Recently, the New York Times published an article on excessive costs incurred by mid-level providers over-treating benign skin lesions. According to the piece, more than 15% of biopsies billed to Medicare in 2015 were done by unsupervised PA’s or Nurse Practitioners. Physicians across the country are becoming concerned mid-levels working independently without proper specialty training. Dr. Coldiron, a dermatologist, was interviewed by the Times and said, “What’s really going on is these practices…hire a bunch of P.A.’s and nurses and stick them out in clinics on their own. And they’re acting like doctors.”
They are working “like” doctors, yet do not have training equivalent to physicians. As a pediatrician, I have written about a missed diagnosis of an infant by an unscrupulous midlevel provider who embellished his pediatric expertise. This past summer, astute physician colleagues came across an independent physician assistant, Christie Kidd, PA-C, boldly referring to herself as a “dermatologist.” Her receptionist answers the phone by saying “Kidd Dermatology.”
The Doctors, a daytime talk show, accurately referred to Ms. Kidd on a May 7, 2015 segment as a “skin care specialist.” However, beauty magazines are not held to the same high standard; the dailymail.com, a publication in the UK, captioned a picture of “Dr. Christie Kidd”, as the “go-to MD practicing in Beverly Hills.”
The article shared how Ms. Kidd treats the Kardashian-Jenner family, “helping them to look luminous in their no-make-up selfies.”
While most of us cannot grasp the distress caused by not appearing luminous in no-makeup-selfies, this is significantly concerning for Kendall Jenner. At the tender age of 21, she inaccurately referred to Ms. Kidd as her “life-changing dermatologist.” Cosmopolitan continues the charade, publishing an article on the Jenner family “dermatologist.”
It astounds me how some medical professionals can contentedly live in the gray, south of brutal honesty, yet somewhere north of deceit. Until a few months ago, the Kidd Dermatology website erroneously listed her educational background as having graduated from the USC School of Medicine with honors and made no mention of her supervising physician. It was later modified to reflect she graduated from the Physician Assistant program at USC.
There are laws mandating physicians display diplomas and certifications prominently in the interest of transparency. According to Title 16, California Code of Regulations sections 1399.540 through 1399.546, a PA in “independent” practice is limited to the scope of his/her supervising physician by law. A board-certified plastic surgeon is supervising “skin specialist” Christie Kidd, PA-C, not a dermatologist. The website of the plastic surgeon states, “Trust only a Board-Certified Plastic Surgeon;” which in my opinion, seems astonishingly tongue-in-cheek. He may believe treating bullous pemphigoid disease is just another day in the life of plastic surgeons everywhere, but plastic surgery is a far cry from practicing dermatology and vice versa.
When asked about this, the Public Affairs Manager, Cassandra Hockenson, at the Medical Board of California responded “there is not a huge difference between plastic surgery and dermatology.” She suggested contacting the Physicians’ Assistant Board for the State of California instead. She kept repeating that the supervising plastic surgeon had no complaints against him. I learned two important lessons from contacting the Medical Board of California: 1) Without complaints, a physician can supervise midlevel providers in any specialty they choose, and 2) while required by law to supervise mid-level providers, the safety of patients is not a high priority for the Medical Board of California.
At a minimum, physicians complete four years of college, four of medical school, and between 3-7 years in residency. The years of education required for obtaining a PA degree are considerably fewer than that of an MD. For all intents and purposes, Christie Kidd, PA-C is running an independent dermatology practice directly under the nose of an apathetic California State Medical Board indifferent to regulations. PA’s can be fined and disciplined by their own board for misrepresentation, however, her “supervising” physician is, in fact, also out of compliance with the law.
While not all celebrities understand the difference in education between an MD or PA, mid-level providers and their supervising physicians should not be immune to the rules and regulations. Honesty, trust, and transparency are ideals essential to the medical profession. Physicians are held accountable for the health and safety of the patients we serve. Google Business modified the Kidd Dermatology listing from “Dermatologist” to “Medical Spa.” The unsinkable Christie Kidd struck a compromise, settling on the designation as a “skin care clinic.” Carpe Diem, Ms. Kidd, Carpe Diem.
Niran Al-Agba, MD is actually a physician. She practices in Washington state.
