Medical Profession Comparison Chart:
Medical Assistant vs. Nurse vs. Nurse Practitioner vs. Physician Assistant vs. Family Practice Physician (updated 3rd February 2023)
*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 | $38,190 | $82,750 (varies significantly by state) | $118,040 | $117,381 | $231,500 |
| Independent Practitioner | No | No | 18 states allow NPs to practice independently | Not yet | Yes |
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Do note there is no such thing as a doctor of osteopathy. The DO degree is doctor of osteopathic medicine, not to be confused with undergraduate and master’s degrees in osteopathy in some other countries. Very big and important distinction.
Hi John, thank you so much for clarifying this. I would reckon the majority of the public including most healthcare practitioners are not aware of this distinction.
Stephen
Great chart to look at all the different routes in healthcare. If I could add something, however, I believe the “total post high school education” for physician is missing the years of residency/fellowship training, which are considered “graduate medical education”. Here’s my math: 4yrs undergraduate + 4 yrs medical school + 3-7 residency/fellowship training = 11-15 yrs total education. The vast majority of physicians complete a residency in order to practice any type of clinical medicine, and residencies are required to become board certified in any field. Anyways, just some thoughts. Great article!
Great article! I’m an NP student and appreciate this dialogue. I love the PAs I know and enjoy the diversity that we bring to the profession as we work together. I’d like to add that I believe there are now 22 states + District of Columbia and Guam that allow NPs to practice to the full extent of their education independently. Thanks!
I’d like to add on my fellow NP’s commentary that there are also
1. More hours in classroom time
2. More time in clinical hours (you have to go back to where nurses start, which are many many many hours ahead of PA’s- these are facts, not judgement)
3. NP’s AND RN’s have optional residency’s, too, Mr. Pascquini, and this is well known.
4. According to state and the NP’s certifications (say….dermatology), an NP can perform office procedures under surgical codes.
5. We have to think, if post-HS education is 6-8 yrs for NP’s and 6-7 for PA’s, there most definitely is more clinic/education hours, naturally.
6. The IOM has determined NP’s as the answer to the lack of practitioners in primary care, not PA’s. There’s a reason.
And the reward goes to …..
No need to ‘one up’ the PA profession, we are all here to serve a good purpose and do what we love . What we don’t need are egotistical providers that damper the healthcare profession.
Excuse me, “Tonya Cumbest-Greer”, but your judgemental onslaught of PAs was extremely inappropriate. We are not here to compare ourselves to others (which ultimately leads to prejudices and judgements). Furthermore, most of the information you gave was incorrect. As an MD I do not sincerely believe that NPs will be the solution for physician shortages. PAs can give prescriptions (with overseeing physician approval, of course), and NPs cannot. I am not normally one to comment, but your judgments were infuriating and they defeat the purpose of why we all serve society. Stop being a bitter asshole, you’re wearing it on your sleeve and are not hiding it from anyone. Glad (for your sake) that you and that bad attitude do not work for me. Stay positive everyone, and remember why we all do it!! Each and every one of you has a role in saving lives. Do not let bitter people like Tonya dampen your spirits! Do what your heart desires. Time to get back to work now. Wishing I was a PA…
you’re awesome.
NPs can prescribe, and they can do so in many states without physician oversight. Not sure where your information is coming from. As evidenced by your response, YOUR comments “defeat the purpose of why we all serve society.”
Although Tonya may have presented a bias in her opinion towards/for NPs, she did so at least somewhat professionally. You have clearly taken a more aggressive, “bitter asshole” approach in minimizing NPs and their value as seen by the IOM. Might I mention that you being an MD gives your opinion on broad matters like physician shortages little to no value, whereas the IOM is literally a committee of experts who have looked deeply into the situation, possible solutions, the cost-benefit analysis of such solutions, so for you to put your two cents in about the matter is moot (and your opinion is likely not evidence-based).
Anyway, all of these professions, MDs, NPs, and PAs serve an incredible higher purpose to better society. They all have their pros and cons. I hope you control your emotions in the future, so as to not tarnish your profession. I really do respect all of the professions. I am sure you do, too. I hope your actions/words reflect that in the future.
M., RN, NP student:
It’s evident from your message to “John Crowley, M.D.” that your bs meter clearly is in tip-top condition. Hopefully you’re just as outspoken on the job as you are on the Web, although I certainly wouldn’t blame you if you decided to bite your tongue instead—you know, in the interest of keeping your job and all. (Lord knows that many professionals—not just docs (but especially docs!)—can’t handle being challenged by those they “outrank.”)
Good luck with your NP studies; I’m sure you’ll be a star!
Completely biased publication and shame on whoever allowed this garbage to be published. There are many patient’s looking to be evidence-based educated regarding education and experience between the different types of providers. It’s crap like this that is is damaging and misleading to all professions.
FYI- EVIDENCE BASED RESEARCH shows NP’s have 7 years more clinical experience than PA’s or physicians prior to graduate school. So as PA and physicians are gaining clinical experience in school NP’s are expanding on their professional expertise. If publishing garbage to inflate an assistant position, then continue an education that will let you be an independent provider.
Of all the nurse practitioner students I have known, they have all been able to work full time and at the very least part time as well paid RN’s while in the first year of NP school.
PA students? yeah, lucky if you can work 6 hours for the weekend at the college library……..
Sorry, but that’s the truth.
Yep Lain you’re right, and that would only work if they let me study during those 6 hours. 🙂
Stephen
That’s because Nurses going to NP are building on their already established medical career. Many nursing students are unable to work while going through nursing school. Nurses going to NP are taking a step up not learning from square one.
As a PA for 10 years, I will say and say firmly, that until the lame term “Assistant” is taken out of our title, we will never get the autonomy or respect we fight for.
Sorry, it’s all about that stupid name. Could they have entitled our profession any more lamer?? Seriously lame.
Nice chart, but very poor actual education description. Why is it that these charts talk about education in years and not college graduate hours. If you want specifics, look at Emory and Duke. Both have PA and NP programs, both require BS degree to enter programs. If I am reading correctly, neither require experience as RN for NP, Duke requires 1000 and Emory 2000 hrs prior healthcare for PA. (I have a family member who started one of those NP programs direct entry, no RN experience, they originally had planned PA but couldn’t get good enough science grades). Now Really compare, gaduate hours for both Emory and Duke are on average 50 for NP and 115 for PA. Stop with the years example on your chart, use actual numbers!. NP will gladly say their programs are longer than PA, because so many are part time, but how many charts actually show the average 50 graduate hours vs 115? If you look closely, one of the schools even say the average PA has over 10,000 healthcare hours.
