# Physician Assistant ?



## philslat (Nov 7, 2018)

What are peoples thoughts or experiences on becoming one from an ems background ?

What routes are out there for paramedics to study for the position ?


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## DrParasite (Nov 7, 2018)

i know quite a few people who went that route.  

route: get a bachelors degree.  then get a masters degree from a PA program.  hard to do full time and go to PA school, but part time/per diem as a medic is def doable.


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## Brandon O (Nov 9, 2018)

Get your bachelors with the necessary prereqs, then apply. The field experience will be useful. Don't plan on being able to work during school.


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## johnrsemt (Nov 10, 2018)

I had a couple of coworkers who did PA school while working FT, one as an EMT Basic, and one as a Medic.  Depends on your work and study habits, and if your company and partner lets you sleep between patients.


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## wtferick (Nov 14, 2018)

A handful of PAs at my Hospital job worked as EMTs/Medics prior to going to PA school. Some local firefighters have even tried to attend PA school but scheduling was tough.


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## Akulahawk (Nov 14, 2018)

Brandon O said:


> Get your bachelors with the necessary prereqs, then apply. The field experience will be useful. *Don't plan on being able to work during school.*


That's one of the reasons I chose not to try for PA school. I _had_ to work full time.


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## Brandon O (Nov 15, 2018)

Akulahawk said:


> That's one of the reasons I chose not to try for PA school. I _had_ to work full time.



Insert some sort of GIF here about... loans.


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## DrParasite (Nov 15, 2018)

Brandon O said:


> Insert some sort of GIF here about... loans.


As someone who had paid off his student loans, and is now dreading more loans when I go for my masters degree.....

Loans are great to help you pay FOR school.  They don't always help you pay the mortgage/rent car payment/insurance, food etc.  When I was looking at PA school, they told every applicant that they COULD NOT WORK during the PA program.  While I'm sure I could have gotten away with a slow 24 hour shift on Saturday or a busy 12 hour shift on the weekend, it wouldn't have made that big of an impact on my ability to pay my bills.  If I had a sugar momma, or lived with family, I could likely pull this off, at least for a few years until I finished school.  Once I became an adult, this became much more difficult.  Now that I have a wife (who isn't sugar momma level yet), and a child (who doesn't being in any revenue, and costs a fortune in diapers), I can't quit my full time job to complete grad school.  I plan on getting loans to help pay for school, but I still have expenses that need to get paid, and student loans won't cover them.


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## Brandon O (Nov 15, 2018)

That sounds... correct. Glad I didn't need to support a family during school.

I guess there's NP school. They usually work.


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## Akulahawk (Nov 16, 2018)

That's exactly the problem. Loans are good for paying _for_ school but they usually don't help with the other issues with life. At the time I didn't have much in the way of recurring expenses but they included a mortgage, family, car insurance, etc. Fortunately I didn't also have a car payment. I still had the usual utilities, gas, and the like. On top of school costs, just add on another $80k for the two years I'd have had to take out for all those other costs, and more for a huge lack of health insurance... which my full time job provided. I barely squeaked out of school with no major debts, but I was able to do it. Going forward, if I choose to do PA school, I'd have to be able to step away from work for 2 full years as well as arrange for all school costs to be covered too. 

I'm not as young as I once was. Before I was as encumbered with such life expenses, PA school would have been far easier to manage. 

NP school should be easier to do from a logistical standpoint but the end result wouldn't allow me the flexibility that a PA has. 

While this is a bit off the topic of PA school per se, it's something people do have to consider when deciding to go beyond Paramedic or Nurse, or whatever, and become a mid-level provider or higher. Certain costs can be prohibitive to a degree if you're not aware of them.


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## FiremanMike (Nov 21, 2018)

I've mentioned this before on other forums, but I'll mention it here.  I can't for the life of me understand why people choose PA over NP these days.  On the front end, the pre-requisite courseload for PA school is nearly all of the pre-requisite coursework for medical school.  If I'm going to take all those classes, I'm just going to take the MCAT and be a doctor.  For those with a bachelors degree, direct entry NP programs only require A&P, biochem, and pharmacology.

While in school, at least with the programs in my area, you will be a full time student with a heavy course load.  Around here, most will have to quit their jobs entirely to accommodate the workload.  NP school can be done part-time.

On the back end, NP's have full autonomous practice authority and PA's likely never will.  While I don't personally plan on being completely off on my own, it sure would be nice to not have that monkey on my back for the rest of my career.  On top of that, they're competing for the same jobs, so it's not like PA's are getting better jobs than NPs..


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## Carlos Danger (Nov 21, 2018)

FiremanMike said:


> I've mentioned this before on other forums, but I'll mention it here.  I can't for the life of me understand why people choose PA over NP these days.  On the front end, the pre-requisite courseload for PA school is nearly all of the pre-requisite coursework for medical school.  If I'm going to take all those classes, I'm just going to take the MCAT and be a doctor.  For those with a bachelors degree, direct entry NP programs only require A&P, biochem, and pharmacology.
> 
> While in school, at least with the programs in my area, you will be a full time student with a heavy course load.  Around here, most will have to quit their jobs entirely to accommodate the workload.  NP school can be done part-time.
> 
> On the back end, NP's have full autonomous practice authority and PA's likely never will.  While I don't personally plan on being completely off on my own, it sure would be nice to not have that monkey on my back for the rest of my career.  On top of that, they're competing for the same jobs, so it's not like PA's are getting better jobs than NPs..



I think the reason has a lot to do with people in EMS just having a bad impression of nursing, and/or for whatever reason just no desire at all to be a nurse in any way, shape, or form. I certainly felt that way early in my EMS career. I went to nursing school very grudgingly _only_ because I planned to make a career out of HEMS and it made no sense to do it as a paramedic when I could do the same job as a nurse and make a lot more money. Turns out it was by far the best career move I could have made for myself, but that's just me.


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## FiremanMike (Nov 21, 2018)

Remi said:


> I think the reason has a lot to do with people in EMS just having a bad impression of nursing, and/or for whatever reason just no desire at all to be a nurse in any way, shape, or form. I certainly felt that way early in my EMS career. I went to nursing school very grudgingly _only_ because I planned to make a career out of HEMS and it made no sense to do it as a paramedic when I could do the same job as a nurse and make a lot more money. Turns out it was by far the best career move I could have made for myself, but that's just me.



I've had those feelings too, and whether nursing undersells it or EMS folks just ignore it, a BSN alone opens up so many different opportunities that you wouldn't even consider.  I used to believe that RN = wiping bottoms and taking orders, but there's such a wide range of different types of jobs that one can get with a BSN it's just staggering.  

I will say that I still maintain I would not be happy as a floor nurse, but I can certainly see a variety of jobs that would make me happy if I had my BSN.  I do still plan on going on to NP school as I feel the practitioner role more clearly fits my personality..


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## DrParasite (Nov 21, 2018)

FiremanMike said:


> I've mentioned this before on other forums, but I'll mention it here.  I can't for the life of me understand why people choose PA over NP these days.  On the front end, the pre-requisite courseload for PA school is nearly all of the pre-requisite coursework for medical school.  If I'm going to take all those classes, I'm just going to take the MCAT and be a doctor.  For those with a bachelors degree, direct entry NP programs only require A&P, biochem, and pharmacology.


When I was looking at nursing school, there were no direct entry NP programs.  They all required you to be an RN and have a bachelors already. So even if you were a paramedic, you would need to complete nursing school and take the NCLEX before you could even think about NP school.  

While you are correct, the PA school requirements are the same as for medical school, the workload is much different.  

PA school was also 2 to 3 years, and then you were free to practice as an allied health professional.  med school is 4 years of schooling, plus a fellowship, then residency (another 3-4 years, plus an internship), and then you are attending (and a provider who doesn't have to run orders by a higher up).



FiremanMike said:


> On the back end, NP's have full autonomous practice authority and PA's likely never will.  While I don't personally plan on being completely off on my own, it sure would be nice to not have that monkey on my back for the rest of my career.  On top of that, they're competing for the same jobs, so it's not like PA's are getting better jobs than NPs..


please explain how NP's have full autonomous practice authority (while still operating under and MD's license), yet PAs who practice under a MD's license have less autonomy....

A buddy of mine is an NP, and has his own clinic.... while he runs it on his own, he still has an MD who he is actually comes in once or twice a month to do stuff, as its operating under his license.



FiremanMike said:


> BSN alone opens up so many different opportunities that you wouldn't even consider.  I used to believe that RN = wiping bottoms and taking orders, but there's such a wide range of different types of jobs that one can get with a BSN it's just staggering.


wiping bottoms has been delegated to the CNA or hospital techs.  **** jobs roll downhill.  There are plenty of NURSING jobs, and plenty of jobs that the nursing lobby group have pushed for RN credentials (I still don't understand why you need an RN cert to handle bed management), but a BSN is still an entry level nursing degree.  the only time a BSN is more is when an RN earns her BSN, and has 5 years of experience in addition to the new shiny BSN.



FiremanMike said:


> I will say that I still maintain I would not be happy as a floor nurse, but I can certainly see a variety of jobs that would make me happy if I had my BSN.  I do still plan on going on to NP school as I feel the practitioner role more clearly fits my personality..


I agree.  When I was looking at nursing school, I was aiming for less than 5 years in either an ER or ICU, before moving into a non-clinical position.  What NP schools allow you to enter without having any RN experience?



Remi said:


> I went to nursing school very grudgingly _only_ because I planned to make a career out of HEMS and it made no sense to do it as a paramedic when I could do the same job as a nurse and make a lot more money. Turns out it was by far the best career move I could have made for myself, but that's just me.


Many people say the same thing about CCT ambulances that are staffed with 1 RN and 1 paramedic.


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## rescue1 (Nov 21, 2018)

DrParasite said:


> please explain how NP's have full autonomous practice authority (while still operating under and MD's license), yet PAs who practice under a MD's license have less autonomy....



There are several states where NPs do not require a physician's authority/license to practice.


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## Carlos Danger (Nov 21, 2018)

DrParasite said:


> please explain how NP's have full autonomous practice authority (while still operating under and MD's license), yet PAs who practice under a MD's license have less autonomy....



In no states do NP’s “practice under a MD’s license”.

A minority of states - one of which is NC - are behind the times and require that a NP maintain a collaborative agreement with a physician in order to practice. In NC this is a formal but very loose agreement with a MD that states the MD will be available for “collaboration, consultation, and supervision”, but none of those things are required when the NP is practicing within the scope of their training. No practice guidelines, no chart co-signing, no chart review, no phone calls, and no visits are required. They just must be available. 

About the same number of states do not require a collaborating physician for NP practice, but do for prescriptive authority. The remaining states - about a third or so of them - require no physician relationship at all for NP practice.


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## DrParasite (Nov 21, 2018)

interesting.... I was misinformed.... do PAs operate in a similar manner, or do they need a loose agreement with an MD for anything?


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## FiremanMike (Nov 21, 2018)

DrParasite said:


> interesting.... I was misinformed.... do PAs operate in a similar manner, or do they need a loose agreement with an MD for anything?



It is my understanding that PA's are lagging behind NP's pretty significantly overall in their recognition and practice rights and that their requirements for the relationship with their supervising physician were much tighter.


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## Brandon O (Nov 21, 2018)

DrParasite said:


> interesting.... I was misinformed.... do PAs operate in a similar manner, or do they need a loose agreement with an MD for anything?



There's a requirement for PAs to have some form of an affiliation or supervisory relationship with a physician (in, as far as I know, every state still). In most places it means there needs to be someone you could call, or someone who looks over a few of your charts per month, or similar.

In practice all of these minutiae doesn't mean much, folks. Your degree of supervision is generally commensurate with your needs and level of experience. I don't know any NP or PA in their right mind who would come out of school and think they can practice without any help, regardless of the law.