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Overall, this sounds like an angry and misinformed physician with a bruised ego. Never have I heard a PA refer to themselves as a Physician nor tout that their medical experience is equivalent to an MD. The MD and PA team that I work with have provided me with seamless care in a world renowned facility. I owe my life to the entire team, including the nurses and administrative staff. Perhaps you should have educated yourself about their education and training before writing this inaccurate and one-sided gibberish. Secondly, stop harassing a profession who’s intended purpose was to help extend access to patient care. Next time, direct your extinguisher to the fire (aka, PA Kidd) directly.
Before knee surgury I was told repeatedly that my private areas would stay covered and underwear kept on during surgury. As a rape victim the thought of being exposed was mortifying!!!! There where stufents,sales person,and God knows who ever else they invite into what I believed was a safe secure environment exposed being knocked out. I woke up to the pa handing me my underwear and was told they where removed during surgury. She lied!!!! She flat out lied to me!!!! After I found out that hospitols where allowing class room full of stufents to come into surgury and all take a turn sticking their fingers in patients vaginas to do pelvic exam for practice with out their knowledge or permission! How many women do you know that would be ok getting finger fkd by a group of strangers while under antethsia? Thank God our government stopped this in mi!!!! Point is have you ever told a patient that would or did happen? Or that un licensed people where allowed in the or? Or that your surgury is on display for students to stare at you? I’m guessing NONE! this is why I do NOT trust dr or pa or rn! You all are not what best for the patient but what’s best for your own purposes. Rest assure I will NEVER NOT EVER GET KNOCKED OUT AGAIN!!!!!! ID RATHER DIE!
The p.a.I see has me on 8 blood pressure pills a day.I have a sleep disorder and go 8 or 9 days without sleep.I have had a sleep study done and have chronic insomnia. She will not give me a sleep medication for this
Also She is cutting me off some of my meds because it’s been 2 months since I’ve seen her can she do this?
You took hours out of your day to paint a disparaging picture of PAs across the country because of a half-wit named Christie Kidd. What a great use of your time! Perhaps you should also consider researching and chronicling the unscrupulous history of your own peers. You would have an endless supply of content.
I just found this article and had to log in just to comment. Your comment is incredibly uneducated, damaging, and inaccurate. No evidence is given. Instead, just subjective blanket insults are thrown towards NPs. I work with an incredible team made up of NPs, PAs, and physicians and we all show the utmost respect for one another. It is sad to know that there are medical professionals out there with such a biased, prejudiced view of their colleagues.
Thanks Bill you adding some extra incentives to the mix.
Good discussion, Allan. I worry that with unusual diseases the correct diagnosis might not be made by the PA or the NP. Say someone with Hgb SC disease or someone with paroxysmal nocturnal hemoglobinuria or the superior mesentaric artery syndrome. But, we are all fallible people and unless you see these things once in awhile, we are all going to miss them, including the sharpest doc. Our longer training means that we might have a trace of memory for a few more rare things and even these traces help us look stuff up. Maybe with artificial intelligence, PAs and NPs can do a fine job in all these areas. My step son is a NP. He wishes sometimes he had gone into the PA route, as he believes there are more challenging jobs out there fo PAs. But he is thriving as a Kaiser cardiac case manager and making a good income. Kaiser is hiring more and more “techs”…they are cheaper, I guess.
“ Why are you so bent on trying to put down the PA profession by pointing out what you perceive as the differences in training or in practice? “
TPNA, where do you come off saying that? You keep assuming others are putting down PAs. You are touchy and defensive to anyone that questions anything about your profession. If you look again at my earlier comment I had two questions that were very neutral. “1) Are we appropriately utilizing our physician and physician extenders for the benefit of patients rather than profit or ego? 2) Not that long ago I believe the pool of physician extenders was relatively small…” and then in answer to a follow-up question I asked a question, (3)”In today’s world is the physician defining their role and if he is, is it based on the needs of the patient or the desires of the insurer?”
These questions do not insinuate anything except to recognize the reality that we don’t know if the dog is wagging the tail or the tail is wagging the dog. Physician practices no longer have the independence they had in former days. Today’s physicians and their extenders frequently are treating code numbers rather than patients.
” it is incredibly difficult to get into a quality accredited PA program, many say it is harder than med school.”
Many say? Many say the moon is made of green cheese when we all know it is made of blue cheese. I am not quite sure what you are trying to prove.
What you call insulting is simply the truth. Horses and Zebras are very much “like” one another, but it is ill-advised to call them the same.
“You brought up the situation of a sicker patient being sent to the PA vs the MD and that it should be the other way around. That is not up to the PA, it is up to the MD and the staff.”