There are PA programs that require very little experience and even more NP programs that require very little experience. So look at actual program requirements.
Hi Janet,
The most basic question that prospective students ask is ‘How long will it take to get this degree? “,” How long will I be in school?” or” How long and how much money will it take me to finish?” Prospective students best understand this in terms of’ months and years, not how many graduate hours it takes to finish, although that is good information. He’s just keeping things simple. He should keep the years of education. It’s helpful. If he did not, individuals will be doing math trying to see how long is a 1000 graduate hours are or look elsewhere for the info in terms of years to months.
Sonja, PA-C
What is the proper form of address for a PA-C —
— as contrasted to “Doctor” for a MD
Same question for a CNRP
Thank you
Hi Mike, honestly what I always tell my patients is just to call me by my first name. “PA Steve” sounds weird as does “PA Pasquini” 🙂 When they say who their primary care provider they should say I see Stephen Pasquini at blank and blank medical center. They may follow that up with “He is a PA.” The kids just call me Stephen. Lots of patients call me doctor, and I will always correct them. Some patients will continue to do this no matter what I say and in those cases, I just throw in the towel!
Stephen
This information is really great!
I’m a male nurse with a BSN from the most widely-regarded nursing program in my state, and my wife is a PA. I walked with her through her PA school and clinical rotations. We had just 1 to 2 hours a day together during her 12 months of classroom training, with one day on the weekends, and that was with a new baby and her trying to make time to be at home. She actually studied less and allowed herself more sleep than nearly all of her classmates. Oh, and PA school is very competitive—only 2% of applicants were accepted into her class, and that’s pretty much the norm. You can’t waltz into PA school like nurses can into ANP programs.
As a nurse, I was initially planning to attend an ANP program. Then I virtually lived through PA school with my wife and saw how incredibly well-trained they were, and had that to directly contrast with my nursing friends going through their bulls*** ANP programs, somehow able to work fulltime jobs and party on the weekends while taking “online classes” to become practitioners. I drive by billboards on the highway touting ANP programs that you can take with mostly online classes, and I want to throw up. This is the kind of training that is supposed to be sufficient for managing dangerous medications and saving people’s lives? This is supposed to be “about the same” as PA training?
I’m a nurse, and I’m telling you other nurses and nurse practitioners, silence yourselves until you’ve looked beyond your ignorant bubbles. There are 3 million nurses in the United States, lobbying power is on OUR side as nurses, and that’s not a healthy thing for the public’s best interests. I know half a dozen nurses in my area who have graduated with a BSN in their early 20’s, worked just one or two years, then immediately started a mostly-online ANP program. I still can’t get over it, online training for an advanced practitioner, are you kidding me? My wife had cadaver lab; you can’t get that online.
Every time a nurse says to me about my PA wife, “Was she a nurse first?” I want to slap that nurse in the face. I’ve encountered so many arrogant nurses thinking their clinical experience is somehow remotely similar to a doctor’s. A doctor spends his day diagnosing, treating, prescribing, making treatment plans, reviewing labs and making significant medical decisions for patients. Big, potentially-life altering decisions, all day. Nurses follow those orders all day. They pass out pills that they do NOT prescribe or dose or critically consider, answer call lights, transfer patients, wipe butts, act as patient and family advocates, assist in codes, and if they’re in the tiny percentage of nurses that work in the ER or ICU, they might have some very small amount of autonomy. And occasionally, a nurse might assist the doctor by catching an error that the doctor missed in making their 1,000 medical decisions for the day. Nurses spend their days carrying out nursing tasks. Those tasks are, 95% of the time, not in any freaking shape or form a substitute or “preparation” for being a provider.
So here is an example of clinical experience that is far superior to nursing in preparing one to becoming a provider: A scribe. That’s right, a scribe, which requires just a high school diploma.
My wife was a scribe for 2 years at a pediatric clinic, albeit instead of a high school diploma she had a bachelor’s degree and had taken all pre-med classes. There was another scribe at the clinic who only had a high school diploma. Being a scribe, my wife went into every single patient room with the pediatricians, and was in on every visit. I worked at the same clinic as a nurse. We would both come home, again, same clinic, same hours, and at the end of the day, she would teach ME, the nurse, what medications were best for what condition or mg/kg guidelines for amoxicillin. She could go on and on about this stuff, because she literally was learning from physicians and rounding with them all day. It made me a little peeved, because my pride was at stake. But that’s the reality. I was giving vaccinations, that I didn’t have to dose or think about, or sending medications home that I didn’t prescribe, or administering breathing treatments that I hadn’t had to compare to other treatment options; my job was to carry out orders, not critically decide which orders were best to give. I worked at that clinic for one year and loved it, and sure, I passively learned a lot and actively pursued learning a lot, but at the end of my time there, my wife still knew way more than I did as a result of being a scribe.
As nurses, we do not prescribe, or diagnose, or spend 8-12 hours a day thinking about this stuff. If a nurse happens to know a lot about a subject, or studies extensively in their off-hours like I did when I worked ICU, that’s wonderful and we should get gold stars for our efforts, but at the end of the day, that’s not our practice. One cannot assume that nursing experience equals “great preparation to be a practitioner,” because for the majority of what we do, it is not preparation at all.
I learned and relearned dosages for Propofol, Fentanyl, Versed and many other drugs while working in an ICU, so that I could look at a patient’s weight and immediately know the correct dose they theoretically should get. It felt good, it was an ego booster. I would go in to an RSI with the drugs, and tell my buddy nurses the dose I expected the Doc to order, and a lot of times I got it right. But I never actually made the decision myself, because I’m a nurse and never expected or allowed to make that call. So when I stopped thinking about that stuff, I forgot it; it had no relevance to my real job, which is being a nurse.
Finally, don’t even get me started on PA versus Nurse Practitioner in terms of their bachelor’s preparation. Let’s just say as a nurse with a BSN, if I wanted to go the PA route, I would have to go back to school and take SEVEN MORE CLASSES, nearly all in the science department, to be allowed to apply to PA school. It’s the same for medical school. But if I wanted to join an ANP program, I could immediately start that ANP program—in my pajamas. ANP’s have way less science background than PA’s.
