EMT-P to PA Route

[abckidsmom]

Well I understand what you're saying. Nurses do impact the families and impact how the patients end up, care wise. PA's and MD's control what methods or drugs will be used, as well as amounts and times per day. Nurses don't have a decision making part as much as PA's or MD's do.

But it's all in the pitch, and the follow through. When the clinical evidence is laid out before you, most of the time you agree with the nurse, or teach her why you disagree. Nurses are definitely a part of the discussion, anyway.

 

[EpiEMS]

If you're thinking medicine (MD/DO) as a profession, I urge you to consider this: http://www.er-doctor.com/doctor_income.html
Nice little elementary analysis of MD/DO income.

 

[medicsb]

The PAs often spend their days suturing and doing little else. They might also have a few low acuity patients that they're managing but that term is a bit of a stretch given that their physician still has control of the patient. I'm sure that it's location dependent but I see PAs being used more like nurses, basically doing the MDs dirty work. It may come down to trust too, but I can understand where the MDs' collective irk comes from when it comes to midlevel providers, the education component is just not there. Of course I have no interest in being a doctor as I realistically do not have the patience to make it through med school. At the very least the majority of the NPs that I come across have strong clinical backgrounds, this has not been always been true with PAs where the zero to hero route seems more prevalent.

Don't get me wrong, I'm still strongly considering it but I want to see the direction that midlevel providers take before committing.

If PAs or NPs want to manage patients on their own, then they should go to medical school. The general function of mid-level providers is take the burden of really low-acuity patients (who should ultimately be overseen by a MD or DO) or to perform certain procedures in place of a physician (also overseen by... a physician).

Anyhow, in defense of PAs, many programs require many hours of healthcare experience prior to admission. But, regardless, PA programs generally have far more clinical hours than NP programs (and more didactic hours, too). With just a cursory search I found few programs requiring experience, It seems just a BSN or MSN will do at many (most?) schools.

 

[bigbaldguy]

http://www.hl7standards.com/blog/2011/04/26/how-much-do-doctors-really-make/

But hey you get to wear a really cool white coat that no one else gets to wear right..........oh yeah pretty much everyone gets those now, never mind.

 

[JPINFV]

Nurses don't have a decision making part as much as PA's or MD's do.

That's because nurses practice nursing, not medicine. While nursing is just about on par in terms of importance as medicine (especially for in-patients), it's just not as sexy as scribbling out a script or something similar.

 

[bigbaldguy]

That's because nurses practice nursing, not medicine. While nursing is just about on par in terms of importance as medicine (especially for in-patients), it's just not as sexy as scribbling out a script or something similar.

Actually scribbling scripts can also be quite lucrative I hear, its actually wasting all that time seeing the patients that makes raking the cash in so difficult. Kind of sad that a doctor at a pill mill sees 80 patients a day and a doctor who actually cares about the patient can only see 15 to 30 but they both get paid the same by medicare/caid/insurance.

 

[FLdoc2011]

Why not go all the way and go to med school? Not trying to be a ****, it's an honest question.

There are lots reasons..... Time/energy/financial commitment to name some big ones. I just graduated med school and my student loans are more than the mortgage I just signed.

Ultimately you'd have to decide if some of the benefits of the PA route (less time, possibly more career flexibility by being able to move among specialties easier than an MD, and not being the ultimate person in charge if that's a plus for ya) versus the benefits of the MD route of more or less being the "captain of the ship" and in charge....though which I guess you could debate with insurance companies and managed care.....

And the field is taking hit, physicians and working harder for less pay and more and more intrusion into how we practice medicine. Overall still a decent living if you are smart with your money but certainly not like it once was and certainly not the best long term financial decision compared to other fields.

Ultimately I loved the field of medicine, couldn't think of anything else I'd rather do, and knew I wanted to be the one "in charge". Will it be worth it in the end? Not sure, so far I have had 5 years of undergrad college, 4 years of med school, and now looking at 6 MORE years of residency training for cardiology before I truly start my own career.

I did give serious thought to going PA though in the beginning. Still think its a good field and work with great PA's every day who enjoy what they do. If I was a little older than I was I probably would've gone that route.

 

[STXmedic]

I don't want to become an MD because I don't like the hours and always being on call as well as the loans and the amount of schooling.

You need to do some more shadowing I think. That's a common misconception.
1) Not all MDs are on call.
2) Your hours are just as likely to be :censored::censored::censored::censored:ty, if not more likely. You think a doctor is going to bring on a PA to be off the hours he wants to be off? And if you want more freedom, you'll be there during times of less physician supervision (nights) so you can have more freedom of practice.

I had some similar misconceptions, but did a fair amount of shadowing/talking with PAs. I'd suggest you go get some more info before you make your decision of PA over MD/DO.

 

[JPINFV]

You need to do some more shadowing I think. That's a common misconception.
1) Not all MDs are on call.

Pretty much any physician in a primary care specialty or hospital based specialty are going to have calls. After all, who is the ED going to get to admit patients at night in addition to general coverage (like that acute abdomen you just brought in who needs a surgeon)? That said, there are general exceptions like EM. Similarly, it also depends on how you set up your practice, especially in fields like radiology which can often be done with a HD monitor any place that can get a secure internet connection.

2) Your hours are just as likely to be :censored::censored::censored::censored:ty, if not more likely. You think a doctor is going to bring on a PA to be off the hours he wants to be off? And if you want more freedom, you'll be there during times of less physician supervision (nights) so you can have more freedom of practice.

Ding ding ding ding ding. Yea, the physician is going to take all of the bad work hours and let you work 9-5.