Supervision is usually even easier in the acute care setting. For example, in the ICU, most places use PAs and NPs indiscriminately (sometimes they prefer one or the other, mostly out of habit), and both are "supervised" in the sense that the intensivist continues to be involved with the patients. What decisions/activities/procedures to handle independently vs collaboratively are a matter for the two of you and your system to work out. The letters don't matter much.


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## Peak (Nov 21, 2018)

DrParasite said:


> interesting.... I was misinformed.... do PAs operate in a similar manner, or do they need a loose agreement with an MD for anything?



Since the AMA created PAs they will always be somehow under the supervision of a Doc, to what extent largely depends on what state they are in. 

I think another consideration in deciding NP or PA depends on what type of practice you want to have. ED and surgical specialties seem to have a larger proportion of PAs, and generally PA training seems to be more geared towards this; neonatal, pediatric, and psych specialties seems to much more strongly prefer NPs, I suspect that this is largely due to NP training tracks specific to these practice areas. 

There are some specialty oriented training programs for PAs, but they seem to have more flexibility in choosing their practice areas than NPs. This used to be the case with FNPs, but there has been a bigger push recently in some areas to have primary care NPs (compared to NNP, PNP-AC, and AGAC) to only practice in outpatient settings.


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## Brandon O (Nov 23, 2018)

Peak said:


> Since the AMA created PAs they will always be somehow under the supervision of a Doc, to what extent largely depends on what state they are in.



Who knows. They haven't been very active pursuing this, but it does mostly depend on the state, not on who created what.



> I think another consideration in deciding NP or PA depends on what type of practice you want to have. ED and surgical specialties seem to have a larger proportion of PAs, and generally PA training seems to be more geared towards this; neonatal, pediatric, and psych specialties seems to much more strongly prefer NPs, I suspect that this is largely due to NP training tracks specific to these practice areas.
> 
> There are some specialty oriented training programs for PAs, but they seem to have more flexibility in choosing their practice areas than NPs. This used to be the case with FNPs, but there has been a bigger push recently in some areas to have primary care NPs (compared to NNP, PNP-AC, and AGAC) to only practice in outpatient settings.



Agree that PAs are usually more suited to surgical work. As I understand it NPs usually need to undertake additional training to assist in the OR.

True that NPs are a bit more specialized in training (roughly specialized programs versus fully generalist NP programs), but how much this matters seems to vary. I have certainly seen FNPs working in the acute care setting.


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## Carlos Danger (Nov 23, 2018)

Peak said:


> Since the AMA created PAs they will always be somehow under the supervision of a Doc



Not so sure about that: Big News for OTP in North Dakota 

Economics is a hard force to ignore over the long term, and economics definitely favors independent "mid level" (again, I hate that term because it is demeaning and factually inaccurate) practice.

For purely political reasons, PA's lag far behind NP's in this area, but they will eventually catch up.


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## Peak (Nov 23, 2018)

Brandon O said:


> As I understand it NPs usually need to undertake additional training to assist in the OR.
> 
> True that NPs are a bit more specialized in training (roughly specialized programs versus fully generalist NP programs), but how much this matters seems to vary. I have certainly seen FNPs working in the acute care setting.



Yeah, NPs would need to get their RNFA.

There are FNPs who work acute care, but they have mostly been there before the proliferation of acute care NP specialties. New FNPs will have a much harder time finding acute care jobs than before. Every RN I know who when FNP instead of AGNPAC or PNPAC ended up having to take a clinic job, this isn't universal by any means but the demand is so much higher in primary care now. 



Remi said:


> Not so sure about that: Big News for OTP in North Dakota
> 
> Economics is a hard force to ignore over the long term, and economics definitely favors independent "mid level" (again, I hate that term because it is demeaning and factually inaccurate) practice.
> 
> For purely political reasons, PA's lag far behind NP's in this area, but they will eventually catch up.



I wasn't aware of that but I'll be surprised if it actually passes. 

Like you said it's all political, and I think the medical and nursing interests will likely both be against it in the long term.


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## Kavsuvb (Oct 24, 2019)

I know Yale Univ's GEPN program only requires a Bachelor's degree and you only have to score well on the GRE exam.


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## DrParasite (Oct 24, 2019)

Kavsuvb said:


> I know Yale Univ's GEPN program only requires a Bachelor's degree and you only have to score well on the GRE exam.


that's a year old program, and us used as a leadin prereq to a MSN.  





> Upon completion of the prespecialty year, students continue on with their graduate studies which includes theory, practice, and research. Students are admitted into their designated specialty when accepted into the program. The Certificate in Nursing and a license to practice nursing in Connecticut are the two prerequisites required for the GEPN student to continue with their graduate work to earn their M.S.N. degree.


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## Kavsuvb (Oct 28, 2019)

DrParasite said:


> that's a year old program, and us used as a leadin prereq to a MSN.


Here's what the Degree plan for YALE UNIV GEPN Plan.





						Graduate Entry Prespecialty in Nursing (GEPN)
					

The GEPN program allows those with a non-nursing background to take advantage of a Yale nursing education to pursue a rewarding career in advanced practice nursing.  This accelerated three-year program combines preparation in basic nursing with advanced training leading to a Master of Science in...




					nursing.yale.edu
				




Here's their Admission requirements. https://nursing.yale.edu/admissions/how-apply/graduate-entry-pre-specialty-nursing

"
The GEPN Program is the first of a three-year, full-time course of study that combines preparation in basic nursing with advanced preparation in a clinical specialty. Students are offered experiences in acute-care hospital units and community settings to achieve YSN’s overall mission of better health for all people.
Upon completion of the pre-specialty year, students continue their graduate studies in theory, practice, and research within their chosen nursing specialty areas and concentrations.
All GEPN candidates for admission to Yale School of Nursing are required to submit the following:
•   Online Application
•   Current Resume/Curriculum Vitae
•   References
Three letters of recommendation (academic, professional, or clinical) must be submitted electronically through the online application system.
•   Transcripts
One official transcript from each college or university attended must be mailed to Yale School of Nursing, or sent digitally via Parchment or _eScrip_. Unofficial transcripts should also be uploaded to the online application. International transcripts must be evaluated by a credentialing agency, such as World Education Service or Educational Credential Evaluators. This includes a course-by-course evaluation, as well as a certified English translation of all non-English transcripts. International applicants should also review: International Applicants Information.
•   Test Scores
Scores from the GRE General Exam are required for applicants. (Note: The GRE requirement can be waived for applicants with a previously completed masters or doctoral degree).
Registration information is available at www.ets.org/gre. YSN’s GRE code is 3998. The GRE needs to have been taken in the last five years. GEPN and MSN candidates should take the GRE no later than mid-October.  Scores from either the TOEFL or the IELTS are required of all non-native English speakers.
•   One essay and two short answer responses to the following questions
Essay (400 – 600 words)
Please address the following three questions in an integrated and comprehensive essay, plus two short answer questions (separately).  Applicants will be evaluated on their ability to compose a well-written and well-organized essay as well as on the substance, thoughtfulness, and clarity of their responses:
Why do you wish to pursue a career in advanced practice nursing?
Please expound upon: (a) your decision to pursue nursing rather than another health care field; (b) your choice to pursue advanced practice nursing (i.e., an APRN/MSN rather than an RN/BSN); (c) your selection of the particular clinical specialty to which you are applying.
What factors have influenced your decision?
Please describe any significant life experiences that have contributed to your self-understanding and development, with respect to your interest in advanced practice nursing. You may discuss, for example, how academic and professional experiences, cross-cultural engagement, or volunteer roles and service projects have shaped your career aspirations and ambitions.
Why are you applying to Yale’s Graduate Entry Prespecialty in Nursing (GEPN) program?
Please articulate how specific aspects of the program, curriculum, faculty, or any other of the Yale School of Nursing’s resources or characteristics, will empower you to achieve your goals in the nursing profession.
Essay  Short Answer (150 - 300 words) for each question
 Please provide a balanced assessment of your personal characteristics as they pertain to a professional environment. Identify your strengths and weaknesses, as well as areas you are working to improve. Discuss your interpersonal style, both in interactions with individuals as well as in group settings. What leadership qualities, conflict management skills, and other characteristics of yours influence how others perceive and respond to you?
Yale School of Nursing’s mission is “better health for all people.” What does that phrase mean to you? How do you intend  to inhabit and implement YSN’s mission over the course of your nursing training and career?
•   Application Fee
A non-refundable application fee of $100 payable by credit card is due at the time the application is submitted.

*Please note*: Candidates to the GEPN program are not required to take any prerequisite courses to apply and be admitted to the program. "

They don't require an Preq's like other NP schools and I have seen YALE Univ GEPN Students because my endocrinologist is a Faculty for them and she uses me as a Lab rat because I have 2 rare diseases.


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## Alan L Serve (Oct 29, 2019)

My dear friend,
PA is spelled out,
"Physician Assistant",
There is no 's,
After physician.


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## jgmedic (Nov 2, 2019)

Alan L Serve said:


> My dear friend,
> PA is spelled out,
> "Physician Assistant",
> There is no 's,
> After physician.



Really? You form a post like that to correct someone's grammar?


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## CCCSD (Nov 2, 2019)

He thinks he’s speaking in haikus...


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## Alan L Serve (Nov 2, 2019)

jgmedic said:


> Really? You form a post like that to correct someone's grammar?



My dear friend,
This is not a grammar
Issue,
This is the name,
of a profession.


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## E tank (Nov 2, 2019)

CCCSD said:


> He thinks he’s speaking in haikus...


 It isn't 'haikus'
It's 'haiku'

(and it wasn't even haiku)


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## PotatoMedic (Nov 2, 2019)

I preferred the third person talk from our friend from down under to this "dear friend" of ours.

But I also have other things to worry about than someone who wishes to sound condescending on the internet.


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## CCCSD (Nov 2, 2019)

E tank said:


> It isn't 'haikus'
> It's 'haiku'
> 
> (and it wasn't even haiku)



sigh....I’m well aware of it.


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## RedBlanketRunner (Nov 3, 2019)

A simple suggestion for anyone going after a higher rung in the ladder, be it NP or PA or similar. Take it in stages. You can do a lot of the pre reqs while working full time. See a good councilor/advisor who knows the classes and normal limits of students. Consider spacing your curriculum out over several years.
From start to finish, my BME was spaced out over nearly 20 years.


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## VFlutter (Nov 3, 2019)

FiremanMike said:


> I've mentioned this before on other forums, but I'll mention it here.  I can't for the life of me understand why people choose PA over NP these days.



Even as a RN I have debated the PA route vs NP because in many cases it really is a better education.

On the back end, NP's have full autonomous practice authority and PA's likely never will.  While I don't personally plan on being completely off on my own, it sure would be nice to not have that monkey on my back for the rest of my career. 





FiremanMike said:


> On top of that, they're competing for the same jobs, so it's not like PA's are getting better jobs than NPs..



There are some specialties, i.e. surgery, that are dominated by PAs. Autonomous practice is a perk but for many in-patient jobs like critical care and surgical it really is a mute point for mid levels.


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## Carlos Danger (Nov 3, 2019)

VFlutter said:


> Even as a RN I have debated the PA route vs NP because in many cases it really is a better education.
> 
> On the back end, NP's have full autonomous practice authority and PA's likely never will.  While I don't personally plan on being completely off on my own, it sure would be nice to not have that monkey on my back for the rest of my career.
> 
> There are some specialties, i.e. surgery, that are dominated by PAs. Autonomous practice is a perk but for many in-patient jobs like critical care and surgical it really is a mute point for mid levels.



To me, it's simple: If you are already an RN or plan to become one, then NP probably makes much more sense. If you are not an RN already and have no desire to be one, then PA is the way to go.

The educational models are very different, and there's no question that PA programs on average are better, but there are also plenty of NP programs that provide quality training and they aren't had to find and the schedule is typically much more convenient because they are designed for RN's who work full time. That's the other advantage of NP over PA; the ability to do your education in "stages", working full time the entire time you are going to school.