PA training is leagues beyond NP training, hands down. Legislation is screwed up to allow NP’s more autonomy, and that’s because of politics, not what’s in the best interests of patients.
As a nurse, I wouldn’t say all this negative stuff about my own profession if it weren’t that I’m nauseated by the sheer idiocy I hear regurgitated in my ranks of fellow nurses. Nurses need a humility check, and they’re not getting it from anyone because there are 3 million of them in the US bossing their way around.
ANP and PA should not be given autonomy. They should always be under the supervision of medical doctors . And by the way, though nurses do not prescribe medications and treatments until they become NP, nurses are always critical to providers orders because their licenses are on the line when they carry out those orders.
There are good and bad programs in both NP and PA schools. To discredit all Nurse Practitioners due to your perception that all nurse practitioner programs are all online and are easy is inaccurate and unfair. I am a current NP student at a major university in the west and would put my program up against any PA or NP program in the Nation (no online classes). At the end of the day, both PAs and NPs have the same goal, providing care for our patients. I have nothing but respect for PAs.
The reason NP’s have a strong voice is that they provide excellent care for their patients. A recent systematic review studying the effect of Nurse Practitioners showed no significant differences (p < 0.05) between effectiveness of care of adults by emergency nurse practitioners and junior doctors. It also demonstrated that Nurse Practitioner-provided primary care had decreased length of stay, decreased time to being seen, increased patient satisfaction, and fewer preventable hospitalizations. Nurse Practitioners are competent care providers.
Jennings, N., Clifford, S., Fox, A., O’Connell, J. and Gardner, G. (2015). The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: A systematic review. International Journal of Nursing Studies, 52(1), pp.421-435.
Dan, I agree. NPs and PAs have the same goal, to provide excellent care for their patients. In addition to your clarification that all NP programs aren’t online, I would like to say that all PAs programs aren’t brick-and-mortar. Also, just because a program is online doesn’t mean that it doesn’t provide and excellent education for the students that attend. I’m sure there are online programs for NPs and PAs that are just as rigorous as any brick-and-mortar program. Personally, I don’t really care for online classes but I can’t argue with results. The research has shown that web-based classes not only are effective in teaching the content, but also enhance the student’s ability to navigate a computer-based program which may come in handy in their future. They also help deliver an education to a variety of people with different learning styles and in different locations.
John,
I don’t know who you are referring about when you say that people can “waltz through NP school” and “party on the weekends” but I worked my tail off in NP school and I had 27 years of nursing experience under my belt before becoming an NP. You see, one has to make Satisfactory Academic Progress in order to continue with the program or you are out on your ear. This means that any grade less than a 3.0 *on a single assignment* means an F and you are asked to leave. As for NPs having a way less scientific background, shortly after getting my MSN, I completed a second masters in Pharmacology and Toxicology (and believe me, that was a much easier program than my NP). If you are telling us that you “give meds without thinking about them” and your job was “just to carry out orders” then you have a serious practice problem, and maybe that’s the real reason why you are so bitter about the nursing profession- you couldn’t get into an NP program, or you would have graduated already.
Thank you for this.
In hindsight, this is long, but if you are at a major dilemma, maybe something I saw from my own experience will be worth reading it all.
To all of those considering their options, you have truly know what type of medicine you happy and how you want to serve in medicine.
If you love emergency type of medicine – fast paced, on your toes, stress, longer hours, etc., then Western medicine is for you. PA, MD, doesn’t really matter. The same can be said about surgery.
If you want to actually heal people from the deepest levels at the root cause of their imbalance, then Western medicine isn’t for you. I am a PA and have been for 20 years. I left after 14 years and got a doctorate in natural medicine and Masters in Chinese medine and acupuncture. Despite the false propaganda espoused by the media and shills like Steven Novella, the medicine does work. And why wouldn’t it? It is befuddling at how people are surprised when holistic medicine works, as though something that came from the ground heals an organism that also came from the ground, or God, or a combination of both however you wish to perceive your existence.
I think it is important to expand on this because people are brainwashed with false propoganda. Do yourself a favor and look up Dr. Dick Thom or Dr. James Sensenig and listen to them speak. Look up Dr. Zhu scalp acupuncture and watch him heal people who have hemi paralysis after a stroke, and how he gets them to begin moving within hours of their initial treatment. But despite this, these egomaniacal people like Dr. Steven Novella attempt to discredit this powerful medicine.
I currently work in a pain clinic filling the role of a PA. I utilized my other knowledge to enhance the outcome of patients. Some patients who see me have failed all injection therapy and others have failed surgery. I help some, and some I don’t. No one medicine will help everyone. But I can say with certainty that Western medicine can never restore balance with a toxic pharmaceutical that all have side effects, whether seen or not.
The main reason I like pain management is because 1. I can use acupuncture to help them. And I also help them with other ailments. 2. Because I don’t have to deal with Big Pharmas drugs that ultimately cause more harm than good over the long term as they throw the organism further into balance.
The realities are that natural medicine isn’t for everyone. Not everyone wants to look in the mirror and see the root cause of their problems. Most all disease is chronic in nature and a violation of natural laws which are within our control – adequate sleep, hydration, stress outlets, mental health, diet, exercise, sleeping in total dark, no EMF, doing fun things daily, and all other things which keep us balanced. That is the root of all disease. And this isn’t for everyone. It’s not for most people in fact. So, that’s why you deal with non compliant patients in Western medicine. They are coming to see you because they don’t follow directions, and even once educated, they won’t. It is what it is. But, there are those who will and those are the people who stick with natural medicine because it involves THEIR participation. There is no “magic pill” which doesn’t exist anyhow. I have zero time for people who just want to take pills. Think about it, you go to school for X amount of years to basically push drugs of Big Pharma? That’s all a Western Doc can do. I can heal with acupuncure, herbs, homeopathic based meds (yes, they work), and even with my hands. Which person do you think is a true healer? I’m not trying to be arrogant, but if you really want to heal people, then step back and evaluate everything completely. And like I said before, if ER or surgery is your thing, Western med all the way. Two very necessary and respectable fields.
