I am totally clueless on what to do :-)

[foreverLaur]

For those of you that don't know me, I'll give some background information. I'll also try to condense this and put it all together from the post I put on the PA forum earlier. Just trying to get as much advice and input as possible.

-I am a 21 year old college junior/senior.
-I attended full time post secondary in high school, but used it as a "joke off" time and received absolutely terrible grades and didn't get credit for any useful classes. I wish I would have used those two years as so much more!
-After graduating high school in 2005, I went to college at a smaller "public ivy league" school and spent two years as an accounting major. I worked for a small firm doing construction project accounting one year and then worked as an auditor for Ernst & Young. I hated my major, hated my school, hated the location of the school, and hated the people there. I wish that (1) I never would have went there (money reasons) and (2) I wish I would have went through with my transfer after my first year
-I finally transferred to the original college of choice for my third year of college. I am carrying with me a 2.51 GPA (primarily brought down by those post secondary years, and not brought up too much by hating everything about my old school/major). I changed my major to something I enjoy (microbiology), love my school, my roommates, and the school's location. I have had a 3.88 GPA since I transferred.
-I have wanted to be a doctor since I was 4 years old. I drew a picture of me working with my pediatrician at that age and gave it to him saying I was going to work with him when I grew up. I used to perform "surgery" on my food.

So, a really big part of me wants to go to medical school. It is all I have ever wanted to do, despite dabbling in many other career options. I have been particularly interested in orthopaedic surgeon, but I have looked at pediatrics (then doing a neonatal/perinatal medicine fellowship), emergency medicine, other surgical fields, and interventional radiology.

However, I am a female who has a strong maternal instinct. I want to get married and have my first kid before I am 30. I want to have 3-5 kids. I don't want to miss anything in their life... a first Halloween, a first Christmas, their first step, etc. I want to potty train them and be there when they go off to their first day of school. I want to go to every event they have, whether it is a play, a musical, a sporting event, etc. I will be 27 years old when I graduate medical school (if I get in the first time around). I am looking at a 5+ year residency then, making me 32. So if I don't want to miss any "milestones" in my kid's lives, I can't really start until I am of that age. I know people say you can "make it work" but a lot of the fields I am interested in make that very difficult. The orthopaedic surgeon I shadowed many times brings her son to work on Saturday's to catch up on paperwork because it is one of the few times she can spend with him.

So, my person viewpoint is that if I do not go to medical school, I will always regret not being a doctor. However, I will never regret not having insanely long hours. I will never regret missing parts of my children growing up. There are many things about being a doctor I do not like. My mom works for doctors. I have shadowed and talked to more doctors than I can even remember.

Needless to say, I believe the cons outweigh the pros of going to medical school in my case. So I have been looking at other options.

(1) Entering a 3 year Masters in Nursing program for people with a non-nursing bachelors degree and working as a Nurse Practitioner.
(2) Entering a 2 year Physician Assistant program
(3) Doing a 12-15 month accelerated BSN program, working for a bit as an RN, and then doing a MSN or DNP program or then entering a PA program

I know I want to work in a hospital as I prefer to crazy busy environment of a hospital over a doctors office. I know I want to touch lives and help people as much as possible. I like the idea of a PA because I could still do surgery.

Any input on which of the 3 routes would be best for me? I am always open to suggestions. Do you think NP or PA would be better suited for me? Why?
I certainly have much better access to nursing programs vs PA programs, but I don't know... can't decide what to do

---

Members don't see this ad.

 

[horsenurse25]

For those of you that don't know me, I'll give some background information. I'll also try to condense this and put it all together from the post I put on the PA forum earlier. Just trying to get as much advice and input as possible.

-I am a 21 year old college junior/senior.
-I attended full time post secondary in high school, but used it as a "joke off" time and received absolutely terrible grades and didn't get credit for any useful classes. I wish I would have used those two years as so much more!
-After graduating high school in 2005, I went to college at a smaller "public ivy league" school and spent two years as an accounting major. I worked for a small firm doing construction project accounting one year and then worked as an auditor for Ernst & Young. I d my major, d my school, d the location of the school, and d the people there. I wish that (1) I never would have went there (money reasons) and (2) I wish I would have went through with my transfer after my first year
-I finally transferred to the original college of choice for my third year of college. I am carrying with me a 2.51 GPA (primarily brought down by those post secondary years, and not brought up too much by hating everything about my old school/major). I changed my major to something I enjoy (microbiology), love my school, my roommates, and the school's location. I have had a 3.88 GPA since I transferred.
-I have wanted to be a doctor since I was 4 years old. I drew a picture of me working with my pediatrician at that age and gave it to him saying I was going to work with him when I grew up. I used to perform "surgery" on my food.

So, a really big part of me wants to go to medical school. It is all I have ever wanted to do, despite dabbling in many other career options. I have been particularly interested in orthopaedic surgeon, but I have looked at pediatrics (then doing a neonatal/perinatal medicine fellowship), emergency medicine, other surgical fields, and interventional radiology.

However, I am a female who has a strong maternal instinct. I want to get married and have my first kid before I am 30. I want to have 3-5 kids. I don't want to miss anything in their life... a first Halloween, a first Christmas, their first step, etc. I want to potty train them and be there when they go off to their first day of school. I want to go to every event they have, whether it is a play, a musical, a sporting event, etc. I will be 27 years old when I graduate medical school (if I get in the first time around). I am looking at a 5+ year residency then, making me 32. So if I don't want to miss any "milestones" in my kid's lives, I can't really start until I am of that age. I know people say you can "make it work" but a lot of the fields I am interested in make that very difficult. The orthopaedic surgeon I shadowed many times brings her son to work on Saturday's to catch up on paperwork because it is one of the few times she can spend with him.

So, my person viewpoint is that if I do not go to medical school, I will always regret not being a doctor. However, I will never regret not having insanely long hours. I will never regret missing parts of my children growing up. There are many things about being a doctor I do not like. My mom works for doctors. I have shadowed and talked to more doctors than I can even remember.

Needless to say, I believe the cons outweigh the pros of going to medical school in my case. So I have been looking at other options.