 

[Vetitas86]

Not to fuel the nursing fire, but as far as patient contact goes, yes for nurses.

As far as the clinical outcome, docs/PAs.

 

[Brandon O]

The PAs often spend their days suturing and doing little else. They might also have a few low acuity patients that they're managing but that term is a bit of a stretch given that their physician still has control of the patient. I'm sure that it's location dependent but I see PAs being used more like nurses, basically doing the MDs dirty work.

A number of the major hospitals around here use PAs in the ED essentially as residents; they assess, diagnose, and treat their own patients, at some point finding a second or two to present it to the attending.

 

[WTEngel]

Don't get caught up in the semantics.

In clinical practice there virtually zero difference in NP and PA scope of practice. They are both classified as mid level providers, and just about any job that is open to one is open to the other. At least that's the way it is around here.

You are just as likely to find hospitals where the mid levels only take low acuity patients as you are to find hospitals where the mid level is doing the admissions into the critical care floors or running codes in the ED. This is really not even facility specific, it has more to do with what physician's group you hire on with.

For those of you who don't know, very few hospitals actually employ physicians anymore. Most of the physician coverage is provided through a contract with a physicians group, and that group has the ability to take on mid levels and allow them to do whatever they like.

One big difference, at least in Texas, is that to be first assist in surgery as a PA, you do not have to have any additional credentials or qualifications, you simply have to be scrubbed in with the surgeon. The NPs have to have a first assist endorsement on their license. NPs however, have the ability to work under their own license without direct physician supervision (due to the specialization they must obtain) where PAs must have chart review within 24 hours of patient contact (I am pretty sure that is the time limit) from the primary physician.

Anyway, sounds like a lot of people on here speculating and not working a full set of facts. There are lots of things that are state dependent, but very few states have different regulations for NPs than they do for PAs.

My advice for anyone considering the PA route...do a lot of shadowing and ask a ton of questions. Also, don't shadow with PAs employed in only one physician's group or specialty. Shadow multiple specialities with various physician's groups.

 

[JPINFV]

For those of you who don't know, very few hospitals actually employ physicians anymore. Most of the physician coverage is provided through a contract with a physicians group, and that group has the ability to take on mid levels and allow them to do whatever they like.

Hospitals, by law, can't hire physicians in California as the "corporate practice of medicine" is unlawful. Basically, since corporations don't have the right or power to practice medicine, they can't make any decision that directly affects a physician's ability to practice medicine. That's why even companies like Kaiser contract out medical coverage to a physician practice group. Granted the [Southern or Northern] California Permanente Medical Group is the group Kaiser contracts with, but it still retains physician control of the practice of medicine.


Also, per the California Board of Registered Nursing, NPs are essentially just RNs with more education and more comprehensive "standardized procedures" than RNs. So basically an NP is an RN with more standing orders.

http://www.rn.ca.gov/pdfs/regulations/npr-b-20.pdf

 

[Akulahawk]

The way I understand things, nurses don't want to fall under the domain of medicine, they want to stay within the domain of nursing... so someone devised the "Standardized Procedure" as a legal means to achieve precisely that while practicing medicine within their authorized scope of practice.

 

[WTEngel]

Which is why the big push for the DNP is a bitt baffling to me.

I don't have an issue with nurses having Doctorate (PhD) level education, I do however have an issue with them being called "Doctor" while in the clinical setting.

I am on a tangent here, and I know you weren't trying to say this in any way, but it seems like the nursing lobby wants to have its cake (being a doctor in scope of practice and title) and eat it too (not ever go to medical school.)

 

[JPINFV]

The way I understand things, nurses don't want to fall under the domain of medicine, they want to stay within the domain of nursing... so someone devised the "Standardized Procedure" as a legal means to achieve precisely that while practicing medicine within their authorized scope of practice.

The thing is, given what I've read of "standardized procedures," I can't see a reason why those can't be drawn up for RNs with the exception of liability both for the RN and the physician. Of course I also disagree with calling the thing where the physician has to specifically authorize what an NP can do to be "collaboration." In any other language than Nurse, it's called oversight.

 

[Tigger]

A number of the major hospitals around here use PAs in the ED essentially as residents; they assess, diagnose, and treat their own patients, at some point finding a second or two to present it to the attending.

Truthfully I lack much in the way of meaningful interaction with hospital staff as a whole in the Boston area. Most of my experience with PAs comes from my work in Colorado.

Obviously practices and procedures are region and facility dependent but there certain themes common throughout the midlevel field I'd imagine. It's refreshing to hear that some places use PAs and NPs as more than suture monkeys.

 

[jjesusfreak01]

Which is why the big push for the DNP is a bitt baffling to me.

I don't have an issue with nurses having Doctorate (PhD) level education, I do however have an issue with them being called "Doctor" while in the clinical setting.

I have a friend who is an EMT-B with a PhD. I continuously threatened that if I ever ran into her on a medical call I was going to call her doctor in front of the patient. Would have been totally inappropriate as doctor in a medical environment implies physician.

 

[Vetitas86]

I have a friend who is an EMT-B with a PhD. I continuously threatened that if I ever ran into her on a medical call I was going to call her doctor in front of the patient. Would have been totally inappropriate as doctor in a medical environment implies physician.

Both of the above quotes. I don't get the DNP either. Why not just go to med school?

 

[Vetitas86]

If you're thinking medicine (MD/DO) as a profession, I urge you to consider this: http://www.er-doctor.com/doctor_income.html
Nice little elementary analysis of MD/DO income.

That's another thing I don't get. Why people would get into any aspect I'd health care just for the money. Baffles.