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[tinyhandsbob]

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[pamac]

You could have googled "physician assistant psychiatric residencies" and found about as much information as asking a question here. I'm a psyche NP, but I'm aware of several psychiatry residencies out there simply from doing that. A residency would probably be considered by many to be the gold standard of post PA school training options. It gives you some bragging rights, and probably some marketability with an employer. I have met one PA that participated in one, but I have no idea what a residency trained PA's level of competency is at after completing one vs. simply starting practice. Certainly, a well structured residency could give you broad exposure to a lot of variety, provided it makes an active effort to do that (which seems to be what most of them strive to do). I think it obviously improves upon just the time that is able to be devoted to psyche specific training in PA school since that component would be just one among several other body systems that need to be covered, and many times psyche rotations are elective. But I also feel like PA's and NP's are generally well suited to entering the workforce in their roles right out of school without such residencies.

The psyche PA's I know are good providers, and except for the one that I've met, none have completed a residency. I'm sure that their first year of practice as PA's probably weren't as robust as the first year of a residency would be, but you have to weigh a number of other issues. Does one wish to relocate to a residency, especially if the PA's didn't compete well for the few spots in each locale? (that's a biggie). Does one want basically another year of training tacked on to two already pretty demanding years already completed? Will completing a residency enhance marketability significantly higher compared to finding a good place to work and starting practice? Will the residency be that much more pertinent to the work that you would be doing day to day vs. getting started and having a year head start getting to know the patient population and applying yourself where you are going to practice?

I don't have a knee jerk reaction to the notion of a residency being automatically a good choice in light of the many other factors that every new provider might have in front of them. I'm not saying that side by side, a residency trained individual isn't typically going to have more knowledge than a non residency provider, but I think you have to ask when that effort evens out, and what costs are incurred.

 

[MidwestPAC]

You could have googled "physician assistant psychiatric residencies" and found about as much information as asking a question here. I'm a psyche NP, but I'm aware of several psychiatry residencies out there simply from doing that. A residency would probably be considered by many to be the gold standard of post PA school training options. It gives you some bragging rights, and probably some marketability with an employer. I have met one PA that participated in one, but I have no idea what a residency trained PA's level of competency is at after completing one vs. simply starting practice. Certainly, a well structured residency could give you broad exposure to a lot of variety, provided it makes an active effort to do that (which seems to be what most of them strive to do). I think it obviously improves upon just the time that is able to be devoted to psyche specific training in PA school since that component would be just one among several other body systems that need to be covered, and many times psyche rotations are elective. But I also feel like PA's and NP's are generally well suited to entering the workforce in their roles right out of school without such residencies.

The psyche PA's I know are good providers, and except for the one that I've met, none have completed a residency. I'm sure that their first year of practice as PA's probably weren't as robust as the first year of a residency would be, but you have to weigh a number of other issues. Does one wish to relocate to a residency, especially if the PA's didn't compete well for the few spots in each locale? (that's a biggie). Does one want basically another year of training tacked on to two already pretty demanding years already completed? Will completing a residency enhance marketability significantly higher compared to finding a good place to work and starting practice? Will the residency be that much more pertinent to the work that you would be doing day to day vs. getting started and having a year head start getting to know the patient population and applying yourself where you are going to practice?

I don't have a knee jerk reaction to the notion of a residency being automatically a good choice in light of the many other factors that every new provider might have in front of them. I'm not saying that side by side, a residency trained individual isn't typically going to have more knowledge than a non residency provider, but I think you have to ask when that effort evens out, and what costs are incurred.

End of Rotation™: Content | PAEA

paeaonline.org

@pamac "and many times psyche rotations are elective." Psych rotations are built into the PA education, you can for sure do more psych rotations as an elective if that is what one is interested in.

Back to the real question for tinyhandsbob: You can do more training (electives) with a psychiatry group while in school and/or do a residency. Also, if you do not do a residency then you really need to do the CAQ in Psych. See Psychiatry CAQ for Physician Assistants - NCCPA

https://prodcmsstoragesa.blob.core.windows.net/uploads/files/PsychiatryContentBlueprint.pdf

Good

 

[pamac]

End of Rotation™: Content | PAEA

paeaonline.org

@pamac "and many times psyche rotations are elective." Psych rotations are built into the PA education, you can for sure do more psych rotations as an elective if that is what one is interested in.

Psychiatry CAQ for Physician Assistants - NCCPA

https://prodcmsstoragesa.blob.core.windows.net/uploads/files/PsychiatryContentBlueprint.pdf

Good

Your program might have had psyche rotations built into the curriculum, but not all do. In another conversation I gave examples of programs that do not offer them standard, but only as electives. Granted, a student such as this that is interested in psyche would naturally gravitate towards using his or her electives for psyche rotations, but that is not a given that it will be a part of the program’s offerings.

 

[MidwestPAC]

Your program might have had psyche rotations built into the curriculum, but not all do. In another conversation I gave examples of programs that do not offer them standard, but only as electives. Granted, a student such as this that is interested in psyche would naturally gravitate towards using his or her electives for psyche rotations, but that is not a given that it will be a part of the program’s offerings.

You tell me all the time to stay in my lane as I am NOT a NP, but you are stating wrong facts. See below and stay in your lane and you are NOT a PA.

See below this is what I copied from page 20-21.

B3.07 Supervised clinical practice experiences should occur with preceptors practicing in the following disciplines: ANNOTATION: PA education requires a breadth of supervised clinical practice experiences to help students appreciate the differences in approach to patients taken by those with varying specialty education and experience. Supervised clinical practice experiences used for required rotations are expected to address the fundamental principles of the disciplines below as they relate to the clinical care of patients. Subspecialists serving as preceptors might, by advanced training or current practice, be too specialty focused to provide the fundamental principles for required rotations in the disciplines below. Reliance on subspecialists as preceptors in the disciplines below is contrary to the intent of this standard. a) family medicine, b) internal medicine, c) general surgery, d) pediatrics, ARC-PA Standards, Fourth Edition Page 21 Effective September 1, 2010 Approved March 2010, updated March 2018 e) ob/gyn and f) behavioral and mental health care.

http://www.arc-pa.org/wp-content/uploads/2018/06/Standards-4th-Ed-March-2018.pdf

This was updated March of 2018 by the ARC-PA.

B2.08 The program curriculum must include instruction in the social and behavioral sciences as well as normal and abnormal development across the life span. ANNOTATION: Social and behavioral sciences prepare students for primary care practice. Instruction includes detection and treatment of substance abuse; human sexuality; issues of death, dying and loss; response to illness, injury and stress; principles of violence identification and prevention; and psychiatric/behavioral conditions. B2.09 The program curriculum must include instruction in basic counseling and patient education skills. ANNOTATION: Instruction in counseling and patient education skills is patient centered, culturally sensitive and focused on helping patients cope with illness, injury and stress, adhere to prescribed treatment plans and modify their behaviors to more healthful patterns.

B3.03 Supervised clinical practice experiences must enable all students to meet the program’s learning outcomes expected of students, for patients seeking: a) medical care across the life span to include, infants, children, adolescents, adults, and the elderly, b) women’s health (to include prenatal and gynecologic care), ARC-PA Standards, Fourth Edition Page 20 Effective September 1, 2010 Approved March 2010, updated March 2018 c) care for conditions requiring surgical management, including pre- operative, intra-operative, post-operative care and d) care for behavioral and mental health conditions.

 

[tinyhandsbob]

End of Rotation™: Content | PAEA

paeaonline.org

@pamac "and many times psyche rotations are elective." Psych rotations are built into the PA education, you can for sure do more psych rotations as an elective if that is what one is interested in.