The autonomy ends up being a non-issue 95+% of the time, because it's pretty uncommon for a NP or PA to work in a setting where they are the only advanced provider. Even when they do, "physician supervision" for PA's (and for NP's where it is required) often amounts to little more than a formal relationship on paper with an MD or DO who they may never even see in practice.


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## SandpitMedic (Nov 3, 2019)

How did I miss this thread? There is much to be clarified.

The comedic poet is correct. The title of the profession is Physician Assistant. Could we change the thread title to reflect that the good people of EMS represent themselves well and understand their partners in medicine? Thank you. (Although, the American Academy of Physician Assistants along with a majority of PAs are looking to rebrand and re-title the profession).

PA/NP (Advanced Practice Providers) roles are determined by state legislation. Therefore, the laws for PAs and their work varies widely state to state. As has been said, the nursing lobby has made great strides in advancing their profession. The PAs are behind on that front, yet they are also a much younger profession. Gains are being made by PAs with regard to federal and state legislation.

Anyone who would badmouth either profession as a lesser demonstrates they don't know what they are talking about, not that anyone has intentionally. Both have their strong suits as well as less strong suits, but they are both positions that require high levels of education and experience to provide medical care at an advanced level much like a general physician. I am not saying PA/NP =/> MD. PAs and NPs in practice are more similar than they are different. Although, practice of PAs right out of school includes prescribing, obtaining H&Ps, diagnosing and treating illness, ordering and interpreting diagnostics, counseling patients on preventative health, performing medical procedures, assisting in surgical operations. NP practice is almost identical, they must obtain additional training in most cases to assist in surgery or to see patients across the lifespan depending on the type of program they attended. NPs also enjoy certain eases in licensing in most states. Most importantly, no provider is in it alone; part of the PA role is understanding limitations and making those collaborative efforts to best serve the needs of each patient.

https://pasdothat.net/

There are certain differences in training, like many have stated. NP school is based on nursing theory and some NP programs aim to specialize right out of the gate (generally after many years of RN bedside experience). PA schools are based on the medical model (like MDs) and programs are uniformly geared towards family practice. As a new grad, a PA can go into family practice or choose to specialize in a given field which may include on the job training (most common) or applying for and attending formal fellowships (residencies, less common) if desired.


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## SandpitMedic (Nov 3, 2019)

Second order of business: the OTP for North Dakota did pass, so Fireman Mike, you can be surprised now. OTP stands for Optimum Team Practice. It is a revitalization effort for PAs to gain an accurate reflection of their role, capabilities, and responsibilities as providers of medicine in the legislative process nationally and at the state level. The goal is that, without unnecessary and archaic restrictive policies, PAs would be able to practice medicine at the top of their training and license, as part of a collaborative team of providers, much like our peers enjoy in their respective NP and physician roles.








						Passage of HB 1175
					

North Dakota PAs, It is with great pleasure to announce that H.B. 1175 has been officially signed into law! After unanimously passing through both the N.D. House of Representatives and Senate,...




					ndapa.mypanetwork.com


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## FiremanMike (Nov 4, 2019)

@SandpitMedic - first and foremost, I apologize if my post came off as badmouthing PAs, my point was then and remains today that the barriers to entry coupled with the fact that PAs are so significantly behind NPs in obtaining practice rights makes it seem illogical to choose PA school.

I agree with the above posts that independent practice isn’t an issue for many and probably won’t be for me, but you have to admit it would be nicer to have that option than not.     

Even after a year of posting this, I still maintain that NP seems more “future proof” or show more signs of future growth potential compared to PAs.  I also agree that in most cases, PA education is more robust..

As an update to my own path, for those interested..  I am currently wrapping up my pre-reqs for the direct entry NP program I was interested in.  With that said, I’ve decided to enter the medic to RN bridge at my local community college and hope to start that next summer.  At that point, I’ll be at year 21 out of 25 in my pension system, so I’ve decided to use that time to take the full pre-med course load.  Once it’s time to retire, I’ll see where I’m at and either make a go for medical school or NP school.  Having the RN in my pocket will give me more options on NP school if I go that route.


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## VFlutter (Nov 4, 2019)

I would be cautious with Medic to RN bridge programs if advanced practice is your goal as in the past some NP schools, especially CRNA, would not recognize them or require additional requriments for entry. That may have changed and I am sure some of the members on here that have gone that route can clarify. Sometimes it is better to just do the traditional route vs jumping through hoops later


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## FiremanMike (Nov 4, 2019)

VFlutter said:


> I would be cautious with Medic to RN bridge programs if advanced practice is your goal as in the past some NP schools, especially CRNA, would not recognize them or require additional requriments for entry. That may have changed and I am sure some of the members on here that have gone that route can clarify. Sometimes it is better to just do the traditional route vs jumping through hoops later



This is a brick and mortar community college program with a well established and locally well regarded RN program.  They have recently allowed medics to join the "bridge" pathway that has been available to LPNs for some time.  It allows me to skip the STNA requirement and two of the "intro to nursing" classes.  

But you are correct, medic to RN bridge courses need to be investigated thoroughly before diving in.  The online program that everyone is familiar with has a bad reputation, is quite expensive, and isn't recognized in many states.

TLR, this is a traditional route to RN..


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## SandpitMedic (Nov 4, 2019)

@FiremanMike will that bridge yield you a BSN? Also, I don't think you were belittling anything, just stating my opinion.
Good on you for taking the steps towards higher education, I applaud your ambition and plan.

For me, PA was the right track. Everyone has their own goals and ideas, and must choose the path for them. I respect your opinion, but since we are out here in the open I will say that PA is a great career choice- espeically for _good_ medics seeking to move up the chain. PAs are making great strides and achieving great things in regards to practice and image equality as well as independence (for seasoned providers)- case and point the ND law. PA is already a great career choice and the barrier to entry is uniformly a bachelors degree, science prerequisites that mirror medical school +/- a few classes, and patient care experience. Entry is highly competitive. Practicing medicine as a PA offers as much or as little autonomy as one desires to seek out with a collaborating physician - you can work in virtually any field that medicine has to offer straight out of graduation without additional classes. PAs have a great future outlook, and the compensation scale is very, very lucrative in some cases making as much as $250k annually just in salary. I would not consider any of that to be "illogical" as you put it, especially for a paramedic.

Here is something else to chew on- By the time you get to the point in which you are eligible for NP school it may well be a requirement to hold a master's degree in nursing. You are correct that the nurses are pushing higher and higher for practice rights; to achieve that they are moving quickly to make all NP programs doctoral programs. Is that "future proofing" or is that going to create a lack of applicants who will just go to medical school or PA school rather than spend 8 years becoming an advanced practice nurse? There are a lot of factors to consider and the future is always uncertain.

I'm not on the anti-nurse/NP campaign- that is also a great career choice. As I said, PA was right for me. My wife is an NP, she was an RN when we met. So I have seen both sides of how getting to each level goes.


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## FiremanMike (Nov 4, 2019)

@SandpitMedic 
1. No, only an ADN, I have a bachelors already in public safety management.. While some NP programs require a BSN, others only require an RN and a bachelors in any field (such is the case at the college I am most interested in).

2. I'm not counting PA out.. in my current plan, I'll be taking the pre-reqs  for med school, so I will be able to choose my path at that point.. Part of me wishes I had a pension system that didn't have such a huge cutoff at 25 years, but on the other hand, it affords me the time to prepare for any of the 3 pathways.

3. Lastly, to your point of my using the word "illogical".. I should qualify that to say "illogical to me".  I can appreciate the desire for a more robust education, but on the other hand it seems illogical to me to chose a path that is markedly more difficult once you factor in the immense amount of pre-medical coursework required for PA school, only to come out on the other end and compete for the same jobs with the same pay as your NP counterparts.  I want it to make sense, because given my personality, I think I might actually prefer the appoach to PA school, but it just doesn't add up in my brain right now..


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## SandpitMedic (Nov 4, 2019)

Good luck in whichever you choose.


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## Alan L Serve (Nov 5, 2019)

The ED where
My patients are brought,
Hires only PAs, not NPs,
As the MDs don't trust
NP education


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## Peak (Nov 5, 2019)

Alan L Serve said:


> The ED where
> My patients are brought,
> Hires only PAs, not NPs,
> As the MDs don't trust
> NP education



Probably has more to do with supervisory billing that they cannot perform on the NPs.


----------



## Alan L Serve (Nov 5, 2019)

Peak said:


> Probably has more to do with supervisory billing that they cannot perform on the NPs.



My dear friend,
I must formally
Disagree,
As I was told this,
By the MDs


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## Peak (Nov 5, 2019)

Alan L Serve said:


> My dear friend,
> I must formally
> Disagree,
> As I was told this,
> By the MDs



Do you think they would have said that it was because they want to make more money?
Also, NPs are typically less wiling to do whatever the attending wants.


----------



## Alan L Serve (Nov 5, 2019)

Peak said:


> Do you think they would have said that it was because they want to make more money?
> Also, NPs are typically less wiling to do whatever the attending wants.



My dear friend,
When the MDs
tell me this
fact
I believe.


----------



## Peak (Nov 5, 2019)

Alan L Serve said:


> My dear friend,
> When the MDs
> tell me this
> fact
> I believe.



Don't be that naive and gullible.


----------



## Alan L Serve (Nov 5, 2019)

Peak said:


> Don't be that naive and gullible.



My dear friend,
I wish you,
A good
Night


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## VFlutter (Nov 5, 2019)

Well I know a CT surgeon that only hires NPs cuz he thinks their bedside nursing experience was invaluable #winning #anecdotal


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## DrParasite (Nov 5, 2019)

SandpitMedic said:


> PA is already a great career choice and the barrier to entry is uniformly a bachelors degree, science prerequisites that mirror medical school +/- a few classes, and patient care experience


One thing to remember is many of the applicants to PA school got rejected from med school, and PA school was their fall back plan.  These are the full time 22 year old students, who all they have done is school full time, so they have straight As, compared to many working stiffs who were going to school while working 40-60 hour weeks. 

It's tough to get in, the graduating classes tend to be smaller (compared to med schools), and the schooling is rigorous and always full time (IE, nearly impossible to work while in school), so you better have some income coming in to survive on while in school.  But if you can do it, the opportunities are def there (although I know a couple PAs who ended up going back to med school).


----------



## SandpitMedic (Nov 5, 2019)

DrParasite said:


> One thing to remember is many of the applicants to PA school got rejected from med school, and PA school was their fall back plan.  These are the full time 22 year old students, who all they have done is school full time, so they have straight As, compared to many working stiffs who were going to school while working 40-60 hour weeks.


Were you in PA school at some point? Did you apply to PA school? Do you hold PA licensure? Do you work for a PA program? Do you have personal experience in the admissions department for any PA schools?

Because if you do not answer yes to any of those questions I'm going to have to point out that you have absolutely zero credibility to make such statements. It's okay to stay in your lane. "I heard it from a bud" doesn't count.
I can assure you that there is more than one PA program, and while one cohort may have had such people - the vast majority of applicants are not "med school rejects." Having been through the process personally and knowing many PAs, students, and applicants I can assure that is not the case. I can probably count on one hand how many I've encountered. In the program I entered, there are zero med school fall-backs.

Here's the thing about "many" med school applicants and PA applicants- they tend to be doers. They don't talk about it, they do it. They keep going until they get in. Highly unlikely that "many" just gave up on their ambition to be a physician after putting in all the work and time for it. Are they out there, sure they are, but to paint the PA profession with a broad brush of med school washouts is intellectually dishonest. Also, admissions folks don't just open the gates of PA school for med school washouts; they tend to frown upon people who would consider their program a "fall back" and have a documented history of entry failure into med schools. Furthermore, PA programs tend to be under the umbrella of a university's school of medicine.

