Medical Profession Comparison Chart:
Medical Assistant vs. Nurse vs. Nurse Practitioner vs. Physician Assistant vs. Family Practice Physician (updated 25th April 2024)
*Programs vary, and the following represents averages for each vocation.
Category | Medical Assistant (MA) | Nurse (RN, BSN) | Nurse Practitioner (NP) | Physician Assistant (PA) | Physician (MD) |
Prerequisite Education | None | None | Bachelor’s Degree in nursing and clinical hours | Bachelor’s degree and clinical hours | Bachelor’s degree |
Learning Model | - | Medical-Nursing | Medical-Nursing | Medical-Physician | Medical-Physician |
Time in Classroom | 134 hrs. | varies greatly by program | 500 hrs. | 1000 hrs. | 2 years |
Time in Clinic | 160 hours | varies by program | 500-700 hrs. | 2000 hrs. | 2 years |
Total Post High School Education | 1-2 years | 2-4 years | 6-8 years | 6-7 years | 8 years |
Residency | None | Optional 6-12 months | Optional 1-2 years | Optional 1-2 years | 3-8 years |
Degree or Certificate Awarded | Certificate or Associate Degree | Associate or bachelor’s degree | Master's Degree planned transition to Doctorate | Master's Degree PA-C | Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) |
Recertification | 60 education points or exam every 5 years | 1000 hours practicing in area of certification or exam every 5 years | 1000 professional practice hours and 12 CE credits per year OR exam every 5 years | 100 education hours every 2 years and exam every 10 years | MD: 50 education hours/year and ABMS certification recommended |
Base Salary US | $40,700 | $89,010 (varies significantly by state) | $124,680 | $120,204 | $238,700 |
Independent Practitioner | No | No | 18 states allow NPs to practice independently | Not yet | Yes |
Megan Medical Student says
For those of you who are still students and are wondering about your chances of getting into program A or B. Here is some information given to me by a mentor from the 2015-2016 application cycle:
So here’s some data that was compiled earlier this week, for the 2015-2016 application cycle (so for the first-year seats in this year’s classes at various programs). Median salaries (not starting salaries) are also included for each profession.
Applicant Information* & Median Salaries**
Gathered and compiled by Aven Humphreys, M.Ed., [email protected]
MD: 53,029 applicants; 831,016 applications; 21,030 matriculated (40%); $187K
Application and matriculation data came from AAMC.
DO: 20,720 applicants; 185,602 applications; 6,778 matriculated (33%); $187K
Application and matriculation data came from NAAHP.
PharmD: 16,454 applicants; 70,752 applications; 15,790 matriculated (96%); $121K
Application and matriculation data came from NAAHP.
DDS: 12,608 applicants; 122,162 applications; 6,097 matriculated; $158K
Application and matriculation data came from http://www.adea.org
PT: 18,459 applicants; 114,027 applications; 9,227 matriculated (50%); $84K
Application and matriculation data came from the 2015-2016 PTCAS Applicant data report.
OT: 8,848 applicants; 35,311 applications; 2,610 offers accepted (29%); $80k
Application and offers made data came from WebAdmit.
PA: 26,000+ applicants; 100,000+ applications; ~7,800 matriculated (30%); $98k
Application and matriculation data came from NAAHP.
Optometry: 2,812 applicants; 13,610 applications; ~1,500 matriculated (53%); $103K
Application and matriculation data came from NAAHP.
Podiatry: 1,194 applicants; 5,862 applications; 674 matriculated (56%); $119k
Application and matriculation data came from NAAHP.
Veterinary: 7,078 applicants; 34,038 applications; 4,200 matriculated (59%); $88k
Application and matriculation data came from http://www.aavmc.org
*Application/matriculation data comes from the 2015-2016 admissions cycle.
**Salaries will depend on region,
Stephen Pasquini PA-C says
This is very interesting… Thanks for sharing!!
Stephen
Rodrigo says
Hi,
I am 50 years old and I have a Masters Degree in Management Information Systems. It is a totally unrelated field, but I have always dreamed of working in the medical industry. It is time for me to change careers and pursuing a PA-C may be easier than becoming an MD. Should I be pursuing this degree considering my age? I know that I need lots of science courses as prerequisites to begin with. I just don’t know where to start. Your guidance and honest opinion is greatly appreciated.
Justin says
Hey Stephen,
I just recently got out of the military, a bit late on the education aspect of my life. I’m enrolled into an EMT program that is due to start in January. Any advice or input you have for me that would help in the process of becoming a PA? My current plan is become certified as an EMY to get as much patient care hours as possible then continue working on my AA to transfer to a University to get a bachelors in health science then attend an accredited grad school to go for my PA certification
Stephen Pasquini PA-C says
Hi Justin,
That sounds like a good plan. My only advice would be to make sure to challenge yourself some in the didactic portion (if you are not already) by taking higher level science courses, adding Spanish to your repertoire, consider mixing up your healthcare experience hours (such as working as a medical scribe in the ER) and take a couple weeks to work overseas (such as in Mexico or the Dominican Republic etc. etc.) to get some global health experience. The more intense and varied the experience the better! There is no “perfect” path and there is no “perfect” application, but you do what you can do with the time you have and continue to put forth your best effort!
Hope that helps.
Stephen
Enomfon says
Hi Stephen,
Thank you for this chart, it absolutely simplifies everything for me. In May, I will graduate with my BS in Biochemistry. I wanted to take a gap year before applying for medical school but I am now leaning towards PA school for the type of future I want. What are some ways that I can distinguish myself for the PA school as well as build up my hours of direct patient care??
Thanks again!
Stephen Pasquini PA-C says
My advice is to go out there tomorrow and start trying to find ways to serve patients in your community. Dedicate as much time as you can to this pursuit. Every waking hour if you can. Put yourself in situations that are challenging and uncomfortable. Be willing to work for free. Bring your enthusiasm to every pursuit. Then present this to the admissions committee.
Stephen
Marc Guttentag says
Hi Stephen! I have a question but my question is open to anyone. When I was child, I always wanted to pursue the Dental route. But as reality sets in, I have considered going into medicine. I know there are many trade-offs. I am 25, with 2 years down from a CC, and now transferring to UF for Microbiology. I have considered going to RN at the state college or an BSN program, but was curious if what people say about anatomy in the PA field is true? More or less, I’d like to become my own boss but I do not necessarily want devote extra time to school as well as sacrifice myself to more debt. I also want Job Security!Just curious if it’s true that PA’s mostly have no Anatomy. I’ve accoutered PA’s in Urgent Care’s that disagree as they state some of their Physician’s come by once a week and that’s it. Ideally, if I went Nursing I’d do CRNA but otherwise I am consider the pros/cons of PA school and specializing versus Medical/Dental School. I do truly believe I am capable of any of these careers and just need a challenge as well as some direction. My age tends to be something eating away at me and discouraging but I am currently a Pharmacy Technician and my boss when to Pharmacy school at 54. So I know it’s just a number. Please let me know your insight. :).
Stephen Pasquini PA-C says
Hi Marc,
I am assuming by “anatomy” you actually mean “autonomy”. The truth is we have a ton of both 🙂 As you start any new job as a PA you will want less autonomy and a lot of help as you learn the ropes. Then as time goes on, you will develop rapport with your patients and your supervisors and in many setting you may be spending the majority of your time practicing solo with an MD a phone call away. This is a common situation. A PA colleague of mine recently started a clinic in Los Angeles where he hired all the staff, including his supervising physician.
I almost went the dental route myself and I still think it would be a fun career. But I have no regrets choosing the PA route and I plant my creative/entrepreneurial seeds in many places outside of my traditional work which allows me to scratch that itch.
I never dread going to work, I enjoy my patients immensely, the ability to develop and implement treatment plans and I love everyone I work with. Couldn’t ask for more from a profession! Also, once you have the PA degree you have a million new ways to make a positive difference in this country and all around the world.