Back to the real question for tinyhandsbob: You can do more training (electives) with a psychiatry group while in school and/or do a residency. Also, if you do not do a residency then you really need to do the CAQ in Psych. See Psychiatry CAQ for Physician Assistants - NCCPA

https://prodcmsstoragesa.blob.core.windows.net/uploads/files/PsychiatryContentBlueprint.pdf

Good

How robust is the residency system for PAs? In other words, if you do well in your PA program, check all the boxes and apply to a psych residency- are you almost guaranteed to find a residency like MD/DOs are? My understanding was that the number of PA residencies is small so only a minority of people are able to take advantage of that route, but maybe I'm wrong.

Lastly- assuming you have done psych electives + a psych residency OR CAQ in Psych, are you as likely to find work as a psych NP or less so? I know psych NPs have some advantages such as being able to practice more independently (depending on state), so that gives them a leg up. From what I've seen however in the job ads for psych midlevels, something like 90% of jobs specify they are looking for a "psych NP", while 10% state "psych NP or PA". If that's the true breakdown of the job opportunities in psych for PAs (9 to 1, in favor of psych NPs), I would be sort of worried about my employment prospects even after a residency.

 

[pamac]

You tell me all the time to stay in my lane as I am NOT a NP, but you are stating wrong facts. See below and stay in your lane and you are NOT a PA.

See below this is what I copied from page 20-21.

B3.07 Supervised clinical practice experiences should occur with preceptors practicing in the following disciplines: ANNOTATION: PA education requires a breadth of supervised clinical practice experiences to help students appreciate the differences in approach to patients taken by those with varying specialty education and experience. Supervised clinical practice experiences used for required rotations are expected to address the fundamental principles of the disciplines below as they relate to the clinical care of patients. Subspecialists serving as preceptors might, by advanced training or current practice, be too specialty focused to provide the fundamental principles for required rotations in the disciplines below. Reliance on subspecialists as preceptors in the disciplines below is contrary to the intent of this standard. a) family medicine, b) internal medicine, c) general surgery, d) pediatrics, ARC-PA Standards, Fourth Edition Page 21 Effective September 1, 2010 Approved March 2010, updated March 2018 e) ob/gyn and f) behavioral and mental health care.

http://www.arc-pa.org/wp-content/uploads/2018/06/Standards-4th-Ed-March-2018.pdf

This was updated March of 2018 by the ARC-PA.

B2.08 The program curriculum must include instruction in the social and behavioral sciences as well as normal and abnormal development across the life span. ANNOTATION: Social and behavioral sciences prepare students for primary care practice. Instruction includes detection and treatment of substance abuse; human sexuality; issues of death, dying and loss; response to illness, injury and stress; principles of violence identification and prevention; and psychiatric/behavioral conditions. B2.09 The program curriculum must include instruction in basic counseling and patient education skills. ANNOTATION: Instruction in counseling and patient education skills is patient centered, culturally sensitive and focused on helping patients cope with illness, injury and stress, adhere to prescribed treatment plans and modify their behaviors to more healthful patterns.

B3.03 Supervised clinical practice experiences must enable all students to meet the program’s learning outcomes expected of students, for patients seeking: a) medical care across the life span to include, infants, children, adolescents, adults, and the elderly, b) women’s health (to include prenatal and gynecologic care), ARC-PA Standards, Fourth Edition Page 20 Effective September 1, 2010 Approved March 2010, updated March 2018 c) care for conditions requiring surgical management, including pre- operative, intra-operative, post-operative care and d) care for behavioral and mental health conditions.

Sigh...
Those are requirements for competencies. They are not psyche rotations. I can post quite a few school specific rotation lists that show that not all of them require a psyche rotation. I’m not going to because I’ve already shown that in another post, and you’ve already shown your cards here: you’ve got nothing.

Primary care providers are often tasked with dealing with psychiatric care due to the dearth of providers and the long wait to get in to see a specialist. Those competencies that you listed are basic to what would be within the scope of a primary care provider to address in most cases. That’s all that the information that you posted referred to.

I get patients all the time that are referred from primary care providers who need the next level of care because their PCP is at the point where they need to hand off because they don’t manage psyche issues all the time.

 

[pamac]

How robust is the residency system for PAs? In other words, if you do well in your PA program, check all the boxes and apply to a psych residency- are you almost guaranteed to find a residency like MD/DOs are? My understanding was that the number of PA residencies is small so only a minority of people are able to take advantage of that route, but maybe I'm wrong.

Lastly- assuming you have done psych electives + a psych residency OR CAQ in Psych, are you as likely to find work as a psych NP or less so? I know psych NPs have some advantages such as being able to practice more independently (depending on state), so that gives them a leg up. From what I've seen however in the job ads for psych midlevels, something like 90% of jobs specify they are looking for a "psych NP", while 10% state "psych NP or PA". If that's the true breakdown of the job opportunities in psych for PAs (9 to 1, in favor of psych NPs), I would be sort of worried about my employment prospects even after a residency.

I’m a believer in the notion that people who are good at what they do can thrive in an environment where they aren’t in the typically dominant provider role. For instance, PAs tend to be found more frequently in surgery, but if an Np is sharp, one can go into that environment and carve a place for themselves. I also believe this for PAs in any realm, and it’s probably even easier in many ways because PA training can cover ground in a broad fashion Vs many NPs who are frequently more narrowly trained.

Job postings notwithstanding, there is nothing that says you can’t approach an employer and offer your services, even if the list says they are looking for an NP. In my situation, if a posting said they were looking for a PA, as an NP, I would skip it because in an independent state, what that probably means is that the organization wants a provider that is cheaper than what an NP would work for, and that they’ve been able to get dependent providers like PAs to sign on because they have fewer options for practice. For instance, as an independent provider, I could simply open up shop across the street and see patients on my own, so naturally I wouldn’t have to compromise on much to get a job. PAs here (and in all states) are essentially dependent upon a physician or practice group for the PAs to be able to work, so that narrows the options for them to be able to bargain. Some employers know this, and take advantage of it. But since it’s psyche, and there is so much need out there, I wouldn’t get too caught up in feeling like you are going to get rolled the moment you hit the workforce. If you like psyche, and really want to do it through being a PA, then you’ll probably always have a job.

Another market that will be harder for you to tap as a PA is contracting out your services. There are lots of counseling practices that need a prescribing provider so that they can offer med management to their counseling clients if they need it. That keeps those clients from having to go somewhere else for their med management, and the practice risking losing them. It also enhances the counseling practice’s image to have a prescriber. Typically, a psychiatrist is too expensive to dabble in that kind of coverage, but NPs are a good match. I know quite a few NPs that are the highest paid employees in those situations, making even more than the practice owners due to the value they bring in. In many cases, the counseling practice will let the NP keep all of their billing, and in some cases add a bit of their own profit margin on top in order to have a prescriber on hand. There are plenty of counseling places that would love to have a slice of the NPs profit, but generally I suggest to any NP that gives much of that up to move on, because the practice needs them more than they need the practice (if you aren’t getting at least 80% of your billing in that situation, you are giving up too much). Unfortunately for PAs, those kinds of lucrative opportunities aren’t as easy to arrange because you need a physician involved to supervise, and they frequently don’t come cheap, or want the liability risk. When a PA gets sued, the lawyers are really looking at what they can squeeze from the physician and their insurance. So in effect, PAs have more ground to cover, and red tape to del with than PAs do. It’s not impossible though.

Things like call, and other duties might be an issue for PAs as well, because they need a physician backup available to them. Essentially, that means an employer needs two people on call rather than one. So then you are dealing with getting a physician to be willing to do that, as well as the liability issue again. Not insurmountable, but more tricky. What I have noticed is that psyche PAs that I know are a bit constrained in my area. I know one that makes as much as I do, and that’s because that person hustles a ton. The other psyche PAs make what the primary car PAs make, which is around $85k to $90k to start. That’s contrasted with my first job, which was up where nurse anesthetist make (and that is typical for the offers my new grad NP peers were getting out of school). I have quite a few colleagues that own their own practices, and contract out services. I pick up hours helping a physician friend of mine, and do so on contract basis for generous pay. Since my friend is a physician and could hire a PA, they haven’t done so yet, but that wouldn’t be hard to do for that doctor.

