Physician Assistant ?

FiremanMike

EMS Coordinator
701
337
63
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

Crowd pleaser
Premium Member
2,230
1,196
113
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)

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.
 

Carlos Danger

Forum Deputy Chief
Premium Member
4,120
2,816
113
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.

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.

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.

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.


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.
 
Last edited:

Carlos Danger

Forum Deputy Chief
Premium Member
4,120
2,816
113
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

Forum Asst. Chief
855
55
28
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.
 

SandpitMedic

Crowd pleaser
Premium Member
2,230
1,196
113
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.
 

DrParasite

The fire extinguisher is not just for show
5,286
1,443
113
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?
 

FiremanMike

EMS Coordinator
701
337
63
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?
 

SandpitMedic

Crowd pleaser
Premium Member
2,230
1,196
113
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.
 

Carlos Danger

Forum Deputy Chief
Premium Member
4,120
2,816
113
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.
 
Last edited:

Akulahawk

EMT-P/ED RN
Community Leader
4,563
977
113
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.
 

CCCSD

Forum Asst. Chief
751
422
63
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.
 

SandpitMedic

Crowd pleaser
Premium Member
2,230
1,196
113
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.
What kind of backwoods flight crew doesn’t know what a CNA is?! 😂😂😂
That’s a great story. You and your toxic masculinity.
 

Lemur

Forum Probie
12
11
3
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.
 

Summit

Critical Crazy
2,400
910
113
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.
 

ffemt8978

Forum Vice-Principal
Community Leader
9,639
578
113
Roses are red,
Violets are blue,
Last chance to keep it civil,
Or I will ban you.
 

Top