Of course in my experience doing global health as a PA I have also seen firsthand just how badly this world needs qualified, caring dentists. 🙂
Warmly,
Stephen
Joe Carusso M.D. says
Practicing solo with a physician a phone call away? I don’t think that is how we envisioned PAs to function in this country. I hate to beat a dead horse but in the first two years of medical school we spend the equivalent of about 30 credit hours per semester, basically studying every waking hour non stop to learn how the human body works, followed by an intense 10000 hours of more clinical experience called residency. Can NPs and PAs provide cost effective care? yes. Equivalent care? How in the world? That is just impossible with the huge gap in knowledge base an clinical experience (around TEN FOLD difference)
GeorgiaCatholicPreMed says
While I understand what you are trying to say here, you are, nonetheless, presenting a fallacious argument (at least in the manner in which you are proceeding). How so? You assert that having a “TEN FOLD” increase in the number of hours automatically implies more knowledge and ability. However, this is provably inaccurate. While spending more time studying a topic, or preparing for a career, MAY make one more knowledgeable than one who spent less time at such, the statement is, in reality, a non-sequitur.
Let’s take a non-medical field example to explain what I mean here. Sally spends 30 hours a week for two years studying mathematics, but Jill only spends 5 hours or less a week studying a lesser mathematics field. Therefore, Sally will automatically perform better in mathematics than Jill? Not necessarily! There are a host of other factors that could come into play here. Sally may be forced to spend the 30 hours per week studying for her mathematics course due to the requirements and constraints of the program. Jill, on the other hand, may have lesser constraints, but along with such more free time with which to pursue other mathematical pursuits. Alternatively, Jill my simply have more aptitude for mathematics than does Sally.
Now, I know someone is going to say this is not analogous to the medical school/PA school debate because the fields are substantially different in nature. However, the same does, in fact, hold true. It is entirely possible that one could complete medical school spending substantially less studying time than a medical school student in another (or even their own) school, and, nonetheless, out perform the student who spent more time on the work. Likewise, it is possible that a person could attend a “lesser” level of education (with no offense meant to anyone by this comment), and still out perform one who attended a “higher” level of education. Education, after all, is not, and should not be considered to be, confined to a building of higher education. If this were the case then any professional, after graduation from their professional training, would never be able to remain current in their field without re-enrolling in the professional school every couple of years (or more frequently). Instead, however, professionals maintain and improve their knowledge by attending continuing education and studying on their own. One need not have a certain degree after their name to be able to learn new material, and/or improve, or expand, their education in a subject (to state otherwise is elitist and, again, a logical fallacy).
With regards to the PA practicing “just a phone call away” from a physician, this might actually be preferable to a person in solo practice (regardless of the level of education) who has no one else at all they can routinely run concerns or questions through. And, again, the statement that this is automatically bad is based simply on assumption.
I also think you misunderstanding the history of the PA profession (which is probably through no fault of your own since you are not a PA – but then again neither am I), The PA profession was originally created at Duke University, through a partnership with other organizations, etc., specifically intended to be able to use PAs in areas where physicians were not readily available. This is why it was initially based on the combat medic approach to training, and many of its early students had received combat medic (or other such military medical training). These students were familiar with working with patients in an area vastly removed from “physician support”. The idea of the PA working in the same office with a physician to “free the physician up” to handle other tasks evolved later in the history of the field.
You are right in saying that the PA profession was never intended to replace the profession of physician, but the actions that have made this appear so have largely been the result of insurance and managed care. Likewise, having spoken with quite a few primary care MDs (and DOs), quite a few of them have stated dismay over what they see as a move for PCPs to be little more than “medical managers” of their patients. Again, however, this move, where it exists, has largely been the result of insurance and managed care. I truly believe if one wants to “fix” this issue then they need to take steps to remove insurance control from the patient-doctor relationship not strengthen it (such as by requiring everyone purchase insurance or else).
This, however, is getting off topic for this response.
My point is that while I agree with you that physicians most certainly have an important place in all of medicine – and while no one could argue against the statement that physicians have more educational hours than PAs – the assertion that “more hours” automatically equals “better provider” is flawed and fallacious (even if in many cases this might be case).
ryan says
Welcome to the new world of ANTI INTELLECTUALISM. Where Less learning is better.
ryan says
Welcome to the new world of ANTI INTELLECTUALISM. Where Less learning is better.
Also, Stephen, why is phyisican only 8 years?
It should be 8-12 years because many schools have joint degrees as part of their curriculmn like MD/PHD.
Stephen Pasquini PA-C says
I have to disagree Ryan. In Europe many pre-med students begin their training the third year of their undergrad. They essentially finish all their didactic coursework in 5 years then go off to do clinicals. More is not always better and as someone who was on the pre-med track the majority of my time at the UW I have to say that P.Chem and O.Chem and Calculus were an utter waste of my time. Just because something has been done a certain way for a long time doesn’t make it right. And I think what we need to do is take a step back and look at the medical school education. I feel if we could make it more like the European model more people would go this route. Time is of course our most precious commodity and many PAs pursue this route because we see MD as a poor tradeoff. It isn’t that we are anti-intellectual, in my opinion it is 100% the opposite.
Respectfully 🙂
Stephen
Nina says
Does having a medical assisting degree help you get some experience before applying to PA schooling?
Stephen Pasquini PA-C says
Hi Nina,
Absolutely, as an MA you can start to get your feet wet and build quality HCE hours. Although this can be a bit more timely and costly route it offers a lot in the form on “hands on” patient care which can be hard to obtain from other options.
Stephen
Dr. Karen Morahan says
Stephen,
Can I have a copy of your comparison table for my class? I’m discussing the difference between the three and this is the most succinct source I’ve found!
Thank you!
Karen
Stephen Pasquini PA-C says
Hi Karen,
I have created a PDF version that you can download here: https://www.thepalife.com/wp-content/uploads/2016/10/PA-v-MS-v-NP.pdf
Otherwise feel free to use it as you like 🙂
Warmly,
Stephen Pasquini PA-C
Ashley says
Hi, I am trying to decide between being a pediatrician md or pediatrician PA. When I look up the differences and pros and cons, mostly they talk about long hours etc. For me and maybe I am wrong but I would think out of all the specialties pediatrics would be the normal work hours from 8 to 5. I am only now really looking into the PA profession becuase there is going to be a new PA school 30 min from my house. Also I am always wary of the amount of debt med students accumulate and as a primary care physician I dont want that amount hanging over my neck. I am still an undergrad majoring in Clinical Laboratory Science and I have a ways to go but I don’t know which profession is most best. Is there really a difference besides the obvious between a pediatric md or pa? Thanks.
Stephen Pasquini PA-C says
Hi Ashley,
You know it is interesting, in all my years in the PA profession I have never met a PA who was specializing in just pediatrics. I spent 10 years working in a rural family practice where probably 70% of my day was working with pediatric patients (which I loved) but to be honest I haven’t seen that many job posting for pediatric PA specialty. I am know it exists, and maybe you have already met some PAs working in this field.
I know pediatric MDs are some of the nicest most amazing people I have ever worked with and I have also heard anecdotally that they are extremely underpaid when compared to their non pediatric MD colleagues. I have always thought that this is one reason there are less PA/Peds job openings when compared to other specialties. I get calls almost weekly for positions in urgent care or emergency medicine.
If I was going into Pediatrics I would probably lean towards MD, I don’t say that often, but it just seems like it may be better in the long run and you may have more option. Of course better yet, would be to contact someone at the society for pediatrics PAs http://spaponline.org/ And have an experienced Pediatric PA give you her/his take. Stephen
Joe Carusso M.D. says
Just FYI, a pediatrician in a small town covers the hospital pediatric unit, the nursery, and while on call any ER admissions, all well as a ton of parent calls, you must be thinking dermatology.
