Understanding educational pathways for NP, PA

College Search & Selection
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Hello, I’m gearing up for fourth and fifth kiddos’ (twins) college searches… #3 is about to graduate, thanks to CC community guidance!

Daughter is interested in hands-on health care (not research or admin). She works hard in honors for 90-95 grades. Her strengths are emotional intelligence, organizing a team and scheduling time. She’s great w tech but being very extroverted likes working with people.

Because we’re not sure med school will be a viable route we encourage her to consider NP or PA. My husband works in community health with a Ped NP, a PA, a FNP clinic manager, a Psych NP and MDs. She can shadow and do interviews.

She will decide what role she wants to go for. My questions are about the educational pathways to help her get there.

Can others with more experience respond?

  • seems like the road forks early. The first decision is BSN or BA / BS, because it determines which schools to apply to. LACs don’t offer BSNs for example.

  • D likes pragmatic learning, routines and protocols, internships and growing into a role… does that make BSN a better route?

  • Which exposes a student to more variety, a BSN or a PA program? BSNs take classes about different populations but PA programs have rotations

  • I know NPs have to decide on a population, but even when thinking about pediatrics, there’s surgery, primary, acute care and different settings. How does that factor in

  • what happens when a student doesn’t get into PA school? I read that med school acceptance is around 40% but PA schools are only around 30%???

  • why do so few RNs go for PA school? Seems like a BSN followed by a PA masters would be the best of both worlds. I’m guessing it’s because the prerequisites don’t match up.

  • Lastly, will masters-level NP be phased out by DNP? Keeping in mind that D has 6+ years of education ahead of her.

Any CC posters with insights into these questions?

THANK YOU

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Seems like she may consider an incremental path:

  1. Community college ADN / RN, pass NCLEX.
  2. Four year college RN->BSN (two year program).
  3. MSN and/or DNP, pass NPCBE.

The incremental path means that she can work in between each step, if earning money and/or gaining experience is needed before going to the next step.

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RN is a perfectly acceptable end goal without the need for 6 years of education.

As you noted, PA schools are hard to get into. Typically pre-PA students choose an undergrad degree that sadly isn’t often super marketable with many job options.

I wouldnt even think about NP specialty until completed with BSN. Dont put the cart before the horse. She would have plenty of time to decide. Nursing has so many options and would open many paths.

Why dont RN’s go to PA school? I have 1 friend who did that. You are correct that the prereqs don’t entirely match up. But honestly, if someone wants the type of job that a NP or PA have, if they have a BSN, NP school has much higher acceptance rates. Not all RN’s are interested in becoming NP’s or PA’s.

Yes, masters NP will be phased out by DNP eventually.

(Im a masters prepared nurse who works in academia with several PA friends).

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I just wanted to note that many LAC-sized schools offer BSN degrees, at least here in Pennsylvania, which has over 50 schools with BSN programs (most of which are direct entry). A number of Pennsylvania LACs have recently started nursing programs to keep up with the demand for new nurses. I do think a student who likes pragmatic learning would prefer a BSN program over a strictly academic program. Another option would be a 5-year direct entry Physician’s Assistant program. Quite a few of those in Pennsylvania as well, though not nearly as many as BSN programs.

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At the present time students are being accepted to masters level NP programs as well as doctoral (DNP) level NP programs. Upon graduation and completion of all the necessary requirements, both groups will be NPs. There is talk that down the road you will need the DNP, but there is nothing definitive yet and if you graduated with a masters prior to this taking effect you will still be permitted (reportedly) to work as a NP (similar to other fields that have gone this route).

If you attend a 4 year college as a nursing major and complete your requirements, tests etc you will be a BSN. You can go on to become a NP (you likely need some experience first) or you can work and remain a BSN.

You can go the CC to 4 year route as well, as noted above.

There are students who attend 4 year colleges that are not direct admit to nursing. If they do not get accepted to nursing (or there is no nursing) and they choose to stay, they can apply to ABSN programs (accelerated BSN, second bachelors) and complete the degree in about 15 months following graduation from college. They will have to pass their tests. ABSN programs vary- some are harder admits than others. After they get some experience they can apply to NP programs. Cost is a factor.

There are students who don’t know that they want to be a nurse practitioner until after they graduate. Those students can apply through the ABSN route, work for a bit, and then go back to school for NP. They will need the prerequisites before applying. These students can also apply to accelerated, direct entry NP programs. These programs will give you both the BSN and NP (masters or DNP). Many programs allow you to work as a BSN while doing the NP portion. Accelerated BSN to NP programs can be quite competitive…. and costly.

The route to become a PA seems easier to follow/understand (at least for me). You can apply to direct entry programs (3+2), apply to PA programs that begin directly out of college, or take time off to complete your prerequisites and patient volunteering hours (you will need a LOT). These programs are competitive.

I would not say… at all…that PA programs are more competitive than entrance to medical school. These are very, very different comparisons and paths etc. An accelerated DNP or PA program with an acceptance rate of 30% … doesn’t mean it’s harder than getting into medical school. Medical school is very competitive for acceptance…. even for top applicants. Totally different comparisons. I will say that there are competitive MD applicants that decide to apply to PA or NP programs instead…. for various reasons…. Fit etc.

