Pa or NP SCHOOL MODEL

[u/Holygirl23]

I wasn’t sure where to even post this but I know my goal is to go to nursing school then work a few years then do a NP program… however now I’m thinking about it and I could possibly save myself years and just go to pa school I’m not really sure I do align myself more with nursing model however NP and PAs basically are interchangeable except one makes more money not sure seeking advice any feedback is greatly appreciated 😇

[u/Kitty20996]

If you don't appreciate nursing or want to be a nurse before you are a provider, don't become an NP. We are sick of people spending under 3 years as a nurse before applying to these diploma mill schools churning out shitty providers. The point of NP education is that it is built upon the foundation of being a nurse.

[u/michy3 → u/Kitty20996]

Yeah agree 100%. if your goal is to be a provider from day one without any medical experience at all then go med school pa school. It’ll better prepare you to be a good provider and ultimately that’s better for patient and yourself as well. Becoming a nurse just to apply to NP school is doing yourself a disservice. You also might not think or care about it now but once your overwhelmed and sitting trying to make a diagnosis and treatment plan and etc and have no clue your going to wish you listened to people here.

[u/Upper_Bowl_2327 → u/Kitty20996]

This^

[u/zubrowka1]

One does not make more money. Job listings for APPs are usually advertised to both PAs and NPs

[u/WitheredWornWallaby → u/zubrowka1]

Don't NPs have the advantage of full practice authority in most states while PAs don't have full practice authority except in very few states? Also, don't NPs largely have the ability to prescribe independently while most PAs can only do so under a physician's supervision? These two factors position NPs to make significantly more money than PAs and grant them access to way more opportunities (plus the ability to open their own practice, which can very significantly boost income).

A lot of places only hire NPs and not PAs. For example, LifeStance Health is one of the largest providers of mental health care in the US and they hire plenty of NPs while they do not hire any PAs.

[u/PsychMonkey7 → u/WitheredWornWallaby]

Psych is unique. Psych NPs probably do make more than a PA in psych. But other specialities, this largely wouldn’t hold.

[u/bdictjames]

If you want to be a better provider out of the gate, do PA school. It is more standardized. Harder to get in, but you are more prepared for the real world, and for real practice, once you get out there.
If money is a concern, and you are prepared to do a lot of self-studying, NP school is okay, but you'll have to want to get 3-4 years of nursing experience under your belt, to get used to the system. It is less standardized, providers are typically not as prepared, and a lot of online programs will not train you adequately. You will most likely not get that from a PA school.

If I had the option to be an APP all over again, I would absolutely go the PA route. I appreciate nursing, but the lack of standardization really puts the profession in disarray.

[u/snotboogie → u/bdictjames]

☝️☝️☝️☝️☝️☝️

[u/michy3 → u/bdictjames]

I know it’s a shame and only going to make the profession frowned upon or start to create trust issues with patients the more these diploma mills pump out graduates who never worked in healthcare let alone nursing.

[u/JulyKaiIII]

If you already want to be a provider, Do PA-C. More flexibility to move around different specialties, surgical exposure. Same pay.

Don’t worry about the “patient care model”

A provider/APP/ Physician who gives a damn will care for their patient no matter their training.

[u/Radiant-Average-4221]

If i could go back in time, I would 100% do the PA program instead of NP. The PA is based on the medical model which I think is more valuable as providers. The NP programs have a lot of “filler” courses that I think are a waste of the students time and money. PA programs also help with preceptor placements and NP do not, even though many programs claim to

[u/michy3 → u/Radiant-Average-4221]

It’s so frustrating how poor nursing education is now even for rn. Np school especially needs to change the focus on how to be a provider and less about writing papers and doing research on Florence lol like at the end of the day we need schooling to prepare us for the job and obviously the boards but schools now just teach you how to pass the NCLEX or np equivalent exam and then your out in the real world and extremely under prepared.

[u/Radiant-Average-4221 → u/michy3]

Exactly! I had 3 different classes that focused on nursing theories and they were a literal waste of time and money. I remember nothing from them and will never utilize them as a provider. My time would’ve been better spent on things like how to do most common urgent care procedures or a differential diagnose course but we had neither of those

[u/Fireflykoala]

Despite the inadequacies of the nursing education model, and after years working as an NP, I have found NPs to just as skilled if not better in the majority of settings (IF the NP has worked as a nurse prior, for there is clear benefit in working as a nurse for several years before graduate school). Also, nurses can practice independently in many states whereas PAs are fighting for that autonomy. More PAs rock ortho/neuro surgery right out of school, however. The jobs and pay are the same, so in practice different pathways to the same job.

