What looks best for clinical hours as a pre PA student?

[angie.19]

Hi,

I have 3 different opportunities and was wondering which one would look best and count for clinical hours for PA school. There is a position as a volunteer at a hospice, working as a medical scribe and working as a caregiver. Thanks for the advice!

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[Planes2Doc]

I thought with PA school you need paid hours, and not volunteer. My guess would be scribe.

 

[21Rush12]

Try the PA forums


Edit: wait, where ARE the PA forums?! Don't we have some?

Sent from my iPhone using SDN mobile app

 

[Catalystik]

Try the PA forums


Edit: wait, where ARE the PA forums?! Don't we have some?

Yes: Clinicians [ RN / NP / PA ]

 

[Apollo1]

Of those 3 options, scribe. However, you don't learn much being a scribe.

 

[pamac]

Honestly, I don't know that one learns very much doing CNA type work either in the big scheme of things. I'm all for good healthcare experience, but realistically, its all basic and entry level stuff. The responsibility factor is useful to experience to some degree, but for me to imagine what I would rather be doing for work, it comes down to whether I would want to do the backbreaking stuff, or the "walk in to work in scrubs following around a physician and not do icky things" stuff... and the scribe stuff wins every time. If PA schools don't care, and these days so many don't, then I'd get my HCE the easiest/quickest way. I don't think that giving bed baths, patient sitting, checking vitals and blood sugars, etc is heavy hitting HCE. Work can get in the way of getting good grades, which is the top factor for getting into most PA schools anyway.

 

[dfw6er]

Depends on the school you're applying to, last I checked. Some PA programs are perfectly happy with scribe experience. Some won't count scribing at all as health care experience....you need to check each program you want to apply to for their positions on HCE. Your best bet is a paid position with direct hands-on patient care experience. EMT-basic doesn't take long to complete and would get you the experience. Most PA programs want you to have shadowed a PA. What I did before applying to PA school was get my EMT-B, then EMT-Paramedic, worked in the field for a couple of years while getting my prereqs together, then took a job in a local family practice clinic working as a medical assistant...the EMT-P credential was more than enough qualification to do MA work...and the clinic had a PA working full time who was more than happy to write me a LOR. The ADCOM for PA school loved this when I applied.

 

[Boatswain2PA]

Angie - the best are FMF, paramedic, combat medic, or RN.

 

[Owlgal]

Angie - the best are FMF, paramedic, combat medic, or RN.

If someone is an RN, their best bet would be going the Nurse Practitioner route rather than the more limited (and more costly) PA route. Unless they're wanting to go into surgery -- then, definitely, the PA route would be best. Transitioning to PA would not make sense, as far as I can see.

 

[DizzyJon]

If someone is an RN, their best bet would be going the Nurse Practitioner route rather than the more limited (and more costly) PA route. Unless they're wanting to go into surgery -- then, definitely, the PA route would be best. Transitioning to PA would not make sense, as far as I can see.

That would only be the "best bet" if they wanted a higher probability of getting into a program, wanting to be able to keep working during school, and didn't mind a less thorough education. Yes, by far, if you are an RN then it is much easier to go the NP route. If you want a more thorough education, then PA is the best route. This would not include CRNA, CNM, PNP, PMHNP routes of course as these are rather dominated by NPs.

 

[Owlgal]

That would only be the "best bet" if they wanted a higher probability of getting into a program, wanting to be able to keep working during school, and didn't mind a less thorough education. Yes, by far, if you are an RN then it is much easier to go the NP route. If you want a more thorough education, then PA is the best route. This would not include CRNA, CNM, PNP, PMHNP routes of course as these are rather dominated by NPs.