The downside of natural medicine is that insurances don’t send you patients like being in allopathic medicine. You have to market yourself aggressively to some extent, or have a very good referral basis from your patients. But when you help people, they send you referrals. But it takes time. Most people fail in running their own business, that’s just fact. But, for me…I love truly helping people AND being my own boss so I will open my own practice under my acupuncture license. If you are “young” you can still take both avenues and get a PA degree, hire an MD to be your supervising doc and still run your own practice and incorporate as much of each discipline as you like. For me, I like pain management because who doesn’t have pain? The market is huge. And since nothing gets cured by Western medicine, surgeries most always fall short (most, not all), and injectiosn are short lived, there is always people for me to help. And that’s typically who seeks the holistic doctor – people who have tried everything else and still have pain. Trust me, those people will be willing to do anything as I am their last stop which is great for me. Everything is an easy sell, and by that I don’t mean billing them for unecessary treatment, but I don’t have to fight them to go along with the treatment plan like others may have had to initially. If I want to do prolotherapy or other procedures when I open my practice that I can’t do under my other degrees, I will just hire an MD to sign off. There’s lots of MD’s who do this for a reasonable fee.
Eventually in a few years I will open my own practice, but at the time, making 160K a year is far more than I will make right out of the gate opening up my own practice and culling my own following. That’s the great thing about using my PA degree for the time being. I went back to school at 40 to achieve my last two medical degrees. And am happy I did. As for student loans, they are income based, so it realy doesn’t matter. And if you are smart and use the laws to your advantage, you can basically pay very little to nothing. But that’s for you to figure out.
For those of you who feel old, or old when you finish as I did when I was 26 getting into PA school, I thought by the time I finished MD school I would be old, so I did the PA thing. I also thought I would be less likely to be sued, too. Not exactly. But I was thinking of all things at the time. Anyhow, time is going to come one way or another and I don’t think age should deter you UNLESSS you wan to do surgery. You will have a very hard time getting a residency position if you are in your 40’s.
Lastly, I feel it necessary to say something about practicing medicine that may be within your “scope” but really isn’t. If you find that you see the benefits of doing acupuncture, while you can practice it with minimal to no training as an MD, or do “dry needling” as a PT (which uses….acupuncture needles and needles an ashi point as in acupuncture) acupuncturists frown upon that because these people really don’t understand the medicine. It’s a 4 year degree for a reason. It’s like being an MD and then trying to adjust people’s neck because you went to a weekend seminar on Chiropractic manipulation. It’s just wrong. People should be adequately trained in what they are doing. Too many people are trying to get their hands in other people’s medicine and in doing so do not provide the best care or education when it comes to that medicine. And yeah, stealing bread from someone else’s plate just isnt’ cool.
Feel free to contact me [email protected]
I really love the comparison chart…thanks for sharing! Of note I disagree with the salary range. Where NPs & PAs are supposed to fall under the “Allied Healthcare” umbrella equally, however in reality this is not the case. In my state NPs have literally taken over the job market–where the same job offer does not even designate PA/NP rather just NP. This is not because NPs are better than PAs but primarily because of strong nursing lobbyists in Washington DC demanding rights for nursing body nationwide. If anything NPs are taking over medicine including doctors…not so much PAs. Hell we cannot even get salary that is of equal level to NPs. For example, on federal level NPs are making $20,000 more than PAs. Something is seriously wrong with this picture. I am not blaming nursing body only although they’ve managed to discredit PAs in order to shine light on their profession but also PAs and PA organizations such NCCPA, AAPA for not having or using their muscle to advocate for more fair labor practice for PAs. Medicine is a field of politics. PAs must advance into Congress in order to advocate on behalf of our profession. If we remain cowardly silent and ‘flexible’ as it’s been drilled in most of us during our training, we will never get what we deserve: a better pay, positive recognition, respect, equal labor practices & education on our function as clinicians. Lastly, this ‘assistant’ must be changed as it’s misleading and outdated from the origin of our profession…we no longer assist as once did in 1960s war era rather we …again something that needs to be advocated on a political level. But it seems there are forces that like to keep us in “assistant” mode to misguide and discredit PAs–all very political 😉 While we collaborate with the SP if need be, we do work autonomously for the most part based on Scope of Practice Agreement and PA/MD relationship provided we have some means of communication again should there be a need. This ‘assistant’ makes us appear to be 100% dependent on the MD–totally false.
Sorry to chime in, but me being a Paramedic student doing hours at the hospital I’ve heard the same from multiple doctors: Nurses and NP’s with backgrounds in emergency care are the most experienced as well as, the best flight medics/nurses. I guess it all depends on the school as well. I have a friend who went straight to nursing school who spends most of her time in a classroom and I have a friend at a community college who spends most of the time doing clinical rounds and simulations. I’ve heard more approval out of doctors for those students who spend more time getting hands on experience as opposed to those who are constantly bombarded with textbooks. Either way, sounds like my path is decided… NP it is, unless someone wants to pay for my medical school 😀
I was a paramedic that graduated from a university program (B.S. in Paramedic Science) who is now attending medical school. The best flight paramedics are not nurses. Many of the best paramedics attend and crush nursing school to earn more money, but the information gained is not the difference. An old class mate of mine just graduated his BSN program as valedictorian with what he described as, “minimal effort.” This isn’t to say nursing is easy, but that our education was demanding as well. You’d expect someone with extensive A&P, biochem, and pharm knowledge to do well right?
Nursing education has little to do with medical decision making, and unfortunately many conflagrate seeing a patient managed by a physician as the same as doing it themselves. Some, put in the effort to research on their own and bridge that knowledge gap from observer to performer, but that is far from the rule.
As long as you don’t forget that your “book knowledge,” is the foundation of your house, which your experience cannot exceed, you’ll do well.
The only problem is the requirements, class hours- and clinical time requirements are wrong for the NP. They are more than stated in the chart. There are National guidelines I don’t see here Also missing is the fact NPs have worked in healthcare as RNs for years – decades even as a requirement for many programs and advancement- and I don’t see that here. I love ma PA colleagues but the data here is wrong.
I am weighing PA school vs. BSN-to-NP. There are no direct MSN NP programs in my state, and I’ve heard the graduates of such programs are of very low competence anyway. So the only practical way to be a competent NP is to become a BSN/RN first, then work as a basic RN for a few years in acute care, then go and get the MSN to become an NP. There are two problems with this, for me as an individual. First, I already have a PhD in another field, so I would be inevitably seen as “overqualified” for an entry-level job as a basic RN–so how would I get the acute care experience before MSN? Second, I tend to fail the personality tests that hospitals seem to require for employment. On the other hand, when it comes to training–while it seems to me that PA training is much more intense and science-based than NP training, I am worried about whether I could get through PA school as a father of two young children. I need to work to help support my family, even if only part-time, and it does take time each day to be a decent father. What do you think?