(1) Entering a 3 year Masters in Nursing program for people with a non-nursing bachelors degree and working as a Nurse Practitioner.
(2) Entering a 2 year Physician Assistant program
(3) Doing a 12-15 month accelerated BSN program, working for a bit as an RN, and then doing a MSN or DNP program or then entering a PA program

I know I want to work in a hospital as I prefer to crazy busy environment of a hospital over a doctors office. I know I want to touch lives and help people as much as possible. I like the idea of a PA because I could still do surgery.

Any input on which of the 3 routes would be best for me? I am always open to suggestions. Do you think NP or PA would be better suited for me? Why?
I certainly have much better access to nursing programs vs PA programs, but I don't know... can't decide what to do

Well, if you want to have a life, and be there for your family, then being a surgeon is not the way to go.

You say you want to touch lives and help people...that is probably more in the range of nursing. Doctors are busy, are typically not very involved with people's lives, are on very difficult time restraints.

You say you have shadowed doctors...well go shadow an NP or a PA.

That will provide you with much, much better information than asking such important questions on a nurse-hating anonymous public board...

And quite honestly, being an excellent parent, raising your kids to the best of your ability, and being there for them is the most imporatnt job ANY parent can do. If you want to to save the world, then don't have kids. If you want to be a parent, then make that your priority. OR have kids, raise them, and THEN go save the world.

 

[lawguil]

Well, if you want to have a life, and be there for your family, then being a surgeon is not the way to go.

You say you want to touch lives and help people...that is probably more in the range of nursing. Doctors are busy, are typically not very involved with people's lives, are on very difficult time restraints.

You say you have shadowed doctors...well go shadow an NP or a PA.

That will provide you with much, much better information than asking such important questions on a nurse-hating anonymous public board...

And quite honestly, being an excellent parent, raising your kids to the best of your ability, and being there for them is the most imporatnt job ANY parent can do. If you want to to save the world, then don't have kids. If you want to be a parent, then make that your priority. OR have kids, raise them, and THEN go save the world.

Agree! Nursing or PA are both great careers with flexability to raise a family.

I've heard of nurses who work 16 hours a week and still make a decent living. I suspect that PA's and NP's could do the same.

As I see it, you don't have to be an MD to practice medicine...............

 

[horsenurse25]

Agree! Nursing or PA are both great careers with flexability to raise a family.

I've heard of nurses who work 16 hours a week and still make a decent living. I suspect that PA's and NP's could do the same.

As I see it, you don't have to be an MD to practice medicine...............

WOW!!!!

Can it be!!!!????
We actually AGREE!!!!!

Excellent post Lawguil

 

[foreverLaur]

but now I have to figure out.... nursing or PA? what is the best route for me to get there?

 

[psychbender]

However, I am a female who has a strong maternal instinct. I want to get married and have my first kid before I am 30. I want to have 3-5 kids. I don't want to miss anything in their life... a first Halloween, a first Christmas, their first step, etc. I want to potty train them and be there when they go off to their first day of school. I want to go to every event they have, whether it is a play, a musical, a sporting event, etc. I will be 27 years old when I graduate medical school (if I get in the first time around). I am looking at a 5+ year residency then, making me 32. So if I don't want to miss any "milestones" in my kid's lives, I can't really start until I am of that age. I know people say you can "make it work" but a lot of the fields I am interested in make that very difficult.

So, my person viewpoint is that if I do not go to medical school, I will always regret not being a doctor.

You can become a doctor and still have kids before your thirties. By the end of my second year, there were at least 18 babies born to classmates, or on the way. While most of the classmates became fathers, not mothers, there were a few exceptions. They, so far, have been able to make it work. One had a very difficult pregnancy in the middle of second year, was out for a few months, but still managed to catch back up, and has not had to sacrifice much time with her new baby. I know another doc in my area that wanted a big family, waited until after residency, then had four kids in rapid succession, while still working. I have never heard her complain about not having enough time to spend with her kids. If you want something enough, you can make it work.

That said, there probably will be some sacrifices down the road. You probably won't be able to make EVERY event that each kid has. Hell, most stay-at-home parents can't manage to do that, how do you expect to be able to do that and have ANY job, let alone one in the medical field? Just because the training for nursing and PA is shorter, does not mean that the hours are phenominally better once out of school. That unrealistic expectation is one thing that you probably will have to sacrifice somewhere down the line, whatever field you ultimately enter.

 

[horsenurse25]

I disagree. Medical school is hard enough, and then residency is brutal. There is NO WAY you can be a decent parent and work 70-80 hours a week plus all the other stuff you do on top of it. Medical school and residency does, and SHOULD take all of your attention. Parenting should not take a back seat to school or career. It should be the priumary job. The other stuff just pays the bills.

I know, you can say X, Y and Z did it. But I would bet their kids are the ones to suffer for it.

All I am saying is that if you want to be a parent THEN BE ONE!!!
If you want to be a doctor, then be one first, THEN be a parent.
Or be a parent then be a doctor. Whatever.

There is no law that says you have to have kids.
But there SHOULD be a law that says if you have them, then you should parent them. Seeing your kid for an hour a day is not parenting. If you are going to have kids, then they should come first, before any career, before any personal gain. Otherwise, do not have them.

I have a friend who breeds dogs. She will not sell any puppy to anyone who works full time since the puppy needs to have someone home for the most part of the day. Otherwise she tells them to get a cat.

If that applies to dogs, why on earth wouldn't it apply to kids????

 

[horsenurse25]

but now I have to figure out.... nursing or PA? what is the best route for me to get there?

Again, go shadow each one and check out whatever school you might go to. Those two factors should shed some light on your plans.

 

[foreverLaur]

Again, go shadow each one and check out whatever school you might go to. Those two factors should shed some light on your plans.

well I have shadowed a PA and my aunt is an NP so I get tons of information from her. Obviously I have more to do but... just looking for people's opinions based on what I have said.

