So I got my renewal reminder for the ACC in the mail today. The ACC for those of you not familiar, was created a few years back by a group of NP's and PA's (Bob Blumm among them, whom I know from the Academy) in order to foster a more collaborative atmosphere and to encourage a partnership between the two groups. I think their aims are admirable, so I usually send in my check.
It reminds me however, how often I am asked to explain the differences between the two, both at policy meetings, and by patients and even MD's (who should know this)
I will start by saying that I hold no personal grudge against NP's, hell, I supervise two of them in our group.
There are however, some substantial differences between the two.
PA's Master's level for the most part, there are still some baccalaureate programs remaining, and I believe one or two certificate programs.
NP's Master's mandated now, however, the NP leadership has now mandated that the Doctor of Nursing Practice degree (DNP) be the entry level degree for the profession.
PA's Based on the medical model. All schools must meet stringent criteria, and be accredited by the APAP. There is ALWAYS one full didactic year, followed by one full clinical year. We are told that we get the "meat" of medical school, essentially the 2nd and 3rd years. As I have not been to medical school, I cannot qualify this statement.
NP's All over the place, there is no nationally based criteria for NP school structure, and many have a mix of didactic and clinical hours, but do not seem to follow any pattern, hence there are sometimes serious questions regarding their educational model.
PA's Licensed by the state medical board, we have to fulfill the same requirements as the MD's....50 hours of CME every year, and we have to take our boards over again EVERY six years. Most MD specialties require boards to be taken every x number of years, most are every ten.
NP's Licensed by the board of nursing, they have to fulfill the minimum CEU requirements for their state. They take a state based NP board exam only once. They do not ever have to take their boards again, and as their board exam is state based, there is wide variability on the testing that actually takes place.
PA's Generally, although not always, much better at procedural medicine, and much better at acute care (ICU's, ER's, Surgical specialties).
NP's Generally, although not always, much better at preventative medicine, and patient counseling, as well as geriatric nursing home care.
Bottom line is, there are differences between us, it is important to recognize these, but also to work together.
I do have a problem with the NP pursuit of the DNP degree as their entry level degree, as they are creating a potential legal minefield for themselves. I have 3 friends who are PA's that have PhD degrees as well, and not a SINGLE one of them will identify themselves as "Doctor" to patients. They don't even have the PhD listed on their clinical nametags, as it is simply NOT worth the potential confusion. I know that I am finishing my Doctoral degree now, and I will follow their example. I can see everything being fine for the NP's until something goes wrong. Which it will, when you practice medicine, as an NP, PA, MD, DO, CRNA, CNM, etc.etc., if you practice long enough, you will have complications and/or bad outcomes. It's just a statiscal reality, and I can see a defense attorney having a FIELD day with the DNP degree. "So, (snidely) DR, was the patient aware that you do not in fact, have an MD?....before you answer that, WHERE did you go to medical school? Where did you complete your residency....DR?, I mean you are ABSOLUTELY SURE that the patient was aware that you are not, in fact, an MD? How could they be so sure, I mean after all, you call yourself a DR, you are treating the patient, are you not?"
And that would likely end badly. So, to any NP that reads this, it is not a slam, merely a concern. I would like to see us both flourish........
(PS.......you should have to re-board too.....dammit)