Which path would you take?

[MexicanDr]

I have been blessed enough to have been accepted into an FNP and a PA program.

I have worked as an ICU RN for a couple years and my goals once I complete my graduate program is to work family medicine, but I also want to be able to work in the Emergency Department and possibly in the critical care setting.

Which do you feel would better prepare me for my future?

Thanks in advance

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[BreathDeep]

Depends what exactly it is that you're preparing for.

Preparing to practice solo? Then go NP.

Preparing to be able to easily switch specialties in the future? Then go PA.

The major advantage of NP is independent practice(in applicable states), but being an FNP could limit you from working in certain specialties should you one day change your mind (and you already seem to be interested in more than one area). The major advantage of PA is your education is more in depth and more well rounded, so all specialties should in theory be open to you.

To prepare for your future you gotta know what you're preparing for first. My personal opinion? I'm PA biased but considering you're an ICU RN already, if you're absolutely 100% super duper sure you want to work in a clinic the rest of your life then go ahead and do FNP. But if you have even a slight itch that you might want to venture into Emergency or Intensive Care, or anywhere else even, then just go PA and let the sky be the limit.

 

[deleted6669]

agree with above. if you want outpt practice go fnp. if you want em, surgery, or critical care go pa.
if in CA I would recommend the dual pa/fnp program at uc davis. best of both worlds.

 

[NYCGuy86]

I have been blessed enough to have been accepted into an FNP and a PA program.

I have worked as an ICU RN for a couple years and my goals once I complete my graduate program is to work family medicine, but I also want to be able to work in the Emergency Department and possibly in the critical care setting.

Which do you feel would better prepare me for my future?

Thanks in advance

PA may be the best option since your interests seem diverse (FM, ER, ICU). With the FNP, you definitely can do FM, possibly ER, but ICU may be difficult (yes there are some FNPs that work in ICUs, some work as hospitalist NPs that cover the ICU, etc., but ACNPs are the specific type of NP that receive education and training related to the inpatient setting, including critical care, not FNPs, and many jobs specifically ask for an ACNP). There are also combined FNP/ACNP programs, however since you already have acceptances in hand, the best thing to do may be PA.

 

[MexicanDr]

Thanks guys!

 

[pamac]

ACNPs are really starting to take over the NP role in hospitals. Plenty of NPs do ER. A friend of mine does ER and works in a family practice clinic. There are averages and likelyhoods for landing any role out there, but if you really want to do something, like work ER in a PA heavy ER environment, then you can make it happen. That said, things are tightening up across the board as far as it goes for being able to jump around, even for PAs, who always used to be the masters of moving around to different specialties. I've noticed the trend is to settle in around something you can thrive at.

For me, it's all about the ability to be independent. PAs will never have that, unfortunately. I couldn't dress that up in my mind when I was getting close to PA school. I just like that nursing was it's own brand. I chose nursing because of that, even though it would be longer for me. As an NP, at the end of the day, I won't have to base my career to my relationship with a physician.... Not that I see them as bad in any way, just that I like the idea of having that little bit of daylight. As a PA, you are a permanent employee by title.

 

[Makati2008]

ACNPs are really starting to take over the NP role in hospitals. Plenty of NPs do ER. A friend of mine does ER and works in a family practice clinic. There are averages and likelyhoods for landing any role out there, but if you really want to do something, like work ER in a PA heavy ER environment, then you can make it happen. That said, things are tightening up across the board as far as it goes for being able to jump around, even for PAs, who always used to be the masters of moving around to different specialties. I've noticed the trend is to settle in around something you can thrive at.

For me, it's all about the ability to be independent. PAs will never have that, unfortunately. I couldn't dress that up in my mind when I was getting close to PA school. I just like that nursing was it's own brand. I chose nursing because of that, even though it would be longer for me. As an NP, at the end of the day, I won't have to base my career to my relationship with a physician.... Not that I see them as bad in any way, just that I like the idea of having that little bit of daylight. As a PA, you are a permanent employee by title.

I tend to agree with PAMAC. Although I am against MLP independence, and I do not foresee my old profession gaining it, it would be nice to not base your life on if a doc dies or quits.

Also from the latest stats I saw there are around 9k PAs and NPs in EDs(I've seen a few EDs here that solely employ NPs as MLP of choice).

 

[deleted6669]

I do not foresee my old profession gaining it, it would be nice to not base your life on if a doc dies or quits.

Also from the latest stats I saw there are around 9k PAs and NPs in EDs(I've seen a few EDs here that solely employ NPs as MLP of choice).

I think the future for PAs will certainly involve a loss of lateral mobility, but gradual increases in autonomy as we shift to a model of collaboration instead of "supervision" as the VA system recently implemented for PAs. I think PAs will always maintain a relationship with medical boards, but some mechanism will be created to allow the pa who works for a solo doc who dies, retires etc to continue working without interruption. Maybe a service of available short-term collaborating docs who can step in to assume the role or something similar. We are also likely going to a future with more education (to doctoral level eventually to compete with the DNPs), required postgrad training in a single specialty, and required specialty board certification on the CAQ model.
regarding # of PAs and NPs in EM- Last figure I heard was over 10k PAs, with probably 40% as many NPs as well for a total # around 14 k.

