Thursday, April 23, 2009

Honored Post of the Month.

Gotta tell ya, there are very few replies on here that just smack it....I mean, HIT IT OUT OF THE PARK....this one did. So I thought I would make it into a whole new post.

Anon 4:33, whoever you are. That was one of the most thoughtful, elaborate, well reasoned posts I have seen. NP's ARE great providers, and are my colleagues, at least to my consideration. But, some of the posts on here, well, they show either

A. DELIBERATE misinformation


B. Ignorance coupled with Misconception.

This is part of the problem, as I said yesterday, too many of us, BOTH PA's and NP's, are so friggin ready to attack at the slightest hint of someone impugning them, that they don't realize, that honest, and careful evaluation of BOTH our strengths AND our weaknesses will only make us BOTH better providers. Here is one poster's reply.

Anonymous said...
I never understand why this is even an argument. NPs are great practitioners in many respects and so are PAs. Physasst said nothing that isn't true, but several notions by the NPs here are. Let me enlighten everyone.

I'm a current Acute Care NP student that has started clinicals and finished didatics, so I can speak with great authority on current NP education. We don't need to recertify, a NP can go through a direct entry program and have no experience, NP education has no more slanted to the medical model than kindergarten has shifted to college, NPs are no more trained to practice independently that a PA, and there is one (hopefully so there will be more) clinical doctorate for PAs through Baylor.

Also the average PA has 4 years medical experience, has more basic science pre-reqs (From UAB PA program)

The following prerequisites:

3-4 semester hours of biology I (lab preferred)

3-4 semester hours of biology II (lab preferred)
3-4 semester hours of microbiology (lab preferred)
3-4 semester hours of human anatomy
3-4 semester hours human physiology (UAB BY 116 or BY 409)
8-9 semester hours of general chemistry (labs preferred)
3-4 semester hours of statistics (upper level, population, and/or health-related with lab preferred)
9 semester hours of psychology (general, developmental, abnormal)

They have higher requirements. This is from the Duke PA program and is representative of most Master's level PA programs.

The ranges of academic and experiential qualifications for the middle 50 percent of accepted applicants for Fall 2008 were as follows:

* Overall GPA: 3.3 – 3.7
* Natural science GPA: 3.1 – 3.6
* Total natural science credits: 47 –74
* GRE General Test scores:
o Verbal: 460 – 598
o Quantitative: 600 – 708
o Analytical Writing: 4.0 – 5.0
* Months of full-time patient care experience: 12 –60

, more advanced science in the didatic year (See UAB PA link above), and does 2000-2600 clinical hours total in the same medical rotations as doctors.

And since NPs have thrown down the gauntlet, let me take you down a peg.(See UAB's ACNP program) The Master's NP is a 18 month long program (24-37 part time which is what many choose to do). It contains a handful of science courses, and don't give me the "I went to nursing school" crap because I have a BSN and it didn't have but handful of sciences. Definitely no biochemistry or gross anatomy.The GRE is waved for students above a 3.2 GPA. The icing on the cake is they do a MINIMUM OF 675 CLINICAL HOURS! Vanderbilt only has 500 and their DNP doesn't add any clinical hours. Just look at the curriculum from the link above for Vanderbilt. How can you even argue that you have received more education.

Even if you somehow did, PAs can go on to post-graduate residencies and will have ~5000 clinical hours in a year. There are quite a few

And just because there were Midwives that practiced out long, long ago, doesn't mean that they somehow magically bequeathed knowledge to all future nurse practitioners.

Neither NP or PA practices "cook book" medicine. PAs can be very independent by owing their own practices or being 6 hours away from their SP. Yes, NPs have the "collaborative" practice which many have taken to mean independent, but it's really semantics. Just because PAs have "supervised" doesn't mean the MD goes through every chart and watches every thoracentesis the PA does. Even if there was a possibility for independent practice with absolutely no MD oversight, PAs don't want it. They know that the terminal degree to practice independently should be the MD/DO education.

I would like for someone to prove me wrong, but since I have links to actual school admissions and curriculum I doubt that you can.

P.S. I'm quitting NP school (sucks because I'm 2/3 through) to become a PA. I've seen both and researched both and find PA to be a better new grad (as long as the have health care experience), have more versatility in their profession (can switch specialties), and more opportunities for growth (PA residencies).

April 23, 2009 4:33 PM

Thanks for a wonderful reply, and no, before anyone goes into ATTACK mode, not because they are switching to become a PA, but because they posted valid, well reasoned logic, coupled with a lot of information. He/She could STILL become an NP, and I would have the utmost respect for this person.

Well played.


Medicated said...


Anonymous said...

This is the poster of that comment. I'm glad you like it. In case anyone thinks I'm not real, my username on the PA forum is EsperPA. You can check my previous postings and see where I've said some of the same things here long before that post. You will also notice that I speak a great deal about UAB both here and on the PA forum since that is what I have the most experience with.

Again, I'm real NP student. I'll be more than happy to send you a picture of my student badge with part of my name blurred out. Just hit me up on the PA forum.

Robert said...

"...the terminal degree to practice independently should be the MD/DO education."

This statement in the context of discussing PAs and NPs consolidated my thoughts about medical school. Another path to medical practice other than med school is necessary. Why? Med school places significant burdens on the student that some excellent potential practitioners (particularly those most likely to wish to practice as GPs) are unable to shoulder.

While there are exceptions, how many parents or people of lower income can take the full decade out of their lives to study through a residency. Why should those who are connected intimately to their communities, families and have the life experiences to enrich their practices be excluded from that group which practices medicine at the "terminal" level? Why should those voices be absent from "terminal" level discourse. (pun intended)

I do not advocate any particular system. But I do not see a problem with a progressive system of education which begins with an RN or even an EMT or CNA and continues through to a "terminal" qualification. The student would gain clinical experience and health system understanding that would make their education more meaningful.

I can say that I am also troubled by the idea of an NP or a PA earning a Dsc and then calling themselves "Doctor" without that qualification being adequately understood. A system of alternative medical education can be innovative but not ad hoc.

For full disclosure, yes I will be entering a PA program, yes I am the parent of a special needs kiddo which precludes my attending medical school and yes general practice floats my turtle.

The Happy Hospitalist said...

Med school places significant burdens on the student that some excellent potential practitioners (particularly those most likely to wish to practice as GPs) are unable to shoulder.)

Where do you get the idea that practicing GP doesn't need a medical doctor degree, but other subspecialities do?

Robert said...

Sorry, that's not what I was trying to say.

PAs were created to solve a problem with availability of GPs because med school graduates have been choosing specialities instead of general practice. I believe that an alternative MD educational path would also provide those who's connection to place and family makes them more likely to want to practice as GPs but less likely to be able to attend med school in one bolus with more professional opportunities and local and rural communities with more resources.

The end result might be more GPs who do not have to break the connection to their communities and are able to enhance their professional status during the course of their careers. Perhaps it would also cause an increase in specialists in under-served communities in the long run.

I will use an example of a person who gets his PA-C in his mid twenties and then studies part time for his masters and then Doctorate in medicine. By forty this person remains grounded in their community, has reached the "terminal" degree in the field(perhaps they will be SMDs-Slow Medical Doctors-like slow food...but different...and think of all the fun we could have with that title) and has nearly 20 years of experience. I admit the example is imperfect and requires a reworking of the infrastructure around medical education and licensing, but perhaps that is what is happening on an ad hoc basis anyway.

No offence intended toward GPs.

Anonymous said...

I think only MD/DO should practice medicine.

Anonymous said...

Come on. Why would you go poking at the bear like that

We didn't start the flame war