NP or PA*** PLEASE HELP

[jaye927]

Hello everyone,

Idk if I'm posting this on the right forum but here it goes. I'm kind of in a sticky situation and really would love some advice from an NP or PA, or even anyone else who is in a similar situation. Okay here we go...

So I am currently an interdisciplinary studies major. I have one more semester left of college that starts in September and ends in December. I've taken all the science pre reqs required for both NP schools and PA schools with just one more class missing depending on which career I choose. If I go the NP route, I need to take developmental psych, and if I go the PA route I need to take organic chem. I've looked into schools for both and this is what it narrows down to at this point. I have a 3.5 GPA and projected to be higher by the time of graduation. I am wondering if I should go the NP route or PA route. Both have great benefits and flaws. I've done my extensive research and learned that the only real difference is that PA's work under the supervision of a physician. NP's can practice independently depending on the state. I plan on living in Arizona for my career if everything works out, so I know they can practice independently there.

The biggest issue is that since I don't have a BSN I need to do an accelerated BSN program which can take anywhere between 15-18 months. After that I can take the NCLEX and become an RN. I wanted to know if I can go directly into NP school after getting my BSN or do I need clinical hours? This is really holding me back even though I want to become an NP because I have completed a 4 years bachelor, and then another 1.5 years must be done then approximately a year of work and then another 2-2.5 years for NP school to become a FNP. It's a lot more schooling, money investment and time.
If I do go the PA route, then I have a masters program of just 2-2.5 years after after my bachelors. I know I need the clinical hours to get into PA school but most schools that I am looking into only require about 500 hours which I am almost done with.

I take into factors such as job opportunities, diversity (such as switching specialties), independence, and pay (even though its not the main factor, its still very important). I know that as a NP I can work independently whenever I choose to, but it is not as easy to switch specialties like PA's can. I'm not saying its the easiest for PA's, but you don't have to go back to school for it. What I am also confused about is the pay scale. I find online a mix of pay scales. Sometimes I see that PA's make more money and sometimes NP's. Is the pay significantly different or are they practically the same. My goal is to eventually at least be making 120k a year in one of these two professions. I know thats not guaranteed with experience, but I know its possible with more hours and hard work.

So is it worth going into NP school for more time and money to be making the same pay, but at least know that I can practice independently whenever I want or should I go the PA route since it offers all the same options except independence? Either seems like good fields, but I am not sure if the extra things for NP school are worth it if the pay is about the same.

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[pamac]

I don't feel like direct entry NP programs are better than any alternatives in terms of cost (direct entry programs are very expensive.... more than PA programs, which tend to be very expensive themselves). They aren't really more appealing than PA school in terms of time either, because they typically take longer. Most folks would back me up in saying that I also feel direct entry NP programs don't offer the robust education that PA school does, and they don't have the benefit of you being an experienced nurse like a traditional NP program would expect applicants to have.

You are right that NPs and PAs make roughly the same wages. The averages are about the same, with PAs typically slightly ahead by a couple thousand dollars or so. Any differences there come down to certain factors like the fact that specialties are often served by PAs, and specialties frequently have procedures and services that PAs can bill more for. There are also far more males in the PA field (40% of PAs are make vs 6% of NPs), and males tend to negotiate better wages and pursue more lucrative positions. Male NPs actually out earn Male PAs overall by about $6000 per year. But in any event, the dollar for dollar comparison is similar enough to probably be a moot point, except for possibly in areas such as psyche, where an independently practicing psyche NP can command quite a bit since their independent status has advantages.

Jumping around to different specialties is becoming more difficult for PAs, and physicians who employ PAs are really looking for efficiency and familiarity in their employees as time goes on. There are people who change gears, but sticking around in a niche is more and more the norm for all providers, although PAs do have an edge there in having more latitude because of their education being more generalist in nature. But you frequently come across posts on PA forums where PAs are nervous about making a jump to a different specialty role because of the learning curve that departs from what they have been doing in their last job. But out of school, you can pretty much chase your dream specialty, whereas NP schools tend to be more categorized into a niche. FNP would give you opportunity to have more breadth in where you practice vs the other NP roles like psyche np, acute care/ adult gerontology np, women's health np, etc. But you also might not be able to break easily into specialties where they do surgery because you can't assist as easily unless you work an angle or go get certified as a "RN first assistant".

Some specialties prefer PAs to NPs in general and vice versa, but that tends to differ with location, and doesn't take into account someone who is determined to land a certain role regardless of whatever trend is in effect at the time. I know NPs that work in surgery, which is typically a much easier job for PAs to settle into. I also know PAs in women's health, which is supposedly the stomping grounds for NPs. Urgent care, family practice, ERs, and inpatient hospitalist roles seem to be filled by both PAs and NPs without any general trends in hiring more NPs vs PAs and vice versa. However, that really can vary quite a bit by location. My facility uses NPs as hospitalists exclusively, and has a 50/50 mix in the ER. The surgeons all have PAs working for them and rounding on their patients, and until recently, PAs were not hired in the ER. The satellite family practice clinics have a 50/50 mix of PAs and NPs. But across town at another hospital system, they like PAs as their hospitalists and only NPs in their ER.