 

[brightness]

Ok, I'll throw out my .02.
This had been my debate for a long time, and I've also thought about doing a PhD/PsyD in psychology, which is what I am going to do if at all possible. Anyway, I have learned a considerable amount about the PA/NP thing, and here's what I would say (just my opinion)-
If you have a strong interest in working with women, children, and babies but NOT surgery, I would go for NP. You can even deliver babies somewhat independently (still with a doctor you can call or that is in your facility) but you cannot do surgical work or invasive births. You can do many things in nursing as an NP, but you have to go back for a post-masters degree everytime you want to switch specialties. You also get to be a nurse first, which I think is cool because it gives you medical experience and income. There are also a lot of part time nursing programs, which makes it easy to go back, even as a mother.
PA school allows you to switch specialities without going back to school, and it allows you to work in a surgical setting. You can't work truly independently, although many PAs have a high degree of independence- they are not able to open up their own practice as an NP would be. Although NPs and PAs can both work in the same settings, PA jobs seem to be more geared towards ER/surgery type positions than pediatrics/ob/ect. Still, I think it makes no difference; as an NP/PA you can find jobs in just about any setting.
The biggest difference is the theoretical/education orientation for PA/NP. NPs are trained in nursing primarily, and the structure of the classes is unique. PAs learn a mini medical model; they learn what the MDs and DOs learn, only a shortened and condensed version. My opinion is that the PA program provides a more rigorous training in medicine, while the NP programs provide a more holistic and very 'nursing theory' based. Looking at the curriculum for both types of programs- many schools have the syllabus posted for each class- can give you a more clear idea of how the classes differ.
Just my musings about the whole thing. Obviously, this is your decision and there are a lot of factors.

 

[deleted6669]

brightness-
good post overall, except for this:
" they are not able to open up their own practice as an NP would be"
many states allow a pa to hire a physician to be their supervisor of record. the physician never needs to be physically present at the practice so the pa "runs the clinic" and sees all pts alone. the md just reviews a % of charts or in some states has a discussion regarding the practice every few months. in no. carolina for example the supervisory requirement is "discussion of practice issues with a physician for 30 min every 6 mo".
I know many pa's who own their own practices. most do primary care but some do outpt ortho and surgical assisting as well.

 

[Febrifuge]

I debated PA vs. MD for a long time; I decided against RN or NP based on my years as a nursing assistant.

...You can't work truly independently, although many PAs have a high degree of independence- they are not able to open up their own practice as an NP would be....

Actually, there are a few PAs here and there that have opened practices, and hired MDs to be the supervising provider. From what I read, there are really very few NPs who own practices, and I would not be surprised if these two very small populations just about even out over the next few years. In short, don't let the "owning and running a practice" thing be what guides you to (or away from!) PA or NP.

...The biggest difference is the theoretical/education orientation for PA/NP. NPs are trained in nursing primarily, and the structure of the classes is unique. PAs learn a mini medical model; they learn what the MDs and DOs learn, only a shortened and condensed version....

Yes, and it's worth noting that PA school is more intense than MD school, in terms of hours per day or per week. At my school, the MD students are not in class five days of every week like we are; they are usually done at noon or 3pm, and we go til 3 or 5 every day. PA school is maybe 2/3 of the stuff covered in four-year med school, and it's done in a little over half the time.

That's something I thought I understood when I was weighing the options, but now that I'm here I feel like it needs underlining. Just another two cents... at this rate you'll have a dollar soon!

 

[foreverLaur]

I heard the same thing. My mom's friend's daughter went to med school for a year, dropped out, and is now a PA. She said the classes in med school were harder and more intense, but that she spent a lot more time per week in class in PA school. She said that she couldn't tell a big difference with how much time she actually spent working per week in med school vs PA school.

 

[brightness]

My boyfriend's sister is a PA student in her rotations and she recently mentioned this to me, but I wasn't sure how it worked. Is it a state-by-state rule? I know that each state sort of has its own mandate for what midlevels can/can't do.

brightness-
good post overall, except for this:
" they are not able to open up their own practice as an NP would be"
many states allow a pa to hire a physician to be their supervisor of record. the physician never needs to be physically present at the practice so the pa "runs the clinic" and sees all pts alone. the md just reviews a % of charts or in some states has a discussion regarding the practice every few months. in no. carolina for example the supervisory requirement is "discussion of practice issues with a physician for 30 min every 6 mo".
I know many pa's who own their own practices. most do primary care but some do outpt ortho and surgical assisting as well.

 

[deleted6669]

Yup, State By State. Will Find A Link For You From Aapa That Lists What States Allow Pa's To Own A Clinic
HERE IS THE LINK...UNFORTUNATELY IT IS DOWN FOR AN UPDATE TODAY BUT TRY BACK NEXT WEEK....
http://www.aapa.org/gandp/shrhldr-procorp.html

 

[core0]

I debated PA vs. MD for a long time; I decided against RN or NP based on my years as a nursing assistant. Actually, there are a few PAs here and there that have opened practices, and hired MDs to be the supervising provider. From what I read, there are really very few NPs who own practices, and I would not be surprised if these two very small populations just about even out over the next few years. In short, don't let the "owning and running a practice" thing be what guides you to (or away from!) PA or NP.

Its actually almost exactly the same. The AAPA reports that 2% of PAs are self employed. That can be anything from owning a practice to contracting for work. The data on NPs is weaker. The best data is probably for Advance for NPs which shows 2% of NPs are self employed.

Yes, and it's worth noting that PA school is more intense than MD school, in terms of hours per day or per week. At my school, the MD students are not in class five days of every week like we are; they are usually done at noon or 3pm, and we go til 3 or 5 every day. PA school is maybe 2/3 of the stuff covered in four-year med school, and it's done in a little over half the time.

I think that the educational models can't be directly compared. Looking at the allo posts at leasts it seems that medical students are more on their own as far as how much class they attend and how they learn the material. The PA world is a little more structured with required classroom time and such. The amount of time spent in class is not necessarily the best measure of amount of information learned. There are a few people who have done both and could comment.

That's something I thought I understood when I was weighing the options, but now that I'm here I feel like it needs underlining. Just another two cents... at this rate you'll have a dollar soon!

Overall I agree.

David Carpenter, PA-C

 

[Febrifuge]

I would love to hear those comments, as well.