If you have any more questions, go ahead and ask. I honestly believe that with psyche, you’ll always have a job, even without CAQ or a residency. I would, however, load up on psyche rotations for your electives in PA school. That would be a must.

 

[pamac]

I forgot to answer about he residencies. So there are a few very large residency programs for PAs in psyche, but most of them are a few seats here and there scattered around the country. As to how competitive they are, I couldn’t tell you. It could be tough to land the one you want, or else it could be a well kept secret that you just walk in to them. Maybe the the PA expert MidwestPAC could give you some insight... that is if you think his track record on unbiased information is solid. I leave that up to you to judge.

 

[tinyhandsbob]

I’m a believer in the notion that people who are good at what they do can thrive in an environment where they aren’t in the typically dominant provider role. For instance, PAs tend to be found more frequently in surgery, but if an Np is sharp, one can go into that environment and carve a place for themselves. I also believe this for PAs in any realm, and it’s probably even easier in many ways because PA training can cover ground in a broad fashion Vs many NPs who are frequently more narrowly trained.

Job postings notwithstanding, there is nothing that says you can’t approach an employer and offer your services, even if the list says they are looking for an NP. In my situation, if a posting said they were looking for a PA, as an NP, I would skip it because in an independent state, what that probably means is that the organization wants a provider that is cheaper than what an NP would work for, and that they’ve been able to get dependent providers like PAs to sign on because they have fewer options for practice. For instance, as an independent provider, I could simply open up shop across the street and see patients on my own, so naturally I wouldn’t have to compromise on much to get a job. PAs here (and in all states) are essentially dependent upon a physician or practice group for the PAs to be able to work, so that narrows the options for them to be able to bargain. Some employers know this, and take advantage of it. But since it’s psyche, and there is so much need out there, I wouldn’t get too caught up in feeling like you are going to get rolled the moment you hit the workforce. If you like psyche, and really want to do it through being a PA, then you’ll probably always have a job.

Another market that will be harder for you to tap as a PA is contracting out your services. There are lots of counseling practices that need a prescribing provider so that they can offer med management to their counseling clients if they need it. That keeps those clients from having to go somewhere else for their med management, and the practice risking losing them. It also enhances the counseling practice’s image to have a prescriber. Typically, a psychiatrist is too expensive to dabble in that kind of coverage, but NPs are a good match. I know quite a few NPs that are the highest paid employees in those situations, making even more than the practice owners due to the value they bring in. In many cases, the counseling practice will let the NP keep all of their billing, and in some cases add a bit of their own profit margin on top in order to have a prescriber on hand. There are plenty of counseling places that would love to have a slice of the NPs profit, but generally I suggest to any NP that gives much of that up to move on, because the practice needs them more than they need the practice (if you aren’t getting at least 80% of your billing in that situation, you are giving up too much). Unfortunately for PAs, those kinds of lucrative opportunities aren’t as easy to arrange because you need a physician involved to supervise, and they frequently don’t come cheap, or want the liability risk. When a PA gets sued, the lawyers are really looking at what they can squeeze from the physician and their insurance. So in effect, PAs have more ground to cover, and red tape to del with than PAs do. It’s not impossible though.

Things like call, and other duties might be an issue for PAs as well, because they need a physician backup available to them. Essentially, that means an employer needs two people on call rather than one. So then you are dealing with getting a physician to be willing to do that, as well as the liability issue again. Not insurmountable, but more tricky. What I have noticed is that psyche PAs that I know are a bit constrained in my area. I know one that makes as much as I do, and that’s because that person hustles a ton. The other psyche PAs make what the primary car PAs make, which is around $85k to $90k to start. That’s contrasted with my first job, which was up where nurse anesthetist make (and that is typical for the offers my new grad NP peers were getting out of school). I have quite a few colleagues that own their own practices, and contract out services. I pick up hours helping a physician friend of mine, and do so on contract basis for generous pay. Since my friend is a physician and could hire a PA, they haven’t done so yet, but that wouldn’t be hard to do for that doctor.

If you have any more questions, go ahead and ask. I honestly believe that with psyche, you’ll always have a job, even without CAQ or a residency. I would, however, load up on psyche rotations for your electives in PA school. That would be a must.

I understand you're in a state where NPs practice more independently. For the rest of states where both NPs and PAs require physician supervision, do you know if PA supervision requirements are stricter than for NPs? I know NPs can be 'supervised' by a physician 'off site' in those states (e.g. California). I wonder if it's any different for a PA.

 

[tinyhandsbob]

I’m a believer in the notion that people who are good at what they do can thrive in an environment where they aren’t in the typically dominant provider role. For instance, PAs tend to be found more frequently in surgery, but if an Np is sharp, one can go into that environment and carve a place for themselves. I also believe this for PAs in any realm, and it’s probably even easier in many ways because PA training can cover ground in a broad fashion Vs many NPs who are frequently more narrowly trained.

Job postings notwithstanding, there is nothing that says you can’t approach an employer and offer your services, even if the list says they are looking for an NP. In my situation, if a posting said they were looking for a PA, as an NP, I would skip it because in an independent state, what that probably means is that the organization wants a provider that is cheaper than what an NP would work for, and that they’ve been able to get dependent providers like PAs to sign on because they have fewer options for practice. For instance, as an independent provider, I could simply open up shop across the street and see patients on my own, so naturally I wouldn’t have to compromise on much to get a job. PAs here (and in all states) are essentially dependent upon a physician or practice group for the PAs to be able to work, so that narrows the options for them to be able to bargain. Some employers know this, and take advantage of it. But since it’s psyche, and there is so much need out there, I wouldn’t get too caught up in feeling like you are going to get rolled the moment you hit the workforce. If you like psyche, and really want to do it through being a PA, then you’ll probably always have a job.

Another market that will be harder for you to tap as a PA is contracting out your services. There are lots of counseling practices that need a prescribing provider so that they can offer med management to their counseling clients if they need it. That keeps those clients from having to go somewhere else for their med management, and the practice risking losing them. It also enhances the counseling practice’s image to have a prescriber. Typically, a psychiatrist is too expensive to dabble in that kind of coverage, but NPs are a good match. I know quite a few NPs that are the highest paid employees in those situations, making even more than the practice owners due to the value they bring in. In many cases, the counseling practice will let the NP keep all of their billing, and in some cases add a bit of their own profit margin on top in order to have a prescriber on hand. There are plenty of counseling places that would love to have a slice of the NPs profit, but generally I suggest to any NP that gives much of that up to move on, because the practice needs them more than they need the practice (if you aren’t getting at least 80% of your billing in that situation, you are giving up too much). Unfortunately for PAs, those kinds of lucrative opportunities aren’t as easy to arrange because you need a physician involved to supervise, and they frequently don’t come cheap, or want the liability risk. When a PA gets sued, the lawyers are really looking at what they can squeeze from the physician and their insurance. So in effect, PAs have more ground to cover, and red tape to del with than PAs do. It’s not impossible though.

Things like call, and other duties might be an issue for PAs as well, because they need a physician backup available to them. Essentially, that means an employer needs two people on call rather than one. So then you are dealing with getting a physician to be willing to do that, as well as the liability issue again. Not insurmountable, but more tricky. What I have noticed is that psyche PAs that I know are a bit constrained in my area. I know one that makes as much as I do, and that’s because that person hustles a ton. The other psyche PAs make what the primary car PAs make, which is around $85k to $90k to start. That’s contrasted with my first job, which was up where nurse anesthetist make (and that is typical for the offers my new grad NP peers were getting out of school). I have quite a few colleagues that own their own practices, and contract out services. I pick up hours helping a physician friend of mine, and do so on contract basis for generous pay. Since my friend is a physician and could hire a PA, they haven’t done so yet, but that wouldn’t be hard to do for that doctor.

