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Physicians Assistant and Nurse Practitioner--are these similar?


garddwr
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Just something I've wondered but don't know much about. Are the roles of physicians assistant and nurse practitioner similar? How are the different? How is the training different? Are earnings comparable? It seems to me that I come across them in similar circumstances--working within a doctors practice but with somewhat limited scope compared to a doctor.

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When I googled it, they appear similar but definitely not the *same*.

The way it boils down, to me, is that a PA is allowed to practice medicine under a doctor's supervision; a nurse practitioner can help perform, or actually perform, "medical TASKS" under a doctor's supervision, but not "practice medicine" like a PA. A PA can prescribe medication. A PA can treat minor injuries and disorders.

 

I may have it wrong - I just googled after all, lol.

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When I googled it, they appear similar but definitely not the *same*.

The way it boils down, to me, is that a PA is allowed to practice medicine under a doctor's supervision; a nurse practitioner can help perform, or actually perform, "medical TASKS" under a doctor's supervision, but not "practice medicine" like a PA. A PA can prescribe medication. A PA can treat minor injuries and disorders.

 

I may have it wrong - I just googled after all, lol.

 

I believe you're correct. My dad was a PA and he had more freedom than a nurse. Quite often he was the one running the clinic, but there was a dr in another city that was his supervising dr. It does depend upon the state though. My dad could write RXs for narcotics. In some states nurses can, in other states they can't. In Texas, it seems like NPs are more closely supervised than PAs.

 

My understanding is that a PA is like a "junior doctor". Not quite, but close. And without the years of school. My dad was army trained so I'm it sure what it takes to be a PA now, but I believe it's a 4year degree.

 

After 35+ years of practice with a masters my dad made just over $100,000.

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It depends in the state of practice. Here NPs and PAs are exactly equivalent in scope of practice and can work without the direct supervision of an MD. Both have the same level of prescriptive authority. Job listings for open positions here usually are for either and not just one. Ie "PA or NP with x# of years experience and practice area sought to...". Both are considered equal, mid level practitioners of medicine here. NPs are a masters above a 4 year BSN with an internship and PAs are generally a 2 year program following a BA or BS degree. There are options for a BS only version of a PA degree but not in my city. Only in a rural training setting. It's a transitioning licensing requirement.

 

Entry level new grads can expect the better part of 90k. Highly experienced or specialized PAs and NPs with additional training can get up to around 180k. That's for Anesthetists and such.

 

I see an NP midwife in private practice for ob-gyn stuff. My counselor is a NP specializing in psychology. My husband sees an NP for general health and a PA for counseling and med management for his ADD. I have been really impressed with the quality of care we have received. Perhaps because the ones we see do not seem to be under the same pressures time wise as doctors, the whole experience has felt less rushed and more personalized. I know that other states have different and often more restrictive laws for "mid level practitioners". Some treat PAs as superior to NPs despite the same or in some cases greater, level of training. PA is a field that originally started in the military and has been more male than female but that is shifting. It is generally accepted that gender is at least part of why PAs were initially given more autonomy and greater range of practice. A larger percent of PAs are being trained in civilian settings than ever before. There is a push here to rename it Physician Associate to avoid confusion between PAs and Medical Assistants (who have less training than a practical, below RN nurse and pretty much just take vitals etc at the start of visits.)

 

I tend to think that more and more states will expand the legal definitions of their practice. We will see more and more midlevels for everyday health needs. The family doctor MD is becoming more rare. It's not uncommon for a clinic at a major medical center to be staffed by mostly midlevels who go and find an MD for the more difficult or unusual cases. MDs are clearly needed for issues like surgery, oncology and most life threatening conditions but not some much needed for a Pap smear or a few stitches or strep throat. I am glad we live in an area with many fantastic medical facilities and doctors but also feel fortunate to have the option to see mid levels for basic care.