Hi Bob,
I tell people all the time that I couldn’t imagine going to PA school now that I am a parent. It would be hard (to say the least) to find time to be a good dad and a good student. But, with the right amount of support it could be done. Also, the parents in my program who were part of the part-time PA program offering at Rutgers did very well and maintained a good home life. I would look into the Yale online PA program as well, this seems like a very good option. Don’t sell yourself short.
Stephen
I can’t resist the weigh in. I am a PA. I agree that NPs and PAs have no business in independent practice. I know many NPs that aren’t poor chaps trying to pick up the slack for MDs/DOs and go into PCP positions. That’s so far from the truth. On the contrary I know many NPs who think they know it all. Sadly, they don’t. I don’t care how many years you have practiced.
I come from a family of MDs, PAs and NPs. I have been in medicine for many years as well. I will say this: from an admin standpoint, when hiring a physician you tend to know what you’re getting based upon where they went to school and where they did their residency. Particularly in the NE and mid-Atlantic area. I attended a real medical school and got my master of science in PA studies. I didn’t go to one of these free-standing PA programs (which I notice are more prominent as you head west), and I find that there are too many variables on what you get from these programs.
That said, I am sorry to offend you nurses, but an NP program is sub-par to these PA programs. I literally went to medical school at an accelerated rate, and nurses can work full time while getting a master’s degree. There is something to be said about that. It’s a fraction of the cost for schooling for a reason. Nursing has a lot of lobbyist in Washington. Hence why they’re getting to practice independently. It’s scary, honestly. Most of my PA colleagues would never want to actually practice independently. We tend to like our collaborative roles.
However, the physician who thinks NPs and PAs are their perpetual resident to abuse and treat as their whipping boy, well that is an entirely different topic.
Also, this salary range is off. I know plenty of MDs who work Monday through Friday from 8-4 and make $650K. I certainly don’t Work those pampered hours as a PA for about 15% of that income. I watch them come in the mornings and leave at night while I’m on the pager and up all night long.
Hi Nicole,
Thanks for weighing in. I have worked with some very competent and very good NPs through the years. In fact, some (as much as it hurts me to say it 🙂 ) were better than a few of the PAs I have worked with. I have found these NPs to be very qualified to do their job in my setting of family practice. I wonder if it has more to do with the person and their own experience prior to NP school? The NPs I worked with all had many years of ICU or ER training prior to becoming NPs. They also were a bit older when they graduated which gave them some life experience. As far as independent practice is concerned I always felt that this should not be something granted directly out of NP or PA school but something that comes with time and experience and possibly even a certification exam.
Also, do you actually know family practice PAs making 500K plus?
Stephen
I don’t even see the point of this discussion or making the comparison. It’s comparing apples and oranges. On average, NPs have 10-11 years of RN experience and focus on one specific population in their education (hence why they do less hours). They are much more limited on switching specialties, and for good reason. PAs on the other hand have varied levels of experience and are basically a mixed bag coming into school. Then after their training, they are allowed to work in ANY specialty. All this latitude but with only 2-3 years of training. You guys tout all the hours you do, but really, if you break it down, you don’t do nearly enough hours for being able to switch specialties at the drop of a hat. IMO, that is why PAs have to be supervised and require more hours of training…There are still PA schools that don’t require a graduate level training, and they have plenty of stand alone online programs as well. In my opinion, I would much rather have a NP with years of RN experience over a PA who was once a phlebotomist or EMT. Interestingly enough, PAs are also fighting for independent practice (not successfully I might add). Kind of a paradox though since they are called assistants.
Well said- RNs usually have 10,000 plus hours of hands on, administering medications, learning signs and symptoms, and taking care of very sick patients( in absence of a MD). To all the other professions- pls dont dumb down a RNs experience…
My thoughts exactly! I always find it interesting when to only generalized medical training they receive is a 2 to 3 years education plus an avg. minimum requirement of 500 hours of healthcare experience prior to entering school… lMAO. Further, in terms of educational requirements… A bachelor’s… Okay! In what? The followings is a excerpt from PENN State University PA program prerequisites 2018:
Applicants will need to complete an undergraduate bachelor’s degree (or equivalent) prior to matriculation into the PA Program.
We prefer that your major be in the health sciences, but this is not a mandatory requirement for application or admission. For admissions consideration, an applicant should ordinarily have:
If not health sciences, then what? Art, English, Computer Science!!! Really!
Okay, so I don’t have to lament or elaborate further pertaining to your lack of healthcare experience prior to entering PA programs. Take myself for example. I am a Family Nurse Practitioner with 1 additional year of Psychaitric training to receive my Post Master’s in Psychiatry. In addition to working as a Psychiatric Nurse Practitioner, I was also a RN for 7 years in Psychiatry prior to returning to school for the Speciality training. Do really believe, your know more Psychiatry than me? Seriously, I’m sure you know the answer to that question…. Stop make me laugh on this bias site written by a clearly bias, PA-C touting himself… lol
Okay bro! If you say so…smh
Can you tell me how often you get someone off of their medications? And what was the situation if you had?
I said I would not, but this argument gets old. PA’s and NP’s are not Physicians. NP’s at least, aren’t trying be physician. Although our roles are similar in that both diagnose, treat and manage acute and chronic diseases, order and interpret labs and diagnostic tests and prescribe medications, our educational and philosophical approaches to patient care are different.
-The nursing model looks more holistically at patients and their outcomes, giving attention to a patient’s mental and emotional needs as much as their physical problems.
-The medical model places a greater emphasis on disease pathology, approaching patient care by looking primarily at the anatomy and physiological systems that comprise the human body.
I guess, in a nutshell, if I need a surgery I’m probably thinking I’d better see a MD. If I’m looking at something more general, like a cold or flu treatment, I’m probably thinking NP or MD. I still don’t know exactly, when I’m thinking,”Hmmmmm…. a PA!”
Sorry to hurt your feelings.
They are all legal drug dealers for the Pharma industry, the same industry that was raping the public over the price of Epipens. How does that make you feel about the true company you serve? People need these Epipens to stay alive in a crisis and they jack up the price as such?
With all of these drugs, billions upon billions of dollars raised, where are the cures? The cure is always looming on the horizon, and has been since Jerry Lewis’ telethon every year giving false hope to these kids, and others. Think about it, we promulgate cutting edge technology as though breakthroughs are happening when they are not.