As an MD you spend the first two years in medical school taking the equivalent of more than 30 college credit hours per semester in basic sciences, Anatomy, Histology, Pathology, Pharmacology etc. you will be studying every waking hour just to survive. Followed by 2 years of intense clinical experience in all specialties. Then residence, an intense 80+ hour per week direct patient contact experience for 3 years.
Do you want to really learn the intricacies of how the human body works and receive at least 10,000 hours of clinical experience? then go to Medical School. How competent are you going to be with the training received as a PA or NP? That is the million dollar question, the difference in training is about TEN FOLD. Just FYI, stating the facts. Don’t mean to offend anybody,
GeorgiaCatholicPreMed says
A recurring theme in your posts is that you have to work your butt off “just to survive” in medical school. While this is most certainly the case for many students, it is not the case for all students. I, in fact, know an MD who traveled extensively for leisure during his first two years of medical school, and even commented that he felt the material was not as tough as it should have been. Is he the norm? Probably not, but my point is that different people find difficulty in different areas. “Difficulty” is highly subjective, and is, therefore, a poor gauge with which to judge one’s ability or rigor of training. One’s person’s “incredibly difficult course” is another’s “easy A”. That’s just the way of life.
I also get the distinct impression from your combined posts that you struggled quite a lot in medical school. This is nothing to be ashamed of, but for some reason you seem to feel the need to make up for this by belittling other’s educational achievements in comparison to what you see as the “far harder” course (medical school). This comes across as simply elitist and out of touch (to put it frankly).
If you want to continue to debate the issue, then do yourself a favor and do so on my objective grounds. Also, don’t feel that you have to prove anything to anyone on here about your abilities. If you are, in fact, an MD, then you achieved your goal (hard and tiresome though it might have been). As it stands, one gets the distinct impression from your posts that you spend a lot of your time feeling inferior to others. This makes me sad for you. 🙁
Joe Carusso M.D. says
LOL!!! I did not have a single classmate that had time to travel or do other activities during the first two years of medical school, and the ones that tried flunked out. the amount of information covered is massive, (about the equivalent of 34 college credit hours per semester) and I did not struggle , everyone of my classmates spent every waking hour studying during the first two years, it is just a fact of life, is it possible that there was one or two super gifted people in my class that did not have to study as much? sure, but I personally did not know any, and I went to the second largest medical school class in the country at the time (Indiana University) I had excellent grades in all my classes and got my top choice of residency during the match. And I was elected class president all four years, which involved a lot of other functions I had to accomplish for my classmates. Feeling inferior? NAH!!!
The only reason I am posting here is that I was trying to find a table that clearly states the difference in training between PAs and M.D.s so I can convince the CEO of my hospital ( I am on the board of directors) that allowing PAs to practice independently in urgent care settings is a bad idea. And I have tons of chart reviews to prove it, including the huge mistake of the child with fever and petechiae that was misdiagnosed and almost died.
And I was taken back by all the comments posted here, I figure I leave my 0.02 for what is worth
GeorgiaCatholicPreMed says
A psychiatrist I am not, assuredly, but your arrogance still reeks of feelings of inferiority. As far as my friend who traveled, this is not made up. He did travel, and he did find medical school less challenging than he expected it to be. Is he the norm? Nope, and I said that in the first post too, but it is the truth.
As far as finding tables to “prove” to a CEO . . . well frankly I find that whole story doubtful. Why? This is a BLOG. That’s right it is a blog, not a scientific journal, academic research forum, etc. Any CEO in the Medical Field I have ever worked for would laugh someone out their door if they showed up with “proof” of something taken from a forum, such as this, where anyone and everyone who comments can hide behind a level of anonymity (with no offense, again, meant to anyone). You may have been looking for a chart, and you may be on a board at your hospital, but information from this site hardly fits the test of what is needed to become “proof” for any sort of policy decisions (and if your CEO doesn’t see it this way then I assure you your legal department would never let that fly – that would be great for the hospital if someone wanting to sue discovered the “policy decision” was made based on a blog). Sorry, I just don’t buy that explanation. Additionally, if you already have “tons of chart reviews to prove it” then why even look for a chart. Couldn’t devise one yourself or have someone in your Health Information Management office work up a nice infographic? How about contacting the respective professional bodies or accrediting agencies to get accurate information? Nope, you’d rather get that from a blog?!?!?! That’s frankly unbelievable. Sorry, but it is.
A blog wouldn’t even count as a reliable source for high school term paper much less one to be used to effect policy change.
That’s the “LOL” part of your posting.
Joe Carusso M.D. says
Dude, obviously you can’t read very well. I was looking for a table to show an accredited PA school curriculum and maybe a side to side comparison if a school has both programs, and that is how I came across this blog and I was taken back by the posts I saw, I never said I am using information from this or any blog to present, I can easily pull out my curriculum from medical school and create a table myself . I already have the chart reviews and cases I need, the table is just an additional, objective piece of information, it is not hard to find any PA school curriculum online , I don’t need the HIM office for that.
In reality the chart reviews are enough objective evidence to suggest a change in the way the urgent cares are managed and staffed, I just wanted to add more.
If you feel I am arrogant, then by definition aren’t you the one feeling inferior?
Believe me, I have plenty of flaws but an inferiority complex is not one of them.
GeorgiaCatholicPreMed says
I read perfectly well as a matter of fact. Well enough to notice that you originally wrote you were trying to find a chart to convince your CEO to change policy, but now you claim you already had enough information to begin with.
I doubt most of what you’ve said about yourself and background is truthful to be honest.
You speak as though you are knowledgeable elsewhere about medical school admissions, and then act like these things are set in stone. The truth is that there is a lot of debate, and research, currently about what does and doesn’t make a good applicant. MCAT 2015 was just one part of the attempt to make admissions decisions more accurate. For years AdComms had said writing tests on the MCAT were a good predictor, but MCAT 2015 research found this was not the case. Many medical schools are revamping their admissions approaches. Again, appeals to authority as you use them are logical fallacies.
Don’t flatter yourself either. Nothing about you makes me feel inferior. I respond with legitimate data and mention legitimate ongoing debate. You respond only with appeals to your own authority.
Sad.
Joe Carusso M.D. says
I don’t need to lie to prove anything, this is just a blog remember? Appeals to my own authority? please. I am just stating common sense arguments that seem to rub you the wrong way. Why so sensitive?
Sounds to me you are trying really hard to overstate how subjective the Medical School admissions process is for some reason. Is it because you are afraid you are not going to get in or because you already have been rejected and now you are trying to “settle” as a PA?
Good luck to you, dude, sounds like you are going to need it.
clamchow says
Because somebody is posting objective information you do not like, you say they are bashing other professions to make themselves feel better. This is childish. The education of a PA is nothing compared to that of a physician and to say otherwise is silly. PA/NP are still important parts of the medical team but do not delude yourself.
GeorgiaCatholicPreMed says
Not trying to overstate anything, and the screen name I use on here is an old one of mine by the way (so it shouldn’t be used to assume my status in school or not). I’m not afraid of being rejected at all. I simply see the world as it really is – and as AdComms will readily admit it is if you take the time to talk to them directly versus placing them on a pedestal as some sort of god-like perfect figures who are unapproachable. You, on the other hand, apparently see the world through a series of truisms that you have devised for yourself devoid of any logical follow through (eg. “more experience means no mistakes”, “bad charts from some prove bad from all”, etc. – perhaps this last one is an indication of the hiring practices of your hospital). Nor do I believe in “settling” in life (and for that matter if one wants to be a PA then that doesn’t mean they have settled – life simply doesn’t work that way . . . sorry if that offends your elitist position). The greatest threat to our medical system, I firmly believe, are overly arrogant providers who refuse to think logically or scientifically about medicine (look at the trouble quacks like Dr. Oz create for people). If you can’t articulate a point outside of reiterating your “TEN FOLD” statement, then I have reservations about your ability to engage in academic or intellectual pursuits at all (sorry if this offends, but all of your responses have been nothing more than ad hominem attacks on my stated assertions – speaks badly of you if you are in fact really a physician).