At my school, med students complain about having to do anything the WEEK of a test. We have at least one major test a week, and frequently have more. I'm sure it's probably apples and oranges; as you say, they are responsible for getting X, Y, and Z covered, whereas we get an email if we skip a lecture and have everything pretty well laid out.

On the other hand, it's midnight and I just finished up my studying to prepare for tomorrow. I don't really see how the med students can do significantly more in one day, or one week.

The point being, people who choose PA over MD because they don't like school, or studying, or being academically smacked around are in for a rude awakening. It's very probably a different sensation, but it's still a smack.

 

[psychbender]

At my school, med students complain about having to do anything the WEEK of a test. We have at least one major test a week, and frequently have more. I'm sure it's probably apples and oranges; as you say, they are responsible for getting X, Y, and Z covered, whereas we get an email if we skip a lecture and have everything pretty well laid out.

Those lucky bastards. For the first two years here, we were "required" to be in class 0800-1700(ish), with three exams every week, except finals week (then, five to eight). Point being, every school is completely different, so any comparison of medical schools as a whole to PA schools as a whole regarding time spent in class is going to be inherently flawed.

 

[foreverLaur]

I think I am leaning towards getting my MSN and working as a CNP.

 

[fab4fan]

Well, if you want to have a life, and be there for your family, then being a surgeon is not the way to go.

You say you want to touch lives and help people...that is probably more in the range of nursing. Doctors are busy, are typically not very involved with people's lives, are on very difficult time restraints.

You say you have shadowed doctors...well go shadow an NP or a PA.

That will provide you with much, much better information than asking such important questions on a nurse-hating anonymous public board...

And quite honestly, being an excellent parent, raising your kids to the best of your ability, and being there for them is the most imporatnt job ANY parent can do. If you want to to save the world, then don't have kids. If you want to be a parent, then make that your priority. OR have kids, raise them, and THEN go save the world.

Excellent.

 

[fab4fan]

WOW!!!!

Can it be!!!!????
We actually AGREE!!!!!

Excellent post Lawguil

When worlds collide.

 

[lawguil]

When worlds collide.

You nurses.....or should I call you doctors now?


Opps back to normal.

 

[lawguil]

When worlds collide.

Please understand that I do believe that nursing is an excellent career choice. In the educational world, nursing is still offered at the associate's degree making it a bargain for your educational dollar.......with lots of jobs to boot.....

Can't beat it in my opinion!

Let's hope that the nursing world doesn't arbitrarily "kick it up a notch" and require the BS. That's just my opinion....why double the cost of the education in a model that is working.

 

[fab4fan]

Nope, nurse is fine. Take a chill pill--it's a vocal few who are agitating for the "Doctor Nurse" title.

You nurses.....or should I call you doctors now?


Opps back to normal.

 

[PhysioMan]

I think I am leaning towards getting my MSN and working as a CNP.

If you want more freedom to work in surgical areas then PA is more advisable IMHO. This is not to say that NPs do not work in surgery, but the medical model used for training PAs coupled with the surgical rotations that are in the curriculum are better suited for the timeline you want. Go here and see Ortho PA info: http://www.paos.org/

Then go here for a better insight on the PA world: http://www.physicianassistantforum.com/forums/

 

[horsenurse25]

You nurses.....or should I call you doctors now?


Opps back to normal.

Nope, most definitely a nurse. And proud of it.

I might work towards a Doctorate of nursing as I have a passing interest in teaching, but I will never go sideways and become a physician. Completely different philosophy and mode of operation.

 

[foreverLaur]

If you want more freedom to work in surgical areas then PA is more advisable IMHO. This is not to say that NPs do not work in surgery, but the medical model used for training PAs coupled with the surgical rotations that are in the curriculum are better suited for the timeline you want. Go here and see Ortho PA info: http://www.paos.org/

Then go here for a better insight on the PA world: http://www.physicianassistantforum.com/forums/

I talked to a few friends of mine doing surgery rotations and another one who has worked in some major hospitals as a CRNA. I got the same responses from all of them.

Most PAs work in non university / teaching hospitals because at the teaching hospitals, they have the residents to do all that type work. The teaching hospital environment is where I would like to work. To double check, I called a few of the big teaching hospitals I am interested in and they told me they only hire PAs in CT surgery and they don't hire very many. They told me to check smaller hospitals.

They also all told me that a PA pretty much does what his or her doctor wants the PA to do. You may get lucky and get a doctor who wants you to scrub in a lot, or you may get one who likes you to do paperwork and scut work most of the time. Just depends...

So, I have decided to go after being an acute care nurse practitioner and a clinical nurse specialist in cardio-pulmonary I think.

 

[lawguil]

I talked to a few friends of mine doing surgery rotations and another one who has worked in some major hospitals as a CRNA. I got the same responses from all of them.

Most PAs work in non university / teaching hospitals because at the teaching hospitals, they have the residents to do all that type work. The teaching hospital environment is where I would like to work. To double check, I called a few of the big teaching hospitals I am interested in and they told me they only hire PAs in CT surgery and they don't hire very many. They told me to check smaller hospitals.

They also all told me that a PA pretty much does what his or her doctor wants the PA to do. You may get lucky and get a doctor who wants you to scrub in a lot, or you may get one who likes you to do paperwork and scut work most of the time. Just depends...

So, I have decided to go after being an acute care nurse practitioner and a clinical nurse specialist in cardio-pulmonary I think.

You mind providing us with the names of the teaching hospitals that you called that don't hire PA's?

 

[lawguil]

Nope, most definitely a nurse. And proud of it.

I might work towards a Doctorate of nursing as I have a passing interest in teaching, but I will never go sideways and become a physician. Completely different philosophy and mode of operation.

Just curious......why wouldn't you pursue the PhD if you're interested in college/university teaching and research?

"D"NP is clinical.............................

 

[foreverLaur]

You mind providing us with the names of the teaching hospitals that you called that don't hire PA's?

I talked to the Cleveland Clinic and the University of Chicago. They only hire PAs in CT Surgery. Otherwise - they have residents that they need to teach how to do all the surgery stuff. No need for PAs to scrub in too.

 

[foreverLaur]

Just curious......why wouldn't you pursue the PhD if you're interested in college/university teaching and research?

"D"NP is clinical.............................

