 Hi everybody, my name is Boris. I'm a first year physician assistant student. Today I'm speaking with Sarah. She's a nurse practitioner and we're going to try to help you answer the question, what is the difference between a PA and an MP? Which career is better for you and how are PAs and MPs changing the medical landscape? Sarah, thank you so much for sitting down and doing this interview. Yeah, thanks for having me. No problem at all. So just a quick introduction. Sarah is a practicing nurse practitioner. She also has a PhD in education and is involved in the education process at our local MP program. So we're definitely going to talk a little bit about that. But the first things I wanted to ask Sarah is just about you a little bit. When did you become interested in medicine? Well, actually it's over 25 years ago. My friend and I decided to be a volunteer candy striver at a local hospital, you know, with the red and white uniform. And that kind of blazed the trail into nursing and medicine in general. I got to really love spending time with a vulnerable population in the hospital setting. So that started the process of nursing and then finally nurse practitioner. Okay. How long did you practice as a RN before you decided to go on to be an MP? Actually, I went to licensed practical nursing school first. It just was more conducive to my work schedules, working and paying the bills on my own. So I did the licensed practical nurse certificate and worked as a LPN in an office setting for a while, going on to my RN. And by the time I was an RN, I worked probably about four or five years as I'm going on for my bachelor's degree. And then, you know, each step that I took, I spent some time in that role as an LPN RN, bachelor's degree, prepared RN, then finally master's degree, nurse practitioner. So as each step went through, I spent some time there and really soaked up the experience in my clinical and school, as far as that in my professional life as well. That sounds like a really long journey. Yes, very long. So one difference between PAs and MPs, at least that I think of is PA seems to be kind of a fast track, you know, you might work a medical job for a little while, and then you go straight to PA. It seems like MP is more designed as you have experience in the field as an LPN, maybe then an RN, and then you finally go on to MP. Is that usually how most people do it? Yeah, so to be a nurse practitioner, you need to be an RN. And to get into nurse practitioner school, you need to have some experience as an RN. And that's important. So it's one of the big differences. Although physician assistants and nurse practitioners, we do the same thing. We diagnose, treat medical illnesses, we follow patients, we prescribe medicines, and we order and interpret diagnostic testing. So I think the similarities are very important, but the curriculum is different in that the nurse practitioner needs to be an R registered nurse first. So that's the biggest difference. Mostly curriculum. Okay. And so I don't know if I ever told you this, but I considered the NP routes versus the PA route. And I actually looked at the University of Rochester program, and they have an accelerated bachelor's, like when you have a bachelor's in a different field, and then you can become an RN in one year. And then you can go on to become an MP, I think it's like two more years. But they did say that you have to work as an RN for at least a year before you can go back and get that MP. Yes. And a lot of the colleges around are doing that back accelerated for people who have a bachelor's in another field. So that's an option as well. But there is a little bit of a break where you have to get some experiences and RN to continue to go. So it's a little bit longer, I think you would say. With the physician assistant, you, you have you said you mentioned medical, some experience of medical, but that's a necessity then. Yeah, so I don't know of a single program that doesn't require patient contact hours is what we call them. And that's usually a hands-on paid kind of lower medical position like an EMT or a CNA or a medical assistant, something like that. So that is required of every program that I've ever heard of, usually a thousand hours, sometimes two. Okay. So time, time wise, probably very similar though, when you think about it, working with the medical experience, that's what's interesting. Yeah, the only thing is you don't have to be an RN, you have kind of you don't have to be that advanced of a medical provider, you could be like a medical assistant or a CNA or something like that. Oh, I gotcha. Sounds like MPs start at kind of an average higher level of competence before they enter their training than PAs. Yes, so you have to have a social degree RN, but there's a new law in New York State with BSN and 10. So you have to have your bachelor's degree within 10 years of getting your RN, aside from, you know, the master's degree. Oh, really? In the next, probably about five years, entry level nurse practitioner will be doctorate of nursing practice. So you'll have to have your doctorate to become a nurse practitioner. So that