PA vs Nurse

Which one would you do?

As you guys know I'm a paramedic. I'm about to make a cross over from working for hospital to work for the fire dept. Difference is in the hospital I have a steady schedule and no mandation which allows me for long term planning and school. In the fire dept I have a penssion plan. Anyway...

I'm not going to be on the streets forever. And even if I want some kind of plan for the future. So. I was thinking about PA program or Nursing program (I already have a BA in forensic psych). All I knwo about PA is that it is like being a doc without being able to prescribe meds. Nursing is just nursing. I love emergency medicine and would like to stay with it. Any nurses or PAs out there to speak their mind?

Matt

It sure is different over here. Nurse practitioners are the mainstay of both A+E and primary care. Nurse Practitioners (NP's) carry out both triage and treatment and as the name suggests prescribing. The new developement in paramedical health care is that some paramedics are electing to train as Emergency Care Practitioners (ECP's) with broadly the same remit as NP's as well as being to used for trauma work if required.

Both roles are fairly autonomous and require a great deal more than 'just nursing'! I'm a 19-20 year old veteran of Ambulance work and have been working in a dual role as a Community Paramedic in primary care for over 3 years now. Basically I'm a single paramedic responder who works in a General Practitioners surgery when I'm not responding to 999 (911) calls.

Great Job, best of both trauma and A&E work combined with primary care. Eventually the CP role will disappear to be replaced by the ECP role.

As to you predicament I'd personally get a few years in the FD and increase your abilities to make decisions in the field. (just my two pennies worth)

Doug

Having been an ER nurse for years before becoming a PA, you're trying to compare apples to peanuts!

The two are so intrinsically different that it's not even apples to oranges!

So far as I know, PA's can presribe in every state in the union now, though I'll admit to some ignorance in the eastern states where I've never had any desire to practice.

To much to write about now, but this isn't and can't be a real comparison.

Bill

PAs are not allowed to prescribe in Ohio and Indiana.

An advanced nursing degree can serve as a gateway to academia or non-medical fields. I know of several nurses who review cases for attorneys, insurers, or state agencies (such as the Bureau of Workers' Compensation).

I don't know of any PAs who have parlayed their degrees into a job that isn't a hands-on, directly health-related field.

There are nurse practitioners who have some degree of autonomy and maintain a practice, under the loose supervision of a physician. To be a PA in Ohio means you're pretty much stuck in the shadow of a physician.

Not that that's necessarily a bad thing. You get to do some of the doctorin', and the doc assumes pretty much all of the headache, responsibility, and litigation burden of prescribing and diagnosing medical conditions (at least, here in Ohio). Yippee!

IMO, "physican extenders" such as PAs and nurse practitioners are going to be more prevalent in the U.S. health care system. Let's face it, docs are expensive and most patient encounters involve problems that don't need the expertise of a medical doctor. We're probably going to see fewer docs treating a greater pool of patients as the population ages. It's more efficient and more cost-effective to let physician extenders treat the majority of cases that don't necessarily require a doc.

That's not to say that extenders have a "lesser" role. Most moms know as much about taking care of a sick child as a pediatrician does, until the kid starts having febrile seizures or goes into a state of dehydration or electrolyte imbalance. You don't need a neurologist for most headaches, nor a hand surgeon for most lacerations, etc. Quite frankly, I trusted my wife more than our first pediatrician, because he was a young man with no kids who'd recently graduated from residency. If our kid had meningitis or an asthma attack the doc would be the one to see, but we didn't need his help to deal with teething pain or croup.

If you're a hands-on kind of guy (as I guess you are), I'd probably recommend going the PA route, depending upon the rules and regulations of your state.

PA's practice with physicians in all states, NP's have more autonomy in some places, being able to hang their own shingle, but that has some problems so far as insurance concerns, with NP's unable to get reasonable rates in some places without that association.

Autonomy is an individual preference, I never have wanted a stand alone practice, and in fact, most doctors don't either, notice how many solo practioners have been absorbed into clinics in the past 10 years.

I practice Internal Medicine and Urgent Care medicine, and have as much autonomy as I want! In IM, I practice with a Physician who is about the same age I am. My Urgent Care spot, I am the only one there most of the time, but have phone access to physicians.

I see 25-35 people daily, and many of my patients have never even met my boss until they are hospitalized.

I forgot about Indiana and Ohio! Those 2 just don't even register on my screen, so I forget about them.

New York has tons of PA's. Contact some of them and see how they like it!

So far as other positions, I know lots of PA's in the Pharmaceutical world, some who are legal specialists, including one lawyer who is a PA/attorney. Others serve as clinic directors, medical directors of clinics and so on.

Bill

Yeah most PAs in my hospitals say go for MD or RN. That's why I asked the question here.

I don't want to discourage you from trying the MD route, but be realistic about the commitment.

