Physician assistant vs nurse practitioner

[Anonymous]

Anonymous wrote:To clarify from an earlier post poster. PAs can also specialize. The ones working in cardiothoracic or orthopedics are trained in that specialty and often well paid.

To clarify More - NPs can work in specialty areas too and often do - but their training/boards are specialized from the start.

[Anonymous]

The large cancer hospital I go to have nurse practitioners who specialize in oncology. The internal medicine doctors here all use nurse practitioners. I trust them completely.

The only time I have seen physician’s assistants is at those urgent care centers that are popping up everywhere. I sometimes take one of my children there for a fever or cough.

[Anonymous]

Anonymous wrote:Doctor married to another with many physician friends: PA and NP are solid jobs we encourage for our own kids or relatives when it is clear the premed coursework will not lead to an MD admission, either from grades or the mcat score. All of us have encouraged our capable medical-interested kids to pursue MD. It is far more autonomy than mid-levels get, and one can pursue many fields to the level of expert. The PA or NP is never the expert, whether it be hospital rounds or clinics. The most common model is they are assigned the needed days(no taking off mon or fri) and the popular vacation weeks the docs are off. They are fillers. They can handle basic conditions but not the complex and for some fields they are never independent (surgery). They do not have ownership in practices nor vote. They are not privy to salary negotiations. If they get bonuses, which many do not, it is 1/10 of docs. Insurance does not reimburse Midlevels well, and that has gotten much worse the past 8yrs or so. Most of us as docs would never see one for our own care, unless it was a basic visit. The training is simply not there for them to be be able to handle complexity. PA spends 85-90k x 2 yrs to eventually get to a salary that is around 100-120k and that is the max for the better fields. Med school if you watch living expense loans is 85-90x 4 yrs BUT many schools at the ivy/Duke/ucsf/washU level have fellowships to cover 1-2 of those years which they award to a large segment of the med school class. The lowest paid fields (primary care) make 250-300k once you are past the 3 year buyin/ramp up. Specialties make 400-600k. Residency pays 80k now which is enough to save and start paying some loans back. 25 yrs ago it was 26k per yr for 80-100 hrs a week for 4 yrs. Half the docs I know are part time and love the balance because they still make 180k+. PA /NP are often not allowed to be parttime.
TLDR Docs only recommend PA/NP to those that have no realistic shot at MD. MD is by far preferable.

Nobody wants a part-time doctor. I’m surprised they have a practice. I wouldn’t trust doctors or np who only worked part time.

[Anonymous]

Anonymous wrote:The large cancer hospital I go to have nurse practitioners who specialize in oncology. The internal medicine doctors here all use nurse practitioners. I trust them completely.

The only time I have seen physician’s assistants is at those urgent care centers that are popping up everywhere. I sometimes take one of my children there for a fever or cough.

Your experience is limited and your bias is showing.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Doctor married to another with many physician friends: PA and NP are solid jobs we encourage for our own kids or relatives when it is clear the premed coursework will not lead to an MD admission, either from grades or the mcat score. All of us have encouraged our capable medical-interested kids to pursue MD. It is far more autonomy than mid-levels get, and one can pursue many fields to the level of expert. The PA or NP is never the expert, whether it be hospital rounds or clinics. The most common model is they are assigned the needed days(no taking off mon or fri) and the popular vacation weeks the docs are off. They are fillers. They can handle basic conditions but not the complex and for some fields they are never independent (surgery). They do not have ownership in practices nor vote. They are not privy to salary negotiations. If they get bonuses, which many do not, it is 1/10 of docs. Insurance does not reimburse Midlevels well, and that has gotten much worse the past 8yrs or so. Most of us as docs would never see one for our own care, unless it was a basic visit. The training is simply not there for them to be be able to handle complexity. PA spends 85-90k x 2 yrs to eventually get to a salary that is around 100-120k and that is the max for the better fields. Med school if you watch living expense loans is 85-90x 4 yrs BUT many schools at the ivy/Duke/ucsf/washU level have fellowships to cover 1-2 of those years which they award to a large segment of the med school class. The lowest paid fields (primary care) make 250-300k once you are past the 3 year buyin/ramp up. Specialties make 400-600k. Residency pays 80k now which is enough to save and start paying some loans back. 25 yrs ago it was 26k per yr for 80-100 hrs a week for 4 yrs. Half the docs I know are part time and love the balance because they still make 180k+. PA /NP are often not allowed to be parttime.
TLDR Docs only recommend PA/NP to those that have no realistic shot at MD. MD is by far preferable.