will change not right now. You can become a nurse practitioner with a master's, but it's going toward, you know, entry level DNP. I've heard about that. There's a lot of buzz in the PA community about possibly getting PAs to be a doctorate degree, but then it'll be confusing, like, are you the doctor? Are they the doctor? You're a doctor, but you're not the doctor. I just want to practice medicine. Exactly, exactly. Yeah. But anyway, so a little bit more about you. Did you consider doing anything besides NP, maybe being a PA or a medical doctor, MDDO? Yes, I considered going to physical therapy school and medical school. Well, again, at the time, the schedule wasn't conducive to that type of program. So that's where nice did the LPN, licensed practical nursing school, because it was a half a day and then I could go to my job, you know, and pay the bills. Sure. But when you were switching to NP, did you consider maybe going on to any different kinds of schooling? No, only because I got my undergrad bachelors from the same school. It was offering the master's. So I already knew the faculty. I was in the area. So it was very fluid to move into the master's program versus, you know, from the bachelors because of that. Sure. So it was kind of like you wanted to do more with your career and be able to help patients at a higher level, but you didn't really want to move to a different state or anything from medical school. It was just very streamlined to go through the program you ended up going through. Right, exactly. Although, you know, graduate school was so challenging, but it made it easier because I knew and more fluid because I knew the faculty, I knew the program and I felt more comfortable, I guess you can say. Okay, the whole thing was just streamlined, the stars aligned and everything. Exactly. Can't blame you. I feel the same way about the program and then right now it's just like you knew them for several years and you've been in the area. It's just like you trust them. You want to go to school there. Exactly. That's important. All right. So switching gears a little bit. As a nurse practitioner, could you describe a typical day in your life if there is one? Yes. As we spoke about earlier, I teach, I teach nurse practitioners and nurses. So I always say you have to practice what you teach. So I also see patients in the outpatient setting in clinic and do that during the week, like one day a week. And then on the weekends, I round at the hospital. It's a nurse practitioner with my collaborating physician. So we see patients, we admit we discharge, do consults. I like that because I'm getting a taste of both worlds inpatient and outpatient. We can bring that experience to the classroom with my students. So so it depends on the day. I do three different things. So it depends on the day. I might be doing a couple different things that day or all three. Sure. Can I ask you which one you like better, the inpatient setting or the outpatient setting? Well, yeah, it depends actually. The hospital, you know, the patients aren't going anywhere. So don't get nervous if I'm running behind. Okay. In the outpatient setting, if you know, somebody has a problem, I have to spend more time with that particular person. I, you know, if I'm running behind, I get nervous. So that has advantages and disadvantages. I never actually thought about that. You never have a waiting room backed up when somebody's inpatient because they're already, you know, they're living there for the time being. Yes, less pressure, less pressure, because I don't like patients waiting. That's my pet peeve. Okay. I think I'd have the same one. I wouldn't want people waiting. And then you also have a lot more available to you at the hospital, more testing, more kind of specialty consults you can just get right there. Yeah, that's a good point too. In the outpatient setting, you really have to think and figure out what you're going to do when you're going to bring them back. You're looking at the diagnostic testing that you might have done last week or the week before and you're up in their symptoms. Maybe you haven't seen them in a couple of weeks. So, yeah, it's a whole different ball game. You're right. Good point. Yeah. So your answer is you like inpatient a little bit better just because it's less hectic. You can do a little bit more and you don't have to wait for them or they don't have to wait for you. Yeah, it's a lot of pressure, although we do get emergencies. So, you know, I think you have your day planned out and then, you know, three people are in the ER waiting to be seen. So a little unpredictable. You know, that's probably true. The acuity of the patient who's inpatient is probably much higher than your typical walk-in ambulatory outpatient person. Exactly. So your day is a little more predictable in the outpatient setting. Yeah. And inpatient, you just don't really don't know when you're going to be done with your day, but that's okay. Sounds like either one. You just don't really know what you're going to get. There's pluses and minuses to both. Exactly. Exactly. Fair enough. And then as far as teaching goes, how