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I think what each specialty varies by state. Someone told that in their state an NP can have an autonomous practice without physician over site. I know in my state NP and PAs are always associated with an overseeing physician, but they are both able to prescribe medicine. I have always seen them as equivalent, but I've always thought of NPs as more highly trained. First, they do an RN or BSN program. They spend time on that. Then (finish BS if they haven't) they return to grad school and get further training in their specialty. PAs enter training from any undergrad background, having taken basic science and math courses. After they finish their training they have spent much less school time on the subject and much less time in patient care compared to an NP who has just finished training.

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I'm in school to be a nurse practitioner. The roles are very similar, but actually the NP has more autonomy in most states than PAs.NPs can in some states practice independently. Both roles can see patients for any type of disease process, treat the disease, have prescriptive authority with some limitations in some states.

 

The difference is in the model of care. PAs practice from the medical model, the model is very similar to that of a MD.

 

Nurse Practitioners practice from a nursing model that aims to treat the patient holistically with lots of health promotion and disease prevention.

 

Both are paid pretty much the same.

 

The education is different. PA school is usually full time on campus for 3 years. NP school can be done online and in your own home, but the last year and a half adds in many hours of clinical that are done with a preceptor. This allows you to work through school, something that would be difficult to do in PA school.

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Thanks for the replies. This is something I want to research further, with the possible consideration of one of my children going into the field or even myself (medicine has always fascinated me, and I was interested in med school as a young adult but opted to go another direction because I worried that the years of training and the probable massive debt would limit my ability to start a family and stay home with my kids.) My sister did graduate work at a British medical school and was intrigued by the much shorter training required of most doctors over there (if I remember correctly, they go straight to medical school after high school and train directly into their specialty, cutting several years off of the training time). I wonder if the training and skills of most doctors over there are more comparable to these mid-level medical practitioners (NP and PA) over here? I do suspect this will be an expanding field, at least if we as a country have a real interest in making medical care more affordable and available.

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My sister did graduate work at a British medical school and was intrigued by the much shorter training required of most doctors over there (if I remember correctly, they go straight to medical school after high school and train directly into their specialty, cutting several years off of the training time). I wonder if the training and skills of most doctors over there are more comparable to these mid-level medical practitioners (NP and PA) over here? I do suspect this will be an expanding field, at least if we as a country have a real interest in making medical care more affordable and available.

 

 

I know a couple of just starting uni students here in the UK and their high school / A level prep is far above what most US people enter with. Most are entering with A* in 5 science and math subject area and at least 11 A or A* core GCSEs. IMO they probably already have an associates degree in US terms before walking through the doors at Uni. I think that explains the program time difference. Also from the one person Post graduate I have talked to she had very little hands on experience with patients while in her Uni program. That comes after.

 

I am far from an expert on this--just an interested observer who has been trying to figure out the differences in the two educational systems since moving to the UK!

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I know a couple of just starting uni students here in the UK and their high school / A level prep is far above what most US people enter with. Most are entering with A* in 5 science and math subject area and at least 11 A or A* core GCSEs. IMO they probably already have an associates degree in US terms before walking through the doors at Uni. I think that explains the program time difference. Also from the one person Post graduate I have talked to she had very little hands on experience with patients while in her Uni program. That comes after.

 

I am far from an expert on this--just an interested observer who has been trying to figure out the differences in the two educational systems since moving to the UK!

 

 

I agree that high school preparation is one area of significant difference between US and UK educational systems. Students begin their specialization in high school, choosing their A level courses according to their interests and future anticipated courses of study. So a student planning to become a doctor needs to start at the high school level by choosing a science-oriented A-level schedule. Even taking that into account, however, the path to becoming a doctor in the UK is shorter. Medical school (entered straight out of high school) is usually a five year course of study, whereas in the US students must first complete a 4 year undergraduate degree followed by at least four years of medical school. A typical student graduates at about age 23, whereas in the US medical school graduates are usually 26 or older. At least, that is my understanding. This does not take into account residencies and further study for specialization, I don't know how the systems compare. I believe American doctors average higher wages that their UK equivalents, they also typically have much higher debt loads. I'm not an expert on any of this, I am mostly going of my sisters reports (she was working on a PhD within the medical school, her primary interactions with the medical students were in classes she taught so she didn't actually go through the UK medical school process herself).