Independent practice is one of the reasons I decided to abandon pursuit of becoming a PA in favor of going to nursing school and then NP school, despite it being a longer path. I already worked in healthcare and worked full time through RN school making decent money. I'm working full time as an RN making what I feel is excellent money while I go to NP school. I own a house and don't have to relocate to go to PA school, and will come out far ahead financially. But I also didn't want to tie my future success directly to a physician that I would have to practice under. If I were doing an FNP job, I'd probably still work for a physician or group, and make about the same as a PA doing the same work. But for me personally, I like the distinction of essentially being my own person rather than feeling like I'd always be a PA squire to the physician knight even if it is only on paper. If I want to leave the practice, I don't have to go out and set up another relationship with a new physician. And there is less red tape to go through as well. As a PA, your ability to work depends so much on the goodwill of a physician. I've read plenty of horror stories on PA forums where the PA ran afoul of their supervising physician and we're trying to figure out what to do. There are another accounts of physicians dying and that instantly meaning that their PA has to stop working and go through the process of linking up with another physician to work for. NPs just keep on trucking. But that rarely manifests itself in reality. Most people get along and things run seamlessly. You can't live life expecting to be able to burn bridges, even as an independent NP. But for me, NP just always felt like a better role.

Another thing about independence... As a PA, you practice under the scope that your physician allows you to. You have a built in boss. Your career is defined by the fact that you need a boss to work your trade. It's in the name of the profession. If you want to do any other role, you do so with the permission of your physician. If they don't like the liability they feel it brings to them for you to volunteer as a medical provider for a marathon or something like that, you don't get to do it. Your medical malpractice insurance is also about 6 times more expensive than NPs as well, which goes back to the fact that PAs are directly linked to physicians. One state is toying around with making PAs "responsible" for their own care, but PAs still have a physician relationship that will need to be intact... so in the end, the trial lawyers always can find a path back to a physician who has the deep pockets (or more accurately, the bigger payouts from insurance because they pay the largest premiums). But back to being an independent NP and volunteering.... I know an NP that is a reserve police officer that is the designated medical provider for the swat team when they are deployed so that there is someone on scene with some skill in case of an immediate need (the person is a former ER nurse/flight medic, and paramedic). As a PA, that whole thing would probably not be allowed by their physician due to liability. I don't see myself volunteering, but I'm comforted by having some leeway with my license to do cool stuff if I can swing it.

All the preferences I noted are specific to my suruation, goals, lifestyle, family responsibilities, etc. I also wanted to stay put where I was at to keep an eye on investments I have here as well as stay close to family... even if it was only for the two years that I would have to leave for school. My spouse has a great job as well that I didn't want to abandon.

But.... Time is money, and if you can get through school quickly and with less debt, then you could be making more money sooner as a PA than you could as an NP, and you could also do so cheaper than doing a direct entry NP program. It didn't make sense for me to leave my good paying job to go to PA school because I would have debt and lost income. So plugging along and getting an RN and then an NP while I made $75k-90k per year in my jobs made more sense than leaving that job to go to PA school and paying $100k for school, and raising a family on loan money, and having my spouse walk away from a flexible job that paid $70k per year (although my spouse has a medical career like me and can get work anywhere in the country too). All told, PA school would leave me well over $200k behind where I am today. Could be close to $275k. BUT.... I would have been in the same boat financially, or worse, if I had done direct entry NP.

In your case, with no healthcare experience or great flexible job, I'd just got to PA school. The training will be better for you than NP as well. If your GPA is going to be above 3.5, you should be fine as long as you get all your other ducks in a row. Don't jeapordize good grades. HCE isn't as important as your GPA. Just get the token amount you need, but hammer out good grades.

 

[jaye927]

I don't feel like direct entry NP programs are better than any alternatives in terms of cost (direct entry programs are very expensive.... more than PA programs, which tend to be very expensive themselves). They aren't really more appealing than PA school in terms of time either, because they typically take longer. Most folks would back me up in saying that I also feel direct entry NP programs don't offer the robust education that PA school does, and they don't have the benefit of you being an experienced nurse like a traditional NP program would expect applicants to have.

You are right that NPs and PAs make roughly the same wages. The averages are about the same, with PAs typically slightly ahead by a couple thousand dollars or so. Any differences there come down to certain factors like the fact that specialties are often served by PAs, and specialties frequently have procedures and services that PAs can bill more for. There are also far more males in the PA field (40% of PAs are make vs 6% of NPs), and males tend to negotiate better wages and pursue more lucrative positions. Male NPs actually out earn Male PAs overall by about $6000 per year. But in any event, the dollar for dollar comparison is similar enough to probably be a moot point, except for possibly in areas such as psyche, where an independently practicing psyche NP can command quite a bit since their independent status has advantages.