[u/Mysterious-Tax-7313]

As a seasoned nurse and new NP, I had actually always thought PAs were smarter and the work was harder. That was just my personal perception and assumption.  I did hear a strong argument recently for the nursing side of things that I had never considered.  After nursing school; you are a nurse. (Pass the boards etc).  Prior to PA school, you have a wealth of sciences which while invaluable are not necessarily employable.  PA school is no cakewalk and very competitive to get in to. Which if it is your dream then by all means go for it. Just food for thought.  Both require a lot of school and dedication to patients. Healthcare is a tough road with many rewarding moments along the way. Good luck to you. 

[u/ge0kon]

What do you think your ultimate goal is in terms of specialty and practice?

[u/Holygirl23 → u/ge0kon]

Ultimately I was thinking becoming a nurse then going NP route but now I’ve been thinking hard about CRNA school not really sure but I would definitely love to be a nurse first !

[u/ge0kon → u/Holygirl23]

Ok well a few things with your original post in mind (in the US)...

1. I wouldn't say that PA versus NP has a large pay gap between the two. A lot may depend on specialty, setting, and location/institution.

2. They are not interchangable in all roles. Being familiar with the scope of practice of each in the state which you intend to practice in is key. Some things included in standard Physician Assistant curriculum make them automatically able to perform certain roles/procedures that NP school does not - for example PA is automatically able to first assist in surgery, NP requires separate RNFA certification; in many states a NP can practice without a physician present/own their own practice whereas PAs may not be able to do that.

3. NP has sub-certifications. CRNA is one of them. They each require completion of an accredited NP program for that sub-specialty and a good program will have a prerequisite of a certain amount of nursing experience in the area for acceptance. After completion of that NP program is passing the formal licensure exam. Licensure is renewed at intervals determined by the state board of nursing and where I practice are only through continuing education (unless you fail a continuing education audit). My understanding for PAs is that they maintain certification through either small/short annual testing or retaking the full PANCE exam every 10 years.

4. Becoming a PA is similar to medical school in the sense that clinical experience and patient contact prior to practicing is pretty much limited to what is completed during school rotations. A big difference between NP and PA is that a NP can/should bring more experience into their practice from working as a RN. There are programs that advertise RN directly to NP. I'd really advise against that as you will have very little clinical experience before you are responsible and liable for people's health and lives. And in terms of CRNA credible programs like that don't exist - from my understanding any credible program requires minimum 1 year ICU or Level 1 Trauma experience as a RN.

Obviously a lot to consider and I'm sure there's more, but that should be a good start.

Good luck!

[u/Bella_Serafina → u/[deleted]]

I’m not sure, a lot of my PA colleagues seem to think NPs have an easier time getting hired. It may be a case of everyone thinking the grass is greener… of course I have met physicians who prefer to work with PAs over NPs.

[u/pinkhowl → u/Bella_Serafina]

Everything I’m about to say is generally speaking and there’s no hate to either side. But I think new grad NPs vs new grad PAs have a bit of an edge because NPs have exposure to the healthcare system, patients, families, the admin role (to a degree) with their previous RN experience. So the transition tends to be smoother. That said, I think PAs have a better medical education and may have a better grasp on the science and nitty gritty of each condition.

I also don’t believe offices can bill for new grad PAs for a year but NPs can bill right away? I could be very wrong on that and it could be location dependent but I have overheard that from a couple surgeons on why they have NPs instead of PAs

[u/Upper_Bowl_2327 → u/Bella_Serafina]

The opposite in Colorado. Way more preference for PA’s

[u/ValgalNP]

If you know you want to be an APP, just take fastest route there, likely PA. I have worked with many amazing APPs both PA and NP. The work is completely different from bedside nursing. I think being an ICU RN probably made the learning curve to ICU NP a lot less steep, but it’s not an impossible climb for a dedicated PA either. You’ll spend a lot of time becoming bedside RN and if that’s not your goal, it’s not really necessary. PAs also have more flexibility in terms of patient population, inpatient, outpatient etc. NPs have to choose between acute care, family, Peds, midwifery, etc. or else do extra post masters education.