There's four years of medical school. The first two years are basic science (Gross anatomy, biochemistry, physiology, pharmacology, pathology, and more -ologies than you can shake a stick at!). You are basically expected to absorb and regurgitate tons of information. The third and fourth years are more clinically oriented, where you follow residents and attending physicians around all day and sometimes all night. Some medical schools try to integrate clinical exposure early on, but you've got to have a fairly large body of knowledge to be even remotely useful to the team.

Assuming you want to do Emergency Medicine, that's another 3-4 years. There are new regulations that limit the number of hours residents can be on duty. I'm not sure what the restrictions are (I think it's 80 hours/week, no more than 24 hours of continuous duty without a break). Even so, you'll be slogging away in the trenches for long hours and little pay and appreciation.

Out of curiosity, why are most of the PAs advising you to go MD or RN? Are they not satisfied with the level of autonomy? Does the pay scale in NY stink?

Even in the restrictive Ohio climate, the PA gig is good. The PAs I know are pretty satisfied with their jobs, and would recommend the profession to others.

Don't knock the nursing profession. If you like critical care, becoming a CRNA is a great choice. Some CRNAs earn more than most doctors.

And I wouldn't make the "nursing is just nursing" comment within earshot of nurses...

Wow,

Every PA I know who is my age, 42, can't imagine going the MD route.

Of the RN's I know, about 200 or so, only 10% would do the RN think again. They complain about constant shift changes, layoffs when census drops, (something that I experienced 3 different times), low census days where they are sent home because it isn't busy, and poor pay.

Many PA's in my area are in the low 6 figure range if they work full schedules, so pay isn't a concern. I realize that is above the national average, but rural/suburban PA's do tend to make more than big city PA's. Most of the NP's I know end up in the education business, as diabetic educators or in the gerontology side of things.

CRNA's make great money, have to deal with call, but also have to have Masters degrees, so you're talking at least 3 years post RN degree.

Specialty PA's in Cardiology, Ortho, and some other fields make $200,000 plus in some circumstances.

Finally, nursing is a great profession, but most nurses don't stay in it because of the stresses associated with the schedule, etc. Check how many nursing grads there are nationwide every year and then how many are going to other professions, there is a reason for the nursing shortage!

I know only 2 PA's, married to each other, and who went to school in their early 20's, who wish they had become doctors. They should have, because when they were in school they were young enough to pull it off. Most PA's come to the job later in life, after other careers.

The vast majority are very happy, though medicine in general right now is VERY scary. In my state, the office is paid less than 25 cents on the dollar to see a state medicaid patient. Try paying staff on that, much less making much yourself!

Bill

After I finished with my BA and began thinking of what I wanted to do as far as healthcare/medicine, I did a lot of research and talking to my wife's friends.

What I saw at my Dad's bedside and what I learned from others basically boiled down to this:
MD = no life except for the hospital for the first 10 years or so. Many broken marriages.
PA = not a bad life depending on what state you're in and who you're working for, but you'll always be a PA.
RN = most flexible in schedule, environment and career path. Depending on how much additional schooling you get you can really get into some neat stuff.

I like the apples to peanuts comparison--the work is really different and it comes down to personal goals. Sometimes I really kick myself for not going the MD route, but there are other days I sit back and say they couldn't pay me enough to be a MD.

PA scope of practice changes from state to state. PAs are usually more technical and procedure/assistant oriented than what I see RNs to be, depending on where you're working.
You would probably have your PA just as quickly as getting your RN, so school time is not a factor. You'll probably spend between 2-3 years in school for a BSN or PA because you already have a BS.
Depending on your area, there may be very few places open for a PA. A few years ago they were limiting how many people could graduate from a PA class in Pittsburgh because of the sudden overflow in the area.

The great thing about nursing--I 've already worked in a couple of different speciality areas and I can keep progressing if I want. If I was a MD with a speciality, I would always be "that,"--same thing for a PA.
With a BS in nursing, I'm primed for a getting into any number of things: research, case management, statistics, management, flight nurse, community health, CRNA, NP, sales (the dark side), legal or teaching. Great thing is that I can do something new every few years if I want and still be an RN.

I think a lot of it can even come down to money, ego stroking and what you really want at the end of the day. I would like more money and I would like the respect that goes with having MD or DO after my name, but that's not what I got into healthcare for and I don't want to sacrifice my homelife (that's what CPF is for). /ubbthreads/images/graemlins/wink.gif

I personally am more interested in flexability and stability than how much I can claim on my taxes at the end of the year--although I would like to drive a new BMW every few years or go on exotic vactations every so often /ubbthreads/images/graemlins/naughty.gif



There are some days I really hate my job, but I don't think anybody out there goes long without going through that as well.
As far as stress, I worked in the SICU in the VA and loved it (except for one or two days that would really burn me). In my current position as a CVU nurse, I've got a unit that had construction completed in December. It's beautiful and functional, but there is too many patients and not enough staff = lots of stress = I'm getting back into the SICU and federal service.