I hope that clears that up. You've already said you meant no disrespect to PAs/NPs in another thread... fool me once...


----------



## SandpitMedic (Nov 5, 2019)

Misguided, albeit unintentional, views like that of DrParasite are the reason PA professional organizations are looking to rebrand themselves and there is a push to to make public outreach and relations a priority. Public confusion about PAs is a large part of why PAs struggle to make as large of gains as say... the nurses. There is a lot of misconception about what a PA is and what PAs do. Here again is a link to a website about the truth about PAs:









						Get to Know Certified Physician Assistants - PAs Do That
					

Certified PAs are highly qualified members of health care teams that diagnose patients, prescribe medications and assist in surgeries.




					pasdothat.net
				




Also, the tradition of PA school, invented by physicians, is to take people with medical experience such as military medics, paramedics, etc etc and turn them into physician extenders with the tools to practice medicine akin to that of a primary care physician. Many PA applicants and PAs are on their second or third career and come in with a lot of experience; do not undercut the value of experience in applying to PA schools. PA is an evolving career, and hopefully there is success in the push to display that to the masses. PAs are here to stay, and I would encourage pursuing it as a career move for those interested.


----------



## Peak (Nov 5, 2019)

SandpitMedic said:


> PAs are here to stay, and I would encourage pursuing it as a career move for those interested.



I suspect that the market for APPs, particularly FNP/AGNP/PNP/RNFA/PA, will be quite saturated for the near and foreseeable future. There are too many nurses who dislike the bedside and are going to NP school. Locally many NPs and PAs are stuggling to find jobs, especially outside of primary care.


----------



## DrParasite (Nov 5, 2019)

SandpitMedic said:


> Were you in PA school at some point? Did you apply to PA school? Do you hold PA licensure? Do you work for a PA program? Do you have personal experience in the admissions department for any PA schools?


No, yes, no, no, and my only experience in the admissions departments was the in person phone calls and interviews when I was looking to go to PA school.


SandpitMedic said:


> Because if you do not answer yes to any of those questions I'm going to have to point out that you have absolutely zero credibility to make such statements. It's okay to stay in your lane. "I heard it from a bud" doesn't count.


See above.  This isn't second hand gossip.  And it's incredibly arrogant to tell me to "stay in my lane," and question my credibility on this topic, when your ignorance is showing by not even knowing what I have done in regards to PA school.   

By the way, since you are claiming to be so knowledgeable, do you hold a PA license?  what PA program you are in, and what program do you work for?  Do you have any experience working in the admissions department for any PA schools?





SandpitMedic said:


> I can assure you that there is more than one PA program, and while one cohort may have had such people - the vast majority of applicants are not "med school rejects." Having been through the process personally and knowing many PAs, students, and applicants I can assure that is not the case. I can probably count on one hand how many I've encountered. In the program I entered, there are zero med school fall-backs.


the program you entered might be different than the ones I looked at.  I had many people who went from undergrad to PA school, and were also applying to med school, which PA being their fall back plan


SandpitMedic said:


> I hope that clears that up. You've already said you meant no disrespect to PAs/NPs in another thread... fool me once...


So yeah, you know the old saying, if you have seen one PA program, you have seen one PA program....


SandpitMedic said:


> Also, the tradition of PA school, invented by physicians, is to take people with medical experience such as military medics, paramedics, etc etc and turn them into physician extenders with the tools to practice medicine akin to that of a primary care physician. Many PA applicants and PAs are on their second or third career and come in with a lot of experience; do not undercut the value of experience in applying to PA schools. PA is an evolving career, and hopefully there is success in the push to display that to the masses. PAs are here to stay, and I would encourage pursuing it as a career move for those interested.


Many PA applicants have limited medical experience, and go from relative Zero to Hero.  Yes, they are on their second or third career (I used to work with a retired cop who now worked as a PA in a trauma center), but there are also plenty of relatively young PAs with little medical experience.

If you can do it, great.  I couldn't take 3 years off three years of my life while I was in school to become a PA (housing and food money needs to come from somewhere), so I went in another direction.


----------



## Carlos Danger (Nov 5, 2019)

Peak said:


> I suspect that the market for APPs, particularly FNP/AGNP/PNP/RNFA/PA, will be quite saturated for the near and foreseeable future.


Not even close. It may happen eventually, and there will always be local or regional exceptions, but nationwide there is already a shortage of primary care providers and that shortage (as well as that in other specialties) is expected to get much worse as so many physicians are reaching retirement age over the next decade.


----------



## SandpitMedic (Nov 5, 2019)

We're going to have to agree to disagree @DrParasite. I'm a PA student - 70% through the program. My wife is also an APP, and our friends are APPs/physicians... If you think you know more about PAs and the work/education of PAs then there isnt much I can do to help that.

The bottom line is that painting PAs as med school rejects is not going to fly, despite the common knowledge that background experiences vary through every profession. I'm not sure that there are any other PA-C or PA-S board members here, but I suspect they would tell you the same thing if there were. Furthermore, on admissions, our admissions folks provide statistical data to those in the program, data that includes professional experience and formal educational background information... Med school reject/drop out was not in the majority of experiences. Yes, that is one program, but there is _no_ data I've seen to verify your statement.

You are a firefighter- your subject matter expertise is not in advanced practice providers and their admissions/educational/professional statistics. It is not arrogance to point out when you make statements that you qualify by being "in the know" so to speak, because you don't know. Your lane departure was clearly obvious, and if you don't like being called on it then perhaps you should understand that you don't know what you don't know, and you don't have to say something just because you can. I'm trying to offer you some constructive criticism and be cordial. I wouldn't presume to tell you that all firemen are X, Y, or Z, nor would I insist I know all about professional firefighting or post in a thread in a matter-of-fact manner about becoming a fireman because I know some firemen and applied once.


----------



## SandpitMedic (Nov 5, 2019)

Remi said:


> Not even close. It may happen eventually, and there will always be local or regional exceptions, but nationwide there is already a shortage of primary care providers and that shortage (as well as that in other specialties) is expected to get much worse as so many physicians are reaching retirement age over the next decade.


Hits the nail squarely on the head.


----------



## Peak (Nov 5, 2019)

Remi said:


> Not even close. It may happen eventually, and there will always be local or regional exceptions, but nationwide there is already a shortage of primary care providers and that shortage (as well as that in other specialties) is expected to get much worse as so many physicians are reaching retirement age over the next decade.



True, if you want to live in the middle of nowhere and do primary care it is easy to get a job. 

If you want to work in a specialty in a place that most people want to live in you are going to struggle to find a job.


----------



## Peak (Nov 5, 2019)

Remi said:


> ... is expected to get much worse as so many physicians are reaching retirement age over the next decade.



People have said that about all kinds of careers for a long time. Boomers don't retire as early as the previous generations do, and typically work at least part time or in a supervisory roll well past their 'retirement'. It's a looming threat I've been hearing about for at least the past 15 years. 

There are also plenty of physicians, they just all want to specialize rather than work in primary care. We have so many that take a trtransitional just so that they can specialize rather than do a family practice or internal med residency.


----------



## E tank (Nov 5, 2019)

Peak said:


> True, if you want to live in the middle of nowhere and do primary care it is easy to get a job.
> If you want to work in a specialty in a place that most people want to live in you are going to struggle to find a job.



hmmm....who is 'you'?  and where is 'the middle of nowhere'?


----------



## Peak (Nov 5, 2019)

You: the job applicant.

The middle of nowhere: Where new grads don't want to or likely even think about living.


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## Carlos Danger (Nov 5, 2019)

Peak said:


> True, if you want to live in the middle of nowhere and do primary care it is easy to get a job.
> 
> If you want to work in a specialty in a place that most people want to live in you are going to struggle to find a job.



"Where MOST people WANT to live". Lol.

I'll just leave this here….

New Findings Confirm Predictions on Physician Shortage

"The projected shortage of between 46,900 and 121,900 physicians by 2032 includes both primary care (between 21,100 and 55,200) and specialty care (between 24,800 and 65,800)."  

"The major factor driving demand for physicians continues to be a growing, aging population. According to the U.S. Census Bureau, the nation’s population is estimated to grow by more than 10% by 2032, with those over age 65 increasing by 48%."


----------



## SandpitMedic (Nov 5, 2019)

Peak said:


> True, if you want to live in the middle of nowhere and do primary care it is easy to get a job.
> 
> If you want to work in a specialty in a place that most people want to live in you are going to struggle to find a job.


Oh man. You're an RN? Are you also an APRN? I mean... the value of input of everyone is appreciated, this is a discussion forum after all. 
Although, I'm really having a struggle with people who are not in the positions they are talking about making these assertions. 

There are regional differences, but there are jobs out there - even for new grads. In fact, many students who do well in their clinical rotations receive offers prior to graduation - in specialties, in places where people want to live. Many jobs posted on the web are secondary to the word-of-mouth system not rendering any interest or qualified applicants.


----------



## Peak (Nov 5, 2019)

Remi said:


> "Where MOST people WANT to live". Lol.
> 
> I'll just leave this here….
> 
> ...



It's the same dribble that's been said for over a decade. The AAMC is also a bit biased and has been pushing for more residency and med school spots for a long time, well before the boomer retirement crisis. 

It is my understanding that you practice in a lower resource non-urban/metro hospital. I'm happy that you are happy where you are working. That being said most new APRNs/PAs/Docs don't want to work in a rural area... hence said shortage.


----------



## Peak (Nov 5, 2019)

SandpitMedic said:


> Oh man. You're an RN? Are you also an APRN?



That line is getting a bit old and lacks insight. I don't have to put feces in my mouth to know I wouldn't like the taste.


----------



## Peak (Nov 5, 2019)

SandpitMedic said:


> Oh man. You're an RN? Are you also an APRN? I mean... the value of input of everyone is appreciated, this is a discussion forum after all.
> Although, I'm really having a struggle with people who are not in the positions they are talking about making these assertions.
> 
> There are regional differences, but there are jobs out there - even for new grads. In fact, many students who do well in their clinical rotations receive offers prior to graduation - in specialties, in places where people want to live. Many jobs posted on the web are secondary to the word-of-mouth system not rendering any interest or qualified applicants.



I work with a lot of APRNs and PAs, and actually have several in my immediate family. 

I've watched several friends, coworkers, and family struggle to find the job that they actually wanted. Several of our nurses are NPs, but can't find employment as NPs. 

I also make more than our PAs in the ED and NPs in the unit. I work about the same number of hours and have far less stress. Until the math changes I won't be doing NP.


----------



## SandpitMedic (Nov 5, 2019)

Peak said:


> That line is getting a bit old and lacks insight. I don't have to put feces in my mouth to know I wouldn't like the taste.


Your shortsightedness is getting old. If you are not a PA, NP/CRNA, physician, or student/applicant to any of the aforementioned... stop acting like you know everything about advance practice providers. You have no credibility - you don't know what you're talking about.

Here is the OP... None of this back and forth has anything to do with it.


philslat said:


> What are peoples thoughts or experiences on becoming one from an ems background ?
> 
> What routes are out there for paramedics to study for the position ?


----------



## SandpitMedic (Nov 5, 2019)

Peak said:


> I work with a lot of APRNs and PAs, and actually have several in my immediate family.
> 
> I've watched several friends, coworkers, and family struggle to find the job that they actually wanted. Several of our nurses are NPs, but can't find employment as NPs.
> 
> I also make more than our PAs in the ED and NPs in the unit. I work about the same number of hours and have far less stress. Until the math changes I won't be doing NP.


That's great. You do you. Where you are it sounds like RNs have it pretty darn good and the APPs should seek employment elsewhere.
If you are only interested in a certain specialty, at a certain salary, in a certain location you will struggle to find work. That can be said for many professions to include medical careers. The market where you are sounds like a place I wouldn't want to be. Like you, I have plenty of anecdotal evidence to the contrary - jobs are out there.