If you have any more questions, go ahead and ask. I honestly believe that with psyche, you’ll always have a job, even without CAQ or a residency. I would, however, load up on psyche rotations for your electives in PA school. That would be a must.

Thanks for the detailed reply. Did you work as a regular RN before doing the NP program or did you do an accelerated program followed by psych NP masters right away?

 

[pamac]

I understand you're in a state where NPs practice more independently. For the rest of states where both NPs and PAs require physician supervision, do you know if PA supervision requirements are stricter than for NPs? I know NPs can be 'supervised' by a physician 'off site' in those states (e.g. California). I wonder if it's any different for a PA.

I really don’t know much about how that works in dependent states. I know that in those kinds of states, NP wages tend to suffer. I’m on different NP social media pages and see posts all the time about NPs looking for advice in navigating practice in states that don’t have good practice rights, and can only draw conclusions from that. It really does sound like quite a pain, and you can clearly contrast their situations with folks that are asking for advice on topics related to operating an independent practice in an independent state. Even amongst the members of those groups, you always read about NPs being like “oh, man, Texas is the worst place I’ve practiced” etc. Theres a wealth of information in those groups, but they are only opened to folks with RN licenses. So there aren’t any states where PAs have more practice rights than NPs, but in about half of states, NPs are closer to having the limited practice rights of PAs vs having the more expanded practice rights of the independent states. There are bound to be states that have something really close to parity between NPs and PAs, but that’s not because those states allow PAs more rights... it’s because they restrict NP rights to be closer to what PAs have. I hope that makes sense. So essentially what I’m saying is that PA practice rights in each state have never been less strict than the NP rights there. But in far too many cases you do end up seeing NP practice rights restricted down close to what PAs work under. And for the record, I would be OK with PAs having more practice freedoms akin to what NPs have. They are trained really well. I’ve rarely been dissatisfied with PA performance. I’ve been dissatisfied with NP performance more often than I’d like. Most of those issues had to do with personality, but that’s just an observation I’ve made. Can’t say it really comes back to the training they got, though.

Thanks for the detailed reply. Did you work as a regular RN before doing the NP program or did you do an accelerated program followed by psych NP masters right away?

Yes, I worked as an RN for quite a while, before school and then worked during. I was in Psyche, so I’d work my hours immersed in psyche, and then do clinic for the hours that I wasn’t working. I loved it. I know of folks who go through an accelerated BSN and then immediately do NP school. It’s possible to do, and if you are a mature minded individual, it can work. I think that would be very stressful to do, and if it doesn’t stress those people out, they are doing it wrong. A bit of experience helps, and it made me much more confident in my practice and clinicals. Where I did clinicals, they also had PA students. I noticed that they were sharp and concise, and could churn out a note faster than me. Conversely, the physicians were much more trusting of me and my take on a situation. There were patients that they just didn’t want PA students in front of because they were high risk. The PA students were young and or inexperienced, and didn’t have the insight that myself and the other NP students did. That mostly came down to experience in the field. If I were an Np student with not experience behind me, I’d expect to have been treated just like the PA students. And in truth, there are also a fair share of loser NP students around as well that make NP students look bad. They are a plague. But often they know just enough about how the system works to land decent rotations and make it through school.

Being able to work as a nurse and also work through school is a perk of being an NP. I did a lot of networking and landed good clinical gigs with fantastic preceptors as well. So instead of relocating to who knows where to do school and rotations who knows where, only to relocate again someplace to find a job, I lived, worked, and job searched in the place I knew very well, and had literally tons of offers for jobs. Not even all NPs take advantage of that, and are scrambling to get their name out after graduation. I had work nailed down a semester before graduating, and applications were a formality. It wasn’t a job search, it was a job selection. For that to happen took networking and word of mouth, and couldn’t be done from across the country.

The PA forums (which is its own independent site) have good insight as well. There are bound to be plenty of PAs in psyche that can offer better insight than me on details about everyday practice. I feel like I do know a lot about certain aspects of the industry, but you should catch up to someone who is directly dealing with PA practice issues. My perspective is most valuable in talking about what I do and how well I like it, and I really do love what I do a lot. I feel like I have a really good gig. The downside for me is that I took a while to get where I wanted to, and I wish I had started chasing this even sooner than I ever did. To do things again, I would have gotten my RN as soon as I could after high school, and then become an Np fairly soon after that. But that’s all. I love the pay, I love the effort I put into the process, I love what I do, and I love their benefits associated with my job(s).

 

[MidwestPAC]

How robust is the residency system for PAs? In other words, if you do well in your PA program, check all the boxes and apply to a psych residency- are you almost guaranteed to find a residency like MD/DOs are? My understanding was that the number of PA residencies is small so only a minority of people are able to take advantage of that route, but maybe I'm wrong.

Lastly- assuming you have done psych electives + a psych residency OR CAQ in Psych, are you as likely to find work as a psych NP or less so? I know psych NPs have some advantages such as being able to practice more independently (depending on state), so that gives them a leg up. From what I've seen however in the job ads for psych midlevels, something like 90% of jobs specify they are looking for a "psych NP", while 10% state "psych NP or PA". If that's the true breakdown of the job opportunities in psych for PAs (9 to 1, in favor of psych NPs), I would be sort of worried about my employment prospects even after a residency.

I think you could get into a residency but you would have to move. There are limited psych residency with limited spots so you will be fighting against others. I think it all depends on your state, if you are in a state with independent NPs then they will most likely have a leg up on you, but if you have better training and you apply to a institution that is well respected they will look at your seriously and you will most likely be on a level playing field. In my state there is no independence for NPs and most likely never will be. All the positions I have seen out there for psych providers is split with "We need a psych NP or PA." I think you will be fine, but I would get that extra training to help you in your career. Good luck!

 

[MidwestPAC]

Sigh...
Those are requirements for competencies. They are not psyche rotations. I can post quite a few school specific rotation lists that show that not all of them require a psyche rotation. I’m not going to because I’ve already shown that in another post, and you’ve already shown your cards here: you’ve got nothing.

Primary care providers are often tasked with dealing with psychiatric care due to the dearth of providers and the long wait to get in to see a specialist. Those competencies that you listed are basic to what would be within the scope of a primary care provider to address in most cases. That’s all that the information that you posted referred to.

I get patients all the time that are referred from primary care providers who need the next level of care because their PCP is at the point where they need to hand off because they don’t manage psyche issues all the time.

No....Please read again, I will post for you.

B3.07 Supervised clinical practice experiences used for required rotations are expected to address the fundamental principles of the disciplines below as they relate to the clinical care of patients.

a) family medicine, b) internal medicine, c) general surgery, d) pediatrics, e) ob/gyn and f) behavioral and mental health care.

Let's see the program(s) that state there are no psych rotations....

 

[MidwestPAC]

I really don’t know much about how that works in dependent states. I know that in those kinds of states, NP wages tend to suffer. I’m on different NP social media pages and see posts all the time about NPs looking for advice in navigating practice in states that don’t have good practice rights, and can only draw conclusions from that. It really does sound like quite a pain, and you can clearly contrast their situations with folks that are asking for advice on topics related to operating an independent practice in an independent state. Even amongst the members of those groups, you always read about NPs being like “oh, man, Texas is the worst place I’ve practiced” etc. Theres a wealth of information in those groups, but they are only opened to folks with RN licenses. So there aren’t any states where PAs have more practice rights than NPs, but in about half of states, NPs are closer to having the limited practice rights of PAs vs having the more expanded practice rights of the independent states. There are bound to be states that have something really close to parity between NPs and PAs, but that’s not because those states allow PAs more rights... it’s because they restrict NP rights to be closer to what PAs have. I hope that makes sense. So essentially what I’m saying is that PA practice rights in each state have never been less strict than the NP rights there. But in far too many cases you do end up seeing NP practice rights restricted down close to what PAs work under. And for the record, I would be OK with PAs having more practice freedoms akin to what NPs have. They are trained really well. I’ve rarely been dissatisfied with PA performance. I’ve been dissatisfied with NP performance more often than I’d like. Most of those issues had to do with personality, but that’s just an observation I’ve made. Can’t say it really comes back to the training they got, though.