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Sorry I can't seem to quote and post this time so I will just reply

 

As I said I am more of an interested observer but I think my new graduate friend said she needs to work in her local hospital (she was going home to Wales) for either 2 or 3 years in order to be a village GP. So essentially a resident for those years. She was fascinated by what dh and I were telling her about US path. But the differences seemed to be terminology in many cases. Honestly not sure that it ends up shorter if they want to practice not do research.

 

According to the stats we have looked at local village GPs make about £120,000 with no malpractice insurance. They are amazingly professional for the most part. Yes people complain but brits love to complain about the weather and health care. They admit it too! LOL

 

My friend just died of cancer a month ago and I was amazed at the kindness her doctor showed not just to her but her family and friends. She came within a couple of hours for months when things were not going well. I was astounded to say the least. She received excellent care and was able to stay home with her family.

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I would imagine it varies a little. In my experience in 2 states, the PA works in an office with an MD or works FOR them, e.g. a PA who goes through the medical history of people having neurosurgery, and makes sure everything on the (crucial) pre-op list is done, like stopping the ASA well ahead of time.

 

NPs, **in my experience** are more independent, often providing the ONLY medical care in, say, a short term emergency psychiatric facility with no MD back up (besides sending the patient to the ER). Some NPs work in a GI office and see the people pre and post endoscopy, so that the MD can limit his/her time to the (very well paying) procedures. I suppose a PA could do that, but they need more oversight in our state and NPs tend to have that role.

 

If a PA had a lazy MD who didn't fear censure, they could be left too independent, too, but most MDs are aware they can get into trouble for not supervising the PAs they have agreed to supervise. **In my personal experience** a PA, because they are more closely followed, seem more likely to turn to their MD to ask a question or refer to them for follow up, whereas the more independent NP often has no one to immediately turn to.

 

**In my personal experience** I have been less than impressed with NP, especially in their lack of knowledge regarding meds. Typical is that they learn one pair of meds to use for seizures, e.g. and so every patient who has a seizure gets started on those two meds. I have learned the names of the NPs I get patients from and no longer bash my brains trying to figure out the logic of why a person was started on those meds ....they are the only ones that NP "knows" and feels comfortable with. Kepra and trileptal for a first seizure, really?? How about stopping the med that has a side effect of seizure?? And here is a key difference. If an MD sends me a patient with X and Y on board and a referral to a cardiologist, I try to think logically about what is going on. If an NP does, I start from scratch, assuming they are a bit lost, e.g. haven't spent much time learning EKG and take the (often faulty) "machine reading" of the EKG as the gospel and referred to cardiology in a knee jerk fashion. It makes more work for me, and I think it is a bit more dangerous for the patient. What I have found the NPs to quite good at is the history-taking and the physical exam. From their notes, I cannot tell if they are NPs or MDs. It is the meds that stick out, sometimes alarmingly so.

 

P.S. the pharmacists I work with see the same problem with NPs, so I'm not alone in noting the odd prescribing.

 

YMMV

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Re: training, I was told by my PA niece that PA's get a general medical education (simlar to a general practice MD) and specialize after graduation through post-graduate employment while NP's get their nursing degree and then choose a specialty to focus on while in NP school. In other words, the NP's graduate as specialists in a particular area of medicine while the PA's graduate as general practitioners and specialize later.

 

Due to some previous medical history, I am "stuck" in internal medicine with a PCM that is a NP in internal medicine... which would be fine if I had diabetes, high blood pressure, or was currently dealing with cancer. However, because she seems focused on those types of issues, she doesn't seem very knowledgeable on general health issues and as a result often has no answer for what ails me.

 

For example, I had what I thought to be a UTI (and it was) after DD was born but the NP was more concerned with the fact that I didn't have my menstrual cycle back yet (DD was only 2 mos old and I was exclusively breastfeeding her) than with my UTI symptoms.

 

Then again, my neice-in-law who is a family medicine NP is very knowledgeable on things pertaining to general medicine.

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