Jumping around to different specialties is becoming more difficult for PAs, and physicians who employ PAs are really looking for efficiency and familiarity in their employees as time goes on. There are people who change gears, but sticking around in a niche is more and more the norm for all providers, although PAs do have an edge there in having more latitude because of their education being more generalist in nature. But you frequently come across posts on PA forums where PAs are nervous about making a jump to a different specialty role because of the learning curve that departs from what they have been doing in their last job. But out of school, you can pretty much chase your dream specialty, whereas NP schools tend to be more categorized into a niche. FNP would give you opportunity to have more breadth in where you practice vs the other NP roles like psyche np, acute care/ adult gerontology np, women's health np, etc. But you also might not be able to break easily into specialties where they do surgery because you can't assist as easily unless you work an angle or go get certified as a "RN first assistant".

Some specialties prefer PAs to NPs in general and vice versa, but that tends to differ with location, and doesn't take into account someone who is determined to land a certain role regardless of whatever trend is in effect at the time. I know NPs that work in surgery, which is typically a much easier job for PAs to settle into. I also know PAs in women's health, which is supposedly the stomping grounds for NPs. Urgent care, family practice, ERs, and inpatient hospitalist roles seem to be filled by both PAs and NPs without any general trends in hiring more NPs vs PAs and vice versa. However, that really can vary quite a bit by location. My facility uses NPs as hospitalists exclusively, and has a 50/50 mix in the ER. The surgeons all have PAs working for them and rounding on their patients, and until recently, PAs were not hired in the ER. The satellite family practice clinics have a 50/50 mix of PAs and NPs. But across town at another hospital system, they like PAs as their hospitalists and only NPs in their ER.

Independent practice is one of the reasons I decided to abandon pursuit of becoming a PA in favor of going to nursing school and then NP school, despite it being a longer path. I already worked in healthcare and worked full time through RN school making decent money. I'm working full time as an RN making what I feel is excellent money while I go to NP school. I own a house and don't have to relocate to go to PA school, and will come out far ahead financially. But I also didn't want to tie my future success directly to a physician that I would have to practice under. If I were doing an FNP job, I'd probably still work for a physician or group, and make about the same as a PA doing the same work. But for me personally, I like the distinction of essentially being my own person rather than feeling like I'd always be a PA squire to the physician knight even if it is only on paper. If I want to leave the practice, I don't have to go out and set up another relationship with a new physician. And there is less red tape to go through as well. As a PA, your ability to work depends so much on the goodwill of a physician. I've read plenty of horror stories on PA forums where the PA ran afoul of their supervising physician and we're trying to figure out what to do. There are another accounts of physicians dying and that instantly meaning that their PA has to stop working and go through the process of linking up with another physician to work for. NPs just keep on trucking. But that rarely manifests itself in reality. Most people get along and things run seamlessly. You can't live life expecting to be able to burn bridges, even as an independent NP. But for me, NP just always felt like a better role.

Another thing about independence... As a PA, you practice under the scope that your physician allows you to. You have a built in boss. Your career is defined by the fact that you need a boss to work your trade. It's in the name of the profession. If you want to do any other role, you do so with the permission of your physician. If they don't like the liability they feel it brings to them for you to volunteer as a medical provider for a marathon or something like that, you don't get to do it. Your medical malpractice insurance is also about 6 times more expensive than NPs as well, which goes back to the fact that PAs are directly linked to physicians. One state is toying around with making PAs "responsible" for their own care, but PAs still have a physician relationship that will need to be intact... so in the end, the trial lawyers always can find a path back to a physician who has the deep pockets (or more accurately, the bigger payouts from insurance because they pay the largest premiums). But back to being an independent NP and volunteering.... I know an NP that is a reserve police officer that is the designated medical provider for the swat team when they are deployed so that there is someone on scene with some skill in case of an immediate need (the person is a former ER nurse/flight medic, and paramedic). As a PA, that whole thing would probably not be allowed by their physician due to liability. I don't see myself volunteering, but I'm comforted by having some leeway with my license to do cool stuff if I can swing it.

All the preferences I noted are specific to my suruation, goals, lifestyle, family responsibilities, etc. I also wanted to stay put where I was at to keep an eye on investments I have here as well as stay close to family... even if it was only for the two years that I would have to leave for school. My spouse has a great job as well that I didn't want to abandon.

