The impending threat of Nurse Practitioners is everywhere you look online – in physician associate facebook groups, forums, and clinical discussion threads – but should PAs feel threatened by NPs in clinical practice?
I think probably once a week, if not more often than that, in a community online that I belong to that is filled with PAs from all over the country, I see a post that goes something like this:
“Is it like this in your area? Where I live NPs are taking over! All the job listings are written specifically for NPs. If you apply as a PA, you don’t get a call back. The legislature is generous to NPs – they have full independent practice authority in this state – and therefore they are more valuable and easier to hire.”
The post goes on to share about the climate and how leadership roles, positions of any kind, are geared specifically towards hiring Nurse Practitioners over Physician Associates.
So, the questions I want to address with today’s episode are:
- Should PAs feel threatened by NPs?
- What should we be doing about it?
Should PAs feel threatened by NPs?
OK – it feels like, at this point, I should share that I live in an area of the country that is PA-friendly as a region. In the northeast there is a disproportionate amount of PA programs and in the Lehigh Valley, in the northeast quadrant of Pennsylvania, there are a lot of PAs. We have an exceptional PA program in our area and in the culture of healthcare in our area, PAs are integral and widely accepted parts of the team.
I understand that this isn’t true everywhere and that certain states and cultures PAs are not as accepted, as prevalent, or seen as valued members of the team when it comes to providing patients with exceptional care. All that I share is colored by my specific experience, and I’m going to try to be as objective as possible, but it’s important for you to know where I’m coming from.
I don’t want to get too bogged down into the specific differences between NPs and PAs in terms of training or certification. I’ll just say this – NPs are trained in the nursing model of care and licensed by the state board of nursing. PAs are trained in the medical model of care and licensed by the state board of medicine. Credentialing, too, differs between NPs and PAs.
The other significant difference is that PAs are trained generally and can practice in any area of medicine that laws allow in their state once certified by the NCCPA – sitting for the PANCE Certification exam and recertifying by taking the PANRE every 10 years.
I’m honestly not well versed in the frequency of NPs certifying etc, but I do know that NPs, early on in their training, even before they apply and choose a program – have to declare a track or focus to their education which erects boundaries as to the areas of medicine they can practice. They choose between categories such as adult, acute care, primary care and pediatrics – and then their education is focused within that area of medicine.
Day-to-Day Function of NPs vs. PAs
Day-to-day NPs and PAs often practice alongside each other in the same specialty and perform essentially the same role. For example – one of our kiddos has strep right now – and when we called the pediatricians office to get them a same-day sick appointment, there was an equal chance we’d be scheduled with the PA or NP (or one of the physicians) and the logistics around the appointment would have been the same.
OK – so here’s the question – should we, as PAs, feel threatened by NPs?
It depends on the culture in your area and the legislature in your state. Are you aware of the laws governing NP practice in your state? What about the ones for PAs?
Do you understand the co-signature or supervising components of what is required in your state?
If the laws and culture are significantly skewed towards creating an environment that is NP-friendly and PA-hostile (or even less friendly), its absolutely something that you want to be aware of.
The other thing that might be happening is that people don’t understand the difference. Oftentimes people don’t keep up with the latest legislature or have an outdated view of the legalities of having a PA vs. an NP in their office.
It’s your job to know the laws so that you make sure you are compliant with them but also so that you can share with those around you if they are mistaken or operating based on outdated information.
Teamwork (Makes the Dream Work)
Listen, it’s not us against them. It’s not PAs vs. NPs. We are all on the same team – to take care of patients – to provide healthcare, access, and exceptional care to our patients.
NPs having the ability to practice at the top of their license and take great care of patients safely doesn’t mean that PAs can’t.
According to the Health Resources and Services Administration, 99 million Americans lack access to appropriate primary care resources. Both PAs and NPs can help to meet the growing need of patients in the United States.
Making it about us and them doesn’t help us and it doesn’t help our patients.
The next question is, specific to PAs and improving the environment for PAs in your area, what can we do about it?
Here are three things you can do to improve your situation and the circumstances PAs are facing in your state:
- Be a badass, incredible PA
- Donate to your state and federal PA PAC organizations
- Advocate for PAs
Let’s break these three steps down one at a time.