----------



## Peak (Nov 5, 2019)

SandpitMedic said:


> Your shortsightedness is getting old. If you are not a PA, NP/CRNA, physician, or student/applicant to any of the aforementioned... stop acting like you know everything about advance practice providers. You have no credibility - you don't know what you're talking about.



You don't need to get defensive, I'm sure you'll find a job. 

A lot of students whether in medicine, nursing, and other allied health careers are provided a very different view in school than the real world.


----------



## Peak (Nov 5, 2019)

SandpitMedic said:


> That's great. You do you. Where you are it sounds like RNs have it pretty darn good and the APPs should seek employment elsewhere.
> If you are only interested in a certain specialty, at a certain salary, in a certain location you will struggle to find work. That can be said for many professions to include medical careers. The market where you are sounds like a place I wouldn't want to be. Like you, I have plenty of anecdotal evidence to the contrary - jobs are out there.



It's just economics. We have a shortage of experienced critical care nurses. We do not have a shortage of APPs.


----------



## SandpitMedic (Nov 5, 2019)

Peak said:


> You don't need to get defensive, I'm sure you'll find a job.
> A lot of students whether in medicine, nursing, and other allied health careers are provided a very different view in school than the real world.


Thanks for the laugh - I'm very in touch with the real world. I'm not defensive- I'm telling you that you are flat out wrong, and clearly you have no interest in learning anything new. You insist you know best... the nurse who knows best about PAs, NPs, and docs _despite_ conversing with a practicing advanced practice nurse and 2nd year PA student _and_ despite actual data presented to you. I'll give you more credit than the fireman for at least being in the ER alongside PAs etc., but I hope people reading can sort the wheat from the chaff in this thread. Holy smokes.


Peak said:


> It's just economics. We have a shortage of experienced critical care nurses. We do not have a shortage of APPs.


Yes, that makes sense, and in your neck of the woods we would call that microeconomics. Things are different elsewhere. Like I said, if I were you I would enjoy that and soak it up.


----------



## SandpitMedic (Nov 5, 2019)

Do I need to smoke check myself? Am I the only one who thinks this is getting redundant?
I'm not the king of the PAs and I don't know everything, but this thread is about PAs... annnnnd I'm the only one here vocal that is in the PA world right now. I think I have a pretty good idea of what I am talking about. I think REMI does also. I'm always willing to take a lesson though, maybe I'm losing my edge- or maybe some folks just enjoy being difficult.


----------



## CCCSD (Nov 5, 2019)

No need for a smoke check.
However...I’m not a PA. I did stay at a holiday inn once.

(note: I was an IDC while deployed and my PA kept 7-3. M-F office hours, while I ran the BAS 24/7).


----------



## SandpitMedic (Nov 5, 2019)

CCCSD said:


> No need for a smoke check.
> However...I’m not a PA. I did stay at a holiday inn once.
> 
> (note: I was an IDC while deployed and my PA kept 7-3. M-F office hours, while I ran the BAS 24/7).


Roger.
Holiday Inn must be banging right now with all the experts in this thread - time to buy stock! And I thank you for your service.


----------



## Carlos Danger (Nov 5, 2019)

Your whole position sounds like that of someone who is trying to justify their decision not to advance their own education. I don't know if that's the case or not, and I really couldn't care less. However, _if _that is the case, you should understand that while making up trends about a field you don't work in might make you feel better about your decision, you really do lose credibility when you insist that you have a better understanding of those trends than the people whose paychecks depend on them. The fact that you make more money as an RN than APN's in your hospital is highly localized and has to do with state and local politics, not the greater trends in healthcare economics.



Peak said:


> It's the same dribble that's been said for over a decade. The AAMC is also a bit biased and has been pushing for more residency and med school spots for a long time, well before the boomer retirement crisis.


Well, the "dribble" that you refer to has come to pass. I'm not sure what numbers you are looking at, but there is currently - and has been for some time - a real shortage of physicians, both primary care and specialist. Naturally, the shortage is more acute in some locales, and non-existent in others. We are talking about national trends. This most recent report simply predicts that the existing trend will accelerate. 

The reason the AAMC has pushed for more seats is because they've known for decades that not enough physicians were being trained, and since they aren't puppets of the AMA like the ACGME is, they've tried to match seats to actual projected need. However, in their infinite and altruistic wisdom, the AMA (through the ACGME) has intentionally trained fewer physicians than they knew would be needed, and they did it in order to create a shortage and artificially inflate demand and compensation for doctors. This whole thing is not only real, but it's actually by design. What the AMA didn't count on is that they'd shoot themselves in the foot by creating as much demand for APN's as they did MD's.



Peak said:


> It is my understanding that you practice in a lower resource non-urban/metro hospital. I'm happy that you are happy where you are working. That being said most new APRNs/PAs/Docs don't want to work in a rural area... hence said shortage.


While I personally choose to live in the sticks, my hospital is actually within an easy commute of one of the most desirable and fastest growing urban areas in the country, in one of the fastest growing states in the country. A city that has seen home values literally double in the past 5 years. In fact, two of my 5 colleagues commute daily from there.


----------



## Peak (Nov 5, 2019)

SandpitMedic said:


> Do I need to smoke check myself? Am I the only one who thinks this is getting redundant?
> I'm not the king of the PAs and I don't know everything, but this thread is about PAs... annnnnd I'm the only one here vocal that is in the PA world right now. I think I have a pretty good idea of what I am talking about. I think REMI does also. I'm always willing to take a lesson though, maybe I'm losing my edge- or maybe some folks just enjoy being difficult.



Do you need to be a teacher to know that they are over worked and under paid? Do you need to be a career politician to be able to vote? Do you need to be a firearms expert to own a gun? Do you need to be an immunologist to known that vaccination reduces the spread of disease? Do you need to be a pharmacist to reconstitute a vial of protonix?

People don't necessarily need to have the exact same experience to have an informed opinion. To say that just because someone doesn't have the exact same experience as you can't possibly have valid insight is so sophomoric.


----------



## Peak (Nov 5, 2019)

Remi said:


> Your whole position sounds like that of someone who is trying to justify their decision not to advance their own education. I don't know if that's the case or not, and I really couldn't care less. However, _if _that is the case, you should understand that while making up trends about a field you don't work in might make you feel better about your decision, you really do lose credibility when you insist that you have a better understanding of those trends than the people whose paychecks depend on them. The fact that you make more money as an RN than APN's in your hospital is highly localized and has to do with state and local politics, not the greater trends in healthcare economics.



Before I went to nursing school I strongly considered what healthcare fields I wanted to work in and spent quite a bit of time weighing the pros and the cons. I considered medical school, PA, nursing, pharmacy, and physical therapy. I choose nursing chiefly because of the opportunity to go advanced practice if I wanted to while also having the flexibility to easily change specialties. I have graduate education outside of the medical field, it just isn't in a field that I actually want to work in. Perhaps one day I'll go advanced practice, but right now it just doens't make sense for me and where I want to be in my life.

I disagree that I can't have an opinion that those who work in a field. Statistics do not become more or less valid based on personal experience.  
While there are many factors that influence the pay scale of nurses and APPs, it isn't limited to just where I'm at. It is a trend in most growing metropolitan areas. 



Remi said:


> Well, the "dribble" that you refer to has come to pass. I'm not sure what numbers you are looking at, but there is currently - and has been for some time - a real shortage of physicians, both primary care and specialist. Naturally, the shortage is more acute in some locales, and non-existent in others. We are talking about national trends. This most recent report simply predicts that the existing trend will accelerate.



Those shortages are largely in areas that are difficult to find applicants for. They do exist, but people fail to mention that most provider shortages are in rural primary care.



Remi said:


> While I personally choose to live in the sticks, my hospital is actually within an easy commute of one of the most desirable and fastest growing urban areas in the country, in one of the fastest growing states in the country. A city that has seen home values literally double in the past 5 years. In fact, two of my 5 colleagues commute daily from there.



So your do work in a rural area? 

I know a CRNA who lives here and flies his Cessna to a different state to practice  and then flies back here to his family. Just because you commute doesn't change the nature of the healthcare facility.


----------



## CCCSD (Nov 5, 2019)

Rural? Run a MEDCAP in the jungles of Belize and let’s talk rural. 😁


----------



## Peak (Nov 5, 2019)

CCCSD said:


> Rural? Run a MEDCAP in the jungles of Belize and let’s talk rural. 😁



Fair enough.


----------



## SandpitMedic (Nov 5, 2019)

Peak said:


> I chose nursing...
> I have graduate education...


I saw a good quote that applies to you. 
"Your degree is just a piece of paper. Your education is seen in your behavior."
I'm sure glad I don't have to work with you.


----------



## Peak (Nov 5, 2019)

SandpitMedic said:


> I'm sure glad I don't have to work with you.



Doesn't hurt my feelings. I'm in it for the patients first, other people's egos are way down the line.


----------



## FiremanMike (Nov 5, 2019)

SandpitMedic said:


> I'll give you more credit than the fireman for at least being in the ER alongside PAs etc., but I hope people reading can sort the wheat from the chaff in this thread. Holy smokes.



Excuse me?

And here I thought we left things on good terms.

If you want to low key attack me later in the thread, I’d appreciate it if you address your responses to me instead of attacking my credibility to others.  You’re like that guy in a group discussion who starts running their mouth to others about the guy who’s standing right in front of you.

I made a few assertions - First, that I felt pre-pa coursework was illogical to me and that it doesn’t make sense to take a year of chem, bio, physics, o-chem, and a&p and not just take the MCAT and go for medical school.  Second, that despite all that extra prerequisite coursework, PAs and NPs compete for the same jobs at the same salary point.  Third, that. NPs are further along in their mission for independence which seems to make them more future proof.

Now then, I’ve already stipulated that my first point was my own opinion so you can ignore that one but since you backhandedly tried to disparage my thoughts, I’ll ask you to refute point 2 and 3, or you can apologize for attacking my integrity without having the balls to come directly at me.


----------



## SandpitMedic (Nov 5, 2019)

FiremanMike said:


> Excuse me?
> 
> And here I thought we left things on good terms.
> 
> ...


I was very direct with you, and Peak. You were making statements that were inaccurate. We don't have to agree on everything.
Damn, I'm getting my firemen mixed up. That was for DrParasite. (edited)

To your point #2: I'm not sure what you're target is here. Yes, both NP and PA have similar functions and salary. Yes, they both have an arduous path of prerequisites to navigate. Going from nurse to NP seems like a logical path. However, going from paramedic to PA seems like a more natural path to me than medic->ADN->BSN->MSN NP. We had a nurse in my PA class. Whichever choice one makes for themselves is the right choice for themselves. There are a lot of variables for an individual. I am not saying one is definitively better than the other. Just responding to the OP about a medic going PA. I already stated I support your decision to do what is best for you.

To your point #3: Yes, the nurses have a great lobby that has advanced their agenda faster than the PAs. The nursing profession has been around much longer than the PA profession, so I am not surprised by this. Neither profession was initially intended to become an independent medical practice free of physician oversight.  However, they are continuously evolving due to many factors including physician shortages. The goal is not to be the first one to independent practice- it is to be part of a healthcare team that is efficient and serves the needs of patients. The PAs have a great outlook and they will get to that goal also, with legislative efforts and support.

Can we be friends again? 👍Low key..


----------



## DrParasite (Nov 5, 2019)

@FiremanMike , I'm pretty sure that comment was directed towards me. the PA student apparently thinks that because he's a student in a PA program, that everyone else who considered PA school and worked in hospitals for years (including 2 level 1 trauma centers) knows absolutely nothing.  I mean, his wife is an APP, and he has many friends who are APPs ,but he's also quick to point out "I heard it from a bud" doesn't count," but apparently when it's his buds, it's ok.  After all, he's not really in any position to make any assertions about PAs, because he's not one (yet).  But he's talking like his an authority on them, without actually being one.