But.... Time is money, and if you can get through school quickly and with less debt, then you could be making more money sooner as a PA than you could as an NP, and you could also do so cheaper than doing a direct entry NP program. It didn't make sense for me to leave my good paying job to go to PA school because I would have debt and lost income. So plugging along and getting an RN and then an NP while I made $75k-90k per year in my jobs made more sense than leaving that job to go to PA school and paying $100k for school, and raising a family on loan money, and having my spouse walk away from a flexible job that paid $70k per year (although my spouse has a medical career like me and can get work anywhere in the country too). All told, PA school would leave me well over $200k behind where I am today. Could be close to $275k. BUT.... I would have been in the same boat financially, or worse, if I had done direct entry NP.

In your case, with no healthcare experience or great flexible job, I'd just got to PA school. The training will be better for you than NP as well. If your GPA is going to be above 3.5, you should be fine as long as you get all your other ducks in a row. Don't jeapordize good grades. HCE isn't as important as your GPA. Just get the token amount you need, but hammer out good grades.

Hello! Thank you so much for replying to my post. I seriously appreciate it so much. I am so grateful for your counsel as I try to figure out whats best at this time. There's a couple of things I forgot to mention in my original post that may be would be good to know. So I am married and am only 22 yrs old. I have not considered the direct entry NP programs. I know those can be quite pricey, but instead I was thinking of doing an accelerated nursing program to get a BSN first. What this does is allow me to use my current BS in Science towards pre reqs and then have 15 months of schooling to get my BSN. After this I was planning on working a little bit as an RN as I applied to NP programs and then get into one of those and work as I'm in the program. I figured it would be good to pay off those student loans as I'm attending school. I don't know if this makes any difference in your original suggestion for me to go into the PA route, but I figured I should mention it. Still curious if even with this, would it be better to go PA route? Thank!

**I dont have any kids haha and you're right I don't really have a flexible job and neither does my wife because we both are TA's for the university that we attend.

 

[pamac]

I basically walked into my RN program because I already had the prereqs from my BS all set.

Accelerated RN programs are pretty nice and make a ton of sense to do for someone that has a degree already, or even in your case. If you can get into PA school quickly, you may be better off doing that than even doing the accelerated BSN. You could even apply to both. I did, and when I got into RN school, but not my top choice PA program, I skipped the rest of the PA program interviews and went to nursing school. That was because I crunched the numbers, and it made more sense for me.

But a BSN and a job as a nurse is a good way to start. Long term, nursing feels like a drag to me unless you find a job you like. I do enjoy my job, but I'm itching to move on to be a provider.

If you do end up going to get the BSN, plan to do NP school rather than going from RN to PA. NP school can be as cheap as $20k, and you can work through it. Financially it's a great way to go. So yes, you mentioning the accelerated BSN does change things a lot in my mind, but I mentioned the things that I'm biased towards, so you need to decide if you are similarly inclined. Unlike me, you may get in to PA school according to a timeframe that works for you. Debt might be a little bit higher, but you will be making good money as a PA. So let's say you do a $90,000 pa program, but are done in 2 years, and start making $90,000 per year from that point. Or you do an accelerated BSN, (don't know the price for that, but let's say it's a relatively spendy $30k) then you start as a new nurse making $70,000 in 15 months. Then you keep on trucking and do a $30k NP program that takes two years, and work while in most of the program. Let's look at you five years out. And not think about other debts, but just go raw numbers, and no expenses or debt pay down. If you go to PA school, in 5 years from when you start PA school, you have been paid $270k, and have $90k in debt. Net profit of $180k. The nursing route in 5 years puts you at debt of $60k, and income of around $240k, for a profit of about $185k. But... It would be a bit more because if you jump right in to an NP program soon after getting your BSN, by about year 4 of your plan, you'll be an NP and let's say you are starting at $90k. So add $20k to the $185. This is a rough estimate overall, and doesn't account for raises that you would get as a nurse and as a PA.

It comes out pretty close either way under those circumstances.... but.... things get lopsided when you account for timing. I don't know the prereqs for the PA schools you are interested in, but organic chem is usually a 2 semester series, and can be a pre req at your college for biochem, which many PA programs require (in fact I know many PA programs that don't require Ochem, but do require biochem). I think regardless of what the specifics are there, that puts more of a delay in your plan vs the developmental psyche requirement for the BSN program. You most likely won't be able to even apply to PA school until next spring under most circumstances, and then you wouldn't start PA school until fall of 2019. I don't know when you could start an accelerated BSN program, but I'm guessing it would be a lot sooner than a PA program. So right away, that puts you almost $200k ahead of you go the nursing route and get in this year, or even next. That's the kind of numbers I was looking at a few years ago. I had only PA school interviews ahead of me when I got into RN school, but no offers on the table. I was not interested in sitting out another application cycle while I waited to hear back from PA schools that I really didn't even want to go to... or worse, face the prospect of having to apply again if I didn't get into even my backup school choices. Time is money. Each year you have to wait it out before you can go to PA school is a loss of a lot of income. I liked the stepwise plan I had for nursing school because it had checkpoints to reach where I could take a breather and make money if I needed. But think of any difference in the time you can start PA school vs the time you can start RN school as a loss of quite a bit of money... To the tune of multiple tens of thousands of dollars per year. And I know of no NP with $100k of educational debt from just their NP degree, but I personally know few PAs with less than $100k debt. One PA I know has over $200k. That's nuts to me.