Yes, I worked as an RN for quite a while, before school and then worked during. I was in Psyche, so I’d work my hours immersed in psyche, and then do clinic for the hours that I wasn’t working. I loved it. I know of folks who go through an accelerated BSN and then immediately do NP school. It’s possible to do, and if you are a mature minded individual, it can work. I think that would be very stressful to do, and if it doesn’t stress those people out, they are doing it wrong. A bit of experience helps, and it made me much more confident in my practice and clinicals. Where I did clinicals, they also had PA students. I noticed that they were sharp and concise, and could churn out a note faster than me. Conversely, the physicians were much more trusting of me and my take on a situation. There were patients that they just didn’t want PA students in front of because they were high risk. The PA students were young and or inexperienced, and didn’t have the insight that myself and the other NP students did. That mostly came down to experience in the field. If I were an Np student with not experience behind me, I’d expect to have been treated just like the PA students. And in truth, there are also a fair share of loser NP students around as well that make NP students look bad. They are a plague. But often they know just enough about how the system works to land decent rotations and make it through school.

Being able to work as a nurse and also work through school is a perk of being an NP. I did a lot of networking and landed good clinical gigs with fantastic preceptors as well. So instead of relocating to who knows where to do school and rotations who knows where, only to relocate again someplace to find a job, I lived, worked, and job searched in the place I knew very well, and had literally tons of offers for jobs. Not even all NPs take advantage of that, and are scrambling to get their name out after graduation. I had work nailed down a semester before graduating, and applications were a formality. It wasn’t a job search, it was a job selection. For that to happen took networking and word of mouth, and couldn’t be done from across the country.

The PA forums (which is its own independent site) have good insight as well. There are bound to be plenty of PAs in psyche that can offer better insight than me on details about everyday practice. I feel like I do know a lot about certain aspects of the industry, but you should catch up to someone who is directly dealing with PA practice issues. My perspective is most valuable in talking about what I do and how well I like it, and I really do love what I do a lot. I feel like I have a really good gig. The downside for me is that I took a while to get where I wanted to, and I wish I had started chasing this even sooner than I ever did. To do things again, I would have gotten my RN as soon as I could after high school, and then become an Np fairly soon after that. But that’s all. I love the pay, I love the effort I put into the process, I love what I do, and I love their benefits associated with my job(s).

Actually, PAs in my state have more practice rights that NPs. The new law will come effective in 4 weeks.

 

[MidwestPAC]

I forgot to answer about he residencies. So there are a few very large residency programs for PAs in psyche, but most of them are a few seats here and there scattered around the country. As to how competitive they are, I couldn’t tell you. It could be tough to land the one you want, or else it could be a well kept secret that you just walk in to them. Maybe the the PA expert MidwestPAC could give you some insight... that is if you think his track record on unbiased information is solid. I leave that up to you to judge.

Show me proof from my messages that I am biased. I am married to a NP, how biased could I be? I have to sleep with her every night. I have only stated facts and provide evidence. You just don't want to accept it. Mature a little and quit pushing buttons in these forums. Just answer the question and be done. No need to add the comments of "Maybe the the PA expert Midwest PAC could give you some insight." You just don't like me cause I call out your fluff/B.S. and set you straight on topics. I could copy and paste several paragraphs of you whining that I said that NPs only get 500 clinical hours and that is not true for every one. Or you act like you have had thousands of hours of psych rotations when I posted Dukes psych rotations and it was 49 credit hours, including 616+ clinical hours. Psychiatric Mental Health Nurse Practitioner
One of the best schools in the nation and you only get 600 hours of rotations. I showed you that I got more than half of your required in a regular PA program. You want to state you are so much better trained but only have 150+ clinical hours more than myself that is NOT in psych. That is why you don't like my comments cause I prove you wrong with FACTS.

 

[pamac]

Let's see the program(s) that state there are no psych rotations....

Clinical Curriculum - | University of Utah

medicine.utah.edu

Clinical Year Preceptorships | Physician Assistant (PA) Program

Students in the University of Wisconsin-Madison Physician Assistant Program receive hands-on clinical training in a variety of settings.

www.med.wisc.edu

 

[pamac]

Actually, PAs in my state have more practice rights that NPs. The new law will come effective in 4 weeks.

Nope. I’d like to see what you are talking about, because in no state does the practice environment for PAs exceed that of NPs. You’ll have to show that is the case, we can’t take your word for it.

 

[MidwestPAC]

Nope. I’d like to see what you are talking about, because in no state does the practice environment for PAs exceed that of NPs. You’ll have to show that is the case, we can’t take your word for it.

The law was already signed by the governor this month. It was announced to over 200 PAs by the AAPA at the state conference I was at recently.

 

[pamac]

The law was already signed by the governor this month. It was announced to over 200 PAs by the AAPA at the state conference I was at recently.

What law is that?

BTW, I just proved you wrong about PA programs that don’t have dedicated Psyche rotations in one of the posts above, so go check those out.

 

[MidwestPAC]

Clinical Curriculum - | University of Utah

medicine.utah.edu

Clinical Year Preceptorships | Physician Assistant (PA) Program

Students in the University of Wisconsin-Madison Physician Assistant Program receive hands-on clinical training in a variety of settings.

www.med.wisc.edu

That is how most of the PA programs list as there rotations. WE all are required to see psych patients. That is apart of our patient log that we must do. Again, you have not been to PA school so how would you know by just reading a website. 22 weeks of primary care is definitely going to get you exposed to psych patients. Come on man, please give this a rest. We all know you think your 600+ clinical hours in psych are equal to a MD/DO.

 

[pamac]

That is how most of the PA programs list as there rotations. WE all are required to see psych patients. That is apart of our patient log that we must do. Again, you have not been to PA school so how would you know by just reading a website. 22 weeks of primary care is definitely going to get you exposed to psych patients. Come on man, please give this a rest. We all know you think your 600+ clinical hours in psych are equal to a MD/DO.

You just moved the goalpost. It went from PA programs all requiring psyche rotations to “well, you’ll see psychiatric cases as part of primary care”. Lol! Okaaaaaay.....

If that’s the case for the OP, then I certainly do recommend a residency.

And I’ll just add that we weren’t comparing Psyche NPs to psyche MD/DOs.... we were comparing Psyche NP to PA psyche immersion. That’s another goalpost you conveniently moved for the sake of salvaging whatever argument you are trying to make.

So anyway, what state is it where PAs are afforded more practice rights than NPs there?

 

[MidwestPAC]

What law is that?

BTW, I just proved you wrong about PA programs that don’t have dedicated Psyche rotations in one of the posts above, so go check those out.

What law is that?

BTW, I just proved you wrong about PA programs that don’t have dedicated Psyche rotations in one of the posts above, so go check those out.

I don't feel comfortable with you knowing where I live. Again, you don't want to believe the information as you are biased as you think NPs rule over PAs, not true everywhere.

You did not prove me wrong as we do have psych rotations, it is a requirement. See the post from Home | ARC-PA. I have been through PA school and every PA I know has to see Psych patients.

 

[MidwestPAC]

You just moved the goalpost. It went from PA programs all requiring psyche rotations to “well, you’ll see psychiatric cases as part of primary care”. Lol! Okaaaaaay.....

If that’s the case for the OP, then I certainly do recommend a residency.