I've dealt with enough students to know that until they pass their boards, they are just students.   After you get that PA-C credential, than I will actually care what he thinks.  After all, as I told a student nurse many years ago who tried to lecture me on something, I don't answer to you, you aren't certified as anything above me, so why should I care what you think of me?  Come talk to me after you have finished your schooling.

Oh, and for the record, I was talking to one of my fellow FFs (he's a volunteer, former career FF/PM who went to nursing school), who is almost done with his CRNA program that is partnered with one of the level 1 trauma centers in the area, and he agreed that there were a lot of PA students who were in the PA program because they didn't get into medical school.  and that statement has as much validity as what your wife said or your friends.

and I'll repeat what I said last time: you know the old saying, if you have seen one PA program, you have seen one PA program....


----------



## DrParasite (Nov 5, 2019)

SandpitMedic said:


> PAs have a great future outlook, and the compensation scale is very, very lucrative in some cases making as much as $250k annually just in salary.


for being an all knowing PA student, this fact that you know looked, well, wrong.... So lets looks at some websites, and see what they say:
Avg PA salary 104k
avg PA salary 95k
avg PA salary 105k

Well, if you are wrong about that one detail (nowhere mentioned a PA making more than 200k, even on the high end), and you are married to an APP, and have plenty of APP/MD friends so you have all this information as a self proclaimed expert, I wonder what else you are wrong about and refuse to admit?

Oh, and I never said PA school was full of med school dropouts.  I said rejects, meaning they ended up in PA school because they had good grades in college, and didn't get into the med school that they wanted to get into, but were accepted into the Physician Assistant program.  Again, details matter, and please don't put words in my mouth or accuse me of saying something that I never said.

Now that you have put your foot in your mouth, maybe you can admit you don't know everything, and maybe, just maybe, even this dumb fireman knows a little bit about what he is talking about?


----------



## SandpitMedic (Nov 6, 2019)

Bingo, bango, bongo.. this is getting out of hand.



DrParasite said:


> for being an all knowing PA student, this fact that you know looked, well, wrong....Well, if you are wrong about that one detail (nowhere mentioned a PA making more than 200k, even on the high end),


Did I say average? The average is low-mid low 6 figures *starting*. Pay depends on specialty, location, and demand. There are also bonuses, CMEs, benfites, etc.  I said you _could _make as much as $250k just in salary, and you can (as can a NP) with experience and the right gig. Can you make that in primary care? No way.



> maybe you can admit you don't know everything, and maybe, just maybe, even this dumb fireman knows a little bit about what he is talking about?


I never said you were dumb. I said you don't know what you're talking about. And I still feel that way.
In case you missed my post from earlier in the thread-


SandpitMedic said:


> Do I need to smoke check myself?... I'm not the king of the PAs and I don't know everything...






DrParasite said:


> I've dealt with enough students to know that until they pass their boards, they are just students.   After you get that PA-C credential, than I will actually care what he thinks.  After all, as I told a student nurse many years ago who tried to lecture me on something, I don't answer to you, you aren't certified as anything above me, so why should I care what you think of me?  Come talk to me after you have finished your schooling.



Are you talking to me or about me? This thread is for people to read and learn about going from medic to PA. I don't really care about your insensitivities. In my opinion, you've really shown your *** with that statement. Too good to learn something from anyone "inferior" to you. Well played. I'll bet you're a real treat at the firehouse.


----------



## SandpitMedic (Nov 6, 2019)

I'm not talking to the distractors anymore. You got a beef? I assure you I 100% don't care, but you can PM me if you really have an itch.
*
This post is for EMS folks looking into PA school*- Do it. It's a great and rewarding career. You'll improve your knowledge, skills, and abilities as well as advance your station in life and in medicine. If you have the aptitude and attitude to succeed, go for it. If you want to go NP, MD, DO, RT, RN... go for it. If you have _*any*_ fire to advance your education and move up the chain of medicine, stoke it. Start taking classes. Start researching programs. Start planning. Make moves and take action. 

There is also nothing wrong with seeking out a good gig in EMS; those are out there too despite the problems in EMS. Learn to be the best paramedic you can be, go HEMS, go FP-C, go CCP, (go fire???  )... never stop learning, and never let your ego convince you there is nothing left to learn.


----------



## Tigger (Nov 6, 2019)

SandpitMedic said:


> Your shortsightedness is getting old. If you are not a PA, NP/CRNA, physician, or student/applicant to any of the aforementioned... stop acting like you know everything about advance practice providers. You have no credibility - you don't know what you're talking about.
> 
> Here is the OP... None of this back and forth has anything to do with it.


You aren't doing yourself many favors with this logic. Healthcare trends are a topic accessible to all with the ability to do a bit of research. Stomping your feet about credibility doesn't do your own credibility much good. If you have evidence for your points, you have evidence (and you do). Making it about experience is just not becoming.


----------



## SandpitMedic (Nov 6, 2019)

Tigger said:


> You aren't doing yourself many favors with this logic. Healthcare trends are a topic accessible to all with the ability to do a bit of research. Stomping your feet about credibility doesn't do your own credibility much good. If you have evidence for your points, you have evidence (and you do). Making it about experience is just not becoming.


There's the smoke check I was looking for. Just would prefer for those not in my profession to withhold statements of absolution about it. It's like when people (even medical people) insist that paramedics are only ambulance drivers- here, we all know that is not true, based on our expertise in EMS. I encourage dialogue based on research and first hand experience; I discourage feels and an unwillingness to be teachable. Trying to stay objective is difficult sometimes.
Thanks for the advice.


----------



## Peak (Nov 6, 2019)

SandpitMedic said:


> There's the smoke check I was looking for. Just would prefer for those not in my profession to withhold statements of absolution about it. It's like when people (even medical people) insist that paramedics are only ambulance drivers- here, we all know that is not true, based on our expertise in EMS. I encourage dialogue based on research and first hand experience; I discourage feels and an unwillingness to be teachable. Trying to stay objective is difficult sometimes.
> Thanks for the advice.



What I'm about to say is 100% in an effort to help you out and not to be a jerk:

Most people won't understand what the PA role really is. Most people don't really understand the role of paramedics, nurses, advanded practice nurses, perfusionists, respiratory therapists, pharmacists, docs, OT, PT, SLP, radiology technologists, and so on. Certainly you can try to educate people on it, but don't get too emotionally invested because you aren't going to change the general public. 

You are going to have to learn to trust your team. At some point you will be wrong. At some point the nurses, attendings, pharmacists, and so on are going to be wrong. If you are lucky and have a good team someone will catch the error before it reaches the patient. When I went from medic to nursing trusting other staff was a huge issue for me, I wanted to do or verify everything myself. There just isn't a way for this to be possible in the American healthcare system.


----------



## FiremanMike (Nov 6, 2019)

SandpitMedic said:


> I was very direct with you, and Peak. You were making statements that were inaccurate. We don't have to agree on everything.
> Damn, I'm getting my firemen mixed up. That was for DrParasite. (edited)
> 
> To your point #2: I'm not sure what you're target is here. Yes, both NP and PA have similar functions and salary. Yes, they both have an arduous path of prerequisites to navigate. Going from nurse to NP seems like a logical path. However, going from paramedic to PA seems like a more natural path to me than medic->ADN->BSN->MSN NP. We had a nurse in my PA class. Whichever choice one makes for themselves is the right choice for themselves. There are a lot of variables for an individual. I am not saying one is definitively better than the other. Just responding to the OP about a medic going PA. I already stated I support your decision to do what is best for you.
> ...



If your “more credibility than the fireman“ comment wasn't directed at me, then we have no beef.  At no point have I spent effort on this thread being a detractor, I'm actually quite capable and enjoy learning from others experiences and opinions.  My only point for even posting in this thread is that I have researched pretty extensively on the various pathways to mid-level/physician pathways.. I was only trying to share my opinions from this research for others to consider as well..


That said, you allude to me making inaccurate statements in your quoted reply, however I summarized my points from this thread and you pretty much agreed with them, so I'm not sure what inaccuracies exist?


----------



## Carlos Danger (Nov 6, 2019)

Peak said:


> So your do work in a rural area?
> 
> I know a CRNA who lives here and flies his Cessna to a different state to practice  and then flies back here to his family. Just because you commute doesn't change the nature of the healthcare facility.



I do live and work in a rural area, but you are completely missing the point.

Look, one last time, here are the facts:


Shortages in medicine are real, on a national basis.


The shortages are most acute in primary care, but exist within specialty areas, as well.


The shortages are most acute in rural areas and inner cities, but there are jobs pretty much _everywhere_


The shortages are projected to worsen, ensuring plenty of jobs and upward pressure on compensation for years to come


Anecdotes based on local anomalies mean absolutely nothing in terms of overall, national trends


If you choose to dispute all or any of this, fine. You do you. But know that you are disagreeing with not only those who work in the field and are privy to a perspective on trends that you are not, but also with every study published on the subject in the last two decades. If you insist that you know more than both of those sources, I can't help you.

That said, I have no interest in expending any more effort trying to change the mind of obstinate individuals who insist on arguing that things in plain sight don't exist. It's just about time for me to head to work at my job that no one wants.

On the other hand, if anyone wants to discuss opportunities in advanced practice, especially advanced practice nursing, and especially Nurse Anesthesiology, I'm here.


----------



## FiremanMike (Nov 6, 2019)

Remi said:


> On the other hand, if anyone wants to discuss opportunities in advanced practice, especially advanced practice nursing, and especially Nurse Anesthesiology, I'm here.



Why did you choose CRNA over NP?


----------



## mgr22 (Nov 6, 2019)

Remi said:


> On the other hand, if anyone wants to discuss opportunities in advanced practice, especially advanced practice nursing, and especially Nurse Anesthesiology, I'm here.



Is the proper term for what you do Nurse Anesthetist? Do you have to be an NP if you want to practice that specialty? How closely are you supervised by anesthesiologists? Would you say you're treated by your colleagues more as a doctor or more as a nurse?


----------



## DrParasite (Nov 6, 2019)

SandpitMedic said:


> Your shortsightedness is getting old. If you are not a PA, NP/CRNA, physician, or student/applicant to any of the aforementioned... stop acting like you know everything about advance practice providers. You have no credibility - you don't know what you're talking about.


wait a second... you aren't a PA, NP/CRNA, physician.... and as a student applicant, you still aren't a PA, NP/CRNA, nor physician, and simply being a student or applicant doesn't make you any more of an expert than any other student or applicant. 

We see this a lot with paramedic students; once they get into a paramedic program, they immediately become know it alls and think they are better than their emt coworkers.... congrats on getting into PA school, but until you actually become a PA-C, you are on the same level as the rest of us, and stomping your feet saying 
	

	
	
		
		

		
			




is not the right way to add to your credibility.  And it's likely to cause you problems when you start working in the hospitals or during your clinicals.

Instead of a smoke check, I'll give you a BS check.... you're providing incorrect information.  I showed you how your salary was GROSSLY inflated, and provided three websites that backed up my claim, and demonstrated how your information was wrong.  Instead of actually providing any source to your claim that a PA could make 250k, you decided to stomp your feet, and say "I'm a PA student, and I know everything, and if you aren't a PA student, how dare you question me!!!!"  Let me give you some advice: when you are wrong, it's ok to admit you are wrong.  Especially when someone provides you actual facts, with a source, that show that you are wrong (like me providing https://money.usnews.com/careers/best-jobs/physician-assistant/salary, which clearly says that PAs don't make anywhere near $250k).  Oh, and if you want to show how someone is wrong, it's a lot better to actually provide a source to back up your claims, instead of simply dismissing what they say as wrong with no actual facts to support  your point.  another helpful tidbit to help you in the future.