Another thing that sweetens the deal for NPs is they don't have to revertify like PAs do every few years. I think PAs have to do that like every 6 years. Everyone has to do continueing education, but NPs don't have to retake a test like PAs. Just pass your initial exam and you are done forever in that respect.

 

[Ollivander]

NPs dominate specialties such as psych, neonatology, pediatrics, family medicine, women's health and most outpatient jobs. PAs dominate emergency medicine, dermatology, orthopedics, surgery, and most hospital based jobs.

As another poster above has already said, NPs don't have to retake an exam and re-certify every 10 years like PAs. NP programs are also cheaper, and in some states they have independent practice rights. It all depends on what's important to you. If you want to start up your own practice I'd suggest going NP. If you want to work in those specialties dominated by NPs I'd suggest going ahead and doing NP, as it'll be cheaper and the path of least resistance. If you're planning on going into one of those PA dominated specialties or have any interest in doing so, your chances are slim to none breaking into them as a NP though. So unless emergency medicine, dermatology, orthopedics, or surgery are of interest to you, then go ahead and go the NP route.

 

[Makati2008]

NPs dominate specialties such as psych, neonatology, pediatrics, family medicine, women's health and most outpatient jobs. PAs dominate emergency medicine, dermatology, orthopedics, surgery, and most hospital based jobs.

As another poster above has already said, NPs don't have to retake an exam and re-certify every 10 years like PAs. NP programs are also cheaper, and in some states they have independent practice rights. It all depends on what's important to you. If you want to start up your own practice I'd suggest going NP. If you want to work in those specialties dominated by NPs I'd suggest going ahead and doing NP, as it'll be cheaper and the path of least resistance. If you're planning on going into one of those PA dominated specialties or have any interest in doing so, your chances are slim to none breaking into them as a NP though. So unless emergency medicine, dermatology, orthopedics, or surgery are of interest to you, then go ahead and go the NP route.

I know plenty of NPs in em.....


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[Ollivander]

I know plenty of NPs in em.....


Sent from my iPhone using SDN mobile app

You're right. It's definitely possible. It's heavily dependent on which geographical region of the country you're located in though. I think all things being equal, when the market tightens up and becomes more saturated with NPs and PAs in the coming years (and it's trending that way fast with all the new programs popping up), PAs will get the nod before NPs. Most docs already prefer hiring PAs over NPs due to their training. I was simply speaking of the economic landscape as a whole. If you compare the percentage of PAs in emergency medicine to the overall number of PAs in the workforce, and then compare the percentage of NPs in emergency medicine to the overall number of NPs in the workforce, you'll see how much more difficult of a time you're going to have breaking into that specialty as a NP than a PA.

 

[pamac]

You're right. It's definitely possible. It's heavily dependent on which geographical region of the country you're located in though. I think all things being equal, when the market tightens up and becomes more saturated with NPs and PAs in the coming years (and it's trending that way fast with all the new programs popping up), PAs will get the nod before NPs. Most docs already prefer hiring PAs over NPs due to their training. I was simply speaking of the economic landscape as a whole. If you compare the percentage of PAs in emergency medicine to the overall number of PAs in the workforce, and then compare the percentage of NPs in emergency medicine to the overall number of NPs in the workforce, you'll see how much more difficult of a time you're going to have breaking into that specialty as a NP than a PA.

Not quite.....While there are more PAs in EM by about one third, they don't dominate there. The breakdown of where NP's and PAs practice has less to do with where they manage to land than where they choose to end up. There is really no way to draw the conclusion that less NPs in ER because they can't go there. Its more likely that they end up in the areas they do due to the fact that the 94% of NP's are female, and migrate to specialties due to quality of life issues relating to caring for their families. And a very large proportion of NPs work in a hospital inpatient environment... I think its actually as large if not larger than the proportion of PA's as hospitalists. Surgery, and surgical associated specialties indeed are likely to be tougher for NP's to break into, but that might have to do with the fact that physicians in those fields want to employ providers that work closer to them to complement the main show that they themselves provide.

And family medicine is quite heavy with PA's.... family practice being the predominant specialty indicated by PA's nationwide. About 9 percent more NPs practice in primary care than PAs... not a huge number overall. But family practice is the largest specialty for both fields. Its roughly 52% to 43% respectively within each career field. So NP's aren't dominating there. By raw numbers, sure... more NP's practice in family practice, but that's because there are double the NP's out there than PA's.