PA and NP are very similar, but there are differences. NP follows the nursing model and it seems they have more autonomy- in some states they can practice with total independence, other states give a lot of independence but not total. Some states give less autonomy. PAs follow a medical model and need to work under a supervising physician…but this may not be true in all states. I believe a few states may offer full autonomy. For both professions it is best to check your state.

I think both offer variety. I know family NPs who work in peds and also obgyn . I know PAs who switch specialties. You can specialize as an NP if you wish (geriatric NP etc) but you don’t have to. While PAs have rotations, NP students have clinicals in various locations.

I think there is overlap in the courses, but you can check various programs.

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I have a good friend who is an experienced critical care nurse (BSN) working in a large Western Pennsylvania hospital for past 25+ years and she just revealed to me she makes $1.00 more than her RN counterparts.

My cousins is an RN as well in Pittsburgh and she is leaving her full time position to chase the money of a traveling nurse.

This is just 2 real world current examples. Nurses salaries have got to change and so do the incentives to go to college for 4+ years.

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Salaries will vary greatly depending on where you work, whether you are a BSN or NP, etc. My field can be healthcare or education… the salaries in healthcare vary wildly depending on many factors.

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Here in the Bay Area you can be a 23 year old new grad RN and be pulling in $140,000. I know we’re the outlier.

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The main difference in practicing as an MD vs as a PA or an NP is that MDs are trained to understand WHY they do what they do, and hence recognize variations from the most common presentations of illness. (Cue the chorus of NPs claiming that their training is equivalent, nay, better, because they do it with feeling). There is no question that the basic science training for MDs is at a much more challenging, in depth, and comprehensive level, and the clinical training is many, many more hours of training. I once totaled it up, and effectively MDs who do only a three year residency effectively undergo about ten times as many hours of clinical training than do NPs or PAs. But the reality is that our society has decided to allow NPs to practice medicine independently, and PAs to do so under the most nominal supervision. It is what it is.

Physician assistants are trained to be exactly that - assistants to physicians, who undergo continuing training by the physicians with whom they are working. I have seen PAs for neurosurgery, who were trained by the neurosurgeons with whom they worked to do many procedures, to assist the MD.

NPs are trained along a completely different philosophy, one that is more independent of physicians.

Your daughter sounds as if she is capable of going to medical school. But the reality is that it is a difficult path, and many become discouraged by the weed out nature of the premed classes (especially Organic Chem), and drop out of the premed track. Her disposition sounds as if she is also very suited for the NP track, or the PA track. Frankly, if one is suited for the NP track, that is the least academically challenging and least expensive route, and compensation can be excellent. I agree that the cheapest way to do it is a community college RN, followed by a state college RN to BSN program, followed by an NP program or the new doctor of nursing certification, with some work in the field in between every level of training. Alternatively, it may be worth the expense for her to apply to direct admit BSN programs at your state college, so as to finish the BSN quickly. She is certainly capable of getting into direct admit BSN programs.

One can also apply to T20 level nursing schools, such as Penn or Duke, and assuming that you’re full pay, pay a lot for the training and have a T20 college experience. But unless one wants to go into academic nursing, it’s a lot of tuition for essentially the same earning power as one would have coming out of your state college.

If your daughter wants a full understanding of medicine, to understand WHY she is doing what she is doing once out in practice, to have all options of medical practice open to her, then she should try for medical school. If she finds the premed track too challenging, she can switch into a BSN in nursing, if she is at a college with a nursing school - since the level at which premed classes are taught is higher than that for nursing school basic sciences, it is possible to transfer into nursing. But from what you describe, she sounds as if nursing, with the goal of becoming an NP, is the more appropriate track for her.

The reason that BSNs don’t apply for PA school is that the BSN doesn’t fulfill the prereqs for PA school. The basic science classes for BSNs are taught at a lower level than are the prereq sciences for MD and PA school.

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There is no question that medical school is a more grueling experience than PA or NP school. And if you specialize as an MD the process is even longer…. much longer…and more intense. I have never met an NP who claims that they have equivalent training… but I guess some do say such things. The pathway to becoming an MD is very different than PA/NP.

Primary care is going in the direction of PA/NP… but there will always be pediatricians etc. MD is absolutely 100% necessary- and always will be.

I think PA and NP have many similarities. The path to get there is different, and the models are different. This student can do some research and decide. The coursework, prerequisites etc will
differ depending on the path.

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This has been an insightful thread, and mirrors a lot of my daughter’s thoughts as well. We have a lot of friends and family in the field and most suggested this path over PA for her specifically knowing her strengths and interests. She is going the BSN route with (as of now) the intention on a DNP.