PA is a great program, NP is a great program, and medical school is a great program.  Each have their advantages and disadvantages, depending on how long you want to be in school, where you want to be in the medical hierarchy, how much debt you want to graduate with, and what area of healthcare do you want to be in.  If I had a sugar momma, who would support me for 3 years, I would have gone to PA school in a heartbeat.  If I was a nurse, I would go to NP school, because you can attend while working.  If I could take 6 years off from life (4 years of medical school, 1 of internship, and the start of residency), and then end up 250k in debt, I might consider medical school.

But if you want to advance you career beyond paramedic, take the educational prerequisite classes, and do it.

I do think there is a shortage of competent MDs in various parts of the US, and PAs and NPs are being used to fill that gap.  But one thing you need to remember is a PA is not the same as an MD, despite then often filling similar roles.

Random fact: in NC, PAs and NPs needs to operate under a doctor's license.  in 15 states in the US, CRNA's don't, and they do the same thing as an anesthesiologist.  Oh, and CRNA's have an average salary of 248k, at least  according to https://txwes.edu/academics/health-...rna-vs-anesthesiologist-whats-the-difference/


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## akflightmedic (Nov 6, 2019)

CCCSD said:


> Rural? Run a MEDCAP in the jungles of Belize and let’s talk rural. 😁



I ran MEDCAPs in remote jungles of the Philippines.  T'was fun, challenging, very educational and heartbreaking.


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## SandpitMedic (Nov 6, 2019)

Is there a draft in here? Must be a window open.
I’m not debating the finer points anymore. Plenty of data has been presented, and I did not mince any words. People can read and interpret how they would like.
If anyone has questions about going EMS to PA I’m happy to help.


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## FiremanMike (Nov 6, 2019)

SandpitMedic said:


> Is there a draft in here? Must be a window open.
> I’m not debating the finer points anymore. Plenty of data has been presented, and I did not mince any words. People can read and interpret how they would like.
> If anyone has questions about going EMS to PA I’m happy to help.



Why did YOU choose PA over NP?


----------



## SandpitMedic (Nov 6, 2019)

FiremanMike said:


> Why did YOU choose PA over NP?


I was a medic with an EMS degree, which included many of the science prereqs. I was also an FP-C working for a HEMS company that had no competitors (running 70%/30% 911/IFT) and was a very good flight program with great continuing ed. I made a pretty good salary, had a killer schedule (1 on/1 off/1 on/5 off) and I was still working per-diem ground because I enjoyed 911 in Las Vegas. I had reached the point at which I felt I was topped out in the EMS world. I enjoyed learning medicine and I wasn't into fire or nursing, but I knew I wanted to move on. I started taking additional college coursework in science and general ed, and I was toying with med school, RT, or PA.
A friend and former colleague for the ambulance service I worked for went to PA school and came back to eventually end up as a supervising advanced practice provider for one of the physician groups in town - we talked at length about PA life, work, and education. We talked about PA history and how PA school was founded for people similar to me... experienced medics who could advance up the scope to provide a higher level of care and become providers of medicine. He was and is a great mentor to this day. Concurrently, my wife was attending NP school. We both had the fire to move up. 

 (A little PA history: PA origins go back to the mid 1960's when Dr. Eugene Stead took a small group of experienced military medics and trained them to become mid-level providers, "Physician Assistants." You can read more here if you'd like) 








						History
					

The PA profession was created to improve and expand healthcare. The concept was lauded early on and gained federal acceptance and backing as early as the 1970s as a creative solution to physician shortages.




					www.aapa.org
				




For me, PA school was a no brainer and a winning option hands down. An education designed for medics (now also zero to hero as some would say) that came with an excellent return on investment. I could be done in 29 months as opposed to 7+ years, at a cost that was about 1/4 of medical school, and would allow a broader scope than other non-provider options. If I were to have gone NP, it would have been a longer road which would include becoming a nurse, which I had no interest in. I could have been an ER RN or critical care RN, but that would have been a detour from the ultimate goal that would have ultimately taken a longer timeline. The PA track allowed me to achieve my goals without shortcuts and was still a faster timeline to practice. 

I'll add that having my previous clinical experience made the didactic year extraordinarily smooth.


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## VFlutter (Nov 6, 2019)

Perfusionist are in high demand...


----------



## Carlos Danger (Nov 6, 2019)

mgr22 said:


> Is the proper term for what you do Nurse Anesthetist?


That is the more common and traditional title for a nurse who performs anesthesia, but Nurse Anesthesiologist is accurate and becoming more common. The definition of "anesthesiologist" is an individual who practices anesthesiology. The definition is "anesthetist" is an individual who provides anesthesia services. So the two terms are logically interchangeable.



mgr22 said:


> Do you have to be an NP if you want to practice that specialty?


I think there are a few states where CRNA's are licensed as NP's, but the education is very different and in most states the licensures are separate.



mgr22 said:


> How closely are you supervised by anesthesiologists?


I am not supervised by anesthesiologists at all. At the hospital I mainly work at, we have one anesthesiologist who is the director of anesthesia for several hospitals and is usually around during the day, but he does not dictate my care and he isn't even always there. If I am called back at night for an OR case or to place a labor epidural or do a nerve block in the ED or place a tube or a line on the floor, I am the only anesthesia provider in the building. At the hospital that I float to sometimes, I am always either solo or work with just one other CRNA. It isn't like that everywhere, but it's also not uncommon.



mgr22 said:


> Would you say you're treated by your colleagues more as a doctor or more as a nurse?


I am a member of the medical staff and treated as such. As I don't fall under the nursing department, I am not subject to any of the silliness that the other nurses are. It's the same with NP's where I work. Again, many places aren't like that, but many are.




DrParasite said:


> in NC, PAs and NPs needs to operate under a doctor's license.  in 15 states in the US, CRNA's don't, and they do the same thing as an anesthesiologist.  Oh, and CRNA's have an average salary of 248k, at least  according to https://txwes.edu/academics/health-...rna-vs-anesthesiologist-whats-the-difference/


No, there are a lot more than 15 states that don't require supervision of CRNA's. In fact only a small minority of states require it, and NJ is the only state that explicitly requires that a CRNA be supervised by a physician anesthesiologist. That 15-state figure (actually, it's 17 states now, I think) refers to states which have opted out of a _billing requirement _by CMS that requires physician supervision _if CMS is being billed_ for the anesthetic. It's a billing requirement, not a legal practice rule of any type. It is a very common misconception, partly because for political reasons, some groups intentionally perpetuate the myth that CRNA's usually have to be supervised.

And that $248k figure is for physician anesthesiologists, not CRNA's. You can certainly make that much as a CRNA, but you'd be making quite a bit more than most of us do. Median for CRNA's is more like $180k.


----------



## Carlos Danger (Nov 6, 2019)

VFlutter said:


> Perfusionist are in high demand...



They are, and they make really good money so it's a great option for those who are interested in that.

However, they aren't really clinicians, they are technicians and the roles available to them are very limited.


----------



## silver (Nov 6, 2019)

This is getting juicy.

To add though, PAs/NPs won't end up filling the gap of underserved areas and specialties though. They will definitely help make it smaller and vastly improve access for individuals. However, in the end it's for a reimbursement issue sadly and without a change to incentive primary care better PAs/NPs will also continue to choose more lucrative positions like physicians have over the years.


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## SandpitMedic (Nov 6, 2019)

silver said:


> This is getting juicy.
> 
> To add though, PAs/NPs won't end up filling the gap of underserved areas and specialties though. They will definitely help make it smaller and vastly improve access for individuals. However, in the end it's for a reimbursement issue sadly and without a change to incentive primary care better PAs/NPs will also continue to choose more lucrative positions like physicians have over the years.


This is true to some extent. However, there are people that genuinely want to work in primary care and who are good at it, despite it being a lower paying position in most cases. The gap will never be closed, and that is part of the problem. There have been some recent changes in CMS for billing and reimbursement for PAs.

Primary care kind of gets the bad end of the stick when it comes to pay and recognition. In reality, primary care is quite complex and good providers need to be on the top of their game armed with all their medical knowledge. They see patients from the cradle to the grave, and deal with every issue from preventative health to complex patients. Primary care is nothing to poo-poo. There are people who like it. For others, money talks.

I will likely specialize simply due to my interests.


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## Alan L Serve (Nov 7, 2019)

DrParasite said:


> One thing to remember is many of the applicants to PA school got rejected from med school, and PA school was their fall back plan.



My dear friend,
This statement
of yours is
incorrect.


----------



## DrParasite (Nov 7, 2019)

Alan L Serve said:


> My dear friend,
> This statement
> of yours is
> incorrect.


my dear friend,
what are you basing
your statement that I
am incorrect?  do you have 
facts or just anecdotes?


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## FiremanMike (Nov 7, 2019)

Remi said:


> They are, and they make really good money so it's a great option for those who are interested in that.
> 
> However, they aren't really clinicians, they are technicians and the roles available to them are very limited.



You might have missed it in the flurry of posts, but I was curious why you chose CRNA over NP?


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## SandpitMedic (Nov 7, 2019)

Is it vertical haiku? Or a quatrain?... What are we working with here in these poetic verses.

I'm no poet. But I like the message.


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## Carlos Danger (Nov 7, 2019)

FiremanMike said:


> You might have missed it in the flurry of posts, but I was curious why you chose CRNA over NP?



Ever since going to the OR for intubations in paramedic school (and later learning to RSI), I was pretty fascinated both by anesthesia itself and by the idea that such a role was available to nurses. As I progressed through my career as a flight medic and later flight / ICU nurse, it just seemed like the natural progression once I decided that I wanted to advance my education and move on.

In the year or so leading up to actually applying to CRNA programs, I looked into NP programs quite a bit as well. I was very tempted by a particular ACNP/FNP track program because it would have allowed me to continue flying full time for a few more years while I did NP school part-time, which I would have liked very much. Also, CRNA education requires a much greater investment of both time and money, so that fact weighed heavily on my consideration.

In the end, I decided that I'd apply to several CRNA programs and if I didn't get in, I'd then apply to the NP program and take that route. The significantly higher compensation in anesthesia and the fact that I'd just always been interested in it were the reasons it was my first choice. If I hadn't gotten into CRNA school, I don't doubt that I could have found a NP role that I was happy with, but I know I'd always wonder if I should have kept trying until I got into an anesthesia program and became a CRNA.


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## Akulahawk (Nov 8, 2019)

Just a simple reminder folks: Keep it civil. Do recall readers learn a LOT from lively debates and discussions... content and (occasionally) facets of character.


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## CCCSD (Nov 8, 2019)

When I was in Nursing school, I worked PT in an ER as an ER Tech in a rural hospital. I wore my CNA name tag since that’s what they gave me, and I wore surgical scrubs. One night, we get a major trauma case and call for a Helicopter transfer.

Crew lands, comes in, looks at my RN, looks at me, notices CNA name tag , starts talking to me about the patients airway since he thought I was a Critical Care Nurse ANESTHETIST... My RN lost it, I just played along.

She spent the rest of the night *****ing about male assumptions. I liked to have died laughing. Female ER Doc that it was hilarious and bought me coffee.

And that was my short lived career in Nursing Anesthesiology.


(in case people don’t get it: CNA is Certified Nursing Assistant).

Derail over. Let’s talk nice.


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## SandpitMedic (Nov 8, 2019)

CCCSD said:


> When I was in Nursing school, I worked PT in an ER as an ER Tech in a rural hospital. I wore my CNA name tag since that’s what they gave me, and I wore surgical scrubs. One night, we get a major trauma case and call for a Helicopter transfer.
> 
> Crew lands, comes in, looks at my RN, looks at me, notices CNA name tag , starts talking to me about the patients airway since he thought I was a Critical Care Nurse ANESTHETIST... My RN lost it, I just played along.
> 
> ...


What kind of backwoods flight crew doesn’t know what a CNA is?! 😂😂😂
That’s a great story. You and your toxic masculinity.


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## CCCSD (Nov 8, 2019)

Dude. Put me in scrubs, and I LOOK THE PART.