I don't believe that the PA provides a more thorough education. Sure, if you're starting out from a non-healthcare stand-point, then PA is probably pretty dang intense. If you've been in healthcare as a professional nurse for any length of time, you aren't going to need to start with the basics that are presented in PA programs. Thus, NP programs are not as "intense", as a person has 6-7 years of RN/NP education versus a few years. And I think that the "softer" people-focused classes absolutely belong in the RN/NP curriculum. Ethics/Policy/Theory -- valuable courses that have heavily influenced my career over the years. It's one of the reasons, I think, that NPs fair better than other providers in relation to patient satisfaction. You seem to think that the traditional physician training model is something that should be strived for by EVERY practitioner. I don't hold that view, at all. I think it is inefficient and does not comprehensively address the realities of healthcare in today's world. Obviously, it is far more comprehensive, scientifically/biologically than either NP/PA education (there's no comparison). But, we have so many physicians who have no idea how to effectively communicate with their patients and have no true understanding that if a patient cannot afford a medication, the medication will not be taken... and that economic and social barriers pose an enormous health risk for the majority of our patients. These things equate to poor patient outcomes. And if a greater emphasis on social/ethics/community/ (and, yes, theory of care delivery) will allow me to better treat my patients, then, yeah, I'm all for that versus a robust surgery rotation as part of my NP training (because, you know, I'm not a surgeon). Medical schools are wising-up, however, and are now requiring more training in these "softer" areas of study.

I think that PAs want to be physicians while NPs tend to want to be, IDK, not physicians -- but something entirely different and very important to our communities. Maybe they want to be "advanced practice nurses" or "nurse practitioners" as the names imply (practicing at the very highest level in their chosen field of nursing). And, while, there are now becoming more and more people who would use NP/PA almost interchangeably, and who view the careers as fundamentally the same -- I object to that. The focus is different. Obviously, there is overlap in practice and patient population, as everyone is still trying to address patient health concerns. My nursing background will have me ask about the patient's support system at home, insurance coverage, usual way of doing things, and evaluate educational/social/cultural barriers when deciding on a course of treatment. Because I know that a medication not taken has zero efficacy. A wound dressing not changed can lead to all sorts of badness. A prescribed diet not followed can be worse than not taking medications. And every time a patient enters our inpatient healthcare system for treatment of a chronic disease, it leaves them vulnerable to nosocomial infections and complications that can be life-threatening. Yeah, NP after being an RN is definitely the "best bet".

 

[Boatswain2PA]

Okay, at it again.

PA education = 12-14 months of intense broadbased medical education, butt in seat, drinking knowledge from a firehose. You learn, and are tested, then learn some more, then tested again. It is almost entirely focused on medical education, with a small amount of "research methods" and public health thrown in. You probably average 30-35 hours of lecture/skills training a week, plus another 30-35 hours of study, and frequently 4-8 hours of beginning clinical rotations. Then you have 12-14 months of rotations that probably average 50-60 hours a week of work/learning. There are tests after each rotation. Mandatory rotations in surgery, emergency medicine, cardiology, womens health, family practice, psych, peds, and geriatrics. 2000 clinical hours as a provider-in-training is the minimum, with many exceeding 2500. PA education is so intense, packing so much education into 2-2.5 years that virtually nobody can possibly work during the program. This is standardized across every PA program in the country.

NP education = Nonstandardized, and can consist of 2 years of education that is often done on-line with a few trips to the classroom a year to do some skills testing. Much of this 2 years of education is advanced nursing management, advanced nursing leadership theory, advanced nursing research methods. Then 500 hours of "clinical rotations" that are often done at the same clinic. Rumor is there are some NP programs that have significantly increased their actual medical education, but I am not familiar with them. Most of the NPs I know, and current NP students, attended programs like I described.

I don't say this to demean nurses or NPs. It's just the facts.

Yes, the best person to enter a PA or NP program is someone with significant previous experience as a RN, medic, etc because they do have some experience with medications, procedures, organization systems, etc. However there is a VAST difference between being a RN/Medic and being a medical provider. One should not conflate experience as a RN/Medic with experience as a medical provider.

All that being said, PAs and NPs compete for the same jobs and mostly the same pay. So, if you're already a RN, then going the NP route is certainly the easiest and cheapest route (although with the implementation of the DNP it may become just as expensive as PA), so it's usually a no-brainer to go NP....unless you want the more in-depth education from PA program. Likewise, if you already have a non-nursing BS, then PA may be your cheapest and easiest route to go (vice attaining RN first, then NP).

 

[Owlgal]

Okay, at it again.