 

[NYCGuy86]

Exactly, it really depends on the area. At my major academic center in NYC, we have PAs and NPs. I work on a neuroscience stepdown as an RN, and we have a neurology NP service. There are also NPs in MICU, CCU, CTICU, telemetry (all hospital-based). There are also NPs in other specialties that have inpatient/outpatient roles through the affiliated university, such as neuro-oncology, various oncology services, electrophysiology, pulmonary, etc. There are PAs in neurosurgery, CT stepdown, transplant, neurology (not their own service like the NPs though), etc.

 

[AnnoyedByFreud]

With the way things have been trending for PAs, I'd think twice about it (note, I did not feel this way up until recently). NPs appear to be gaining more and more traction (another state recently granted independence, the VA just granted NPs independence and not PAs, etc.), while it seems like PAs have very little advocacy and are currently being hung up by their own licensing organization. The NCCPA has actually been advocating against laws to expand PA practice (see the PA forum for more info on that disaster). Unless you absolutely want to do surgery or live in an area that virtually never hires NPs for the specialty you want, I'd recommend becoming an NP. You can always improve yourself as a provider by not being a slouch in school (I'd recommend going above and beyond your program's requirements), finding excellent mentors, and continuing to read/learn during your career.

 

[Mad Jack]

PA bro, PA.

 

[NP 2 DPM]

Hello everyone,

Idk if I'm posting this on the right forum but here it goes. I'm kind of in a sticky situation and really would love some advice from an NP or PA, or even anyone else who is in a similar situation. Okay here we go...

So I am currently an interdisciplinary studies major. I have one more semester left of college that starts in September and ends in December. I've taken all the science pre reqs required for both NP schools and PA schools with just one more class missing depending on which career I choose. If I go the NP route, I need to take developmental psych, and if I go the PA route I need to take organic chem. I've looked into schools for both and this is what it narrows down to at this point. I have a 3.5 GPA and projected to be higher by the time of graduation. I am wondering if I should go the NP route or PA route. Both have great benefits and flaws. I've done my extensive research and learned that the only real difference is that PA's work under the supervision of a physician. NP's can practice independently depending on the state. I plan on living in Arizona for my career if everything works out, so I know they can practice independently there.

The biggest issue is that since I don't have a BSN I need to do an accelerated BSN program which can take anywhere between 15-18 months. After that I can take the NCLEX and become an RN. I wanted to know if I can go directly into NP school after getting my BSN or do I need clinical hours? This is really holding me back even though I want to become an NP because I have completed a 4 years bachelor, and then another 1.5 years must be done then approximately a year of work and then another 2-2.5 years for NP school to become a FNP. It's a lot more schooling, money investment and time.
If I do go the PA route, then I have a masters program of just 2-2.5 years after after my bachelors. I know I need the clinical hours to get into PA school but most schools that I am looking into only require about 500 hours which I am almost done with.

I take into factors such as job opportunities, diversity (such as switching specialties), independence, and pay (even though its not the main factor, its still very important). I know that as a NP I can work independently whenever I choose to, but it is not as easy to switch specialties like PA's can. I'm not saying its the easiest for PA's, but you don't have to go back to school for it. What I am also confused about is the pay scale. I find online a mix of pay scales. Sometimes I see that PA's make more money and sometimes NP's. Is the pay significantly different or are they practically the same. My goal is to eventually at least be making 120k a year in one of these two professions. I know thats not guaranteed with experience, but I know its possible with more hours and hard work.

So is it worth going into NP school for more time and money to be making the same pay, but at least know that I can practice independently whenever I want or should I go the PA route since it offers all the same options except independence? Either seems like good fields, but I am not sure if the extra things for NP school are worth it if the pay is about the same.

My recommendation ? Finish your BSN, work in acute care for at least 1 year. I'd recommend you find your niche in either Med Surg or ICU. There are 2 routes for you to go if you so desire to go into Advanced Practice Nursing. You can get your DNP and specialize in Acute Care , Adult Gerontology, Family Nurse Practice, et al. If you love ICU and want more? Id recommend the DNAP and practice as a CRNA.

There is a massive demand for Nurse Practitioners, plenty of opportunity for you to practice as a hospitalist or work in outpatient or even do home visits if you so desire that's to your interest.

The benefits of APN is that you can eventually practice with more autonomy than say PAs who literally are tied to the physician vis-a-vis collaborative agreements.

 

[DizzyJon]

My recommendation ? Finish your BSN, work in acute care for at least 1 year. I'd recommend you find your niche in either Med Surg or ICU. There are 2 routes for you to go if you so desire to go into Advanced Practice Nursing. You can get your DNP and specialize in Acute Care , Adult Gerontology, Family Nurse Practice, et al. If you love ICU and want more? Id recommend the DNAP and practice as a CRNA.