And I’ll just add that we weren’t comparing Psyche NPs to psyche MD/DOs.... we were comparing Psyche NP to PA psyche immersion. That’s another goalpost you conveniently moved for the sake of salvaging whatever argument you are trying to make.

So anyway, what state is it where PAs are afforded more practice rights than NPs there?

Ok, I am done with you. No goalpost was moved. All PA programs do require Psych rotations. Is not see psych patients in a outpatient facility, inpatient facility, ER, nursing home, etc not count as see psych patients? We must log all of our patients and what disease they have such as depression, GAD, Bipolar I, etc. Not sure what you are thinking is a psych rotation?

I was stating a fact that you think your training is better than PAs and just the same as a MD/DO that gets 15,000+ hrs of training. I just told you have I got more than half the training in PA school in psych from what Dukes Psych NP program offers. That would mean that a PA interested in psych would do extra rotations in psych which would at least equal (most likely be more than) your training. Plus adding on a PA residency and/or CAQ.

Have a good one.

 

[pamac]

Ok, I am done with you. No goalpost was moved. All PA programs do require Psych rotations. Is not see psych patients in a outpatient facility, inpatient facility, ER, nursing home, etc not count as see psych patients? We must log all of our patients and what disease they have such as depression, GAD, Bipolar I, etc. Not sure what you are thinking is a psych rotation?

I was stating a fact that you think your training is better than PAs and just the same as a MD/DO that gets 15,000+ hrs of training. I just told you have I got more than half the training in PA school in psych from what Dukes Psych NP program offers. That would mean that a PA interested in psych would do extra rotations in psych which would at least equal (most likely be more than) your training. Plus adding on a PA residency and/or CAQ.

Have a good one.

When I came across PA programs that had dedicated psyche rotations, which happen to be many of them, they were no longer than four weeks in length. 40 hour weeks x 4 weeks equals 160 hours of psyche clinical. That’s not 50 percent of 600 hours, it’s closer to 1/4.

Again, if that’s what the OP is going to get, then maybe you are trying to make the case for a psyche residency. I’m not trying to make that case myself, but I would suggest the OP look into the possibility of doing more psyche rotations as electives. That’s all I’ve ever suggested on the matter.

And also.... what state are you in where PAs are supposedly going to achieve more practice freedom than the NPs there, and what law are you referring to that allows for that? I can understand not wanting your location to be put out there for everyone to see, but that’s such a big claim to make that it becomes tremendously problematic to use as a drive by claim. That puts a burden on you to refute. So again, I will insist that in no state are PA practice rights less restrictive than NP practice rights.

 

[FiremedicMike]

pamac - from your dialogue I assume you're bickering with midwest. I put him on ignore several days ago, you should too..

 

[pamac]

pamac - from your dialogue I assume you're bickering with midwest. I put him on ignore several days ago, you should too..

I don’t mind highlighting absurdity. He tends to do most of the heavy lifting for me.

 

[tinyhandsbob]

Actually, PAs in my state have more practice rights that NPs. The new law will come effective in 4 weeks.

can i ask what your state is?

 

[tinyhandsbob]

When I came across PA programs that had dedicated psyche rotations, which happen to be many of them, they were no longer than four weeks in length. 40 hour weeks x 4 weeks equals 160 hours of psyche clinical. That’s not 50 percent of 600 hours, it’s closer to 1/4.

Again, if that’s what the OP is going to get, then maybe you are trying to make the case for a psyche residency. I’m not trying to make that case myself, but I would suggest the OP look into the possibility of doing more psyche rotations as electives. That’s all I’ve ever suggested on the matter.

And also.... what state are you in where PAs are supposedly going to achieve more practice freedom than the NPs there, and what law are you referring to that allows for that? I can understand not wanting your location to be put out there for everyone to see, but that’s such a big claim to make that it becomes tremendously problematic to use as a drive by claim. That puts a burden on you to refute. So again, I will insist that in no state are PA practice rights less restrictive than NP practice rights.

Ok, I am done with you. No goalpost was moved. All PA programs do require Psych rotations. Is not see psych patients in a outpatient facility, inpatient facility, ER, nursing home, etc not count as see psych patients? We must log all of our patients and what disease they have such as depression, GAD, Bipolar I, etc. Not sure what you are thinking is a psych rotation?

I was stating a fact that you think your training is better than PAs and just the same as a MD/DO that gets 15,000+ hrs of training. I just told you have I got more than half the training in PA school in psych from what Dukes Psych NP program offers. That would mean that a PA interested in psych would do extra rotations in psych which would at least equal (most likely be more than) your training. Plus adding on a PA residency and/or CAQ.

Have a good one.

@MidwestPAC just to clarify, are you a PA that practices solely in psych?

 

[pamac]

@MidwestPAC just to clarify, are you a PA that practices solely in psych?

He doesn’t practice in psyche, and he won’t tell you what state he’s in, which isn’t an unreasonable stance to have. However, he is mistaken about those practice rights that he insists are more favorable to PAs than NPs. It simply is not the case.

 

[MidwestPAC]

When I came across PA programs that had dedicated psyche rotations, which happen to be many of them, they were no longer than four weeks in length. 40 hour weeks x 4 weeks equals 160 hours of psyche clinical. That’s not 50 percent of 600 hours, it’s closer to 1/4.

Again, if that’s what the OP is going to get, then maybe you are trying to make the case for a psyche residency. I’m not trying to make that case myself, but I would suggest the OP look into the possibility of doing more psyche rotations as electives. That’s all I’ve ever suggested on the matter.

And also.... what state are you in where PAs are supposedly going to achieve more practice freedom than the NPs there, and what law are you referring to that allows for that? I can understand not wanting your location to be put out there for everyone to see, but that’s such a big claim to make that it becomes tremendously problematic to use as a drive by claim. That puts a burden on you to refute. So again, I will insist that in no state are PA practice rights less restrictive than NP practice rights.

Onsite supervision, chart review, and working with a new physician for a set amount of time has changed for PAs. The onsite supervision is set at the practice level for PAs and is spelled out for a certain amount of time for NPs. The chart review is set for a certain time frame (for NPs) and set at the practice level for PAs. The % of charts reviewed is the same. The amount of hours a APP must work with a physician (new to the NP/PA) is set at the practice level for PAs and a certain amount of time is set for NPs. Everything else is the same for NPs/PAs such as mileage from the physician, communication with the physician, controlled substances, billing/reimbursement, etc.

So yes these are big changes cause if I get a new collaborating physician that doctor and I can set the amount of time he/she comes on site (if any, it can be done by telehealth in the new law) and set the amount of time (if any) that we have to practice together. This is not the case for NPs, even though things can be done via telehealth, the onsite supervision is still in place for NPs and set at a certain time frame.

 

[MidwestPAC]

@MidwestPAC just to clarify, are you a PA that practices solely in psych?

No I do not practice in solely in psych.

 

[MidwestPAC]

He doesn’t practice in psyche, and he won’t tell you what state he’s in, which isn’t an unreasonable stance to have. However, he is mistaken about those practice rights that he insists are more favorable to PAs than NPs. It simply is not the case.

I am not mistaken. One of the lawyers from AAPA spoke at a state conference I attended this year and she showed us the laws and what has changed. Also, the president of the state chapter spoke after her to update everyone on the laws that were signed by the governor. How do you sit there and say this is simply not the case. Do you truly think I come on here lying about this? If so then you have some major issues you need to deal with. You truly do not want to accept any fact that goes against NPs. Get over it, NPs cannot rule every single state and every single thing in life.

 

[MidwestPAC]

When I came across PA programs that had dedicated psyche rotations, which happen to be many of them, they were no longer than four weeks in length. 40 hour weeks x 4 weeks equals 160 hours of psyche clinical. That’s not 50 percent of 600 hours, it’s closer to 1/4.