does that work out for you day by day? So, day by day, I love it. And right now, we have moved most of our, you know, all of our didactic portion and lab portions online would be some COVID restrictions. So that's been a challenge, but we're all adjusting and we're being more creative. Some people say you can't be present with your students if you're not in the same room with them. And we're really proving otherwise. So we're being there for our students in the asynchronous and synchronous way, but again, online and not in person. So that's been a challenge. Definitely. And how about seeing patients? Are you seeing patients mostly over telemedicine? Oh, good question. So, you know, if they're pretty sick, we bring them in still, although that's limited. We try to keep the telemedicine for not as critical patients. Of course, they would come in or go to the hospital because the, you know, disadvantages of telemedicine is you're not able to put your hands on them. So we try to do the less complicated patients via telemedicine. So similar to what we're doing now, I'll have two screens, one with the video and talk in the headset, and then I'll be typing and the other. And, you know, we do a lot. We get a lot done. Patients are happy about that. Some people, you know, are 60 miles away. So they're very pleased that we could take care of some things over the video. Yeah. So in school right now, I'm a first year. So they're teaching us the whole, you know, history and then physical and then, you know, you do your assessment and plan, you base everything off that. Now your physical is taken away from you. So it's just like it's half the exam. But I guess for some people, it still works out. Yeah, some people it does work out. Okay. So at the nurse practitioner program that you work at, you don't just teach, you're also involved in admissions. You were telling me earlier, you actually interview quite a lot of the folks that you consider for the NP program. Could you tell me what you look for in a candidate to accept to your NP program? Sure. So there's an initial evaluation process where the potential student writes, you know, an essay of why they want to go to NP school. They send in their transcripts, we look at their GPA, of course, and their involvement in the community around us. We get recommendations from their peers and other faculty, their previous managers. And we use that as an initial evaluation. Out of that group, we interview a select amount of people. And we look at that, but then we also ask the student, you know, how do you plan on going to graduate school? How do you plan on balancing work, life, family, want to make sure they can do it? We want to make sure they're their heads in the right place. We want to make sure they're able to run their grades, but also with their motivation. It's nice to see the person, talk to them, meet them. I think that's important. And just discuss the program. It's not just asking the potential student, you know, what they want. We also tell them about our program because maybe they're interviewing in other places as well. So we want to make sure it's a good fit. I think that's the biggest goal. Make sure it's a good fit. Make sure they understand what the program's focus is. Our program is primary care focused. Someone that wants to go into anesthesia or in the operating room, it probably won't be the right fit. So we just want to make sure we're all on the same page and they're going to be successful. I think we really want to make sure of that. You know what, I'm glad you reminded me. I definitely, there's a lot there I want to explore, but the biggest thing is you said that your program specifically is primary care focused. With PA programs, they're all generalists. You kind of specialize afterwards. Can you talk a little bit about different and P programs and what they focus on? Sure, sure. So, um, yeah, this particular program is primary care, a family nurse practitioner. So, you know, the hours in clinical are focused on primary care. There are some opportunities to do your clinical hours in specific specialties like women's health or cardiology. But it's not the majority of the hours. So that's important. And the didactic portions also focused on that primary care. Other programs, pediatric nurse practitioner will be focused and you'll be certified in pediatrics. So the pediatric nurse practitioner wouldn't be able to work with adults. Okay, family nurse practitioner, you can in fact work from cradle to grave. You can work in pediatrics, you can work with geriatrics. You can even in our state, you can work in acute care. But again, you're not certified in acute care. So you might see that down the road where there's going to be some doors closing for FMPs to work in acute care setting like the hospital setting. Right now you could, but insert other states can't do that. So it depends on the state you're with. Also nurse anesthesia, that's again master's degree working as an anesthesiologist. And there's a clinical nurse specialist and there's adult nurse practitioner, adult Jerry, where you could only see adults and no pediatrics. So