There is a massive demand for Nurse Practitioners, plenty of opportunity for you to practice as a hospitalist or work in outpatient or even do home visits if you so desire that's to your interest.

The benefits of APN is that you can eventually practice with more autonomy than say PAs who literally are tied to the physician vis-a-vis collaborative agreements.

There are still a good number of states that APN are "tied to the physician". Just because one is required to have an agreement doesn't mean one can't practice with full autonomy. Every day I go to work there is no physician there. There is no supervision. There is nobody telling me what to do or not do. I've worked in places where I've never even met my CP. Yes, there are PA positions, as well as NP, where you do not get this freedom, but don't set aside the entire profession because of some misunderstanding about what collaboration/supervision actually entails. I worked in Hawaii. An NP independent state. NPs working in the ED had to staff certain patients with an attendings just as the PAs did, and had to follow all the same rules as PAs in the hospital. NP weren't allowed privileges in the hospital without a sponsoring physician. They couldn't have admitting privileges. So, there is a bigger picture then simple dependent vs independent.

 

[NP 2 DPM]

One major difference between the two professions is the type of education required. Whereas physician assistants qualify through a more general medical examination, called the PANCE, and are not required to complete a residency, nurse practioners generally qualify through an exam more specific to population of focus, such as pediatrics or geriatrics, and have practical experience as BNs before qualifying. Usually, NPs and PAs are both able to diagnose and treat illness in addition to prescribe medication; however, nurse practitioners may have to apply on the state level for certain additional responsibilities, such as prescribing medication.

Another difference between the practice of physician assistants and nurse practitioners is that a physician assistant must practice under the supervision of a physician. Although pysician assistants, or PAs, may be able to perform certain duties on their own, they do this under the authority of their supervising physician. On the other hand, nurse practitioners may have more independence in that they can carry out some tasks in providing healthcare and assistance independently, without supervision by a physician, depending upon state laws, level of education, and additional certifications and qualifications achieved.

Because physician assistants have to work in sync with a qualified physician, the number of hours they work is more closely related to that of their supervising physician. On the other hand, nurse practitioners may have more autonomy in that regard. Since, in some states, nurse practitioners can work solo, nurse practitioners can decide when and for how long they work. If their work is not dependant on any other medical professional, they will have more discretion as to their own professional lives and routine.

Also in the NP paradigm, we have the Full Practice Authority movement which will soon cover most of the stages as state legislatures debate the evolution of medicinal praxis.


Regards ,
NP 2 DPM

 

[DizzyJon]

One major difference between the two professions is the type of education required. Whereas physician assistants qualify through a more general medical examination, called the PANCE, and are not required to complete a residency, nurse practioners generally qualify through an exam more specific to population of focus, such as pediatrics or geriatrics, and have practical experience as BNs before qualifying. Usually, NPs and PAs are both able to diagnose and treat illness in addition to prescribe medication; however, nurse practitioners may have to apply on the state level for certain additional responsibilities, such as prescribing medication.

Another difference between the practice of physician assistants and nurse practitioners is that a physician assistant must practice under the supervision of a physician. Although pysician assistants, or PAs, may be able to perform certain duties on their own, they do this under the authority of their supervising physician. On the other hand, nurse practitioners may have more independence in that they can carry out some tasks in providing healthcare and assistance independently, without supervision by a physician, depending upon state laws, level of education, and additional certifications and qualifications achieved.

Because physician assistants have to work in sync with a qualified physician, the number of hours they work is more closely related to that of their supervising physician. On the other hand, nurse practitioners may have more autonomy in that regard. Since, in some states, nurse practitioners can work solo, nurse practitioners can decide when and for how long they work. If their work is not dependant on any other medical professional, they will have more discretion as to their own professional lives and routine.

Also in the NP paradigm, we have the Full Practice Authority movement which will soon cover most of the stages as state legislatures debate the evolution of medicinal praxis.


Regards ,
NP 2 DPM

Oh boy....where to begin.

Agreed - PA are general practitioners and trained on core specialties. NPs are more specialty specific.
Disagree - not all NPs have experience as RNs before qualifying. You can become an NP without ever working as an RN
Disagree - the term "under the supervision" is not a proper term. That sounds like we must be watched and that is not true. Some states may call it "supervision" but really is collaboration or in some cases just an agreement that we are linked in practice together. Some PAs require a supervisory agreement in which they will say state under what circumstances they will refer a patient to the physician or a specialist. Some may list specific procedures the PA will perform. I have no duties I perform under the authority of my supervising physician. I perform them under the authority of state practice act and my hospital privileges.
Disagree - "work in sync"? Where did you get this idea. Hours may very. A physician does not need to be working in order to practice. We don't even have to ever see each other in many specialties. I've worked in places in which I've never even met the supervising physician. Very few NPs own their own practice and decide when and for how long they want to work.