All the DNP programs I have seen are only partially clinical. They still require some research and a thesis... just not like a PhD or a DNSc does. Yuck!

 

[lawguil]

All the DNP programs I have seen are only partially clinical. They still require some research and a thesis... just not like a PhD or a DNSc does. Yuck!

Many bachelors programs require a "thesis". Adding a capstone project doesn't make it a "partially clinical" hybrid.....it's very much a clinical degree. When they spend 2-3 years taking the research credits and working on their thesis, I'll recognize them as doctoring degrees........but if they did doctorate level work, they would just award them a PhD....after their defense of course.

However, I've recently reviewed some of the PhD (earned doctorate) programs in nursing......they are the real deal. I would have no problem saluting a PhD in "nursing".

 

[foreverLaur]

Many bachelors programs require a "thesis". Adding a capstone project doesn't make it a "partially clinical" hybrid.....it's very much a clinical degree. When they spend 2-3 years taking the research credits and working on their thesis, I'll recognize them as doctoring degrees........but if they did doctorate level work, they would just award them a PhD....after their defense of course.

However, I've recently reviewed some of the PhD (earned doctorate) programs in nursing......they are the real deal. I would have no problem saluting a PhD in "nursing".

Weird - none of the programs in my state require any sort of "thesis" or writing project or anything. The DNP program I am looking in requires two classes in Advanced Nursing Research. They also require a research project and a thesis. Additionally, 50% of the curriculum revolves around teaching. Very little of it is clinical. Keep in mind this program also has a Ph.D in Nursing. Just seems to research based for me.

If I find a program that just gives me more coursework and more clinical to make me a better prepared nurse, I'm all game. I just have not found one yet. None of my MSN programs require any sort of writing or research.

DNP by 2015? Yea right. They have been saying BSN is going to be required for all RNs since my aunt was getting her BSN and that was over 30 years ago.

 

[core0]

I talked to the Cleveland Clinic and the University of Chicago. They only hire PAs in CT Surgery. Otherwise - they have residents that they need to teach how to do all the surgery stuff. No need for PAs to scrub in too.

Umm I would not base my career decision on a phone call to two hospitals. A quick perusal of the Cleveland Clinic site shows more than 20 available positions. Only a few are in surgery. I am not sure about University of Chicago but most of the other teaching hospitals use PAs extensively. Surgery has traditionally been dominated by PAs.

As far as residents there is something called the ACGME rules that are discussed here extensively. With the limits on resident work hours many programs are replacing the hours with PAs and NPs. It usually takes two NPPs to replace one resident. There is also an entire world that does not include academic medicine and even within academic centers there are non-teaching services.

It sounds like you still have some research to do. The ability to find a job is area dependent. Even within a city some practices may prefer one type of NPP over another.

David Carpenter, PA-C

 

[foreverLaur]

Umm I would not base my career decision on a phone call to two hospitals. A quick perusal of the Cleveland Clinic site shows more than 20 available positions. Only a few are in surgery. I am not sure about University of Chicago but most of the other teaching hospitals use PAs extensively. Surgery has traditionally been dominated by PAs.

As far as residents there is something called the ACGME rules that are discussed here extensively. With the limits on resident work hours many programs are replacing the hours with PAs and NPs. It usually takes two NPPs to replace one resident. There is also an entire world that does not include academic medicine and even within academic centers there are non-teaching services.

It sounds like you still have some research to do. The ability to find a job is area dependent. Even within a city some practices may prefer one type of NPP over another.

David Carpenter, PA-C

If you think I'm basing my entire decision on two phone calls then you are very mistaken. I have been doing extensive research for about 6 months now. I have spoken to hospitals, spoken to people in each career, shadowed both careers, looked up schooling for both careers, and weighed my options. I have determined that being a CNP will fit slightly more of my goals than being a PA-C will. The only thing I would want to do with a PA is work in surgery. I have spoken to doctors who are all about it and other doctors prefer to have their PAs order tests, see patients, do rounds, scut work, paperwork etc. At least in the area I plan to live in long term, they aren't big on PAs.

I agree it is a by area thing - and my area doesn't use many PAs where CNPs are very very heavily used.

 

[horsenurse25]

Just curious......why wouldn't you pursue the PhD if you're interested in college/university teaching and research?

"D"NP is clinical.............................

That is what I am talking about. The Doctorate degree in nursing. Although that is a LOT of work. I might just go for the DNP as that is slightly more clinical based (and in my mind easier).

But to be quite honest, I have not really looked into either degree very extensively. It is just a passing thought that I might teach. Most of my family members traditionally have been teachers and I broke out by going to medical school, then dropped out due to family reasons and went on to get my BSN and then NP. So getting back to teaching sorta appeals to me. Sorta.

 

[lawguil]

If you think I'm basing my entire decision on two phone calls then you are very mistaken. I have been doing extensive research for about 6 months now. I have spoken to hospitals, spoken to people in each career, shadowed both careers, looked up schooling for both careers, and weighed my options. I have determined that being a CNP will fit slightly more of my goals than being a PA-C will. The only thing I would want to do with a PA is work in surgery. I have spoken to doctors who are all about it and other doctors prefer to have their PAs order tests, see patients, do rounds, scut work, paperwork etc. At least in the area I plan to live in long term, they aren't big on PAs.

I agree it is a by area thing - and my area doesn't use many PAs where CNPs are very very heavily used.

It's clear that you're very proud of your decision and future direction.

Just for giggles, what exactly do you like about the NP profession that is so different than the PA profession.

In my experience, when people are pursuing NP over PA, it's because they are already an RN, their interested in Anesthesia or midwifery, or access to school.

My understanding is that PA's tend to have a great deal of autonomy that typically mirrors their supervising MD/DO in many specialties.

Is it true that NP's have to follow agirithms in their evaluation and treatment and don't have the luxery of medical decision making? (just a rumor).

 

[PharmDr.]