Suddenly the needs of the patient seem to melt away. The insurer, whether you realize it or not, substantially influences how physicians practice. That, in turn, influences how the practice decides who sees the patient.
My questions neither favor the physician or the extender. They are questions of value and lead to the question of the best patient care and the ability of the patient to gain control over his own body. Nothing I am asking is meant to insult the PA or the physician. Do not assume that the person you are communicating with has no experience.
Why are you so bent on trying to put down the PA profession by pointing out what you perceive as the differences in training or in practice? PAs are measured all the time, it is incredibly difficult to get into a quality accredited PA program, many say it is harder than med school. We take a difficult board exam, are required to do CMEs and repeat boards. Most importantly we are being placed in roles where we are doing exactly the same thing as Doctors. We are providing the exact same care in many areas of medicine so statements like “Horses are “like” Zebras, but they are far from being the same.” is very insulting. If you don’t want a defensive attitude you might want to stop using insulting questions and statements. PAs do not practice medicine based on the needs of insurance companies, I am one so I know. You brought up the situation of a sicker patient being sent to the PA vs the MD and that it should be the other way around. That is not up to the PA, it is up to the MD and the staff. If the MD tells people what he or she wants and defines the role they want their PA to take then we are a good team. I really hope if you are sick someday you get some quality care from a PA and your clear bias might begin to change.
Ah thank you. I have not seen such a fuss before either, but it is interesting in that much in the way of dialogue may be generated. Beethoven is a worthy pursuit.
AdamW, If I had expected individuals reading my work would bring my family members into the discussion, I might have spent less time putting together his Celebration of Life and more time updating my website.
In two years of writing experience, no one has ever gone after me personally as two of the commenters did here.
I picked one instance because it is a story and readers relate to stories. I have not cherry picked this one because she is a PA, you will see in other work I have written about NPs or other MDs when it seems appropriate. This was intended as a post about transparency and I discussed one rogue PA. This was not intended to insult the profession as a whole.
Finally, as for updating my website being “truth in advertising”, my father passed away at the end of October, and to be honest (which I am to a fault), I have not decided what to do regarding the website. I am thinking on it, but it doesn’t feel right to erase my fathers existence after 47 years of practice in my hometown. Maybe it is just a notation mentioning he passed away in 2017 after founding our business partnership?
You may feel I am intentionally being dishonest and that is your prerogative, in reality, I am grieving a huge loss of my father, business partner, colleague, friend, and mentor — all at the same time. While you may never read another thing I write because this piece angered you to such a great extent… you might like this one, https://www.kevinmd.com/blog/2017/10/physicians-deserve-mercy-silentnomore.html
I believe it portrays that we are all doing the best we can in this field, whether MD, DO, PA, or NP. All the best to you in the future.
For the record, dermatology is not a specialty that I enjoyed either. Being white myself, I have faced most prejudice in a situation like this where my name conjures up a preconceived notion of what someone of Arabic descent looks like. Some new patients show up in my office and can’t believe I look and talk “just like them” (their words not mine.) You should see their faces when they find out I am an Irish Catholic…
Regardless, I agree with you that collaborative environment with respect amongst colleagues is the best choice and yes, many of us in rural areas are so darn busy, we would love to have an MD, NP, or PA join us; because our patient loads can really be overwhelming..
Anon91, Great question. Glad you asked…. this is my opinion: https://thehealthcareblog.com/blog/2017/05/29/md-vs-dnp-why-20000-hours-of-training-and-experience-matters/
You will find that piece was almost as controversial as this one. Up next, is a story about an MD who needs an ethical reset. 🙂 Then everyone will be unhappy with me, but will they talk about how to make things better for all of us? I hope so. Thank you for your comments.
I think your comments are very fair. Thank you for the constructive criticism on this piece. I have much to learn in the world of writing and am always looking to improve my skills. I do see your point about the flow. My intention was to introduce that the lines between physicians and mid-level providers are increasingly becoming blurred and then go on to describe a situation where one individual has taken misrepresentation to a higher level. I think all MDs, DOs, PAs, and NPs should be aware of this and help us all stay within our boundaries.
As to the title change, ALL of the editors, whether at THCB, KevinMD (titles are ALWAYS altered), and even at my hometown newspaper where I write a monthly column, take liberties with titles and they are intended to grab readers attention.