The absense of symptoms does not mean a person is healthy. In fact, samples of fetal blood chord was analyzed and over 200+ environmental toxins were discovered https://www.ewg.org/research/body-burden-pollution-newborns. We are not born ‘pure and clean’ like people think. There are over 100,000 toxins now in our environment, and many are linked to cancer, so the notion of finding a cure for cancer is a bit preposterous. Are people being cured of cancer? Maybe, maybe not. I don’t have the reference but roughly a third of cancers will remit spontaneously regardless of what you do. Only 2.3% of cancers respond to Chemo. Clin oncol (R coll radiol). 2004 Dec;16(8):549-60 It goes on to state: The overall contribution of curative and adjuvant cytotoxic chemotherapy to 5-year survival in adults was estimated to be 2.3% in Australia and 2.1% in the USA. As the 5-year relative survival rate for cancer in Australia is now over 60%, it is clear that cytotoxic chemotherapy only makes a minor contribution to cancer survival. To justify the continued funding and availability of drugs used in cytotoxic chemotherapy, a rigorous evaluation of the cost-effectiveness and impact on quality of life is urgently required.
The reality is that many people with cancer are being cure. My mentor has cured various types of cancer, MS, Lyme diseaes, and others that are deemed incurable. However, the reality is that cure resides in restoring balance. That’s all there is, balance. If all of your organs and organ systems are in balance, then you can’t have symptoms. If you don’t have symptoms, you can’t have a diagnosis. Unfortunatley, Western medicine doesn’t focus on restoring balance, only suppressive therapies and medications. Why? Because it is a for profit industry. And if you research the Flexnor Report of 1910, you will see the beginning of this which was funded by the Carnegie and Rockefeller families to end competing interest.
And for the record, I have a PA degree, and of my three degrees it is most useless in restoring someone’s health. Great for diagnosing pathology. And that is for the most part what all diagnoses are, it’s pathology. Nothing can be done for the patient until it breaks down. Symptoms are managed with drugs until something shows up on an MRI and they need the pathology cut out. Drugs manage the symptoms until the patients renal studies show renal failure, then dialysis can be started. Back pain is managed until the spine is unstable enough to do surgery or someone decides to cut on them because they see a HNP which winds up not helping becaues it wasn’t the true cause of the pain to begin with. A study was done on roughly 100 people who were asymptomatic. 1/3rd of them had a HNP and didn’t even know it. That should tell you something about findings on a scan.
Remember, this is a system that once performed frontal lobotomies for back pain! They locked up Ignez Semmelweiss for suggesting that washing your hands pre-partum delivery would decrease post partum hemmorage and death! They sent this guy to an insane asylum! Doctors were on TV promoting smoking of Came Cigarettes! Do people truly grasp how incompetent and grossly negligent these actions are? But yet, you suggest Earthing to someone and you are a quack. Not just that, but Clint Ober has a book full of scientic studies which back this us. It’s that pesky earth again, providing us energy that heals the body. Crazy, stuff.
Thank you, Alexander. Well said.
As someone who has completed both an NP and a DO degree, the training of do/md is much more thorough and difficult. Classroom aside, after completing one year of residency, I took note of how much well structured residency was compared to NP rotations. The learning over time curve was much steeping (useful information learned per time unit) and also with less busy work. NP/PA are great assets to the medical community, but they do not replace physicians. These arguments stating more education does not equal better outcomes are silly. Sooner or later we do hit diminishing returns as we see the same thing over and over, but those without the 10000 hour residency grind have likely not seen everything they need to see prior to being thrown fully out into the open to treat patients independently. The gap does narrow as experience is gained but in most cases does not close fully due to the prior lack of basic science and structure of residency.
I am not sure what it is with NP/PAs trying to take over medicine with their lesser educations. I do not see PT/OT/PHARMS trying to do the same thing. I also do not see non engineers trying to take over engineering fields.
Every time somebody states that a physician’s education is important they get bashed for trying to belittle others. This is a childish response to a fact.
What is next? are NP/PA going to try to get independent rights to do surgery?
If you want fully autonomous practice, go the medical school. If you want to be an NP/PA and work alongside physicians, do that. Do not take the shortcut and beg for more rights.
Do not even get me started on the equal outcome studies performed. One cannot judge one’s diagnostic ability by comparing outcomes of HTN, DM, lipids, and other simply ailments, which is what every single NP VS MD study quantifies. Just because I can dunk a basketball just as well as shaq can on a 4 foot goal does not mean I am as good of a ball player.
@Clamchow. Clam, I am an NP student and have been in nursing over 30 years in one form or another. I do believe you have misunderstood the entire point of autonomy for NPs. It is not about being better than MDs or even equal to. NPs require autonomy to fill sorely needed PCP slots. Fewer and fewer MDs/DOs are choosing primary care as a career; the majority seem to want to specialize. The autonomy is needed so that more patients can receive primary care. I am assuming your response could be, “then they can be supervised by a Dr.” Well that would be find and dandy if there were enough primary care doctors. FNPs are not competing WITH doctors, they are trying to relieve some of the fantastic burden of the poor chaps and lads that have chosen to do primary care in residency. Part of the reasons many seem to prefer specialities are increased salaries, and a more focused work arena. Primary care doctors have to know a little about everything. Their days are long and tiring with a high burnout rate.
From the patient’s standpoint, even with insurance, many times it is a wait of 1-3 months to see your primary care doctor for an issue unless urgent. Even an urgent issue could have a wait of 2 days – 2 weeks or a recommendation to go to the ER if they can not wait.
I work in a university hospital which has a med school and residency program. I work with anesthesiologists every day. Many of these residents were primary care or internal medicine prior to going back to residency to switch to anesthesiology.
Long story shorter, FNPs are not the same as a PA or an MD or a DO. NPs are governed by boards of nursing and have a nursing focus. What that means is that NPs focus on patient education, prevention, health maintenance, nutrition and wellness. Granted NPs do assess, diagnose and treat. But the reason that their appointments take longer are the reasons listed. The approach is more holistic in nature vs problem focused. I hope that clears up some of the confusion.
I meant poor chaps and lasses that choose primary care.
*Correction I meant poor chaps and lasses that choose primary care.
