Registered nurse vs physician assistant
December 28, 2013 1:44 PM   Subscribe

Hello. I need your opinion on going back to school. I currently work in healthcare in a hospital lab as a technician. I make good money don't get me wrong but I would like more responsability, more clinical diagnosis and treatment related job. I want to interact with patients and be a more important person than just a lab tech. I am thinking nursing school or physician assistant school. Please tell me the reality on the field, which one job gives you more satisfaction: pa or rn?i am 27, almost married,no kids, no house. I have a bachelor in biology/ medical technology. Do you think the rn to nurse practitioner is a better option than the physician assistant?
posted by barexamfreak to Work & Money (16 answers total) 9 users marked this as a favorite
I have a bachelor's degree in nursing. I am a Registered Nurse. RNs do not medically diagnose. So, if you want to medically diagnose, do not become an RN. RNs do not independently treat. They follow doctor's orders.

If you can get in to PA school, go for it. Aim high. My RN degree has served me well but physician's assistants make more money and garner more respect, in my opinion.

Good luck.
posted by Fairchild at 2:22 PM on December 28, 2013 [1 favorite]

I'm not familiar with the field, but doesn't nursing school beyond a bachelors mean a Nurse Practitioner, which is ranked higher than an RN?
posted by ribboncake at 2:26 PM on December 28, 2013 [1 favorite]

You can get into NP school with a BS in bio np. I would go that route and aim for a DNP instead of just a straight FNP or some other NP. There are more opportunities there than for a PA.

To answer ribboncake: no, not really. If you want to be an RN and have a degree in something else you can do a bridge program where you just do nursing classes/clinicals rather than the whole four year program, but you can definitely go from some other BS degree into a BSN.
posted by syncope at 2:34 PM on December 28, 2013 [1 favorite]

There are master's degrees in nursing other than NPs. There are clinical nurse specialists, there is a Master's of Science in Nursing Education, etc. NPs complete special training to become NPs. It's a specific field of study.

Yes, a Nurse Practitioner is ranked higher than an RN. They work collaboratively with a physician (at least in my state of Florida) and can medically diagnose and treat.
posted by Fairchild at 2:36 PM on December 28, 2013 [1 favorite]

I was going to say that your decision should be between being a Nurse Practioner and a PA, not an RN and a PA. I think that's been said.
posted by ethnomethodologist at 2:48 PM on December 28, 2013 [2 favorites]

I was kind of researching the same thing awhile back. From my understanding both jobs are mid-level clinician roles, with the PA getting a more medical based training and the NP getting a more holistic training (more of the psycho-social, patient centered aspect). So it would be up to you how you would like to be trained, but I believe after a few years on the job, the work experience and your own persona would counterbalance or supplement whatever training received. I do know with a Masters of Nursing in Science, you can teach clinicals.

Also, my friend told me at her GI clinic, that the PA got replaced by a more experienced NP since NPs get paid a little lesser than PAs and that benefited he clinic. And that NPs have more independence. I believe this all depends on where you work and what type of setting, but it's something to think about.

It is my opinion that both of them do the same thing if the setting is a doctor's office. I don't have more information, but perhaps you can go to and type in a search for NP vs PA school.

Here is one thread:
posted by LadyAerin at 3:13 PM on December 28, 2013

I think that if you are choosing between NP and PA and you don't feel pulled strongly in either direction, you should go with the degree that will be faster and cheaper.
posted by Snarl Furillo at 3:14 PM on December 28, 2013 [6 favorites]

It also has to do with where you are geographically, what speciality/specialties you're interested in, and the kind of setting you'd like to work in (hospital, clinic, private office, etc). There is a huge movement towards patients receiving more care from NPs and PAs and less from MDs, but whether it's an NP or a PA seems to vary in large part based on those three factors. Envision your dream job -- say, working in an OB/GYN practice -- and visit some near you and see what kind of staff they have.
posted by telegraph at 5:25 PM on December 28, 2013

The basic distinction between the NP and PA credentials is that PAs do less school and get paid more.

No, really. PA programs are pretty uniformly three years. NP programs are increasingly doctoral rather than masters programs, and take up to five. Yet PAs pretty consistently make more than NPs do, across disciplines and locations.

NPs do more primary care than PAs tend to, and an NP doing primary care can be significantly more independent than most PAs. Some NPs basically run their own primary care practices, basically checking in with their "supervising" MD every few weeks. But PAs are the ones doing the more technical, specialized stuff, which is another reason they tend to get paid better. They do more in-patient work, whereas NPs tend to be more outpatient, on the whole. These are merely tendencies, obviously, but they are tendencies nonetheless.