it depends on the focus of that program. So make sure when you're looking into a program, what is the focus? What are the hours for clinical? How is it broken down? You want to make sure that you can keep an open mind. Like you said, you might specialize after. So I'm assuming you're going to keep an open mind with your clinical experiences that maybe your interest may change. Yeah, I think he's kind of have more of an opportunity for that to kind of drag our feet and what we want to specialize in and then change, you know, five, 10 years down the road. With an NP, it's it's kind of more of like an MD where once you do your specialty training, you really have to get retrained before you work with a different population. Well, again, like a FMP could work in different specialties, but you're going to see down the road that it's going to be more specialized, like you said. And that brings me to PA. You could work in the OR as a first assist, right? Yes. Okay, so we can't we can work in the surgery department and see patients outpatient or inpatient, but we can't go into the OR as a first assist. But after we after FMP graduates, they can go to a different program and get certified as a first assist after they get their FMP. So there's another difference there. It's a big difference. I also didn't know that because I mean, everything you hear as a student so much is coming at you, you never know what to believe. So I've heard in a lot of like surgical settings, PAs are typically like first assist, we might do some inpatient outpatient stuff, but mostly we're in the OR and MPs are mostly handling the clinic. But you said that you can get certified as an MP and also work in the OR. Yeah, we have an MP that's faculty here, and he got his certification as a first assist. So he goes into the OR sees outpatient, he does everything. Okay, so what is the training involved? Like once you've already completed your MP training, you want to be a first assist? Is it like two months, six months, a year? I'm not sure exactly. It's a few months. And then there's some clinical hours, of course, in the OR. I have to do so many hours in that role, of course. So I don't know the details, but it's less than a year. Okay. So it's it's not insignificant, but it's definitely not like a whole another two, three year degree. Exactly. Yeah, very doable. Well, I definitely learned something. So if you want to be an MP, but then you decide you want to do surgery, you could always get that as well. And it's not, you know, a huge commitment to go do more training. So that's cool. Another thing is if you're an FMP, you just graduated, took your boards, now you're pricing an internal medicine, then you decide you want to be a psychiatric nurse practitioner, you could go on for that certification. So you want to have to do the whole program again, you do those specific courses for that specialty, and then you'll sit for the psychiatric nurse practitioner boards. Okay. And those things basically just have everything that, like as an FMP, you didn't get trained for. So maybe it's a year or so, maybe six months, whatever the difference is. Exactly. Okay, well, that makes sense. So I really didn't know that you can kind of pick and choose. You just need a little bit more specialized training, which might actually be a good thing to be honest with you. Yeah, because you have your core, your core classes, like your pathophysiology or pharmacology, you know, you have those some of those core classes. So if you do go on for another specialty, some of those will be transferable. And does that make sense? It does. It's kind of reminding me of like a girl scout or a boy scout belt, you just get your badges and you can get like all these different trainings throughout your career and you can do all those different stuff. Yeah, exactly. That's kind of cool. I think with the PA field, it's it's kind of similar, but there's no structured training. There's more and more residencies coming out, but it's just like office specific. So it's basically just your resume. There's not as many like structured trainings like for surgery and psych and things like that. So how many hours, how many hours of clinical do you have to complete? I think PA programs are required about 2000. 2000. Okay. We have a lot of different rotations, core rotations like psych, primary care, ER, all that good stuff. So it's simply interesting. I didn't know all that about the NP route. That is interesting. Yes. So another big elephant in the room is MPs by law can practice independently. PAs cannot. Depending on the state, we guess like New York state, you could practice independently. You know, I think it's important because let's pretend I'm working with a collaborating physician and that collaborating physician decides to retire tomorrow. I technically can still work without the collaborating physician. And that's important, especially, you know, on rural areas where there's no primary care or there's scarce primary care. I think it's important in that sense. I by all means don't plan on opening up a practice. You know, I just don't have that entrepreneurship. I like