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## Lemur (Nov 9, 2019)

DrParasite said:


> my dear friend,
> what are you basing
> your statement that I
> am incorrect?  do you have
> facts or just anecdotes?


PA programs are not filled with medical school applicants who didn’t get in. It’s not a point of great importance, but it’s wrong and it may negatively color some people’s perceptions so I thought I’d chime in. Generally people are admitted based on their merits as an applicant to the profession.


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## Alan L Serve (Nov 13, 2019)

DrParasite said:


> my dear friend,
> what are you basing
> your statement that I
> am incorrect?  do you have
> facts or just anecdotes?



My dear friend,
My statements
are based only
In facts. Ever.


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## Summit (Nov 13, 2019)

Alan, post like a normal person. Nobody cares what you are typing in verse.

That said, PA applicants are not med school rejects. That is silly. Choosing PA is more often a lifestyle/career choice. PA, like NP, is going to have better life balance and less up-front time investment with some trade-off in earning power and role limitations.


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## ffemt8978 (Nov 13, 2019)

Roses are red,
Violets are blue,
Last chance to keep it civil,
Or I will ban you.


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## DrParasite (Nov 13, 2019)

Lemur said:


> PA programs are not filled with medical school applicants who didn’t get in. It’s not a point of great importance, but it’s wrong and it may negatively color some people’s perceptions so I thought I’d chime in. Generally people are admitted based on their merits as an applicant to the profession.


You sure about that?  so you have checked with every PA program, and asked the applicants if they applied to med school?  especially the ones who are under the age of 25?  

Think about this: in many cases, the prerequisite classes are similar.  they often have  high academic requirements, with minimal prior work requirements.  they are providers in the medical field.  No, not every PA students got rejected from medical school, but to say there aren't any is sheer ignorance.  

And yes, a college student with high grades in the sciences and some work experience in healthcare (and a bachelors degree) often makes for a strong admission to PA school too.

I mean, unless https://forums.studentdoctor.net/th...-make-it-into-med-school.924692/post-12676095 is wrong.  or this recommendation https://differentmedicalcareers.com/not-getting-into-medical-school/ or https://blog.accepted.com/dreaded-med-school-rejection-now-2/  or https://medicalschoolhq.net/pmy-254-md-vs-pa-lets-talk-about-it-with-a-pa-to-help-you-decide/ are also wrong.....


Alan L Serve said:


> My dear friend,
> My statements
> are based only
> In facts. Ever.


then feel free to actually provide a verifiable source, not just anecdotal comments/


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## PotatoMedic (Nov 13, 2019)

ffemt8978 said:


> Roses are red,
> Violets are blue,
> Last chance to keep it civil,
> Or I will ban you.


Least yours rhymed...


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## SandpitMedic (Nov 13, 2019)

Who’s uncivil?

Delusional perhaps, but not uncivil.

As for the poem guy... it’s a little different, but he’s not wrong.


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## VentMonkey (Nov 14, 2019)

SandpitMedic said:


> As for the poem guy... it’s a little different, but he’s not wrong.


Come on. It’s unnecessarily pompous. Get your point across like everyone else on this forum. No need for beatnik auditions.


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## Alan L Serve (Nov 14, 2019)

DrParasite said:


> You sure about that?  so you have checked with every PA program, and asked the applicants if they applied to med school?  especially the ones who are under the age of 25?
> 
> Think about this: in many cases, the prerequisite classes are similar.  they often have  high academic requirements, with minimal prior work requirements.  they are providers in the medical field.  No, not every PA students got rejected from medical school, but to say there aren't any is sheer ignorance.
> 
> ...



My dear friend,
SND is not
Research,
Your claim remains
Unverified


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## jgmedic (Nov 14, 2019)

Alan L Serve said:


> My dear friend,
> SND is not
> Research,
> Your claim remains
> Unverified


In all seriousness, why? Why do you write like this? At this point I'm honestly just curious.


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## SandpitMedic (Nov 14, 2019)

Triggering everyone.


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## PotatoMedic (Nov 14, 2019)

Alan L Serve said:


> My dear friend,
> SND is not
> Research,
> Your claim remains
> Unverified


I just cracked up laughing because I read it with William Shatner's voice!


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## Carlos Danger (Nov 14, 2019)

PotatoMedic said:


> I just cracked up laughing because I read it with *William Shatner*'s voice!


He's the guy from Star Wars?


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## VentMonkey (Nov 14, 2019)

Remi said:


> He's the guy from Star Wars?


Duh, everyone knows he’s the guy from _Rescue 911_.

As far as the PA thing. If you’re not going into the nursing field and want to practice as a mid-level, go to PA school.

If you’re interested in becoming an RN, and then eventually practicing as a mid-level, it seems so much more practical to segue into an NP program.

Also, if you want to practice with more independence as either, get hired at a CAH in an austere environment. All practical decisions and solutions.


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## ffemt8978 (Nov 14, 2019)

VentMonkey said:


> Duh, everyone knows he’s the guy from _Rescue 911_.



I'd say everyone knows him as the guy from Airplane 2.


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## DesertMedic66 (Nov 14, 2019)

ffemt8978 said:


> I'd say everyone knows him as the guy from Airplane 2.


I thought he was the guy who played on Twins.


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## SandpitMedic (Nov 14, 2019)

DesertMedic66 said:


> I thought he was the guy who played on Twins.


No, that was the guy from Rambo.


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## SandpitMedic (Nov 14, 2019)

VentMonkey said:


> As far as the PA thing. If you’re not going into the nursing field and want to practice as a mid-level, go to PA school.


Well, yeah, if you can’t get into medical school. 

Lolz. What a joke. Just can’t get off of it.


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## akflightmedic (Nov 15, 2019)

No, he is the guy from Boston Legal.


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## SandpitMedic (Nov 15, 2019)

akflightmedic said:


> No, he is the guy from Boston Legal.


Isn’t he the guy from Unsolved Mysteries?


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## akflightmedic (Nov 15, 2019)

In all seriousness, I used to make fun of The Shatner, like many do...however, when I was in Trashcanistan, and ran out of pirate DVDs to watch, I started buying older TV shows. I picked up Boston Legal and basically binge watched it from start to finish (all 5 seasons). It is a quirky show and I almost gave up on it, but boredom kept me committed.

MAN! I gained an entirely new perception of Shatner...and greatly appreciate his acting. The character development, the interwoven story lines, and the odd yet true friendship of his with Spader....freaking amazing. I actually disliked both these actors for many years, however the two of them together, it was a great formula.

I definitely recommend Boston Legal if you ever want a great story line and very entertaining show.


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## CCCSD (Nov 15, 2019)

He’s actually a great comic actor.


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## SandpitMedic (Nov 15, 2019)

akflightmedic said:


> In all seriousness, I used to make fun of The Shatner, like many do...however, when I was in Trashcanistan, and ran out of pirate DVDs to watch, I started buying older TV shows. I picked up Boston Legal and basically binge watched it from start to finish (all 5 seasons). It is a quirky show and I almost gave up on it, but boredom kept me committed.
> 
> MAN! I gained an entirely new perception of Shatner...and greatly appreciate his acting. The character development, the interwoven story lines, and the odd yet true friendship of his with Spader....freaking amazing. I actually disliked both these actors for many years, however the two of them together, it was a great formula.
> 
> I definitely recommend Boston Legal if you ever want a great story line and very entertaining show.


Time out...
You don’t like James Spader?
We aren’t internet friends anymore! 😂
Have you not seen The Blacklist?


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## ffemt8978 (Nov 16, 2019)

That's enough of the Shatner...back on topic please.


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## Lemur (Nov 20, 2019)

DrParasite said:


> You sure about that?  so you have checked with every PA program, and asked the applicants if they applied to med school?  especially the ones who are under the age of 25?
> 
> Think about this: in many cases, the prerequisite classes are similar.  they often have  high academic requirements, with minimal prior work requirements.  they are providers in the medical field.  No, not every PA students got rejected from medical school, but to say there aren't any is sheer ignorance.
> 
> ...


SDN is not a legitimate source to get information about PA applicants. My understanding of the applicant pool comes from being in a leadership position with in my state’s PA academy and regularly working with faculty from multiple programs in our area and nationally on PA education related events. I’ve also participated in the admissions process.


PA applicants are a heterogenous group. Prior applicants to medical school make up perhaps single digit percentages of class composition. There are multiple reasons for this.

I don’t care to press this point to change your mind, but to ensure there is a challenge to what you’re saying for others to read and keep in mind, as they stumble onto this thread.


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## SandpitMedic (Nov 20, 2019)

Lemur said:


> SDN is not a legitimate source to get information about PA applicants. My understanding of the applicant pool comes from being in a leadership position with in my state’s PA academy and regularly working with faculty from multiple programs in our area and nationally on PA education related events. I’ve also participated in the admissions process.
> 
> 
> PA applicants are a heterogenous group. Prior applicants to medical school make up perhaps single digit percentages of class composition. There are multiple reasons for this.
> ...


Louder for the people in the back.
Well said.


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## Ewok Jerky (Nov 25, 2019)

I skipped a few pages and see we are still arguing about PA schools being filled with med school rejects?

The program I went to had 1/30 in my class. Late 20s guy who was a paramedic.

The admissions team didn't think med school flunkies would make good PAs because they would always be unhappy about being a second tier provider, and I tend to agree with them. I've never been invited back to career fairs because I tell all the kids who come to my PA Table to go to medical school instead 😂

Anyways back to the OP,
Find a few programs and make a list of pre-reqs and get going. check off all the boxes on your way to a Bachelor's Degree in literally anything. Keep getting experience as an EMT. Apply to PA programs far and wide.


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## SandpitMedic (Dec 14, 2019)

There have been some recent “feeler” surveys out for PAs changing their title. These are sponsored surveys from the AAPA and their hired consulting agency.

The vote thus far has seemingly favored the title Physician Associate. There is an underdog title that about 30% support: Medical Care Practitioner.

The official vote and change will not be until April or May 2020 at the next national PA gathering. It does appear the title will be missing the word “assistant.”


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## Kavsuvb (Dec 14, 2019)

Akulahawk said:


> NP school should be easier to do from a logistical standpoint but the end result wouldn't allow me the flexibility that a PA has.


As far as NP's, it depends on what State your in and for example, in Connecticut, NP's have independent practice rights and full practice rights. Here's a list of states that allow NP's Full practice. https://campaignforaction.org/resource/state-practice-environment-nurse-practitioners/

As with NP's, Most NP's specialize, in Family practice, Women's health, pediatric and Psychiatric/Mental health. Whereas PA's you have the same opportunities to specialize as an MD/DO. 

As with PA's most PA's fill in for places where they can't get a Doctor and cover for the Doctor when the doctor is away at a conference or working on the much harder cases.

In my experience, I had an NP who specializes in Endocrinology and especially in treating people with very rare diseases that I have. She graduated from Smith College with a Biology degree and got her Nursing degree from Yale Univ school of Nursing GEPN Program


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## Frank frankerson ESQ (Apr 19, 2020)

At least your thinking


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## VFlutter (Apr 19, 2020)

Kavsuvb said:


> As with NP's, Most NP's specialize, in Family practice, Women's health, pediatric and Psychiatric/Mental health. Whereas PA's you have the same opportunities to specialize as an MD/DO.
> 
> As with PA's most PA's fill in for places where they can't get a Doctor and cover for the Doctor when the doctor is away at a conference or working on the much harder cases.



The most popular NP track is Family (FNP) as it offers a lot of flexibility however there are many whom still work in various specialties including some in ER and function just the same as PAs who "cover for the Doctor".

Although some surgical specialties are still predominantly I have seen CTICU or NeuoSurg groups in my area that are exclusively NP. Pretty much interchangeable it most areas. NPs are not delegated to Women's Health and Psych as the PAs do all the "MD stuff".

Having said all that, still think PA education is better for acute care without solid bedside experience. The direct to NP route is a joke.


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