that threaten MD and DO. The MD lobby is infinitely more powerful and has been effective in limiting what can and cannot be done by NP’s. This is one fight that I do not want to be involved in.

The best I advice I could give is for your friend to go shadow each for several days. It’s a very tough decision to be sure, so you better make it with all of the available facts. Otherwise, she too will wish she had “gone to medical school.”
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Postby anamaky » Tue Jun 13, 2006 7:41 pm

Hey 8ML,
I haven't read all of your post :) so sorry if you already addressed this, but your first line stopped me in my tracks, YOUR WINDOW FOR BECOMING AN MD IS SO NOT CLOSED. I don't know why you would think that. I have classmates (we just finished first year of med school thank you very much) who are in their late thirties and early forties, so if this is what you want, it's not too late for you.
Now I'll go and read the rest of your post to see if you had a question :)
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Postby CaribMD » Tue Jun 13, 2006 9:50 pm

8ML wrote:This is a problem that I have been struggling with for the past couple of years. I’m 33, married, and still working on an associate’s degree. Needless to say, I believe I have missed my window for becoming a MD. So the struggle has been either to pursue P.A. or N.P. I work with several of each here so I have had the opportunity to see both in their natural habitat.

I have decided on P.A. for several reasons. My personal view is that the medical community as we know it is about to change drastically. It cannot continue to operate in the model that it has for so long with the advent of such a litigious and pessimistic society. Medicare and private insurance continue to lowball the medical community and this places hospitals of the “for profit” nature in a real pickle. How do you make a profit when insurance has essentially predefined the price?

T”


It's not too late to go premed, your young and can go to medschool, As my signature says my age I'm not young and still will see many benifits as an MD, As an RN going to PA or NP would not pay off as well in Money nor job satisfaction.

Think about it.
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Postby horvat » Fri Jun 16, 2006 11:26 am

Thank you for all of your insights. I do think that it is important to be brave and go for what you really want. My friend chose nursing school mainly because of the many career choices that an RN can pursue. I myself am also in RN school but am getting ready for the MCAT next spring. After 2 semesters in RN school and some nurse aid experience I feel that this career would stifle me. The reason I have had a problem with nursing is the hospital reality of an RN and the disease approach. Sooo, I hope the adcoms dont attack me for this but I still intend on finishing the RN school and applying to med school. I guess for some of us it takes longer to find the path we want to follow.
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Postby momtwo » Wed Jun 28, 2006 8:44 am

My daughter is finishing up the PA program and is very happy. It's a masters program @ Duke. She already has accepted contract for her first job. She didn't want to be a doctor, didn't want the time involved in schooling and it didn't fit in with what she wanted in life. She's pleased with what she choose (as everyone should be). As for why she didn't choose NP over PA.....the job description of a PA fit her personality more. For some it'd be the other way around and NP would fit their personality better and for some they'd choose medical school.
In the office where she accepted her first contract there will be 5MDs, 1 PA and one NP. She actually is glad there's an NP there--they'll do different things. I'm sure the docs did the hiring of one NP and one PA for a reason.
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