Nobody wants a part-time doctor. I’m surprised they have a practice. I wouldn’t trust doctors or np who only worked part time.

DP but people generally don't know who's working part-time or not. It's not advertised.

[Anonymous]

Anonymous wrote:To clarify from an earlier post poster. PAs can also specialize. The ones working in cardiothoracic or orthopedics are trained in that specialty and often well paid.

PAs aren’t specialized. They only know what the physician they are working for teaches them- it’s informal “on the job” training in that specialty. As where an NP gets formal specialty training and sits for an exam to be certified in that specialty.

[Anonymous]

Because there are lots of people in healthcare here, figured I would ask: my kid is looking at a Bio major in college next year, and thinking about what path she'll eventually follow. She's a smart kid- but fairly introverted. Whenever I mention healthcare fields, her reply is 'ugh, I'd have to touch other people and interact with them all day long'. She would thrive in a lab type setting, or one where she could work consistently with a small group of people... She's job shadowing a perfusionist this fall, and I'm going to suggest she checks out medical dosimetry. Any other suggestions? Those are two fields that I think high school kids have rarely heard of, but would perhaps fit an more introverted, STEM type kid. Dr or Vet might be too "peoplely". She is currently thinking lab research in the veterinary field (Vet Science) but open to any suggestions you may have. TIA

[Anonymous]

Anonymous wrote:

Anonymous wrote:Doctor married to another with many physician friends: PA and NP are solid jobs we encourage for our own kids or relatives when it is clear the premed coursework will not lead to an MD admission, either from grades or the mcat score. All of us have encouraged our capable medical-interested kids to pursue MD. It is far more autonomy than mid-levels get, and one can pursue many fields to the level of expert. The PA or NP is never the expert, whether it be hospital rounds or clinics. The most common model is they are assigned the needed days(no taking off mon or fri) and the popular vacation weeks the docs are off. They are fillers. They can handle basic conditions but not the complex and for some fields they are never independent (surgery). They do not have ownership in practices nor vote. They are not privy to salary negotiations. If they get bonuses, which many do not, it is 1/10 of docs. Insurance does not reimburse Midlevels well, and that has gotten much worse the past 8yrs or so. Most of us as docs would never see one for our own care, unless it was a basic visit. The training is simply not there for them to be be able to handle complexity. PA spends 85-90k x 2 yrs to eventually get to a salary that is around 100-120k and that is the max for the better fields. Med school if you watch living expense loans is 85-90x 4 yrs BUT many schools at the ivy/Duke/ucsf/washU level have fellowships to cover 1-2 of those years which they award to a large segment of the med school class. The lowest paid fields (primary care) make 250-300k once you are past the 3 year buyin/ramp up. Specialties make 400-600k. Residency pays 80k now which is enough to save and start paying some loans back. 25 yrs ago it was 26k per yr for 80-100 hrs a week for 4 yrs. Half the docs I know are part time and love the balance because they still make 180k+. PA /NP are often not allowed to be parttime.
TLDR Docs only recommend PA/NP to those that have no realistic shot at MD. MD is by far preferable.

Nobody wants a part-time doctor. I’m surprised they have a practice. I wouldn’t trust doctors or np who only worked part time.

You clearly do not understand how medicine works in the 21st century.
First, over 50% of the docs I know from my top med school are part time, and they are some of the most beloved and successful doctors in their fields. Half are at one of the Big Known Boston teaching hospitals doing three 12 hr shifts a week, but counts as PT, the other half are in private practice. All different specialists, some male most female. "Part-time" doctor is full time at any other job: it often means 3-4 days a week, or 32-40 hrs a week. Full time amounts to 50+.