PA/NP=midlevel practitioner. They do the exact same job. PA's are more heavily represented in surgery and ICU areas, while NP's generally are found more in womens, IM, peds, FP (non are exclusive). It is easier for an RN to progress to NP, but as long as the RN has the pre-req then PA is another choice for him/her. It all boils down to what "you" feel comfortable doing in your life. I had a totally different outlook on things when I didnt work as an RRT down in south FL. Now, nursing is not even an option for me. It is a lot of BS that RN's deal with. Nursing is a great career and I respect nurses greatly, but they can have it. You really have to work in the field to "really" know what goes on. Being an MD/DO isnt everything, nor is being an NP/PA. Achieving a title in medicine is not what benfits the patients nor is your CRNA salary. I strongly believe that previous healthcare experience is invaluable to your future career. It really humbles you. Our healthcare system really needs bright, creative, and passionate providers that look outside the box for treatment options and delivery of care. Anyways....good luck!

 

[lawguil]

PA/NP=midlevel practitioner.

Correct, but certainly not the complete picture.........although similar, still very different paths to achieve status as an NP or PA, different style of schooling, and different advantages to each.

thus, the debates

 

[lawguil]

on 10-30-07 foreverlaur wrote:

Just trying to get as much advice and input as possible.

so your open to suggestions

-I am a 21 year old college junior/senior.....................

your a young adult and naturally, you're not quite sure what you want to do.

I have been particularly interested in orthopedic surgeon, but I have looked at pediatrics (then doing a neonatal/perinatal medicine fellowship), emergency medicine, other surgical fields, and interventional radiology..........

You seem to like surgery, EM, and a variety of other fields such as peds.......

However, I am a female who has a strong maternal instinct. I want to get married and have my first kid before I am 30. I want to have 3-5 kids. I don't want to miss anything in their life...

But you want to be a good parent

The orthopedic surgeon I shadowed many times brings her son to work on Saturday's to catch up on paperwork because it is one of the few times she can spend with him..................

just curious, what did the orthopedic suggest?

So, my person viewpoint is that if I do not go to medical school, I will always regret not being a doctor.................
Needless to say, I believe the cons outweigh the pros of going to medical school in my case. So I have been looking at other options.

you'll always regret not being a doctor, but it seems to be the right choice for you.........so what is the next best thing to being an MD/DO that will fit your desired lifestyle?

(1) Entering a 3 year Masters in nursing program for people with a non-nursing bachelors degree and working as a Nurse Practitioner.
(2) Entering a 2 year Physician Assistant program
(3) Doing a 12-15 month accelerated BSN program, working for a bit as an RN, and then doing a MSN or DNP program or then entering a PA program

So it's NP or PA or RN........and still flirting with the MD

I know I want to work in a hospital as I prefer to crazy busy environment of a hospital over a doctors office. I like the idea of a PA because I could still do surgery.

and you prefer the hospital over the MD office

Do you think NP or PA would be better suited for me? Why?
I certainly have much better access to nursing programs vs PA programs, but I don't know... can't decide what to do

So you ask for some advice.


On 11-2-07 you stated the following:

Most PAs work in non university / teaching hospitals because at the teaching hospitals, they have the residents to does all that type work. The teaching hospital environment is where I would like to work. To double check, I called a few of the big teaching hospitals I am interested in and they told me they only hire PAs in CT surgery and they don't hire very many. They told me to check smaller hospitals.

They also all told me that a PA pretty much does what his or her doctor wants the PA to do. You may get lucky and get a doctor who wants you to scrub in a lot, or you may get one who likes you to do paperwork and scut work most of the time. Just depends...

These statements lack a lot of insight or truth. PA's work in teaching hospitals, have their own case loads, are the preferred practitioner 1st assisting in surgery, and work in every specialty in medicine. They enjoy a great deal of autonomy. NP's also work in a variety of specialties and seems to have the market anesthesiology and midwifery.

Also on 11-2-07, you stated:

If you think I'm basing my entire decision on two phone calls then you are very mistaken. I have been doing extensive research for about 6 months now. I have spoken to hospitals, spoken to people in each career, shadowed both careers, looked up schooling for both careers, and weighed my options. I have determined that being a CNP will fit slightly more of my goals than being a PA-C will. The only thing I would want to do with a PA is work in surgery. I have spoken to doctors who are all about it and other doctors prefer to have their PAs order tests, see patients, do rounds, scut work, paperwork etc. At least in the area I plan to live in long term, they aren't big on PAs.

It seems from your original post on 10-30-07 to the post above dated 11-2-07, you discovered that nursing is the right career path for you.

I think nursing is a great choice, but if you want my opinion as you suggested above....well......

PA is the next closed thing to an MD as far as education and practice.
PA has the ability to move from specialty to specialty without going back to school. NP's cannot. Above you mentioned a number of specialties that you were interested in from ortho and EM to peds......My understanding is that PA's easily outnumber NP's in ortho and EM. NP's cannot change specialty without additional schooling.

I think PA's and NP's could offer a similar level of flexibility. It largely depends on the job you decided to take....although; RN's may have the most flexibility with the ability to take per-diem shifts. You also mentioned that nursing education is more accessible were you're live. This is obviously an advantage for nursing

In my opinion, based on what you mentioned above, the PA may be the best compromise based on what you want to do. If staying near home is important, then RN education obviously wins.

For what it's worth

 

[fab4fan]

It seems like she had pretty much made up her mind before posting. I'm not sure you can go from having no idea on 103007 to being fairly certain on 110207. Maybe it's just me, but I don't make major life decisions that fast.

I hate to say it, but it's a myth to think you can have a fantastic career and have the kids, the house, the two cats in the yard, etc. You can certainly have all of those things, but you may not be able to have them all at the same time. If you really want kids, have the kids first. School will always be there. You only get one chance to be with your kids when they're little. You can't count on others to cover for you or work for you so you can get to that recital/game.

Horsenurse made a lot of horse sense in her post, Laur.

 

[foreverLaur]

Well I was looking into other sources besides just this forum. I have found people in both fields in a variety of different practice settings that I have talked to extensively.

Also, have kids first then get a career/job second? Okay great, but how do you expect me to pay for those kids? I am not being the type of mother that relies on her husband for everything financial.