Again, if that’s what the OP is going to get, then maybe you are trying to make the case for a psyche residency. I’m not trying to make that case myself, but I would suggest the OP look into the possibility of doing more psyche rotations as electives. That’s all I’ve ever suggested on the matter.

And also.... what state are you in where PAs are supposedly going to achieve more practice freedom than the NPs there, and what law are you referring to that allows for that? I can understand not wanting your location to be put out there for everyone to see, but that’s such a big claim to make that it becomes tremendously problematic to use as a drive by claim. That puts a burden on you to refute. So again, I will insist that in no state are PA practice rights less restrictive than NP practice rights.

You have not attended a PA program so you would not know about rotations.

 

[pamac]

You have not attended a PA program so you would not know about rotations.

I know that you insisted that all rotations required a dedicated psyche rotation. Now you insist that simply covering psyche concepts is just as good.

 

[pamac]

I am not mistaken. One of the lawyers from AAPA spoke at a state conference I attended this year and she showed us the laws and what has changed. Also, the president of the state chapter spoke after her to update everyone on the laws that were signed by the governor. How do you sit there and say this is simply not the case. Do you truly think I come on here lying about this? If so then you have some major issues you need to deal with. You truly do not want to accept any fact that goes against NPs. Get over it, NPs cannot rule every single state and every single thing in life.

There’s no way for me to rebut if I don’t know what state you are in. But with pretty much everything you’ve posted, I’ve been able to show that you tended to be a bit off in your assessment. If your state is somehow the one state where PAS have more practice freedom than NPs, then I guess that is a pleasant coincidence for you, but I hardly think that is truly the case, and I’m at a loss to address that with the current info that you’ve given me. What I can say is that in my independent state, I practice with full independence and answer to the board of nursing for my advanced practice care.

 

[tinyhandsbob]

It's most likely Michigan or Illinois, although I think it's Michigan.

"PAs in Michigan are no longer required to work under supervision or delegation of a physician (2017). PAs are required to work with a participating physician according to the terms in a written practice agreement. Notwithstanding any law or rule to the contrary, a PA may make calls or go on rounds without restrictions on the time or frequency of visits by a physician or the PA. (MCL 333.17076 (1)) "

https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/arc-public/state-law-physician-assistant-scope-practice.pdf

 

[pamac]

It’s not Illinois. They just allowed NPs to be independent after 4,000 hours. Not great, but it’s independence. It will get whittled down over time. That’s just a start for places like Illinois and Virginia. Michigan is a terrible place to practice if you aren’t a physician, so who knows what kind of chaos is being sowed there. States like Michigan and Missouri... ones that were in their prime 40-50 years ago...are kind of the old guard when it comes to being solid for the entrenched physician establishment. But id still be surprised to see anyone cut the leash to the PAs, especially after they’ve seen NPs move ahead. Michigan also doesn’t have a nursing practice act, which puts it below any other state I think.

So that is a great link. And it highlights what is probably going on in Michigan. Recently there, they changed the language of the statute. PAs are no longer “supervised or delegated to”, which sounds good. There also aren’t any statutory limits to how many PAs can enter into an agreement with a physician. Sounds good too I guess... just mostly for the physicians. But there is a requirement to have a contractual arrangement with a “participating physician”. Huh? So without a physician, can a PA practice? No. It is nice that the board of supervision for PAs is not the board of medicine per se like every other state, but the Michigan task force on physician assistants, which is made up of 7 PAs, 5 physicians, and 3 public members, which is probably the most progressive level of representation in the country for PAs governing themselves. So there is a chance that in one of the cruddiest locations for an NP to practice, that PAs might have the blessing to have as many PAs as possible be hired by physicians to bring in tons of revenue to that practice. If they aren’t associated with a practice, any practice, by contract, then they cannot practice. I haven’t researched NP practice rights there other than to see on the aanp website that Michigan is in red, meaning bad practice rights for NPs. That still leaves me scratching my head trying to figure out how this is a step forward for PAs, and why it would get a standing ovation at a conference, but that could very well be what MidwestPaC is referring to. It’s not independence, but it’s... something.

 

[MidwestPAC]

I know that you insisted that all rotations required a dedicated psyche rotation. Now you insist that simply covering psyche concepts is just as good.

Show proof of your assumption. I never said anything about a "dedicated psych rotation." Again you and I just don't see eye to eye. You like to twist words a lot for your benefit. I will never win against you nor anyone else that is not Pro-NP. Have a good day!

 

[MidwestPAC]

It’s not Illinois. They just allowed NPs to be independent after 4,000 hours. Not great, but it’s independence. It will get whittled down over time. That’s just a start for places like Illinois and Virginia. Michigan is a terrible place to practice if you aren’t a physician, so who knows what kind of chaos is being sowed there. States like Michigan and Missouri... ones that were in their prime 40-50 years ago...are kind of the old guard when it comes to being solid for the entrenched physician establishment. But id still be surprised to see anyone cut the leash to the PAs, especially after they’ve seen NPs move ahead. Michigan also doesn’t have a nursing practice act, which puts it below any other state I think.

So that is a great link. And it highlights what is probably going on in Michigan. Recently there, they changed the language of the statute. PAs are no longer “supervised or delegated to”, which sounds good. There also aren’t any statutory limits to how many PAs can enter into an agreement with a physician. Sounds good too I guess... just mostly for the physicians. But there is a requirement to have a contractual arrangement with a “participating physician”. Huh? So without a physician, can a PA practice? No. It is nice that the board of supervision for PAs is not the board of medicine per se like every other state, but the Michigan task force on physician assistants, which is made up of 7 PAs, 5 physicians, and 3 public members, which is probably the most progressive level of representation in the country for PAs governing themselves. So there is a chance that in one of the cruddiest locations for an NP to practice, that PAs might have the blessing to have as many PAs as possible be hired by physicians to bring in tons of revenue to that practice. If they aren’t associated with a practice, any practice, by contract, then they cannot practice. I haven’t researched NP practice rights there other than to see on the aanp website that Michigan is in red, meaning bad practice rights for NPs. That still leaves me scratching my head trying to figure out how this is a step forward for PAs, and why it would get a standing ovation at a conference, but that could very well be what MidwestPaC is referring to. It’s not independence, but it’s... something.

Once again I have never used the word independence.... You will b*tch about cold ice cream wouldn't you? These are huge steps for PAs, you might not like it but this is reality. You live/work in a NP independent state so you have a mind set that all NPs should be independent and PAs should be below you. This is changing and most of the PAs I know do NOT want independence practice rights, just OTP. Making the rules at the practice level. Much safer for the patient, physician, and PA. You can say all you want but I would never trust a NP that things he/she does not need a MD/DO behind them. Also, never said there was a standing ovation at a conference....just an announcement. I hope you don't treat your patients like you treat people on here. It makes me sick.

 

[tinyhandsbob]

@MidwestPAC On a different note, what are PA prescribing rights like? Do you have your own independent prescribing number the way a physician does, or is your prescription number somehow subjugated under the supervising physicians? Also, I know the scope of practice is specialty related. How does this affect your prescription rights in reality? Since you cannot have your own practice as a PA in most states, is your prescription ability restricted to periods of formal employment? And does anyone watch what you prescribe outside of the % of cases that have to be reviewed by your supervising physician (assuming your state requires that)? For example, say you are between jobs and give your wife a refill on her prescription anti-dandruff shampoo (I know you're not really supposed to, but let's not focus on that here please). Are you even able to do that, the way your prescription number as a PA is setup? And if you are, will it somehow show up on your supervising physicians radar?

 

[pamac]

You have your own DEA number, but as a PA, if you prescribe between jobs without having a supervising, callaborating, or “participating” physician, you are in breach of your license, and you’ll catch the attention of the board of medicine. That is illegal.

That’s not the case for NPs in independent states.