Perhaps you don’t engage as much with those in Academic Medicine (or Academics at all) as much as some of us do, but that doesn’t mean that your statements about a provable static, set-in-stone and never changing, admissions formula are any less flawed. However, those of us who do take the time to do such understand that, currently, what does and doesn’t make a good applicant – and then a good physician – is being vigorously debated in places a lot more prestigious than any blog.
Nevermind, however, just present your CEO with the research findings proving what you already expected to find to begin with. If this blog offends you so much, then move along.
For the record, I am not a PA, have not applied to PA school, and will not apply to PA school (not that that matters at all).
GeorgiaCatholicPreMed says
Oh, and lookie here, an article about a prestigious medical school who [gasp] decided to take a good, scientifically-based, look at the curriculum, and procedures, they had used for and modify them towards something that works better. Kind of doesn’t jive with your “everything is set in stone” and “more hours in lecture automatically makes a better provider” approach does it?
Sorry, but this article is about truth not wild speculation to assuage one’s insecurities.
http://uvamagazine.org/articles/adjusting_the_prescription/
Mike says
Oops ! “Misleading” not Miss leading. I don’t know who “Miss” leading is. ha ha!
Stephen Pasquini PA-C says
No worries Mike, your comment was not at all Miss Leading 🙂
Stephen
Mike says
I think it is miss leading for you to put 4-6 years for the education requirement for PA’s. It is required to have a Bachelors degree (4 years) and Masters degree( 2-3 years). So the required time should say 6-7 years rather than 4-6.
Stephen Pasquini PA-C says
Hi Mike,
You are right. In fact, at the time of the initial publication many PA programs were still offering BS degrees. Of course, that has since changed. So I will update the chart. I appreciate you taking the time to point this out and leave feedback!
Warmly,
Stephen
Joanne says
Hi Stephen!
I stumbled upon an interesting question while preparing for an interview: “Should PAs get reimbursed the same as physicians?” I’ve never really thought about this question before as money is not my motivation for choosing my career path. I wanted to hear your perspective on this if you so kindly would.
Thank you,
Joanne
Stephen Pasquini PA-C says
No I don’t think PAs should get reimbursed the same as physicians. One of the most attractive aspects of our profession is that we can provide high quality care at a reduced cost – which in turn promotes greater access to care and helps solve the problem of growing healthcare disparities. Also, we are not MDs for a reason, we have less training and it makes perfect sense that this be reflected in our pay. If we are paid the same as MDs then what would be the incentive to be an MD? It is imperative that we as PAs remain a viable cost effective solution to healthcare moving foreword.
Joe Carusso M.D. says
With the huge difference in training, should PAs and NPs be performing the same level of clinical care as M.D.s? yes NPs and PAs are cost effective but are they equivalent? Any person with common sense that looks at the depth of their knowledge base as well as the TREMENDOUS difference in clinical training during residency will tell you that it is impossible that two health practitioners with such a MASSIVE difference in education and experience can be anywhere close to equivalent, and I have heard plenty of PAs and NPs state that they are just as good as any physician. REALLY????? Just stating the facts.
GeorgiaCatholicPreMed says
To extend your argument to the realm of MD vs MD, one could just as easily state that a Neurosurgeon would be “better prepared” to treat a pediatric patient, regardless of the complaint or issue, simply by virtue of having spent more time in formal education than does the average General Pediatrician. However, neither you nor anyone else would assert that this is accurate. If the child has a neurological issue which can best be treated by surgery then, of course, the child should be placed in the hands of the neurosurgeon (no offense, but I don’t think any of us on here – including you – would want a General Pediatrician performing neurosurgery in their office or elsewhere). However, if the child is not presenting with a neurological complaint, then the neurosurgeon is provably not the best person to treat this patient (regardless of number of hours in formal education – with neurosurgery being a minimum of 7 years post medical school and general pediatrics being 3 years post medical school).
Now, before you or anyone else comes unglued claiming this is “apples and oranges” or some other inaccurate representation of your argument, let me remind you that your entire argument hinges on years of training and experience. Therefore, this response which directly challenges the assumption that a specific number of years in training automatically makes one more prepared than one with less is appropriate to the debate.
If you want to debate the merits of PA vs MD then appealing simply to the false assumption that more hours automatically equals better provider is faulty (and holds up no better here as a logical argument than it would in the neurosurgeon/pediatrician example above).
Joe Carusso M.D. says
I completely disagree, the human body is an incredibly complex organism, a deep understanding of how it works . i.e. anatomy physiology, etc. and disease processes . i.e. pathology, microbiology, etc. Is critical to be a competent clinician. Then at this level compare the training received by M.D.s and mid levels and you will see a massive difference in both depth and volume. You are correct in that I should be more specific in what type of practice we are talking about, my point is about how mid level providers are used theses days as “independent providers a phone call away from a physician” let me be more specific, in the town I live there are several urgent cares in which PAs practice without any supervision and take care of anyone that walks through the door. for all practical purposes the equivalent of a family physician who did at least a 3 year residency, roughly 10,000 hours of hands on clinical training , compare apples and apples and see how that compares to a PA or NP, taking care of primary care patients. Therefore compare both classroom preparation (which is the foundation) plus clinically relevant training for the tasks they are asked to perform, if you compare those two the difference amounts to roughly ten fold.
In case you are wondering how I ended up on this wormhole, I was looking up tables that summarize the difference in clinical training between M.D.s and PAs to present to my hospital CEO, who chose to allow PAs to practice independently on our local urgent care centers, which I completely disagree. This after one of my patients was seen with petechiae and fever by a PA (with 13 years of experience mind you) diagnosed with a viral rash, given a shot of rocephin and sent home. That my friend is a blunder a astronomic proportions, the 4 year old child had Acute Leukemia and almost died, therefore I feel it is my duty to point out dangerous practices that place children at risk. I strongly believe, as this case points out beautifully, that the level or training PAs receive is to be that “Physician Assistants” allowing them to practice as independent primary care providers is both dangerous and irresponsible, unfortunately the economic forces in this country are allowing it to happen everywhere.
GeorgiaCatholicPreMed says
Here again, I understand what you are trying to say, but your manner of doing so is still flawed.
It’s interesting that you bring up Acute Leukemia specifically. Interesting because local to where I am here, the same type of blunder occurred. This one, however, involved an MD Pediatrician making the same flawed diagnosis of viral rash until the child was eventually carried by the parents to the closet pediatric specific hospital. Aside from just illustrating that the same situation can occur regardless of training, it also suggests, at least to me, that the viral rash misdiagnosis is a common one in this type of scenario when a misdiagnosis is made (being unfamiliar with the complete differentials for these two disease states I can only make this assumption based on similar circumstances in the two cases). However, as a realist I would suggest that in both cases the providers – PA or MD – diagnosed what they were most familiar with seeing. Don’t believe this occurs? There is actually a wealth of research data suggesting that regardless of level of training people – and not just health professionals – don’t look for what they aren’t used to finding in a given situation (this probably exists because from an evolutionary standpoint the most common finding – not the least – is what one has to contend with for reproductive success, but I can’t say for certain, of course – which means, of course, the one making the finding not the one suffering from the least seen occurrence).