[Anonymous]

Anonymous wrote:Because there are lots of people in healthcare here, figured I would ask: my kid is looking at a Bio major in college next year, and thinking about what path she'll eventually follow. She's a smart kid- but fairly introverted. Whenever I mention healthcare fields, her reply is 'ugh, I'd have to touch other people and interact with them all day long'. She would thrive in a lab type setting, or one where she could work consistently with a small group of people... She's job shadowing a perfusionist this fall, and I'm going to suggest she checks out medical dosimetry. Any other suggestions? Those are two fields that I think high school kids have rarely heard of, but would perhaps fit a more introverted, STEM type kid. Dr or Vet might be too "peoplely". She is currently thinking lab research in the veterinary field (Vet Science) but open to any suggestions you may have. TIA

How about Pharmacy. Pending on the facility, she could still provide hands on care via pt education but still not have to touch people. The pay is as good as NP or PA without the productivity requirements. Could even work from home.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Doctor married to another with many physician friends: PA and NP are solid jobs we encourage for our own kids or relatives when it is clear the premed coursework will not lead to an MD admission, either from grades or the mcat score. All of us have encouraged our capable medical-interested kids to pursue MD. It is far more autonomy than mid-levels get, and one can pursue many fields to the level of expert. The PA or NP is never the expert, whether it be hospital rounds or clinics. The most common model is they are assigned the needed days(no taking off mon or fri) and the popular vacation weeks the docs are off. They are fillers. They can handle basic conditions but not the complex and for some fields they are never independent (surgery). They do not have ownership in practices nor vote. They are not privy to salary negotiations. If they get bonuses, which many do not, it is 1/10 of docs. Insurance does not reimburse Midlevels well, and that has gotten much worse the past 8yrs or so. Most of us as docs would never see one for our own care, unless it was a basic visit. The training is simply not there for them to be be able to handle complexity. PA spends 85-90k x 2 yrs to eventually get to a salary that is around 100-120k and that is the max for the better fields. Med school if you watch living expense loans is 85-90x 4 yrs BUT many schools at the ivy/Duke/ucsf/washU level have fellowships to cover 1-2 of those years which they award to a large segment of the med school class. The lowest paid fields (primary care) make 250-300k once you are past the 3 year buyin/ramp up. Specialties make 400-600k. Residency pays 80k now which is enough to save and start paying some loans back. 25 yrs ago it was 26k per yr for 80-100 hrs a week for 4 yrs. Half the docs I know are part time and love the balance because they still make 180k+. PA /NP are often not allowed to be parttime.
TLDR Docs only recommend PA/NP to those that have no realistic shot at MD. MD is by far preferable.

Nobody wants a part-time doctor. I’m surprised they have a practice. I wouldn’t trust doctors or np who only worked part time.

All of my female friends who are physicians are part time. My friends and I have marveled at the fact that being a surgeon is the new work-life balance job because my (female) friends who are surgeons set their hours, never at full time, get paid an insanely large amount, and enjoy their work. Joke's on those of us who became lawyers.

[Anonymous]

I think it's funny that PAs and NPs are called "midlevels" in medicine. That makes it very clear where they sit in the hierarchy. In my field, we would never be so blatant about it. We say everyone is an equally important part of the team blah blah blah. I think it's funny that in medicine, they make no bones about the hierarchy.

[Anonymous]

I haven't been through most of these comments but I have a kid who is just starting out as a nurse and eventually wants to be an NP and another kid who thought they wanted to be a PA but changed course before finishing college.
My understanding is an NP adheres to a patient care model while a PA follows the medical model that doctors also use. It seems like PAs are more focused on acute care and NP is more ongoing (e.g. peds/family medicine, etc.).