As far as practicing within scopes, for PAs and NPs that aren’t in independent practice states, your scope is determined by either the board that oversees you, the supervising physician, or the practice or facility you work for. For independent NPs, the scope is determined by the nurse practice act, board of nursing, or else whatever you think you can defend in court. I could manage illness outside of psychiatric diagnosis, and I’ve prescribed things along those lines rarely, but I feel uncomfortable venturing into that realm, so I refer. When you have a license to protect, you tend to get over the desire to help a family member out with a cholesterol medication refill or an allergy script. I don’t want a paper trail of myself bending the rules that a lawyer can refer to. Another thing, you really need to only be prescribing for established patients, and documentation demonstrating that relationship need to be present. Having those kinds of rules to stick to gets you out of conversations like “hey can you prescribe me that anti itch cream? I’d like to have some but don’t want to go in to my doc.” If you consistently stick to a personal rule about not prescribing to non patients, then you can throw out a “No” without leaving that person angry. It’s liberating to have a solid rule of no family and friends. Some states also have this established as law. I know that’s a bit farther than what you asked for, but it’s good insight for folks to have.

 

[MidwestPAC]

@MidwestPAC On a different note, what are PA prescribing rights like? Do you have your own independent prescribing number the way a physician does, or is your prescription number somehow subjugated under the supervising physicians? Also, I know the scope of practice is specialty related. How does this affect your prescription rights in reality? Since you cannot have your own practice as a PA in most states, is your prescription ability restricted to periods of formal employment? And does anyone watch what you prescribe outside of the % of cases that have to be reviewed by your supervising physician (assuming your state requires that)? For example, say you are between jobs and give your wife a refill on her prescription anti-dandruff shampoo (I know you're not really supposed to, but let's not focus on that here please). Are you even able to do that, the way your prescription number as a PA is setup? And if you are, will it somehow show up on your supervising physicians radar?

I have a NPI and DEA, can prescribe schedule II-VI and every thing else. PAs can own their own practice, not sure where you heard that from? I know several PAs around the country and have practices. You just have to have a physician on board and some states make someone else than the PA own a small percentage of the practice (such as 1%). If I am between jobs you cannot prescribe without a physician on your license. Now if that physician continues to collaborate with you then you are fine (even after the job). That is between the PA and the doctor. I would never write a RX for my wife ever, so no issue there.

 

[pamac]

I have a NPI and DEA, can prescribe schedule II-VI and every thing else. PAs can own their own practice, not sure where you heard that from? I know several PAs around the country and have practices. You just have to have a physician on board and some states make someone else than the PA own a small percentage of the practice (such as 1%). If I am between jobs you cannot prescribe without a physician on your license. Now if that physician continues to collaborate with you then you are fine (even after the job). That is between the PA and the doctor. I would never write a RX for my wife ever, so no issue there.

I don’t need a physician to do any of that. And I can prescribe at any time, all by myself. And I can own my own practice, all by myself. It works well. I like it.

 

[MidwestPAC]

I don’t need a physician to do any of that. And I can prescribe at any time, all by myself. And I can own my own practice, all by myself. It works well. I like it.

That's cool man and glad you are happy. I would not be happy with all that on my shoulders not being a MD/DO. NPs/PAs need oversight and just because the BON threw millions of dollars at your state and passed laws doesn't mean NPs are competent or that is ethically/morally correct.

 

[pamac]

That's cool man and glad you are happy. I would not be happy with all that on my shoulders not being a MD/DO. NPs/PAs need oversight and just because the BON threw millions of dollars at your state and passed laws doesn't mean NPs are competent or that is ethically/morally correct.

Nobody threw millions at my state to accomplish NP independence.

We do have oversight through the State Board of Nursing, so we are comfortable with the ethics and competency aspect you tossed out there. They investigate every single complaint.

Don’t you guys have to take an exam every 6-10 years to recertify? NPs don’t have to do that either.

 

[MidwestPAC]

Nobody threw millions at my state to accomplish NP independence.

We do have oversight through the State Board of Nursing, so we are comfortable with the ethics and competency aspect you tossed out there. They investigate every single complaint.

Don’t you guys have to take an exam every 6-10 years to recertify? NPs don’t have to do that either.

You are having other nurses from the BON oversight you, do you NOT see that problem? NPs train with other NPs. You do not know what you do not know. That is the big issue and you cannot see it. A complaint is valid when the patient knows what to look for and then to get a hold of the BON to file.

Yes, we mimic physicians in re-certifying every 10 years. I know NPs don't do that and RNs in my state do not even have to get CEUs, but other professions like my old profession (Respiratory therapy) we have to take 3 board exams and get a 20+ CEUs every 2 years. I never understood that and once again nurses are getting away with crap that other professions do to show they are competent.

Doesn't that scare you not to retake boards every 10 years? How do I know as the public you are update on your knowledge, skills, research? Please don't tell me cause your CMEs....cause PAs have to get at least 100 CME hours, 50 hours of category 1 and 50 hours of category 2. If you have a CAQ then it is more.

 

[pamac]

You are having other nurses from the BON oversight you, do you NOT see that problem? NPs train with other NPs. You do not know what you do not know. That is the big issue and you cannot see it. A complaint is valid when the patient knows what to look for and then to get a hold of the BON to file.

I don’t see it as a problem, just like I don’t see having the board of medicine overseeing physicians is a problem for physicians. Practicing outside of scope and evidence based care is practicing outside of scope and evidence based care is practicing outside of scope and evidenced based care.... whether you are a physician, NP, or respiratory therapist. What you don’t see is that you don’t want a physician deciding on issues surrounding something like respiratory therapy scope, or even NP scope. Physicians are masters of their care, so they should evaluate their own. They wouldn’t be experts on what RNs need to be doing at all levels, so you wouldn’t ask them to be.

 

[MidwestPAC]

I don’t see it as a problem, just like I don’t see having the board of medicine overseeing physicians is a problem for physicians. Practicing outside of scope and evidence based care is practicing outside of scope and evidence based care is practicing outside of scope and evidenced based care.... whether you are a physician, NP, or respiratory therapist. What you don’t see is that you don’t want a physician deciding on issues surrounding something like respiratory therapy scope, or even NP scope. Physicians are masters of their care, so they should evaluate their own. They wouldn’t be experts on what RNs need to be doing at all levels, so you wouldn’t ask them to be.

But the issue is NPs want to have their DNP and be equal to MD/DO so aren't you trying to play doctor without being a doctor? The issue with physician oversight is PAs and NPs are NOT doctors so they need a higher level to watch over them not the same level, nurses watching nurses. Your training is inferior to a MD/DO as is MY training, that is why we need oversight. You don't think a pulmonologist should oversee the respiratory therapy department? All RT departments have medical directors. Do you think a radiologist should over see the radiology department with techs? How about pathology or orthopods overseeing PT/OT departments? There has to be a captain of the ship and it sure as **** is not a PA or NP.

 

[pamac]

But the issue is NPs want to have their DNP and be equal to MD/DO so aren't you trying to play doctor without being a doctor? The issue with physician oversight is PAs and NPs are NOT doctors so they need a higher level to watch over them not the same level, nurses watching nurses. Your training is inferior to a MD/DO as is MY training, that is why we need oversight. You don't think a pulmonologist should oversee the respiratory therapy department? All RT departments have medical directors. Do you think a radiologist should over see the radiology department with techs? How about pathology or orthopods overseeing PT/OT departments? There has to be a captain of the ship and it sure as **** is not a PA or NP.

I think you are missing the point of state boards. They are responsible for maintaining established professional standards of care, and overseeing what takes place within the bounds of their practice. You are inadvertently taking the conversation to a different place where we are... essentially arguing apples to oranges. No, I don’t think that RNs need physicians leading their regulatory boards, which is why you don’t see that happening often at all. As an RN, the physician wasn’t my boss. They weren’t in my organizational structure, and weren’t the final arbiter of whether the care I provided was within the bounds of the nursing practice act.