It’s also interesting that you brought up Urgent Care specifically. I’m not sure if you are aware, but, at least in this area of the country, there is heavy debate over exactly what qualifications anyone should have to be able to “practice” in an Urgent Care. This is, in part, because the patient population they see is not as predictable as some other areas of practice. No one, or at least mostly no one, would suggest that a Family Physician should assume the role of an Ophthalmologist, but in an Urgent Care setting that same Family Physician may be assuming the role of everything from Emergency Physician to Pediatrician to Podiatrist to patient populations they are actual more comfortable treating. This is for the Physician that is competent. Sadly, however, many of these “Urgent Care” facilities – especially the fly-by-night ones that pop up in strip malls here, there, and everywhere – employee providers that couldn’t cut it elsewhere (this is the truth for MD, PA, or NP, and it doesn’t mean everyone who works in one is this way, of course, but it seems to be a type of practice these types of people can flock to). In my personal opinion, Urgent Cares exist mostly to cash in on the person who would otherwise use the ER as their primary care. However, if you don’t have a provider on the up and up enough to recognize when more definitive, perhaps tertiary, care is needed at these places, then people are bound to fall through the cracks (again, regardless of the degree the provider has behind their name). I am aware of several horror stories of Urgent Cares sending those with MIs home with antibiotics and advice to “follow up” with their PCPs only to have them end up going to the hospital later via ambulance with worse outcomes. In most of these cases what should have stuck out as a potential cardiac issue was treated as something along the lines of an infectious disease (again, this was what these providers saw more of). So, in your particular example, I think an Urgent Care would not be the place to take a pediatric patient presenting in the manner in which the patient you mention was presenting (regardless of who the provider at the facility was). Even so, however, things could be, and have been, misdiagnosed even in tertiary care facilities.
So, you might ask, if I agree with you on these issues, then why do I saw your analysis is still flawed? Simply put, you still seem to be drawing a line between more education and only better outcomes. This, however, simply doesn’t work. If that were the case you would never have anyone with higher education ever mess up.
I should also point out that I completely agree that the human body is complex, and to that end I have long advocated for more in depth anatomy and physiology, etc. in mid-level programs (and more actual medical science based classes in many NP programs where social science takes the majority of the credit hours). Nevertheless, I am still able to recognize that simply providing more educational hours does not correlate with only improved outcomes. There is a benefit to more training, and more education, but simply having both doesn’t prevent one from being ill-equipped to handle a job (nor does it mean someone with lesser formal training couldn’t take it upon themselves to acquire more legitimate education – just because some may not doesn’t mean all do not).
I am aware of a pediatrician that gave a mother very bad advice about how to handle their sick child – advice that almost resulted in the death of the child. However, this does not mean that just because the child was eventually diagnosed correctly, and treated correctly, by a subspecialist pediatrician (with more than 3 years of residency as the general pediatrician had completed) that one should then advocate for every pediatric patient to only be seen by subspecialists regardless.
For what its worth, I think there should be over site – as a safety net if you will – for all health providers (MD, PA, NP, OD, DO, DPM, DMD, DDS, DVM, etc.). This is because everyone of these people is capable of making a mistake, and, sadly, everyone of these professions turns out highly “educated” people who are incompetent to actually do the job. But then I don’t avoid all of them because of the few . . .
Joe Carusso M.D. says
the problem with urgent care is that the parent that took the sick child did not know the severity of the illness , assumed it was just a mild viral illness, and so did the PA. It was drilled to us in medical school and residency that fever and petechiae is always an emergency, it is acute medicine 101, I really doubt that a competent pediatrician will miss that.
The other point you are completely missing is the value of residency, every day you have morning report in which several cases are discussed, a resident presents the case and then is cross examined by pediatric sub specialists, general practitioners, pharmacists , radiologists ,etc, tons of valuable teaching happens there every single day, furthermore when residents are on call they initially manage patients with very little supervision (a team of an upper level resident and an intern (first year resident)), then discuss the admission in the morning or later on with the attending. This happens day after day (and night when you are on call) , for 3 years and roughly 10,000 hours. PAs and NPs do not have an equivalent training environment, no to mention the time spent taking care of critically ill patients in NICU and ICU and tons of pediatric subspecialty clinics. My point again if you add up all those direct patient care clinical hours together with all the learning opportunities with very smart and qualified clinical teachers at teaching hospitals you end up with roughly a ten fold difference in preparation between an M.D. and a PA. Suggesting that the difference is not meaningful is laughable , anybody with common sense who looks at the details of the training should see that clearly.
GeorgiaCatholicPreMed says
First, it is simply erroneous to say that an MD Pediatrician would not have ever missed it (my example is not made up the pediatrician who missed the fever and rash was/is a Board-Certified Pediatrician with near 20 years experience). Mistakes happen is my point here (regardless of level of training). Second, I highly doubt that PA students are not told to consider a high fever and petechiae an emergency. In other words, since many PA schools are located at, or affiliated with, medical schools, it seems unlikely that these educational institutions would simply not mention signs of a “true emergency” to students in pediatrics rotations and courses.
As far as the “problem with urgent care” in this situation, and in many others (be the provider MD or PA) is that not only does the family not recognize a potential emergency, or severity, but often the provider does not either. Urgent Cares are, sadly, kind of like ERs used to be before the advent of Emergency Medicine as a specialty (which makes it a good time to point out that I am not a young student – I’ve returned to school later in life). At those times, the “ER Doctor” was often who ever was on call and/or the lowest person on the totem pole (so to speak). This person often had limited ability to recognize true emergencies. Often, in this part of the country, the “ER Doctor” was a local GP who was moonlighting. That is not a good combination. Interestingly enough, some of the local “Urgent Care Doctors” now are Family Physicians who are moonlighting. Urgent Care, in other words, lacks, for the most part, a unified system of training in general (regardless of level of education) making it problematic across the board.
As one “Urgent Care Physician” told me once when I was an EMT, the problem with urgent care is that no one is actually sure what is and isn’t urgent care in many cases. He went on to say that to some it is “just less than an ER” and to others “it is just an after hours family practice”. In my time I have been to “Urgent Cares” that both did, and did not, have defibrillation equipment, but all of which had patients coming in with potential cardiac issues. Again, I see these issues as endemic to the “Urgent Care” environment in general and across the board.
I also want to point out that I am not now, and have not been, arguing that physicians do not have more training than PAs or NPs. Instead, I have argued against the assertion that “more training” can never lead to a bad outcome, bad provider, etc. This is the fallacious part of your argument.
For what it’s worth, I think PAs should have to residency. Why? Medicine is not a “generalized” field anymore if it ever was at all. More and more extra knowledge is needed to make correct decisions. On that, at least, I think we agree. Again, where the disagreement lies is in the assertion that the “ten fold difference” means that PAs could never be competent to treat a patient and/or that physicians could never be incompetent. That, at least to me, seems to be the base of your overall argument. In that, it fails to the appeal to authority fallacy (aside from simply being a non-sequitur).
Personally, I think 3 years for a Primary Care residency for an MD is not long enough. Most physicians I have spoken with say “medical school gives you the science and residency teaches you to be a doctor”. If this is the case, then 3 years to be “leading the crew” seems to be too little (and with newer OSHA mandates on work hours many academic physicians I have spoken with believe residencies are now turning out underqualified physicians, in many cases, compared to what they used to turn out). Some other countries use the “Junior Doctor” approach whereby the graduate physician works as a trainee for several years under supervision before even deciding on what we would think of as a residency.
Regardless, the fact remains that more education does not create some sort of barrier to incompetence. It might make it less likely, but it doesn’t prevent it. That is the illogical, flawed, part of your argument.
Joe Carusso M.D. says
So you think a 3 year residency is not long enough but we are allowing PAs and NPs with minimal training to practice as independent providers all over the place?
I don’t think that is safe at all
GeorgiaCatholicPreMed says
I never said I thought independent practice was best either. I only pointed out that distance practice was, historically, part of the reason for the development of the PA profession. All of the PAs and NPs that I know personally don’t agree with completely independent practice either (not everyone agrees on this I understand).
Again, my issue all along has been that you have basically asserted that more experience, education, etc. means a person can never make a mistake, and less means the person is pretty much guaranteed to make mistakes. That’s the issue I find fault with not with concerns over independent practice.