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I beg to differ. Primary care is being taken over, in fact, has been taken over, by NPs and PAs, Even when one is referred to a specialty for a complex medical issue that requires high-level training, high-level algorithmic diagnostic skills, and many years of clinical experience, one’s first visit is often with an NP or PA. Society seems to believe that one doesn’t need the education and training to become a board-certified MD to think - just to do procedures, when in fact, it is exactly the opposite! One needs only focused technical training to do a repetitive procedure, such as a bone marrow biopsy, whereas one needs a lot of education, plus years of clinical experience to recognize atypical presentations and properly diagnose and treat. This is what the last two years of medical school and all of residency/fellowship are - many years of clinical training compressed because one spends so many hours, at least 80/week, and it used to be at least 100 hours/week, in the clinical setting, seeing case after case after case. This is the training that allows an MD to recognize the rare case of pneumonia in a sea of cold viruses, the one case of lymphoma in a career of strep throats, the appendicitis in an ocean of gastrointestinal viruses, the pulmonary embolus instead of pneumonia. Procedures are easy. They’re simple, and they’re repetitive. Yes, they require technical skill, but in many ways, they don’t require more education that any other field in which technicians do procedures. But society has spoken, and has deemed that primary care and many other specialties that require thinking can be managed by physician extenders, rather than MDs, whereas the lucrative procedures (such as endoscopies) are reserved for MDs, even though they’d probably be better done by an NP or PA technician.

My kid is heading towards MD, but I tried to convey to them that unless kid wants to conduct research and teach in an academic medical center, their intended specialty is currently being taken over by NPs, in addition to all the primary care fields. Doesn’t matter - that is what kid wants, and what kid is suited for, this is what kid will do.

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You bring up a lot of points, but I do not want to stray too far from the topic.

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I sat in this very discussion earlier this fall. My wife (CRNA 25 years) and her friend (NP plus Doc in Nursing) talked to my friend’s daughter. She was thinking PA and looking at 5 year programs. That’s a heavy commitment out of the gate was the consensus plus a BSN gives a lot of flexibility and career choices. She’s done some shadowing and is going the BSN route instead.

Another friends daughter graduated from UMiami last year and is going to PA school this upcoming fall. She’s worked hard the past year. You need a lot of clinical hours to apply to PA school. It’s a stressful process applying for PA school.

I’m guessing BSN’s don’t go the PA route because BSN’s have other career paths they can take. Plus they seem like different skill sets and personalities.

Small schools in Pennsylvania offer BSN’s.

I don’t think NP’s or PA’s will be phased out. There’s a shortage of everything.

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(And I know many NPs who left the profession completely or who are back to staff nursing. Kids can shadow all they want but the reality of working in healthcare today is very, very different. I think its something they have to work in themselves. Those with a bsn have options beyond direct patient care.)

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I am currently an NP, certified in family practice. I’ve been a nurse for almost 25 years and 12 of those years have been in the NP role.

Contrary to what was said above, my prereq classes (chem, physics, A&P, micro, etc), were taken alongside the bio/chem majors and were not “watered down” as a nursing major. Not all programs were/are like that. I went to a four-year BSN program directly out of HS.

Worked as an RN for about 10 years prior to deciding to going back to become an NP. My nursing specialty included emergency and cardiac nursing. I feel ER nursing best-prepared me for learning about a lot of the subtle vs textbook presentations to many different scenarios. Learned what the initial workups and treatments should be for a lot of different conditions. Developed that “sixth sense” you need to have when something just doesn’t seem right and you need to dive deeper.

Returned to school for my MSN as an NP. Chose this route because as a mom with 2 small children, I could return to school part-time and still work to support my family. PA programs are FT, and it would be nearly impossible to work while going to school.

I would say that if you want to go straight through your bachelor’s and master’s and be able to work right away as an mid-level provider, go the PA route. If you prefer to get your BSN and then work as a nurse for a bit (highly recommended) before going straight to grad school, go the NP route.

I am old school in my belief that nurses should not become NP’s without having worked at least a couple years as a nurse first. You need to be able to learn what you don’t know in patient presentations. These things you typically won’t learn from a textbook.

Specialty can also help determine which path to choose. If you want to be in the OR during surgeries, go the PA route. Neonatal medicine, go the NP route. You will likely see both types of mid-levels together in most of the other types of clinical areas.

I practice in a state that requires physician collaboration. We have a very, very good working relationship with each other - very respectful of each other’s knowledge and clinical expertise on both ends.

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My wife was a critical care nurse at a major hospital before becoming a nurse anesthetist. She maintains it was the best learning experience that still helps her today. I would assume the same about ER nurses.

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Thanks to everyone who has chimed in on this thread.

There have been many great insights shared.

I really appreciate hearing these things to consider.

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My best friend is a CRNA - one of the smartest people I know!! I believe for CRNA programs it is required that you have a few years of strong ICU/CCU nursing experience before applying.

I truly respect what your wife does and the level of knowledge she needs to have to do what she does! It’s no joke!

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I know premeds who got straight A’s and graduated with a 4.0….and then decided on the NP route. The prerequisites are not “watered down.”

I think med school is more grueling, but many want a more balanced life… and NP (or PA) can be a better fit for that person.

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