 

[pamac]

Makati highlighted the main appeal to me of independence... The issue of collaboration. Professional distance like I have with my nursing license makes sense to me. I might be a bit paranoid, but I gravitate to situations that provide me with the greater palate of options in the event that things go south (within reason). PA school seemed like a very expensive pathway that would lead me to a situation where the future I paid for with money and significant sacrifice would ultimately depend on me then securing a relationship with a landlord of sorts. Where I'm at, as an NP, I could sever ties with a physician at 1700 and be working the next day at 0700. At the very least, I could hang a shingle out and feed my family. I'm not certain, but I think I could buy or lease a laser and remove tattoos. I could administer Botox on my own. I don't want to do any of those things, nor make the argument that my training will be equivalent to physicians (or PAs for that matter), but I don't want to be a PA squire to the MD knight in terms of regulations... I want to be a free agent that can put food on the table under a variety of circumstances. NPs have that wiggle room that PAs don't. I'm not interested in workaround arrangements that allow me to do my job. There are already enough hoops to jump through with all the other requirements out there for reimbursement and privileges, and the like.

Degree creep in the NP realm is absolutely ridiculous, and I hope it doesn't leak into the PA realm as well. They are killing the golden goose that makes those professions somewhat appealing, especially PA. You add any more school on to that, and you'll have a bunch if people asking themselves why they aren't going to medical school. For me, when a bunchof my classmates in undergrad didn't get into professional school or whatever, because of grades or MCAT or dat scores, a few went to podiatry, or else went foreign medical, and others retooled their coursework and made medical school happen. The pre PAs had really good grades (often better than some of the guys going for med school). Most of the pre PAs could easily have done med school and got in first try. Those kinds of folks will really have to take a hard look at that if PA school gets any longer. Three years is almost med school, and yeah, you have residency afterwards. But... the alternative is starting out as a green PA and slogging along for about as long until you are comfortable with the work of a provider. Right around the time you are hitting your stride as a confident PA, you would be walking out of a med residency and getting ready to cash rather nice paychecks. If Pa school is as hardcore as we all know it is, let that speak for itself instead of trying to match a DNP by playing the degree inflation game... I think it won't accomplish what proponents hope, and will only become an anchor.

 

[deleted6669]

many would argue that the transition from MMS to DMS (doctor of medical science) for PAs wouldn't require any additional coursework. Many(most) PA programs are already at 100 + graduate credits and include a thesis or dissertation. We just aren't giving them the degree they have already earned. Anyone else doing that volume of graduate credits already gets a doctorate for doing so.
I understand the rest of PAMACs points above. I am someone who has made a career out of "work-arounds". I work solo nights and in rural settings at 2 out of 3 of my jobs and have minimal to no interaction with docs until the point at which I call a hospitalist for an admission or surgeon for a surgical consult. At 2 out of 3 of these jobs my role is 100% interchangeable with the docs who work the days I am not there. I can see the allure of an independent license, but have been able to make due without one. The PA profession will always maintain ties to medical boards, but over time I think we will see PA practice look more like NP practice in "non-independent" states; that is PAs working with collaborating physicians of record (not "supervisors"), no specific chart review requirements, and gradual increases in autonomy and scope of practice. A mechanism will be created to allow for continued practice if the primary collaborating physician is unable to continue in that role.
The cost of this will be a transition to a training model that requires doctorates, postgraduate training, and passage of specialty exams beyond PANCE, likely using the newly developed CAQ model.

 

[MexicanDr]

but over time I think we will see PA practice look more like NP practice in "non-independent" states; that is PAs working with collaborating physicians of record (not "supervisors"), no specific chart review requirements, and gradual increases in autonomy and scope of practice.

Are you than saying that NPs have it better than PAs? Sadly sounds like it..

 

[deleted6669]

but over time I think we will see PA practice look more like NP practice in "non-independent" states; that is PAs working with collaborating physicians of record (not "supervisors"), no specific chart review requirements, and gradual increases in autonomy and scope of practice.

Are you than saying that NPs have it better than PAs? Sadly sounds like it..

In terms of hoops to jump through to practice? You bet.

 

[MexicanDr]

If you had to do it all over again and had a choice between an FNP or PA program, then what would you do?

I want to be marketable once I am done with my education and be able to work in Family Practice, but also EM and even Critical Care honestly. I have no desire whatsoever to start my own clinic believe me..

 

[deleted6669]

If you had to do it all over again and had a choice between an FNP or PA program, then what would you do?
.

Medschool > PA+ em residency. never np. sorry, not my thing.

 

[pamac]

Depends on what you mean by marketable. PAs always seem to find jobs, and you probably could jump around through all those as a PA a lot easier than as an NP. But you have to imagine that with each jump, you would need to make the case that you are as effective as a PA in that specialty that hasn't made as many jumps.... In other words, your prospective employer might like the diversity you bring.... Or they may rather have a PA like EMED, that has decades of experience.