Mario says
What is the curriculum like for PA’s? How does it compare to medical school? I know their anatomy, etc. is a lot easier than the anatomy in medical school (I know this due to having fellow classmates in med school who were PA’s and I asked them what they thought about med school difficulties vs PA school difficulties), but I never ended up asking them what courses we would take that they wouldn’t take – like where’s the difference in the formal training?
Joe Carusso M.D. says
And there lies the paradox. What is the value of all those hours spend learning detailed anatomy, pathology, histology , pharmacology, etc.? During my first two years of medical school I only took time off to eat and sleep, it was just impossible to keep up otherwise. What is the value of 3 years of residency, being on call and working 35 hour on call shifts every third night taking care of patients. How can PAs and NPs perform similar tasks when their training in both basic sciences as well as clinical experience is so far below M.D.s (around ten times less) look in detail at the classroom hours and clinical hours , it is around a TEN FOLD difference.
Do you think that does not make a difference on the quality of care they provide? You tell me. Is there a decline in the quality of care by substituting physicians with NPs and PAs? If not, should we then do away with medical schools? Fascinating questions.
In my personal opinion, the human body is by far the most complex machine we can ever encounter, I am humbled by it every single day. In this country we are slowly dumbing down the necessary qualifications to provide care for our patients, it can’t be a good trend and it will have serious consequences on the quality of care provided in the long run.
Anybody with common sense that looks at the depth of classroom experience and the sheer number of direct patient contact hours of a Medical Doctor vs a PA or NP can draw the obvious conclusion that the care provided can never be compared, it is not remotely close. Just the humble opinion of a rural pediatrician for what is worth.
Go to Medical School if you can, you won’t regret it.
GeorgiaCatholicPreMed says
I don’t think anyone is arguing that medical schools should be “done away with”, but I also think it is nearsighted to not recognize that – number of years in school being greater or not – primary care is becoming more and more “patient management”. Therefore, it is less attractive to many medical students – although I admire anyone, such as yourself, who has chosen to approach a primary care field despite the fact that student debt is ever on the rise. Nevertheless, if insurance is going to consistently see PCPs as simple “medical managers” then they are going to push for the less expensive provider (no offense meant to anyone here).
Also, there are physicians who do see themselves as less qualified in certain fields than PAs (based on the PA and MD’s respective backgrounds). A couple of years ago, for a personal example, my Grandfather fell cutting his face significantly and dislocating his shoulder. In the ER he was seen by a really nice ER Physician who reduced his should relocation, ordered tests to check for a brain injury, etc. Then, when it was time for stitching, this same physician entered the room with another man he introduced as a PA. The physician told us that the PA would be doing the stitching because, having previously been a surgical assistant, he had “more experience” stitching than the ER physician. The ER physician also said, “he also does a better job of it than I do, and I don’t want you walking out looking like Frankenstein’s monster.” We all laughed.
Now, obviously the ER Physician had more time in medical school than the PA did in PA School (even though the two were about the same age), but, nonetheless, the MD recognized that this PA was better prepared to perform a procedure than he himself was. Is this the case all the time? Most certainly not, but it can be on occasion. Now, suppose this physician had taken the approach that simply by virtue of having spent more time in medical school than this PA did in PA school that he was the one who was better prepared to perform the suturing. My Grandfather may have left that ordeal with an ugly scar versus the nicely healed one he has.
My point being that arrogance has no place in either field, and when one reverts simply to superiority based on arrogance then they set themselves up to make mistakes.
It is also worth pointing out that while you tell Mario to “go to medical school if you can,” Mario, as per his statement about “fellow medical students” in his original comment appears to already be in medical school.
April Smith says
I’m curious. I gave a complicated medical history (Crohn’s, allergies to meds, inflammation still uncontrolled, stenosis at the site if prior surgical bowel resection, inflammation that causes frequent blockages to name a few. As such, do you feel that I may be better suited to have a doctor as opposed to an assistant or practitioner.
My insurance pays the same whether it’s a doctor or not.
I question why insurance would pay the doctor the same as a non-doctor (NP offense intended).
I understand, as a paralegal, that sometimes one may have gained more experience at some things than the actual person with the degree (doctor, attorney, etc.).
But given that I’ve had such trouble, I hesitate to go to anyone other than an MD. That’s not to say that I’m happy with my doc, because I’ve been looking at alternatives for awhile.
The length of the residencies doctors must go through is quite impressive as opposed to a NP or a PA.
Thanks for your reply!
What are your thoughts?
Gwen says
Well, I am a relatively new nurse practitioner. I agree that when you look at the clinical training of a nurse practitioner it looks minimal on the surface, however, most nurse practitioners have years of nursing experience prior to completing a master’s degree. Personally, I worked as a nurse while going to school for the last 10 years–ASN/BSN/Masters (and prior to that had a bachelor’s degree). So, I had about 1000 hours of clinicals, but I also worked in an ICU for 4 years (one on one with the critical care physicians) who are very respectful of the nurses. For example, in the morning I would make a plan for my patients and present it to the physicans who stopped by. We titrated drips, helped with procedures, called physicians when our patients were worsening. That was our job, FYI, to keep patients alive…the physicians are not at the bedside. Experienced nurses actually take care of the problems and just tell the docs what they did (then the docs put the orders in). Before my ICU experience, I worked on a medical floor and in an emergency department. As a new NP, I’ve had to learn more about diagnosing outpatient issues (rashes, colds), but I get the same experience as an NP, as I would if I worked under an attending that a resident physician would get. We work together. It doesn’t have to be a situation where we have to be disparaging to each other. I have had excellent physicians teach me, and they have been so kind. Personally, I think Nurse Practitioners or PA’s should have the opportunity to challenge the medicine boards after 5 years of practice. That would be an objective measure of our knowledge. We have physicians in this country who went to medical school from all over the world. We judge them based on test scores too, because, lets be honest…how likely is it that all medical schools all over the world are high quality? Same for NP schools. The people who work the hardest and learn the most should be able to practice with the most autonomy. In my opinion
Joe Carusso M.D. says
Are you kidding me?? have NPs and PAs try to pass the USMLEs and see how many make it? Or just the MCAT . How about a medical school level Anatomy and Physiology course with cadaver disection. It would be a slaughter. If I have to guess I would say about a 10% passing rate at best.
GeorgiaCatholicPreMed says
Ah, but there’s the rub isn’t Joe? In medicine, as in all science, we don’t base statements on “guesses”. You guess 10%, someone else guesses 20%, and another 5%, etc. Who is right? We don’t know unless we do the research to arrive at the data. To the best of my knowledge there has been no controlled study in which PAs and NPs regardless of time spent working have been tested using the USMLEs. Therefore, you can’t empirically make the statement they would do worse.
As far as the MCAT goes, several PA schools will also accept the MCAT, so I would assume that at least some of this applicant pool have taken the MCAT (and there is research to suggest that standardized tests such as this are not the best indicator of one’s ability to handle a profession).
Likewise, several PA programs have cadaver dissection, and I am even familiar of at least one Associate’s Degree granting institution in Alabama where non-professional students can apply for, and compete to be accepted, to take a human cadaver dissection gross anatomy class (and they aren’t medical students either – gasp). Nevertheless, you can’t say with any certainty that PA students, NP students, or anyone else for that matter would be “slaughtered” by “medical school level anatomy”. I would assume based on this statement of yours that you found these classes to be difficult (and there is nothing wrong with that), but that doesn’t mean everyone else would experience the same level of difficulty in the class as you did.
Ultimately, your response here makes unsubstantiated, off the cuff, claims, that appear to be based more in your experience with medical school than in any sort of research into the issue. One could just as well state that General Pediatricians (such as yourself) would be “slaughtered” should they try to complete a “more rigorous” residency such as say cardiothoracic surgery. However, this, as with your statement, would simply be fallacious. While there are most certainly some of your fellow pediatricians who decided on the field because they felt other fields would be too hard (or perhaps because they lacked the aptitude and ability to pursue a certain other field), this by no means all of them are this way.