Well put Laura. That’s exactly why NP’s and PA’s evolved in the 60’s. To cover the gap in health care which is worsening. It drives me bonkers to hear a patient say they can’t get into a PCM for 3-9 months because they haven’t been seen for a year so their considered a ‘new patient.’ You’re also correct about the toll of primary care driving physicians to specialize. My view of physicians is that they add (orginate?) a deeper layer to medicine. Clinical experience is totally learned the hard way, so I get what clamchow is saying about new graduates being thrown to the wolves. Well, the wolf part is my add on. But it’s true. Pick your rotation preceptor VERY carefully. And set goals for what you want to achieve in your rotation in addition to what’s printed on your curriculum.
As a PA practicing for over 13 years I have to agree with you. I do not think PAs or NPs should have independent practice rights without some type of advanced certification (something most of my PA and NP colleagues disagree with me on). It may be that we need to make an independent practice bridge, possibly a board exam to get your “PA-C-I” allowing for some sort of independent practice. This could be beneficial in some circumstances.
It paradoxical that you would want independent practice. By nature, you are an assistant to the physician. Your profession would have to completely redefine it’s role and literally change its name.
Hi Alexander,
It is paradoxical but is a byproduct of our current medical model and will expand care and allow PAs to practice in situations where we are currently very limited (such as overseas). As the AAPA has said “Once OTP is incorporated in state law, it will expand access to care, especially in medically underserved and rural areas, expedite PA licensing, and give PAs a greater ability to provide volunteer medical services such as responding to disasters. In addition, the elimination of the requirement to have a supervisory agreement with a physician will free up physicians’ time to focus on meeting patient needs rather than filling out burdensome paperwork.” I think a lot of the details still need to be “teased” out, but all in all, it will be better for patients, and this is what really matters. https://news-center.aapa.org/wp-content/uploads/sites/2/2017/05/OTP_FAQ_FINAL.pdf
I guess, but im tryig to think of a better name for you other than physician assistant, as to not confuse the public. At least with nursing its not so confusing and they have their own defined separate profession and curriculum. I feel like for PAs to make this work, they would have to pave their own path away from the medical model to distinguish themselves (like nursing has done) or align even further with medicine (like the DOs did) and have a Flexner style revolution in your profession.
Ha ha, Alex! and Stephen…. I too, long for a different title. People don’t know the difference between a Nurse Practitioner and a Licensed Practical Nurse. All they hear is nurse and practi… and assume you’re like their cousin Susie who is an LPN. I wish I had cash for every time someone said, “Oh, you’re smart! If you work really hard you can be an RN one day!” Or my favorite, “If you work really hard, maybe you can become a PA!” I’m already ‘like’ a PA…? Sorta…. No? My other favorite heard in grad school, “I hope when you become an NP, PA whatever, you’ll keep your nursing license!” I have to maintain my state RN license as a base for advanced practice and national certification. So. Yep, I’m keeping it.
So, I’m feeling the pain Stephen. I like your idea of demonstrating independent practice for an additional identifier. That would make sense for both professions, although theoretically, that’s what the certification does now. But there are different levels of NP schools. The first 5 years out of graduate school are going to shake you to the core, depending on the quality of the program (clinical vs. theoretical), your clinical rotation and preceptor, self-confidence and understanding your weak spots and seeking help as needed. Also the first jobs out of graduate school.
If you work in a practice where you’re expected to be independent, you’ll grow quickly. If you work in a practice that requires a mother-may-I for every decision and prescription, you’ll remain stunted until you leave. And finally – prior clinical experience as an RN. You’re right about the ER/ICU background — it lays a foundation for being expected to take independent action. It also cements the desire to manage your own patients and/or practice after watching a new group of medical students, interns, and residents rotate through every month and make the same errors over and over. You begin to think, “Really? Is this about brains or experience? It can’t be about education and grades, cause these folks are genius smart, yet they insist on putting my brittle COPD patient on 100% FIO2 until rounds the next morning. Or giving a medication that will slam their blood pressure down. ‘Yeah, you can order that, but I won’t do it. Meanwhile, I’m here to support you and more precisely, the patient, so I’ve prepped the crash cart and spiked a couple IV bags for you.’ I’ll be right here when you need me. Or, in a combat situation with MD’s 6 mos out of residency when a patient arrives with a gunshot wound and they want to cover the holes and intubate just before they’re put on the helicopter. Without placing a chest tube. And don’t know practical physiology well enough to understand that ‘no, the heart rate is not increasing and the pulse ox dropping from blood loss. You just created a tension pneumo and no, they can’t wait 15 min to get to the combat hospital before getting a chest tube. I know, I know I’m ‘just a nurse’ [practitioner] but you’re going to have to trust me on this one.’
By the way, the PA’s reading this story will be pleased to learn that while the MD argued with me, an experienced PA jumped in and placed a chest tube, literally behind his back. The patient did fine. (the actual facts of this story have been modified to protect the innocent). But I was later berated by the MD who said I made him doubt himself until he talked the Brigade surgeon and found out I was right. I simply told him, “Look. You’ll notice I don’t say much around here, so when I do, I suggest you listen. You may have thought I was ‘bragging’ when we first met and I told you I was an ER/ICU nurse and a trauma instructor prior to be selected for this mission, but I had a reason for telling you that so that when the time came, you would know my background. And, everything I do can be backed up with evidence-based literature. Everything I do.” Instead, he had worked with (brace yourself), LPN’s and didn’t really know the difference. Which was just weird, really.
My advice to anyone still reading this, choose your clinical experiences wisely. Education doesn’t always trump experience. Nor does experience necessarily trump education. And if all else fails, research, research, research! Find smart minds whose expertise is slightly different from your own. That can be a PA, NP, or DO/MD, RN or LPN. Be respectful of their experience and you will always learn something new and useful.
As for choosing which path to pursue, RN, NP, PA, DO, MD? It depends on time, money, family, and practice philosophy. None are right, none are wrong. They’re individual decisions, our journeys come from many origins, and we are a team. We are stronger together. No point in competing or sniping. What we do is difficult. And there are too many regulators out there to make our lives a nightmare (looking at you, Hamster on a Wheel, a patient every 6-10 min philosophy in the name of money). We need to stick together.
“I am not sure what it is with NP/PAs trying to take over medicine with their lesser educations. I do not see PT/OT/PHARMS trying to do the same thing. I also do not see non engineers trying to take over engineering fields.”
This is actually what many professions are doing. Most all professions are trying to get their hands in acupuncture, because it works. And now PT’s are changing the name of it to dry needling so that they can circumvent the law so that they can do it and most importantly….bill out. It’s always the money thing.