*NOTE* I never intended to work as an RN. I only intended to use it as a stepping stone to either (1) get the experience for PA school or (2) use it as a stepping stone to get my Masters in Nursing

I get a pretty consistent story when I talked to people about what an advanced practice nurse does. There are a ton of schools available to help me get there in all areas. I feel comfortable with that, when I get consistent stories.

That isn't the case with a PA. My aunt in california works as a critical care nurse in SoCal. There, they don't use any advanced practice nurses in any ICU environment, only intensivists. They also only use PA's in CT Surgery.

Another friend who is a CRNA who worked in the Cleveland Clinic and now the University of Chicago hospitals said "I just took a little informal survey here (I'm at work) and no one knows of any PAs here, but we do use NPs (I'm at a major university hospital). Also, I don't think that you have any less flexibility as an NP than you do as a PA--if you're an adult or acute care NP, you can essentially work in any field (besides peds). There are some specific areas that use a lot of PAs--specifically cardiothoracic surgery. However, if you get one of those jobs, what you do depends 100% on what the surgeon you are working with lets you do. There is not a defined role for PAs there--ie. you may be in the OR, or you may be writing orders and doing"

If I knew I could be a PA and spend half my weekend seeing the patients and the other half scrubbed in and assisting in surgery, I'd 100% go for it. However, from what I have heard, what you get to do as a PA depends on what doctor you work under.

I talked to a neonatologist attending at Columbus Children's who said that the NNP's pretty much run the NICU there.

How am I supposed to figure this out if I get very contradicting advice about the PA profession? Even when I shadow, some have jobs I would love and others have jobs I would hate. Again... depends on the doctor you work for...

 

[fab4fan]

How are you going to spend time with your kids if you're working to put yourself through school?

Who ever said you had to rely on your husband for everything? Back that train up. Call me old fashioned; I just think if you're going to have kids, then you should make those kids your priority until they're able to fend for themselves. Oh, and as for how to expect you to pay for the kids? Don't have them until you can afford them--d'oh!

Love the comment "I never intended to work as an RN. I only intended to use it as a stepping stone..."

 

[foreverLaur]

How are you going to spend time with your kids if you're working to put yourself through school?

Who ever said you had to rely on your husband for everything? Back that train up. Call me old fashioned; I just think if you're going to have kids, then you should make those kids your priority until they're able to fend for themselves. Oh, and as for how to expect you to pay for the kids? Don't have them until you can afford them--d'oh!

Love the comment "I never intended to work as an RN. I only intended to use it as a stepping stone..."

Well I need to be an RN to get my MSN so I would be an RN before entering a Masters program... wouldn't that qualify as a stepping stone? If I find that nursing isn't my thing, I could then use that experience to enter a PA school. I could always pick up shifts working as an RN even if I was a PA, if I so chose to do so. Plus, the PA schools I am interested in say: "Applicants must provide documentation of health care experience, either paid or voluntary, that reflects direct patient care with decision-making process necessary to become a successful PA student and graduate professional. It is highly suggested that applicants have 1,000 hours of experience." Anyone have any ideas to get that type of experience? My best idea was to do a 1 year RN program...

And I don't intend to have kids while I'm still in school. I'll be in my low 20s. Way too early for kids!! I intend to get my degree finalize around 25, and not have kids til I am 30. As in... work for 4-5 years before starting a family. Ideally, I'd like to be married by 25 as well. So far, on track but we shall see.

I intend to then work part time while my children are little. That is what my mom did - worked part time as a nurse.

 

[core0]

snip

That isn't the case with a PA. My aunt in california works as a critical care nurse in SoCal. There, they don't use any advanced practice nurses in any ICU environment, only intensivists. They also only use PA's in CT Surgery.

However, if you get one of those jobs, what you do depends 100% on what the surgeon you are working with lets you do. There is not a defined role for PAs there--ie. you may be in the OR, or you may be writing orders and doing"

If I knew I could be a PA and spend half my weekend seeing the patients and the other half scrubbed in and assisting in surgery, I'd 100% go for it. However, from what I have heard, what you get to do as a PA depends on what doctor you work under.

You can look at the facts overall. There are about the same amount of people working as NPs as PAs (around 70k for each profession). 35% of PAs work in surgery. Similar numbers for NPs are harder to find but probably around 1-2% of NPs are working in surgery. While ACNPs and to some extent ANPs do roughly the same job working inpatient medicine as PAs, these represent less than 25% of NPs. Many of the NPs that are currently working in the hospital are FNPs that are having increasing difficulty getting credentialed. While there are many FNP programs less than 1/3 of the programs are ACNP or ANP. There are distance learning options for NP that are not available for PA.

As far as the work environment for PAs in surgery, that is completely up to the relationship between the physician and the PA. That is what defines the MD/PA team. Because of the way that payment works, most surgical jobs in private practice are divided fairly evenly between OR time and clinic. Academic centers or hospitals represent less than 25% of PA employers. Most PAs in surgery work equally in both environments.

I talked to a neonatologist attending at Columbus Children's who said that the NNP's pretty much run the NICU there.

Yep and I can show you several large NICUs that use only PAs. Even within a given city it can vary from hospital to hospital.

How am I supposed to figure this out if I get very contradicting advice about the PA profession? Even when I shadow, some have jobs I would love and others have jobs I would hate. Again... depends on the doctor you work for...

This is the nature of medicine. It will not change whether you are an NP or PA. There are good jobs and bad jobs.

Ultimately an RN position is good medical experience. I am puzzled by a number of things. In your original post you state that you want to get married and have your first kid prior to age 30. If you do PA you are looking at 2 years after your bachelors so say 24 or so. If you do RN you are looking at roughly the same time frame. If you do NP now you are looking at the the RN plus another 2-3 years for NP (3-4 for DNP) and the need to get RN time before school.

However all this discussion about marriage and kids presupposes a potential spouse (I am somewhat old school here). That adds another dimension. Now you not only have to worry about school and such but can the other make a change based on their life/job. If you have the ability to work anywhere and go to school anywhere then this is superfluous. However, if you are limited in where you can work and where you can go to school by spouse/family then your educational program should be designed around the work environment for that area (NP or PA friendly) and the availability of an educational program in the area (either NP or PA depending). So ultimately what you want to do depends on whether you can or cannot move.