Again, arrogance leads to mistakes. Approach the issue with more reasoned, and less knee jerk offensive, responses.
Joe Carusso M.D. says
Just look at the facts, compare the training received by M.D.s and mid level providers, hour per hour, class per class across the board. After reviewing that , it is laughable to assume that it does not make a difference.
For what is worth, all and I mean ALL, 100% , of the PAs and NPs I know applied to medical school and did not get in. Draw your own conclusions . No arrogance on that statement, just a fact.
GeorgiaCatholicPreMed says
That statistic, unfortunately, says more about AdComm decisions of who is and is not qualified to apply to professional school than it does ability to practice medicine. I’ve had more than one member of an Admissions Committee tell me that they see PAs and NPs who subsequently apply to medical school, often, as someone who thinks that obtaining the higher level training will “improve” their own feelings of self worth or image in society (don’t blame the messenger here for this – not saying I agree with this). Others have told me that those who attempt to leave “needed” medical fields for medical school are also often looked at less than favorably. One person even said “this gives the impression that the applicant wasn’t sure what they really wanted to do when they applied the first time for their career, and what would happen if they did this again with medical school”. Even though this is not the job of Medical School Admissions Committees, many of them see their job as admitting those who can serve the longest in the field (but people like Sanjay Gupta and Michael Crichton prove that not everyone who makes it into medical school is going to stay in clinical practice).
For what it’s worth, I actually know of 2 PAs who are now MDs, one NP with now an MD, one who is in medical school now, and Biomedical Engineer who is now a Spine Surgeon. I also know a guy who got into medical school, on his first attempt, just because he took up a dare from a friend – who was also applying to medical school – to take the MCAT and apply (the friend making the dare didn’t get in that application cycle although he did later).
My point being that AdComms are extremely subjective in their decisions. While there are some objective factors that play a role, the final decision is subjective. To assert that a subjective decision proves an objective fact is also problematic and fallacious.
Joe Carusso M.D. says
Whaaaaaat? You are questioning the wisdom of the physicians on admission committees all across the country? and you truly believe that after years of doing it medical schools don’t have very effective and objective measures to predict a candidate’s likelihood of success in Medicine? You are going off the deep end buddy!! You completely lost the little credibility you had left.
Please, please ask your PA friends and NP friend who are now MDs to tell you the difference in their level of training and preparedness to be a successful healthcare provider.
GeorgiaCatholicPreMed says
Not of the deep end at all.
A study conduct in the 1980s found that quite a few of the AdComms at certain schools were asking leading questions to applicants to determine whether or not they thought the applicants were religious, and, if so, were discussing ways to avoid admitting those applicants regardless of academic ability or other objective measures. That’s one things. For another, schools such as the University of Virginia have conducted studies showing that traditional “pre-medical” preparation might not actually be a good indicator of an applicants ability to study and successfully practice medicine. To that end, UVa removed all course prerequisites from their admissions decisions. By their own admission, most of their admissions decisions are based on a subjective assessment of the applicant pool.
I am a biologist, and, as such, a scientist. In real science we don’t place a person, or their decisions, upon a pedestal simply because they have obtained a certain title, rank, or years of experience. It is a logical fallacy to do so. AdComms are humans, same as every other human, if you truly believe that they might never make a decision based on subjectivity – regardless of years in the job – then you’re delusional.
None of the stories I have relayed to you are made up. I spend a lot of time talking to other professionals, and I talk openly with them about the realities of their jobs. My credibility is not threatened simply because some self-proclaimed internet doctor – who is now also on a board a hospital – says it is.
Joe Carusso M.D. says
you are making a blanket statement that most AdComms are extremely subjective in their decisions, so you are a Medical school admission criteria expert? these institutions have been around for decades and I guarantee you a lot of very capable people, ( physicians, administrators, researchers) have looked at objective measures to predict the success of candidates and have lots of objective data that has been analyzed over the years to optimize the entire process, it is not in their best interest to admit people that are going to flunk out or not perform well, especially when they have lots of students to choose from. Your credibility is not threatened by me, but by your own comments.
DBH says
You must not know many PAs and NPs if all of them you know applied to Medical School and didn’t get in….Particularly NPs…I can say for sure that most NPs never apply to medical school. My wife knocked out all Pre-Med requirements while studying for her BSN, graduated with a 3.9, scored a 40 on the MCAT and ultimately chose not to apply to Med School because she wanted to provide affordable high quality care and she wouldn’t be able to do that as an MD (the affordable part). Prior to starting NP school she had over 7K clinical hours of patient care as a nurse (which counts for something…especially if we consider that she saved MDs butts on more than a few occasions). She attended Duke University for her DNP FNP where she added another 3 years of school and nearly 1K clinical hours (700+ Primary Care and 200+ for a cardiac specialty). For the three years following this she received another 6,000 hours under the direct supervision of a family Physician. So before she ever started practicing completely independently she had 7 years of formal education and 13K clinical hours of diverse patient care. The books they use in FNP school were the exact same books you use in MD school for like subjects such as Pathophysiology, Health Assessment, etc…. We all know that MDs misdiagnosing is not uncommon and generally it has nothing to do with education or experience. More often than not it comes down to human behavior/psychology. I’m sure it’s the same reason for the misdiagnosis in the PA scenario you bring up. Regarding the Fever/Petechiae scenario… I just asked my wife off the cuff what she would do with a patient presenting fever and petechiae. She said there were a number of things that could cause it ranging from viral, bacterial, meningococcal, ITP and leukaemia. She said if there appeared to be a mechanical cause for the petechiae she would treat and review in 12 to 24 hours. If there did not appear to be a mechanical cause then she would run the appropriate labs to test for things such as ITP, leukaemia, etc.. She said this is very basic and identifying the potential underlying issues that could cause fever/petechiae was something she was trained on in her undergraduate education (likely well before most MDs would provide any kind of patient care in a clinical setting).
Keen says
I have a little over 20 years as a PA in family practice, emergency medicine and internal medicine. I’d never though of taking MCATs or USMLEs until I read the posts by Dr. Carusso. Not that this would count necessarily as a real world test, but so far of the 100 MCAT practice questions and the 60 or so MSLE practice questions I’ve found online I’m batting at 95%. I haven’t set foot in a formal classroom in 19 years or so. Guess my pre PA school education wasn’t really that bad afterall, and I also guess that getting into med school might not be as hard as some might imagine.
GeorgiaCatholicPreMed says
I noticed Carusso (cause, seriously, I highly the person posting under that name is really a physician or doctor of any type) never responded.
As a scientist myself, I get upset at people like Carusso who rush tossing around unsubstantiated claims like they are empirical evidence. It, at the least, suggests poor undergraduate and professional training in the scientific process if, again, they are really medical professionals (which I doubt).
The entirety of his responses are nothing more than ad hominem attacks against others, and an almost religious zeal for physician = perfection (which no real physician I know would ever claim they have achieved).
More than likely he’s a disgruntled, failed medical student, who thinks that what ever he is really doing in his career/life is inferior to others (which, again, is very sad).
Like you, DBH, I have never, personally, worked with PA or NP who went into those fields because they couldn’t get into medical school. PA and NP school (and RN school before NP in this case) are also highly competitive. If a person is a bad applicant for one, then they are usually a bad applicant for others. There might be some people who have come from this background to the PA or NP career, but I doubt they got rejected from medical school this application cycle and then got accepted to PA/NP school without any problems the very next application cycle (without doing something substantial to improve their “look” to AdComms – PA, NP, or Med School).
Tell your wife I said I highly admire people like her who have decided to work with the underserved. It is not easy, I’m sure, but it is certainly needed.