States claim that licenses are there to protect the public. Really? Then why can a PT do acupuncture under the guise of dry needling? Why can an MD do acupuncture with taking a weekend course, and some states with not even that? But yet it’s about protecting the public, right? Nonsense.
And how about the PA profession? I had to take that stupid board exam 4 times now after graduating! Over 100,000 PA’s practicing, and what…$375 is it to take the exam? That’s 37 MILLION 500 thousand dollars in revenue every 6 years! Now it will be every 10 years. What a freaking scam this profession is. Complete nonsense. No other profession has to do this, not even the MD’s who suprvise PA’s! Let that sink in, not even the supervisors have to recertify to “attest their competence” needs to retake an exam of the people they are supervising for the same purpose of ‘competency’.
Medicine is purely a FOR PROFIT industry. Cutting edge technology, latest advanced research and all the other buzz words being used, but yet we are sicker than ever before. How is that? Why is that? It’s because the “cures” reside within us, with the innate ability of the body to heal itself. The brain to make the right decisions such as exercising and eating right. Lungs to do deep breathing to calm the sympathetic nervous system which everyone is dominant. Who engages in parasympathetic activity? Everyone’s hopped up on coffee in the morning to rev up the ANS because they are sleep deprived. If you aren’t sleeping you are not healing. How about writing that on a prescription pad? RX: Stop shoveling fat foods down your throat, sleep 8 hours, sleep in total darkness because even the smallest of lights will altar your secretion of hormones, do deep breating daily, use castor oil packs to facilitate your liver to detoxify and your peyer patches to enhance immunity (look it up – castor oil marrion institute Dr. Thom), and the list goes on. But that stuff doesn’t make money. Drugs and more drugs do make money. So let me get this straight, if drugs are the answer, and genetics and the “bug” is to blame for all illnesses, why are we sicker than ever? If antibiotics for every cough, sniffle and sneeze is the answer, why is everyone so sick? Could it be that we suppress the immune system and drive the imbalance deeper in the body?
How is it that from an single microscopic egg and sperm that we have come to view the body as some incompetent entity? Not just incompetent, but grossly incompetent. How do we know better and more than this driving innate intelligence? Your job as a doctor is to identify and remove all obstacle to cure so that the body can do what it needs to. People can’t heal because they have too many obstacle in the way. It’s like a car trying to cross a road with a tree down across it. It has the ability, but it can’t. You can pump the patient with all the drugs you want, that isn’t going to bring about homeostasis. To think otherwise is absurd.
Chris, I get your point about medicine being about money and you’re right. But I need to point out that dry needling is not acupuncture…. The similarity is a dry needle, but there it ends – sorta. Dry needling targets hyper irritable muscle cells to get muscle knots out which is why PT’s do it. Acupuncture stimulates the nerves in the brain and spinal cord that release neuro-chemicals such as serotonin.
Meanwhile, back to subject of this post. Has anyone reading this ever encountered a truly awful doctor and wondered how they can be doing medicine? Or an NP or PA that was incredible; or your patients say things to you like, “I don’t care what your title is, your the best doctor I ever had?” We can study more, have more clinical, have all the clinical hours in the world and it won’t matter if we don’t push ourselves, keep current on evolving medicine, and view the world from the patient’s perspective. The patient will think we’re awful or great depending on their view. This entire argument is obviated by reality. A good NP/PA knows when to consult/refer. I don’t personally need *supervision.* What makes me good (as an NP) is recognizing what I don’t know. I have only once been in a position where I was ‘supervised.’ It consisted of two doctors carefully watching my notes to see what my clinical decisions were. It was very weird. It was almost funny, but it wasn’t. Finally after about 9 months they realized I didn’t need to be “supervised.” But they never lost the feeling that they should be watching every move of the PA’s and NP’s.
For students considering NP/PA/MD/DO, research the models. NP’s under the nursing model are holistic. So are DO’s. MD’s and PA’s tend to be straight medicine, no-nonsense, it’s about business. But that is changing as we prove that compassion goes a long way toward healing.
Unfortunately, the business model makes you choose daily if you’re going to spend extra time with your patient, or usher them through their 6 min visit because you’re trying to see 30-40 patients a day, which saps the compassion right out of you unless you enjoy being yelled at for running behind, or getting fired. If we could just get the administrators out of medicine and stop reimbursing by the head, we could make major progress. But how do you put a monetary price on taking 5 min to explain a medical plan/medication to a confused patient? You can’t. What you can put a price is on how many people you saw and billable procedures. Our business is getting lost in that. I do not like being a hamster on a wheel and right now, that is what primary care is about. No matter which route you choose.
Engineer here. We run our profession to the maximum benefit to the public and thus to the detriment to ourselves. We’ve automated away most of the jobs that existed 20 years ago and made our salaries plummet after adjusting for inflation.
We’ve increased what a degree covers by making the curriculum increasingly insane, but went backwards from a MS to a BS being the minimum requirement and the Professional Engineer certification is basically useless except for civil these days. And yet the actual base knowledge required and continuing education has skyrocketed. You also need a lot more experience to get into the heavy duty analytical roles or anything with real decision making power. Of course in most corporations managers with zero technical knowledge or the marketing and legal departments tend to dictate all technical decisions these days anyways. Unlike a doctor, lawyer, or accountant, people don’t listen when an engineer says do X or bad things will happen.
And yet technicians and technologists – kind of like nurses vs doctors, have taken over a lot of the lab work, field work, testing, and QA. Drafting is dying because CAD makes it trivial. H1B visas and remote workers flood the market with slave labor but joke educations. Coding bootcamps and very informal professional standards of practice is making software engineering in particular increasingly a bad profession. Mechanical and Electrical are like surgeons or specialists and pretty hard to replace, except we’ve been able to develop elaborate computer programs that in the right hands can calculate the optimal design within the laws of physics for almost anything, so very, very few of us are needed anymore. We’ve done similar things in medicine with software that has the entirety of human medical knowledge/literature to diagnose patients (and outperforms MDs), but legal barriers prevent it from eroding the medical profession.
Stephen,
The comparison chart is wonderful as a summary of the 3 professions. One major flaw that I am hoping you could correct easily is the need to validate the data by citing your sources. I would like to utilize this chart for legislator education, but I cannot fully utilize this comparison without citable, valid sources of the info.