[Anonymous]

Anonymous wrote:

Anonymous wrote:Doctor married to another with many physician friends: PA and NP are solid jobs we encourage for our own kids or relatives when it is clear the premed coursework will not lead to an MD admission, either from grades or the mcat score. All of us have encouraged our capable medical-interested kids to pursue MD. It is far more autonomy than mid-levels get, and one can pursue many fields to the level of expert. The PA or NP is never the expert, whether it be hospital rounds or clinics. The most common model is they are assigned the needed days(no taking off mon or fri) and the popular vacation weeks the docs are off. They are fillers. They can handle basic conditions but not the complex and for some fields they are never independent (surgery). They do not have ownership in practices nor vote. They are not privy to salary negotiations. If they get bonuses, which many do not, it is 1/10 of docs. Insurance does not reimburse Midlevels well, and that has gotten much worse the past 8yrs or so. Most of us as docs would never see one for our own care, unless it was a basic visit. The training is simply not there for them to be be able to handle complexity. PA spends 85-90k x 2 yrs to eventually get to a salary that is around 100-120k and that is the max for the better fields. Med school if you watch living expense loans is 85-90x 4 yrs BUT many schools at the ivy/Duke/ucsf/washU level have fellowships to cover 1-2 of those years which they award to a large segment of the med school class. The lowest paid fields (primary care) make 250-300k once you are past the 3 year buyin/ramp up. Specialties make 400-600k. Residency pays 80k now which is enough to save and start paying some loans back. 25 yrs ago it was 26k per yr for 80-100 hrs a week for 4 yrs. Half the docs I know are part time and love the balance because they still make 180k+. PA /NP are often not allowed to be parttime.
TLDR Docs only recommend PA/NP to those that have no realistic shot at MD. MD is by far preferable.

Nobody wants a part-time doctor. I’m surprised they have a practice. I wouldn’t trust doctors or np who only worked part time.

Many physicians and physician scientists at highly esteemed academic medical centers work 0.6 or 0.7 FTE. Hope you never develop a complicated dermatologic or oncologic issue needing subspecialty care.
Signed,
MD at MGB

[Anonymous]

Anonymous wrote:Because there are lots of people in healthcare here, figured I would ask: my kid is looking at a Bio major in college next year, and thinking about what path she'll eventually follow. She's a smart kid- but fairly introverted. Whenever I mention healthcare fields, her reply is 'ugh, I'd have to touch other people and interact with them all day long'. She would thrive in a lab type setting, or one where she could work consistently with a small group of people... She's job shadowing a perfusionist this fall, and I'm going to suggest she checks out medical dosimetry. Any other suggestions? Those are two fields that I think high school kids have rarely heard of, but would perhaps fit an more introverted, STEM type kid. Dr or Vet might be too "peoplely". She is currently thinking lab research in the veterinary field (Vet Science) but open to any suggestions you may have. TIA

Your daughter is right. There is a lot of customer service in health care. It can be rewarding, of course, but also draining for an introvert. My scribe went into some sort of PA-type of school for handling pathology specimens. Other ideas - biostat for scientific papers, geneticist, radiologist, EMR or biotech?

[Anonymous]

I’m an introvert too yet love being an MD with direct patient care. A controlled setting like Doctor-patient relationship is different than sat a social group setting. Consider having her do a Meyers-Briggs test to see what type of introvert she is and what jobs are well suited for her (is a starting point guide, not gospel).

To the PP who prefers “full time” doctors. Do you mean 40 hours/wk? Do you mean over 5 days, 6 days, or 7 days? What does your definition of full time include? Face to face patient interactions only, work to run the practice, charting, reading/learning, conferences, On call? Well, whatever it includes, you should definitely see whomever you are comfortable with. As a part-time MD, my clinic days are packed as are my OR days. For me, seeing patients part time is the reason I’m not burned out in my early 50s and instead still love the job.

Most people don’t know how hard doctors work when they are seeing patients. It’s working at top speed all day often without any scheduled breaks or lunch break, having to be “on” the whole time, thinking fast, moving efficiently, making lots of consequential decisions quickly, and being accommodating and understanding of all different types of personalities.

The term midlevels is used for transparency for patients. Most patients want to know the qualifications of their provider.
To the PP who mentioned in their line of work, the team is emphasized, you probably aren’t interacting directly with dozens of different individual customers each day. Yes in medicine there is of course a hierarchy given the vast difference in training level and ethics of transparency.

Yes being a doctor has the potential for incredible work-life balance, immense job satisfaction, job security, fascinating work, and you’re doing good for people and society. You work hard for this and sacrifice a lot along the way. If I could go back, I’d do it all over again.