Megan Medical Student says
I would understand where your are coming from in saying you should be allowed a chance to take the medical boards. Knowledge wise the exam would judge your understanding of medicine. But, there are two sets of boards one basic science and one clinical. You would have to pass both. In addition to this, I would not believe a NP nor PA would be ready to take on the role of MD unless they had completed a traditional residency program. (Yes, you might argue but I’ve had 10,000+ clinical hours, and my argument back is there are very few experiences that can replace the depth and challenge of residency.) There are many reasons people choose to become a NP or PA. I believe one of them is to avoid the years of training MDs must undergo. It would not be fair for a NP or PA to simply pass the boards, receive the title MD, and then be able to receive the same responsibilities and salary. If you would be willing to donate 3-5+ years of your life to 80 hours a week where you would be barraged with this and that and your attending would be breathing down your neck.. Maybe we could talk then. (Also, honestly who would do this? Become a NP or PA (most likely have other life responsibilities like a family, position in the community, etc.) and then decide hey, guess what family I will not see you for the next 3+ years… doubtful) Yes, MDs do this, but our families, friends and outside commitments are all aware of this from day one and we make a lot of sacrifices. Still, this is just not the best idea. What would be the incentive to become a MD the traditional way then?
GeorgiaCatholicPreMed says
There are probably some people that apply to PA/NP schools because they are looking for a “quicker route”, but I highly doubt many of these actually matriculate (some probably do but not the majority). PA and NP school applications have skyrocketed over the years. Just like in medicine (human or veterinary) these schools are in a buyer’s market – they are the buyers and the huge number of applicants are the sellers. None of these programs have to scrape the bottom of the barrel to fill seats (and if they are doing this then they are probably for-profit schools outside the US in places like the Caribbean – which is not meant as a slam to anyone that has graduated from one of these, but let’s get real many of them, especially the fly by night ones, are basically looking for a pulse in order to admit).
To me at least (and no offense meant) the “quicker route” approach implies a level of laziness or at least a lesser drive. If those people have it with their career ambitions, then they probably did with their undergraduate preparation too. In other words, they probably don’t have the grades, GRE schools, etc. that AdComms are looking for anywhere (PA, NP, or MD/DO).
For what its worth, I also don’t personally know any PAs or NPs (and I know quite a few) who would really want to be an MD either. As you mention, several of them mention the “extra time” they have had for family, outside life, etc. as the reason they are happy where they are. You would get some who would try to game the system if “testing in” were allowed, but not many I don’t think (and the ones that would see this as an “easy” route wouldn’t make it anyway).
Ultimately, “test exempting” education of this type is a bad idea, and the same would go if an RN with 20 years experience wanted to just “test exempt” NP school, for example. There is more to school, as you say, than just grades and “passing tests”. Then again, if the USMLE was offered to NPs and PAs for access to getting an MD why not other people? What about PharmDs, DPTs, ODs, etc.? None of this would be a good idea at all (and it is an erroneous way to think about “proving” ability to work at a level anyway, I think). I think you would agree that the USMLEs – and other such professional tests – are not the “proving ground” for these professions. Instead, they are one more step in the proving that has been going on, and will continue to go on, before and after the test. A person has “proven” their ability to be able to take the test before they ever are allowed to do so. The tests might “prove” the person is not prepared, but that doesn’t necessarily work in reverse.
Anyway, my main reason for writing was simply to point out that the “quicker route” idea gets a lot of mileage on the boards, etc., but I doubt those people make up a significant portion of the applicant pool much less the profession. A university local to me here currently has over 800 “pre-nursing majors” (and counting), but they only admit around 80 people a year to the professional phase (and they accept outside applications too). The average “coursework” before starting nursing school that I student has there is 3 and a half to 4 years (that means they graduate from nursing school after having been in school for 5 and a half to 6 years already which hardly makes this a “quicker route” at all).
Stephen Pasquini PA-C says
I agree 100%!
Stephen
Nancy says
I’m surprised by the list a abilities for PAs. I do assist my collaborating physician on occasion but I do all my own surgeries for my patients. My collaborating physician is available for any consultation at any time if I need his assistance. It lists some tasks as only assist but I practice alone under the scope of practice he created based on his assessment of my abilities. I hold a 4 year Bachelor’s degree and then went to PA school after prerequisite classes to receive a Master’s degree and the fastest that could be accomplished was 7 years but yet it states 4-6 years. All the NPs I know do all of that in 5 years yet is says 6-8. They are “transitioning” to a doctorate but PAs have to go back to school for no less than 3 years full time to earn a Doctorate. NPs must have a great lobbyist on their side.
Stephen Pasquini PA-C says
I think the NPs are helped by their strong union. In my opinion a doctorate degree as an NP or PA make little sense, what should a patient call us then? Doctor? There are many 3+2 programs that allow students to graduate with a PA degree in 5 years and there are similar degree programs for NPs as well I presume. Still not sure how I feel about this fast-track into practice, but from an economic perspective it makes quite a bit of sense. Thanks so much for sharing your insights!!
Stephen
Malcolm says
Hi,
Just letting you know, Nurse Practitioners also have residencies/fellowships as an option (1-2 years), particularly in specialty fields. Also, many PA fellowships/residencies allow nurse practitioner applicants, just have to read each program’s requirements on which NP specialty/population focus are eligible. (Typically they require an FNP, family nurse practitioner since they provide for all ages and populations with acute and chronic conditions). ]
Emergency Medicine Specialty
http://aaenp-natl.org/Fellowship_Programs
Other Specialities (e.g. primary care, urgent care, oncology etc.)
http://www.graduatenursingedu.org/nurse-practitioner-residency-programs/
There’s more out there, just have to google it.
Wish everyone the best of luck in your career-choice!
Stephen Pasquini PA-C says
Hi Malcolm,
Thanks so much for sharing your knowledge and resources!
Stephen
medicgoingnp says
I appreciate this chart so much! I have been deliberating between the NP and PA routes and this helps a great deal.
I have been a Paramedic for eight years, who is currently filling in prerequisites for a Paramedic-BSN program. Eventually, I will go the NP route, once I have been an RN for a bit. I would like to become a PA, as I am accustomed to being taught by physicians (all of our CMEs were taught by our medical director or guest speakers selected by him – also physicians). However, there are no PA programs that allow you to work while you are in school. I understand their reasoning, PA school sounds extremely difficult. I am an older student, though. I cannot afford not to work.
Thanks again!
RWF says
I suggest you avoid the bridge programs. I am also a paramedic and was in this situation of wanting to expand into nursing. I choose a traditional nursing program. I know three very smart paramedics who have all failed at the paramedic to RN bridge. I am currently an NP student as well. Do yourself a favor and enroll in a standard RN program. Good luck!
Stephen Pasquini PA-C says
Thanks for the advice!
Joanne says
What are the differences between the “Nursing Model” and the “Physician Model?” Is the teaching approach significantly different? Is the training different? Are the clinical rotations different between the two models?
Stephen Pasquini PA-C says
Hi Joanne the nursing model and the “physician” or “medical model” are probably best distinguished by the medical model’s particular attention to diagnosis and treatment. While the nursing model does include diagnosis and treatment along with pathophysiology and an understanding of disease processes. it’s concern is on the needs of caring for the patient (and everything that this encompasses). Obviously, there is some overlap here and advanced practice nurses are trained to be diagnosticians. But, at the core of the nursing and physician model is the need for them to fulfill two completely different roles, with the medical model being more diagnosis and management focused.
Skaiye Finney says
Hello,
Between an NP and an MD, which do you think has a stronger relationship with the patient? My major dilemma as an undergrad nursing major is knowing which one I want and not wanting to limit myself if the NP route is not challenging enough. What else should I consider?
Skaiye Finney says
Hello,
Between an NP and an MD, which do you think has a stronger relationship with the patient? My major dilemma as an undergrad nursing major is knowing which one I want and not wanting to limit myself if the NP route is not challenging enough. What else should I consider? I am in the biggest fork of my life at the moment.