PLEASE READ: Another article regarding NP lateral mobility:…


  1. Hi James, Very nice job describing the differences (and similarities!) of NP and PA. I'm glad the JAAPA article was useful for you. Your "interpretation" concisely summarized the lateral mobility in the NP and PA fields. Best, Virginia

  2. James, an FNP is just as versatile as a PA degree. The reason for less clinical hours is that we have so many hours either clinically or in acute care. Along with our undergrad clinical hours. When we start our clinical hours, we know assessments, equipment, treatments, you name it. You do not have to have any medical experience to become a PA but just have the science courses. So, that said, please educate yourself further.

  3. NPs are generally trained by nurses and many get most of their "training" online nowdays it seems. there are exceptions especially in universities with medical schools that incorporate NP and PA students. PAs are trained by physicians.
    NPs are under nursing board of states and practice on their nursing license even though they diagnose and prescribe (sounds like actual medicine more than nursing doesn't it?), PAs are under medical board. NPs practice medicine with a nursing license with oversight by the nursing board. PAs practice medicine with physician supervision under oversight of medical board.

  4. It is important to note this very greatly depending on what state one lives in. In Indiana, NP's are not autonomous and require physician collaboration. Also, NP's hold a nursing license while PA's hold a medical license.

  5. I have trained both NP and PA. PA are light years ahead of NP in basic medical knowledge (understanding disease process). NP can prescribe once they know the disease but so can anyone who has no background in health. I would prefer MD treating me but if MD is not available I will let PA evaluate me . I will never let NP touch me, few are good and some are no better than homeless guy from the street.

  6. Costs of education? Sounds like PA route would be more economical than Nurse Practitioner route considering that to be a nurse practitioner, you are required to be an RN and Have a BSN before going to the nurse practitioner school.

  7. I'm interested in working in community health centers but I noticed that job descriptions mostly ask for nurse practitioners… in fact, I haven't seen any posting for physician assistants. Does anyone know if physician assistants are used in these types of facilities?

  8. Clinical hours are lower in NP school but NPs cannot just jump to different specialities. FNPs are not allowed to treat in the hospital and they should not because there is acute NP training for that which will be another year or two of didactic and another 600 hours of lab and clinical. So if you know someone who has both FNP and acute care that is dual degrees and they most likely have more didactic classes and clinical hours.

  9. Hi James,
    I enjoyed your explanation. I felt compelled to add a VERY important point that wasn't mentioned about NP clinical experience prior to NP certification. All NPs are licensed practicing nurses prior to NP school, which means we have countless more clinical hours than mentioned in your video. This is a point that should never be neglected to be mentioned. Most RNs have, at least, five years of nursing practice prior to application to grad school. Thanks for your consideration!

  10. Hey, I am currently a student of the practicums program currently pharmacy technician trainee. Liked the video since I'm going to college in the next year. Also u should make a video on hosa practicums

  11. I barely got a position working as a care giver at a mental home. I am doing mostly of a CNA job because I am in heavy care. However, I am not certified. I hate cleaning poop the most. I don't think I can take cleaning poop any longer. What bothers me is that there is a guy with all kind of mental issues plus MRSA who is not isolated. There are 11 people in that small room with wheel chairs. It is very challenging and most people do not know that I am there to collect patient care hours. I am also trying my best to keep my job. Still got a long way to go ?

  12. Hi James, thank you for an informative video. I saw that in order to get into a PA program one needs 500 hours of direct patient care experience. How can one get this experience as a biology major? Thank you for the great work you are doing.

  13. Overall Great video! I think you did a great job at hitting key points however, I just wanted to point out a couple things at least from the NP perspective. First, you are right in terms of how NP's select a specialty when they choose the specific program. This can hinder you from lateral movement. However, if you choose the family nurse practitioner program which I would say is probably the most common type of NP you encounter, this trains you for the pediatric, maternal, adult and geriatric population. This allows you to lateral move more freely among specialities (cardiac, neuro, ENT, OB, peds, derm, etc) . However, it is within a primary care scope so that includes outpatient, inpatient (not ICU/ER unless fast track or Peds ER), and urgent cares. So with this specialty there is a lot more accessibility with lateral movement. I believe the only limitation is really with psychiatric, critical care and anesthesiology. For those three areas you must have your degree within those specialties. 