PA education = 12-14 months of intense broadbased medical education, butt in seat, drinking knowledge from a firehose. You learn, and are tested, then learn some more, then tested again. It is almost entirely focused on medical education, with a small amount of "research methods" and public health thrown in. You probably average 30-35 hours of lecture/skills training a week, plus another 30-35 hours of study, and frequently 4-8 hours of beginning clinical rotations. Then you have 12-14 months of rotations that probably average 50-60 hours a week of work/learning. There are tests after each rotation. Mandatory rotations in surgery, emergency medicine, cardiology, womens health, family practice, psych, peds, and geriatrics. 2000 clinical hours as a provider-in-training is the minimum, with many exceeding 2500. PA education is so intense, packing so much education into 2-2.5 years that virtually nobody can possibly work during the program. This is standardized across every PA program in the country.

NP education = Nonstandardized, and can consist of 2 years of education that is often done on-line with a few trips to the classroom a year to do some skills testing. Much of this 2 years of education is advanced nursing management, advanced nursing leadership theory, advanced nursing research methods. Then 500 hours of "clinical rotations" that are often done at the same clinic. Rumor is there are some NP programs that have significantly increased their actual medical education, but I am not familiar with them. Most of the NPs I know, and current NP students, attended programs like I described.

I don't say this to demean nurses or NPs. It's just the facts.

Yes, the best person to enter a PA or NP program is someone with significant previous experience as a RN, medic, etc because they do have some experience with medications, procedures, organization systems, etc. However there is a VAST difference between being a RN/Medic and being a medical provider. One should not conflate experience as a RN/Medic with experience as a medical provider.

All that being said, PAs and NPs compete for the same jobs and mostly the same pay. So, if you're already a RN, then going the NP route is certainly the easiest and cheapest route (although with the implementation of the DNP it may become just as expensive as PA), so it's usually a no-brainer to go NP....unless you want the more in-depth education from PA program. Likewise, if you already have a non-nursing BS, then PA may be your cheapest and easiest route to go (vice attaining RN first, then NP).

You always crack me up with this. Like even the direct entry NP programs are somehow just a couple of years of "nursing stuff" and then they hand you a degree and let you practice without a thought to passing boards. You do know that direct entry NP programs (which are akin to PA schools, as both enter without a degree in healthcare) aren't 2 years, right? And they don't offer those on-line. And seeing as how outcomes for NPs are absolutely comparable to other providers -- yeah. It's kind of funny how you characterize things. PA programs are 2 years long. TWO YEARS. And you've got people coming into those programs who have barely any patient contact (CNA, scribes, phlebotomists). You're playing catch up. An RN has 4 years of education that turns out skilled health professionals. A RN passes boards. Then, they go to NP programs, which are 2-3 years long. With required clinical components. With boards. The vast majority of NP students have significant time in as a professional RN before entering their NP program. PAs are just playing catch up -- I'm surprised that they are letting people who two years ago were flipping burgers at the local tasty-freeze, with a degree in English, treat patients as Providers -- but that's the new PA situation.

 

[Boatswain2PA]

To summarize between Owlgirl and myself.

PA programs take burgerflippers (with near 4.0 GPAs in science pre-req's) and give them two years of intense education to be a medical provider.

NP programs take nurses and give them two years of mostly fluff to be a medical provider.

With the caveat that most PA students have variable amounts of medical experience (including RN, combat medic, paramedic, down to scribe/CNA), and there are some NP programs that are striving to improve their medical training. Unfortunately though, PA programs are requiring less and less medical experience, and most NP programs are still very weak in medicine.

That's a pretty accurate summary of the differences.

 

[Owlgal]

To summarize between Owlgirl and myself.

PA programs take burgerflippers (with near 4.0 GPAs in science pre-req's) and give them two years of intense education to be a medical provider.

NP programs take nurses and give them two years of mostly fluff to be a medical provider.

With the caveat that most PA students have variable amounts of medical experience (including RN, combat medic, paramedic, down to scribe/CNA), and there are some NP programs that are striving to improve their medical training. Unfortunately though, PA programs are requiring less and less medical experience, and most NP programs are still very weak in medicine.

That's a pretty accurate summary of the differences.