The PA profession now has their own equivalent of Full Practice Authority support by our national organization just this year and now we will begin our journey to independence just as NPs did.

 

[NP 2 DPM]

According to the Institute of Medicine , all Nurse Practitioner programs will switch to Doctoral prepared curricula culminating in the DNP. Prerequisite to this is at least a BSN and 1-2 years experience practicing as a Registered Nurse Professional.

For the DNAP, the degree awarded to Certified Registered Nurse Anesthetists, there is a prerequisite of at least 2-3 years as an ICU nurse .

Hospital systems are managed and governed under the Nursing Model. Entire hospital units are run by the Nursing Manager , and in which Physicians / NPs / PAs work closely with.

So , ultimately , there is a powerful clout the Nursing profession and our agencies have in healthcare polices.

Hence why I recommend to the OP and others looking around on the benefits and breadth of opportunities in Nursing. The sky is the limit in Nursing

 

[NP 2 DPM]

I basically walked into my RN program because I already had the prereqs from my BS all set.

Accelerated RN programs are pretty nice and make a ton of sense to do for someone that has a degree already, or even in your case. If you can get into PA school quickly, you may be better off doing that than even doing the accelerated BSN. You could even apply to both. I did, and when I got into RN school, but not my top choice PA program, I skipped the rest of the PA program interviews and went to nursing school. That was because I crunched the numbers, and it made more sense for me.

But a BSN and a job as a nurse is a good way to start. Long term, nursing feels like a drag to me unless you find a job you like. I do enjoy my job, but I'm itching to move on to be a provider.

If you do end up going to get the BSN, plan to do NP school rather than going from RN to PA. NP school can be as cheap as $20k, and you can work through it. Financially it's a great way to go. So yes, you mentioning the accelerated BSN does change things a lot in my mind, but I mentioned the things that I'm biased towards, so you need to decide if you are similarly inclined. Unlike me, you may get in to PA school according to a timeframe that works for you. Debt might be a little bit higher, but you will be making good money as a PA. So let's say you do a $90,000 pa program, but are done in 2 years, and start making $90,000 per year from that point. Or you do an accelerated BSN, (don't know the price for that, but let's say it's a relatively spendy $30k) then you start as a new nurse making $70,000 in 15 months. Then you keep on trucking and do a $30k NP program that takes two years, and work while in most of the program. Let's look at you five years out. And not think about other debts, but just go raw numbers, and no expenses or debt pay down. If you go to PA school, in 5 years from when you start PA school, you have been paid $270k, and have $90k in debt. Net profit of $180k. The nursing route in 5 years puts you at debt of $60k, and income of around $240k, for a profit of about $185k. But... It would be a bit more because if you jump right in to an NP program soon after getting your BSN, by about year 4 of your plan, you'll be an NP and let's say you are starting at $90k. So add $20k to the $185. This is a rough estimate overall, and doesn't account for raises that you would get as a nurse and as a PA.

It comes out pretty close either way under those circumstances.... but.... things get lopsided when you account for timing. I don't know the prereqs for the PA schools you are interested in, but organic chem is usually a 2 semester series, and can be a pre req at your college for biochem, which many PA programs require (in fact I know many PA programs that don't require Ochem, but do require biochem). I think regardless of what the specifics are there, that puts more of a delay in your plan vs the developmental psyche requirement for the BSN program. You most likely won't be able to even apply to PA school until next spring under most circumstances, and then you wouldn't start PA school until fall of 2019. I don't know when you could start an accelerated BSN program, but I'm guessing it would be a lot sooner than a PA program. So right away, that puts you almost $200k ahead of you go the nursing route and get in this year, or even next. That's the kind of numbers I was looking at a few years ago. I had only PA school interviews ahead of me when I got into RN school, but no offers on the table. I was not interested in sitting out another application cycle while I waited to hear back from PA schools that I really didn't even want to go to... or worse, face the prospect of having to apply again if I didn't get into even my backup school choices. Time is money. Each year you have to wait it out before you can go to PA school is a loss of a lot of income. I liked the stepwise plan I had for nursing school because it had checkpoints to reach where I could take a breather and make money if I needed. But think of any difference in the time you can start PA school vs the time you can start RN school as a loss of quite a bit of money... To the tune of multiple tens of thousands of dollars per year. And I know of no NP with $100k of educational debt from just their NP degree, but I personally know few PAs with less than $100k debt. One PA I know has over $200k. That's nuts to me.

Another thing that sweetens the deal for NPs is they don't have to revertify like PAs do every few years. I think PAs have to do that like every 6 years. Everyone has to do continueing education, but NPs don't have to retake a test like PAs. Just pass your initial exam and you are done forever in that respect.

Look into PMHNP, there is a great need and they're starting them here in NJ at $130k, with potential to go up to $180k! The potential is limitless !

Carpe Diem !