working with my collaborating physicians. I love teaching. I love doing all this. But people who do, that's certainly I say go for it. If you have a plan, a goal, go for it and you could. So for instance, your DEA license, the license that allows you to prescribe medications, it does not have another physician on it. It's just yours. Right, correct. That's a big deal. Never thought of it that way. What is what's the PA do? What are they how to handle it? So the PA, you have to be hired by a practice and you have to have a supervising physician on paper before you can get your DEA license. OK, I gotcha. So I never actually thought of it that way. What you said before, like if your physician got to admit something happens to them or if they retire or something like that, you technically can't practice. You can prescribe medications until you have another one. Yes, it's interesting. Very interesting, but that's the utility I see of it. I don't, you know, as far as entrepreneurship, that might be something else might do. I mean, I have heard of like PA run practices, but they have a physician on staff that basically signs off for them. Oh, OK. I think you could have like an LLC with a physician. I mean, anybody can own a practice. You don't have to be certified in anything. But if you want to practice in your own practice, then that's true. That's right. It's messy. All right. So let's see here. So we talked about NP admissions, what it takes and kind of what you look for. Is there a personality type you think is really ideally suited for an NP career, at least in your program? Well, I would probably umbrella the NPs, PAs, the MDs as far as personality types, because you do need your group together, because you need your clinical skills, you need your didactics. But as far as personality, I think that we all as providers need empathy. You know, and just being sensitive to what the patient's going through, especially our vulnerable populations. I think that's huge across all health care providers. That that personality, you know, that caring, empathetic personality. Definitely. That's going to be number one, you would say empathy. Absolutely. It's funny because the way that Bentley said orientation and like you ask a lot of PAs, what's a personality type of a PA? They usually jump to type A, get it done, get everything done, you know, just like responsible, motivated, energetic, empathetic is definitely in there. Maybe it's assumed, but the very first thing they say is you got to be type A. That's interesting. So that's an interesting difference. Well, that's something I know as we used to work together for us, as the audience might not know, but that's something that knows about you how very meticulous you were with detail, professional on time. And very good with the patients. So, you know, I think that shows your personality and that's important and you're going to have your clinical skills, your didactic. But if you don't have that, you know, it'll be very difficult to survive in medicine because you have to be organized, you have to be paid attention to detail. I mean, these are patients lives. So that's a very positive attribute about you that I've seen before you went to PA school. I appreciate it. Yeah, I definitely think you can't be a careless person because one little, you know, point zero one on a lab value could mean if you're in the ER or life or death. So, yeah, I just don't see how you can practice without that. That comes out exactly. Exactly. It's important. Not everybody has that. Well, I appreciate it. Just so the audience knows, yes, we did use to work together. I was a medical assistant in the practice that Sarah works at currently. So how do you see our current medical system changing and what role do you see providers like NPs and PAs playing in that change? Well, when I think about the future of medicine, the first thing that comes to mind is the shortage of primary care providers, primary care physicians, specifically, especially in rural areas. So I see the physician assistants and nurse practitioners filling that gap. I see them feeling that get very well. And that's the biggest, biggest hurdle that I see. I also see nurse practitioners and physician assistants also being more more holistic. We already are, but just integrating other specialties within our practice, you know, like in my practice, it would be lovely if we had a dietician working closely with us and maybe an occupational therapist. So I see more of that, more interdisciplinary care. I'm hoping that will continue. Insurance is reimbursed for that care. So you're saying maybe more of a team aspect more than it is now. Yeah, so, you know, one point is my dissertation was how healthy behaviors help patients. And, you know, the number one of the number, the highest thing is diet. So diet affects your health. And I can't even refer a patient to a dietician without telling them, well, this might not be covered by your insurance. And you might be spending this amount of money, but it's really, really important that we, you know, you get some one-on-one dietary education. So I think that insurance companies