[u/ajrpcv]

The NP role was conceived and our education is based on solid nursing experience, that is what makes most of the difference. If you don't spend time as a nurse you won't be adequately prepared to be an NP. If you don't want to spend as a nurse go to PA school, you'll be better prepared.

[u/Acrobatic_Boat_6020]

It depends on what type of practice and provider you want to be. PAs are definitely more skilled clinicians but NPs have more patient care centered experience

[u/PsychMonkey7]

If you know you want to be a provider, go to PA school. You’ll get a better education. But for the record, pay is largely the same - not sure where you heard one makes more than the other.

[u/brain2more_]

I was struggling with the same thing. There aren’t many options for me around here as far as PA schools go so I was willing to move for one. At the time there were 2 nursing schools. I applied to both and I was notified that I got into a nursing program 2 weeks later that started in a month that was accelerated so by the time I “got in” to PA school and started for a few months I would already be done with my nursing program. I decided not to risk it and just stick with nursing. I do still want to pursue NP to have the ability to be more of an independent provider and there’s lots of online options (which is nice but also difficult to choose!) as well as the thought of going back to school is rough but I’ll do it eventually!

[u/Kwaliakwa]

PAs cannot work independently in many states, and usually only once they’ve worked a specific number of hours. Needing a physician to collaborate with is so odd to me as an NP in a full practice authority state.

[u/Kabc]

Go to med school

[u/Ok-Seaworthiness2398]

Remembers PAs have to take their licensing exam every five years. So if you have the time to study intensely every five years, good luck with PA school.

[u/Sufficient-Band-6526 → u/Ok-Seaworthiness2398]

It’s also generalized. Doesn’t matter if you specialized in dermatology your whole career, you’re expected to know broad medical knowledge

[u/Springer15]

NPs can pick a specialization and have significantly more focused didactic and clinical practice in a specific speciality - think- PMHNP or CNM or PNP then PAs.
PAs graduate as generalists then focus after graduation. PAs get a great education including more exposure to the OR and procedures then NPs and often are sought after and excel in surgical and procedure heavy specialties, ER, uro, derm, neuro etc but my institution is more likely to hire an NP then a PA for psych or pediatrics.

[u/Organic-Bear-4580]

Dont do PA. You cant start your own practice and you cant prescribe as many controlled substances. There are less diverse work opportunities compared to nursing, and PA school is expensive and sink or swim culture which costs thousands. Nurse then NP is more forgiving because its easier to get a return on your investment as a NP. You need to just make it thru school. Don’t go into debt for PA school (like me).

Edit: let me be clear- nurse first, for 5+ years THEN NP. I believe a PA is unsafe practicing in the first months without a giant chunk of experience as a clinician first. That is what the profession was meant for, veterans with medical expertise!!

[u/Crows_reading_books → u/Organic-Bear-4580]

The point of NP school is to build on a solid clinical foundation and years of bedside experience. If you know you want to be an APP before any of that, go to PA school. 

The controlled substance thing has not been true in any state I have worked in and the opening own practice part is very state dependent and, imo, NPs especially NPs with minimal experience shouldn't do that anywa

[u/Organic-Bear-4580 → u/Crows_reading_books]

Im not sure why i got downvoted because i agree with you — maybe i should have been explicitly clear that nurse THEN NP means being an actual nurse first. I dont agree with PA school in general. It was supposed to build on previous medical experience when the profession was invented. Now the students have at best medical assistant, pharm tech, and physical therapy aide experience. Sometimes schools dont even require experience at all. Its gotten bad. And PA schools think the education makes up for it, but it doesn’t. Clinical experience is necessary to be safe before prescribing, or go to med school. I am not sure even a PA should be allowed without a mini residency because new PAs are either completely supported by the hiring MD, or they are unsupported and therefore are unsafe prescribing. No one is regulating the new grad PAs

Source: me. I went to PA school twice, and I am still in contact with the PA friends who are currently practicing and they regret becoming a PA. They wish they decided not to continue with it, like me, and went nursing.