Be an incredible, badass PA
First things first – to improve things for yourself and others in your state, and across the country for that matter – you can be a badass.
Being incredible at your job – doing what you do well, taking great care of patients, and being awesome – that helps everyone.
That reputation will extend to others in your area. You will set the tone for excellence. Your patients will tell their friends. Your collaborating physician will spread the word to their colleagues in other specialties. You showing up every day and doing the best you can to take care of your patients, operate at the top of your license and to the fullness of your training, has incredible ripple effects.
Your reputation isn’t just your reputation. It extends to others in your area, in your state, and across the country.
Yes, doing good is the right thing and YES being awesome at your job is something you should be doing anyway, but in case you’re lacking motivation to keep showing up as the best version of you – because healthcare is hard and patients are people and burnout is real – you are showing up for every PA!
Donate to your state and federal PA PAC organizations
Here’s the thing about NPs – NPs were once nurses – and nurses have been around since Florence Nightingale in 1820.
The PA profession is a baby compared to the nursing profession. We have been around since 1967.
So nurses have been in existence for 200 years and PAs for around 60 years, and there are 250,000 NPs and over 3 Million RNs practicing in the US to our 165,000 PAs.
This means that there are nearly 25x as many RNs and NPs who are advocating for change, legislation, and looking out for their own interests as PAs.
I don’t want to paint RNs and NPs in a selfish light by saying that – we are doing it, too – but I want to highlight the incredible difference in the numbers of nurses as compared to the numbers we have as PAs.
We need each person to donate, to sign up to attend your states’ day visiting your state legislators. Get involved at a federal level, Check that box that says “donate to the PA Political Action Committee” when you are signing up for your AAPA membership or registering for the AAPA conference.
If we want to change the landscape for PAs in our area, we have to change the legislature. Dave Mittman shared why this matters and the fact that our laws are essentially the same ones from 1970 when PAs first started practicing – check out the full post here. They are due for an upgrade and with the legal system in the US – this means advocacy and involvement – yours, specifically!
Advocacy is key and involvement is so important… but a change in mindset is also in order. There are plenty of patients to go around. It doesn’t have to be PAs and NPs divided, vying for the best position in the state from a legislative standpoint. I believe there is room at the table for everyone.
Healthcare isn’t going anywhere and we don’t have to feel threatened by or angry with Nurse Practitioners. There is room for all. This abundance mentality can be hard after years of thinking otherwise, but give it a try and see what you think.
Be an Advocate for PAs
Your microclimate is your specifical satellite office, practice, group or department. What can you do to advocate for PAs within your specific group or in your organization to advance PA practice?
Advocacy is everyone’s responsibility. This is something that I’m embarrassed to admit I largely ignored early on in my career.
Be on the lookout for opportunities to sit on committees, be invited to the table, lead the PAs or Advanced Practice Providers at your organization. Feel knowledgeable enough and empowered to stand up, raise your hand in meetings, and share your experience.
This is important everywhere, but especially if you are in a region of the country that feels to employ more NPs, who place a different or possibly higher value on those Nurse Practitioners.
Visibility matters. You have the ability to increase that visibility for PAs in your area.
We are expecting incredible growth as a profession – 28% growth in the coming decade. Now is the time to advocate so that all those PAs graduating, becoming certified and looking for jobs in your area are seen differently than you were when you first started.
NP & PA Community in Healthcare
We are in this together. A rising tide floats all boats and the tide for PAs, for the perception of, the employment of, and the influence that PAs have on impacting exceptional patient care… that tide is rising.
It’s the reason for this show. It may even be the reason that you pressed play on this show in the first place.
Listening is great but taking action is even better. Think of one thing you can do to provide value, change perception or increase visibility for PAs in your practice.
Talk to your kids’ and their friends about what PAs do. Present at the local job fair about what PAs are capable of!
Be vocal and continue to be in an incredible PA. This is the antidote to feeling threatened and the answer to the question “should PAs feel threatened by NPs?”
There is room on the team and at the table for great PAs and great NPs – patients need us all to be able to do what we were trained to do, to diagnose and treat, to be there for and take care of patients – with that abundance mentality there is no need to feel threatened by our NP colleagues.