need to come on board with this interdisciplinary approach. Why do you think that is? Because diet is so important, at least for anybody who's tried to take care of their own health. Why do you think dietary, you know, dieticians just aren't as accessible or insurance just doesn't see them very highly? Or what's going on with that? I don't know. I don't, I guess it depends. I always have a problem with referring for a dietician, for example. I'm not sure why they're not paying. I think it makes such a huge difference. Maybe we need to spend more time talking with these insurance companies and telling them how this would actually help them and save them money, prevent hospitalizations down the road. But I don't know. It's mind-blowing. Do you see us as primary care providers or, I guess, outpatient providers doing more of that counseling? Or is that just not something we can do, not in our scope of practice? Well, yeah. So, you know, I do a lot of education, but there's always a barrier of time, you know, and especially an outpatient too. So I'd love to spend an hour with each patient, but that probably won't work out with the practice I'm at. And as far as revenue, you know, we have to keep the doors open. So and I understand that. But I, yes, I'd love to spend more time with them, but that is a barrier. So and we have patients that are sick that need to be seen. So you can't end all that time educating. You do spend a little bit of time motivational interviewing and helping them formulate a plan. That's what I want to school. That's why I wanted to do this for. But it's not always realistic that you can spend as much time as you want with your patients. OK, you said you were you've been practicing for what, 20 years or so? Going on 17. Going on 17? OK. I rounded way up and I'm sorry. So over 25 years in nursing, but going on 17 as a nurse practitioner. As a nurse practitioner. All right, I'm going to put it this way. From your quarter century of medical experience, do you think that what percentage of patients that you see, do you think would be conducive to keeping a food diary honestly and bringing it to you as a diagnostic tool? So I'd say about 30 percent would do that because I've had to do that. Really? Who would have benefit 100 percent? Yeah. Well, Sarah, are you ready for rapid fire? Sure, sure. Favorite food? Black olives. Black olives just by themselves or on pizza? Both. Oh, really? OK, you really love black olives. All right. Dream vacation spot. Florida, we go to Clearwater, Florida every year. OK, is that South Florida? No, more on the east. OK, but it is by the ocean. Yeah. Oh, yeah, definitely. OK, favorite animal? Cats. Cats. There's a cat tree behind me, but the noodle cat's not in there right now. She's usually here. iPhone or Android? iPhone. iPhone. All right, favorite 90s TV show. Well, you know, I'm dating myself because I am a lot older, so I go back to three company days in the 70s and 80s. OK, I don't think I was quite alive yet, but I've definitely heard of three company. I know the song. Yes, John Ritter. Yeah, I didn't know that part. All right. And last question, if a tree falls in the woods and nobody is around to hear it, does it make a sound? Yes, it makes a sound. It does? Yeah. OK. So the last person I interviewed on this channel was a medical student and he answered that very technically. He said, well, yes, of course, it's not based on the observer. It's based on the frequency. It's like, OK, dude. Whoa. He went all the way into the physics of it. Oh, I love it. But I guess so. It does make a sound. So he was right. He said you would say that. All right. Well, Sarah, is there anything else you'd like to say to the pre-med, pre-nursing, pre-PA, pre-NP students watching this? I'm grateful that you allowed me the opportunity to talk about our professions. I am, you know, in an amicable way. I love that. And I'm very passionate about physician assistants, nurse practitioners, MDs, PTs, all of us working in synergy, you know, and I want you to let you know that my primary care provider is a physician assistant. Really? And all my providers along the years have been either a nurse practitioner or a physician assistant because, you know, I trust them. I know I'm going to get more time. And one on one, I am very pleased with my PA. You know, I've heard that from a lot of people. They actually prefer having a PA or NP because we do have a little bit more time for them. We actually listen. I've heard that too. So, you know what? That's a really good thing to say. And definitely thank you for coming on. Thank you for doing the interview. The reason for this is the last person I was consulting said there is a million PA versus MD videos out there, but not a single PA versus NP video. Interesting. Okay. Well, I'm glad we did this. Me too. And I definitely learned something. Yes. See, I'm going to go back and be a nurse practitioner now. Don't tell my program. And I'll be a PA. Hey, there we go. We could do that. Just swap programs. So again, thank you very much for coming on and hopefully we'll do this again. All right. Thanks, Boris. Take care. All right.