Finally while surgery has gotten significantly better in the last 10 years, even in the PA environment it is not what I would call family friendly. While there are job sharing arrangements and fixed hours, they are more prominent in primary care practices than surgery.

Just some thoughts from another anonymous writer on the internet.

David Carpenter, PA-C

 

[foreverLaur]

This is the nature of medicine. It will not change whether you are an NP or PA. There are good jobs and bad jobs.

Ultimately an RN position is good medical experience. I am puzzled by a number of things. In your original post you state that you want to get married and have your first kid prior to age 30. If you do PA you are looking at 2 years after your bachelors so say 24 or so. If you do RN you are looking at roughly the same time frame. If you do NP now you are looking at the the RN plus another 2-3 years for NP (3-4 for DNP) and the need to get RN time before school.

However all this discussion about marriage and kids presupposes a potential spouse (I am somewhat old school here). That adds another dimension. Now you not only have to worry about school and such but can the other make a change based on their life/job. If you have the ability to work anywhere and go to school anywhere then this is superfluous. However, if you are limited in where you can work and where you can go to school by spouse/family then your educational program should be designed around the work environment for that area (NP or PA friendly) and the availability of an educational program in the area (either NP or PA depending). So ultimately what you want to do depends on whether you can or cannot move.

Finally while surgery has gotten significantly better in the last 10 years, even in the PA environment it is not what I would call family friendly. While there are job sharing arrangements and fixed hours, they are more prominent in primary care practices than surgery.

Just some thoughts from another anonymous writer on the internet.

David Carpenter, PA-C

http://nursing.osu.edu/Academic.aspx?page=9
^--I can get my MSN and sit for the NP exam 3 years after I graduate so I will be 25 when I am a Nurse Practitioner - without being an RN prior to entering the program.

I am also engaged.

 

[core0]

http://nursing.osu.edu/Academic.aspx?page=9
^--I can get my MSN and sit for the NP exam 3 years after I graduate so I will be 25 when I am a Nurse Practitioner - without being an RN prior to entering the program.

I am also engaged.

Three issues:
1. The average GPA for admission is 3.5 which given what you described above is going to be difficult.
2. No ACNP which makes it hard to work in the hospital. I don't know how Ohio views CNS
3. Can you get a job in Ohio with a direct entry NP. Take a look on allnurses.com there is a long thread on this. Lots of I can't find a job with a DE degree mixed in with lots of nobody in my DE program is having trouble finding a job. Ohio is a tough state for both NPs and PAs. I would definitely find out how DE is accepted there.

David Carpenter, PA-C

 

[foreverLaur]

Three issues:
1. The average GPA for admission is 3.5 which given what you described above is going to be difficult.
2. No ACNP which makes it hard to work in the hospital. I don't know how Ohio views CNS
3. Can you get a job in Ohio with a direct entry NP. Take a look on allnurses.com there is a long thread on this. Lots of I can't find a job with a DE degree mixed in with lots of nobody in my DE program is having trouble finding a job. Ohio is a tough state for both NPs and PAs. I would definitely find out how DE is accepted there.

David Carpenter, PA-C

1. It is my undergrad school so I have an advantage. Plus, GPA is only 20%. The rest is things like experience, GRE, LORs, personal statement, etc. So I think with an estimate 3.3 and a very high GRE I should be okay.
2. They are getting an ACNP program in 2009 (which is in time for me)
3. Are they discriminating because we don't have a BSN, just an MSN? That is the only difference. Would I be better off doing a 15 month accelerated BSN program and then entering a 2 year MSN program that way? The only downfall is that OSU's grad entry program is the only program where I can meet all the prereqs prior to graduating undergrad and therefore go straight in and not have an awkward year off where I have to take 1-2 classes and try to find relevant work experience to give me health insurance.

 

[core0]

1. It is my undergrad school so I have an advantage. Plus, GPA is only 20%. The rest is things like experience, GRE, LORs, personal statement, etc. So I think with an estimate 3.3 and a very high GRE I should be okay.
2. They are getting an ACNP program in 2009 (which is in time for me)
3. Are they discriminating because we don't have a BSN, just an MSN? That is the only difference. Would I be better off doing a 15 month accelerated BSN program and then entering a 2 year MSN program that way? The only downfall is that OSU's grad entry program is the only program where I can meet all the prereqs prior to graduating undergrad and therefore go straight in and not have an awkward year off where I have to take 1-2 classes and try to find relevant work experience to give me health insurance.

Well as someone who had to bring up an even more awful GPA, don't underestimate the difficulty. As far as discrimination, I am not sure the reason. I have never met an ACNP that did not have several years of ICU experience prior to school, although admittedly my N is very low. The reasons for employment are very complex, but I would include networking from previous positions, feedback from staff nurses etc. On the other hand in my previous job every ICU had several FNPs that were working as staff nurses for a number of reasons.

You have to find out what your market is. This is even more difficult since the program does not exist and there are no ACNP graduates to get info from. Remember the school has no obligation to make sure that you are employed after graduation. Graduate nursing is the true wild west as far as getting information post graduate experience.

David Carpenter, PA-C

 

[fab4fan]

Well as someone who had to bring up an even more awful GPA, don't underestimate the difficulty. As far as discrimination, I am not sure the reason. I have never met an ACNP that did not have several years of ICU experience prior to school, although admittedly my N is very low. The reasons for employment are very complex, but I would include networking from previous positions, feedback from staff nurses etc. On the other hand in my previous job every ICU had several FNPs that were working as staff nurses for a number of reasons.

You have to find out what your market is. This is even more difficult since the program does not exist and there are no ACNP graduates to get info from. Remember the school has no obligation to make sure that you are employed after graduation. Graduate nursing is the true wild west as far as getting information post graduate experience.

David Carpenter, PA-C

Nice try Dave, but she's got it all figured out. I wonder why an opinion was even requested in the first place?

You're being awfully optimistic, Laur, if you think you can just waltz into ACNP without some significant clinical experience. Do you even know what all is involved with the job? You think you'll be ready to manage acutely, critically ill pts? On your own? Without any experience?

Sorry, but this is a classic example of why I am four-square opposed to DE.