    In terms of requirements prior to entering a program I think its also important to note that the majority of ARNP programs require not only your BSN degree but a minimum of years working as an RN as well. Just something to note when planning out how long everything will take. Most require 1-2 full time years however, programs like anesthesia and critical care typically require anywhere from 3-4 full time years of CRITICAL CARE (ICU/ER)  RN experience. 

    Another thing to consider especially for those who have a specific MD/clinic/hospital they plan to work with is if you plan to practice in a state where complete NP independence is not yet passed you need to look at billing preferences. For instance, a MD is reimbursed 100% for services when something is performed by he or his PA. This is because since PAs work directly with an MD there are limitations in the MD being able to essentially leave the office while the PA is seeing patients. So since an MD is essentially supervising whether they are physically in the room or not insurance companies will reimburse at 100%. For ARNPs the same is true if the MD is present in the vicinity. However, with an ARNP the MD has the option to leave, go out of town, go on vacation, etc and his patients can still be seen by the ARNP. But, insurance companies typically only reimburse at 85%. With that said, some doctors find 100% reimbursement more important. Others find having the flexibility to leave their office, take vacation, etc is more important. So its something to take into account when searching for jobs. Now keep in mind this entire reimbursement topic only applies to states that do not grant ARNPS complete independence. 

    Other than that I think this video is very accurate and explains a lot of questions both people looking to pursue the character and patients in the field ask regularly. Either job route is fantastic. It ultimately comes down to how much time you want to invest leading up and receiving your degree, how independent you want to be, and what kind of area you want to work in. Either way, I am sure you will be happy!

  14. PA's can work independently. Many PA's own their own clinics and hire/outsource an MD/DO to act as the supervising physician. This SP does not need to practice in the same clinic. They need only be capable of fulfilling whatever the state requirements are (for example, reviewing your notes).

    The reality is that the PA and NP are about as similar as a DO and MD when it comes to acute care. Specialties and long-term patient care are where the real differences are at. The main difference (IMO) is that PA's are typically found working in an environment where they are supplementing the services of a physician and the role is well understood. I don't have much experience with NP's working acute care, but so many have told me about how they feel the line between the NP and the DOC in the hospital is blurred, and they end up spending a lot of time having to prove their relevancy. These 4 or 5 NP's that have told me this (small sample, so do with it what you will) explained that as a result, they felt very insular and closed in from the other providers. They end up working better with the other nurses (not a bad thing) than with the docs.

    The few NP's I have worked with in the acute care setting enjoy ribbing the PA's, and we do the same back. But our roles are similar (except where our specialties diverge) and our working relationship was never strained, but one did have many issues with docs who understood what PA's could do, but not NP's.

  15. Excellent video!! I was surprised at the fact that you genuinely remained objective and unbiased. Had you been otherwise, you would have most certainly pissed off a whole lot of nurses lol. I'm personally going on a different route. I'm a new RN and I know I have two options: DNP in geriatrics or DNP in anesthesia. I don't want to do what physicians basically do, I'll leave that to the NPs and PAs, so I'll stick with anesthesia instead. Good video! Helped me understand this better since this is a topic that confuses most of us!

  16. I worked at a hospital with both NP and PAs for many years.

    The reality is that there are more differences than similarities.

    One a PA education is more generalized.
    NP education is more specialized.

    The reason for this is:

    PAs can only do a palimiary observation and have to submit their observations to the MD who then has to do a final observation.

    The Physician does the diagnosis and decides what treatment will be administered, but most of the time PAs accompanies the MD in the room to allow the MD to diagnosis the patient, PA will hear what the doctor's treatment plan is; Physician will then leave to see another patient. PA writes the Rx for the patient, makes sure they schedule another appointment and sees the patient out.
    PAs will also do this from NPs as well.

    NPs can do observation, diagnosis and treatment without oversight from a doctor. This is why NP require more specialized training and education.

    Though PA can do clinical work to a degree.
    Most of the time their is in a supporting non-clinical roll.


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