So it's less a question of which credential provides more satisfaction. It's a question of what you want to do and which credential will let you do more of it.
posted by valkyryn at 5:57 PM on December 28, 2013 [2 favorites]

One difference that I haven't seen anyone mention is that all PA programs that I am aware of require you to have a pretty high number of clinical hours of experience before admission, whereas the experience requirements (and other academic requirements) for NP programs are highly variable. I just pulled this page up on Google, but it looks pretty good in terms of spelling out the clinical experience requirement and how many people go about getting it. Perhaps your current medical technology job would count, but that is something you would want to call the PA schools you're applying to and ask.
posted by hydropsyche at 6:20 PM on December 28, 2013

I work with a lot of nursing students. All are going for a BSN, but some of them are already RNs, and others already have a BA or BS in something else. I've helped a few of them look into NP programs and they universally require you to have a BSN first. To go from a BS to a BSN may take as long as two years. One of the students I've worked with has a BS in biochemistry and it's taking her two years. I think you need to seriously look at local programs, talk to admissions offices, and see which is most likely to admit you, which will take the least time, which will cost the least. And you should probably forget about trying to do it full-time while working full-time.
posted by mareli at 7:27 PM on December 28, 2013

You need to do some research on both the laws and the prevailing practices where you work, as well as what you want to do. In my state, NPs essentially practice independently with only minimal oversight, can prescribe all the same medications as a physician can, can refer to specialists, do procedures, etc. On the other hand, in my state PAs need "direct supervision," meaning their supervising physicians almost always see the patient as well on the same day unless it's for something very simple, so they have much less clinical independence. In my state PAs cannot write prescriptions--they have to be written under a physician's name. These privileges vary a LOT from state to state and result in different patterns of practice. In my state the need for daily supervision and inability to write prescriptions means that almost no PAs practice in outpatient primary care, for instance--it's just too heavy a burden on the supervising physician--but hospitalists and surgeons work with them a lot because the PA can be on the hospital floor when the attending is not around. PAs have also substituted for residents in a lot of programs due to the new work hours requirements, so they assess and treat patients but are directly supervised by an attending physician. So you need to figure out what the situation is where you live.

Salaries can also be a little complicated. In my area there is a nursing union but the PAs are not currently represented by a union. So even new NPs at my institution can make fairly high salaries because in general they worked as RNs first, so they have some seniority. On the other hand, as valkyryn pointed out, PAs tend to work in inpatient and specialty settings, so there is a salary premium for that.

Someone above made a point about NP programs mostly wanting people with BSNs--this is a real issue now that nursing is such a hot career, so that even programs that technically allow people with non-nursing bachelors' degrees to be admitted may not actually admit anyone without one.

Finally, you need to look closely at the schools you're going to be applying to and their placement rates for graduates.
posted by The Elusive Architeuthis at 9:23 PM on December 28, 2013

I'd put my money on RNPs having the better long-term career prospects than PAs. With the pressure on medical costs, there is going to be a fierce political battle in coming years over how clinical roles currently reserved to MDs/DOs are decanted to non-MD/DO professionals.

The lobbying and organized labor infrastructure of nurses is second to none, and will be deployed for the benefit of RNPs, while PAs are a new profession with essentially no organization at all.

RNPs have the big advantage in that the MD/DO lobby isn't fighting to keep the basic care interventionalist roles that RNPs and PAs are moving into. Your typical physician is happy to have an RNP or PA stich up your index finger after you sliced it chopping tomatoes, but is not at all happy for your PhD psychologist to prescribe your anti-depressant or your optometrist to give you your botox injections.
posted by MattD at 9:24 PM on December 28, 2013

the experience requirements (and other academic requirements) for NP programs are highly variable.

Except there's a universal requirement of a BSN. There's no equivalent requirement for PAs, hence the clinical requirements. Many NP programs also have clinical requirements, but given the clinical experience inherent in the BSN, there is some variability there.
posted by valkyryn at 3:30 AM on December 29, 2013

You asked about satisfaction. It's not even close: PA school is a much better option than being either a nurse practitioner OR even a primary-care doctor IF you can get in - there's less schooling, more pay, and more prestige/respect than in the female-dominated field of nursing (gah, patriarchy). Don't know the OP's gender. According to this article in The Atlantic, the average female primary-care physician would have been financially better off becoming a physician assistant. Sounds crazy, but it's true.

The median salary for a PA right out of school is approximately $86k/yr. The training to become a PA is much cheaper than medical school AND/OR a PhD program in nursing, etc. In addition, PAs begin to earn money earlier than doctors, who have many years of low paid internships after school. Money earned earlier in life is worth more than money earned later in life, because of returns on investment. In order to pay off that education and training investment, doctors need to work harder and earn more money later.

If being a PA is even more satisfying than being a primary-care MD, then I would probably forget all about being a nurse practitioner and go with the PA option for its lower cost of entry and higher return on educational investment.
posted by hush at 9:44 AM on December 29, 2013 [1 favorite]

the experience requirements (and other academic requirements) for NP programs are highly variable.
Except there's a universal requirement of a BSN. There's no equivalent requirement for PAs, hence the clinical requirements. Many NP programs also have clinical requirements, but given the clinical experience inherent in the BSN, there is some variability there.

NP programs do not have a universal requirement of a BSN. I believe they universally require a bachelor's degree in something, but there are definitely DNP and MSN degree programs that will earn you an NP license that are specifically geared towards people who have a bachelor's degree in something other than nursing. They tend to spend the first 18-24 months getting you to the point where you take the NCLEX exam to become an RN, and then you work as an RN while you finish the doctorate or master's program to become an NP.

Honestly the level of independence in each career and the requirements for entry to school programs are so different depending on what state you're in, you'd really get better information by checking into the practice acts for the state(s) where you'd be willing to work and the admission requirements for programs in your area.
posted by vytae at 2:29 PM on December 31, 2013 [3 favorites]

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