Ok. To correctly sum it up:
PA -- maybe (some programs don't even require a bachelor degree) a bachelor's degree. Could be in English Lit. for all we know, took a few pre-req courses in pharmacology, microbiology, etc. (with at least a B) and is then trained for TWO YEARS to be a provider.

NP -- has a four year NURSING degree (that requires hundreds of hours of clinicals as part of the degree) and likely at least a few years of bedside nursing experience, working alongside other healthcare professionals and directly with patients (you know, saving lives, and all that). Then goes on to a two year program that involves 700-1000 hours of additional clinicals plus courses in advanced pharmacology, pathophysiology, etc (for which they cannot receive a grade below a B). So, SIX YEARS to be a provider.

Most PA students are NOT RNs or even paramedics. They run more along the lines of CNAs. And, a "near 4.0 GPA in science pre-req's"? -- that's a B. So, you have B average students with a couple of months experience in basic (think minimum wage or slightly above) "medical experience".

 

[pamac]

She makes good a lot of good points. The one about B averages is a unique take on GPA. But fact is that maintaining a GPA above a 3.6 is an impressive feat when you are talking about folks taking courses like biochem, o chem, general chem (the real one, not the ones the pre nurses take), and most other common fare for folks in the sciences. Its kind of cliche among most folks who struggled as pre-meds, but my GPA really did suffer because I took the hard classes and had class schedules that were booked solid with sciences. Most of the folks I know personally that got into PA school were good students, but not even most of them were dedicated biology majors. They got good grades in their majors, and good grades in the 5 or six prereqs, and the 4 or 5 classes that were prereqs for the prereqs that they took as electives. I probably could have shown up as a better student if I was a business major, and able to devote plenty of time to the few hard courses I had on my plate instead of taking a hard science, a chemistry, a math, and another tough bio course as my elective, and juggling that kind of schedule every semester. And so many PA schools love love love unique educational backgrounds that are outside of the typical life sciences grad.

But PA school is just 3 semesters, and then 3 semesters of clinical, which hopefully is demanding. I'm more impressed by the built in clinical time, because that's where a lot of the functional knowledge seems to come from.

 

[pamac]

I don't buy the argument that physicians and PAs aren't as well versed as NPs about life struggles of patient problems that supposedly NPs are superior at addressing due to our nursing backgrounds. As a nurse, I don't have any more avenues to solve some of the educational, cultural, and social barriers of my patients than most others in the healthcare environment, with the exception of maybe social workers (which I have no desire to be or act like). At the end of the day, I can know about a patient's insurance information, home life, reasons for resistance to following instructions, willingness to change a dressing, etc, but will a physician or PA approach treatment in an incorrect manner vs an NP even though they didn't take "reinforcing-unpopular-realities-in-pleasant-ways-with-patients-who-don't-listen-to-you-506" in school? I've been in plenty of rooms with physicians and PAs, and am frequently impressed by how adept they are at presenting information, perceiving patient concerns, and circumventing issues. I take plenty of mental notes to help me tailor my approach to patients. If you think NPs have a corner on the market for common sense, I fear too much coolaid has been consumed.

Apart from the new super young PAs being churned out at age 24, your typical PA is well acquainted with dealing with human beings, because not long before they were PAs, they were regular folks. And a physician spent 80 hours a week through residency dealing with patients who came back to see him or her if they didn't crack the cultural competency code to get them to follow instructions and take the life improving medications they need to take to improve. So I consider their skills to be honed just as well as the former nurse who would heard people's stories but was too busy or powerless to solve anything more than a med pass and standard unit procedures. Taking an NP course promoting the "nursing approach" isn't going to make anyone an expert on getting to the root of problems. And it doesn't take a class to convince a physician or a PA that folks would rather have a medication off the $4 perscription list if possible, or that it's not a good idea to prescribe opiates if the patient has a relative who steals them, or to address a new moms hesitancy to vaccinate her baby in a way that respects the fact that she is holding back because she loves her child and is basing her info on what other loved ones have told her. It's ignorant to think that nurses manage to get in tune with the human condition better than others in healthcare. It's just silly to insist that NP school has an edge in anyone because they load up on fluff to promote that end.