I had no intention of implying that all mid-levels are dishonest or incompetent, rather I wanted to open dialogue amongst all of us, as colleagues, to better define our roles and boundaries. Being open, honest, and transparent builds a patients’ trust and that is good for patients, all clinicians, and our healthcare system as a whole. Thank you for your feedback. I do appreciate it.
You don’t really want to go there, do you?
Respectfully, most of us don’t. Do you really want to compare the PAs who daily labor to provide care to average Americans to those who cater to the KARDASHIANS? To be honest, I would never want to work in dermatology. Even dermatologists often cannot make a diagnosis, and treat empirically accordingly.
I am sure that Dr. Al-Agba has faced unfair prejudices. Perhaps based on the fact she may not look like me. I have experienced white privilege on a daily basis. I know that I am treated differently than my African American colleagues, as well as other minorities, when their credentials are far superior to mine.
Patients have preferred me to some MDs, because the MDs are “other”, even if they were born in the US. This is wrong, and I have told the patient as much.
Never would I want to cheapen the sweat equity of MDs. But the fact remains that a minority of medical school graduates are going into primary care, and nature does abhore a vacuum.
Is it better that patients receive no care rather than from a PA/NP?
I am so grateful that I work in a collaborative practice with MDs who respect and value my efforts, and are far too busy to be threatened by me.
Absolutely nailed it. Couldn’t have said it better. Thank you.
I’m a former PA. I’ve been a physician for 12 years. PA school was very challenging. PA school is as competitive as med school so the IQ of a PA is very high. Any RN can go to NP school and most now do it online. RN’s love to tout how their RN exoerience should count fir something toward their NP. It’s apples and oranges. Until you’ve been both you can never understand how you just can’t know what you don’t know. The eyes cannot see what the mind does not know. This article is about a PA gone rogue. More often this is a story about an NP. In general PA’s are a stronger bunch and much less likely to advocate for independence. But it has been happening in some states. I support the PA profession as long as it stays on our team. NP’s will meet their maker when they start getting sued for their stupidity. As physicians there is a new nationwide movement to not train NP’s. Guess they’ll be doing their rotations online as well.
Being neither MD, PA, NP, RN or anything else with initials, I don’t have a dog in this hunt. But as a reader and interested inhabitant of the peanut gallery, perhaps I can suggest a bit of clarification. Perhaps Dr. Al-Agba could ask the editor to restore her original title, as the current title appears to be a point of contention with the mid-level practitioners.
Also, the first paragraph, about mid-levels over-treating benign skin lesions, does not logically lead to the content of the remainder of the article, which Dr. Al-Agba states is about transparency and which discusses the case of a single PA failing to clarify that she is not a physician. If this article is truly about transparency and correctly identifying one’s professional education and credentials, then the first paragraph is out of place – and would be more appropriate in an article discussing why mid-levels might be overtreating certain conditions. As it is, conflating the first paragraph with the content of the remainder of the article and adding in the current title (which I can accept was an editorial decision rather than Dr. Al-Agba’s intended meaning) leaves an impression that mid-levels are dishonest and incompetent, so I, as an unbiased spectator, can see why the mid-levels here might be perturbed.
We are not physician helpers either. The word assistant is a misnomer.
As a PA, this is concerning. It seems like Christie Kidd was intentionally trying to mislead the public as to her degree and qualifications. I always correct my patients when they refer to me a Dr. Anon, and explain that I am a PA and work in collaboration with physicians.
What are your thoughts on DNPs who open their own clinics and refer to themselves are Dr. SoandSo?
I see this quite frequently as I live in a rural state that grants NPs independent practice, even as new graduates. Unfortunately when I express my concern about this to NPs, the response is usually that nurse has a doctorate and has a right to themselves doctor. Although, from what I understand, the DNP when compared to ARNP confers no increase in clinical knowledge, rather more education on nursing theory.
There is a lot of misinformation in this comment. Lets break it down:
1. “They only need a BA in every subject, ex: art history”. True, you can have a 4 year degree in anything. However, no matter what degree you obtain, there multiple prerequisite course requirements in biology, inorganic chemistry, organic chemistry, statistics, and upper-level science courses ranging from microbiology to embryology. Here is an example: https://medicine.uiowa.edu/pa/education/prospective-students/course-requirements . Exact requirements may differ between schools, but overall you must have taken courses in the hard sciences regardless of your undergraduate degree.
2. “It used to be they didn’t need any clinical before they began practice. Now at least clinical hours are required” . Like djwatt21 commented, the PA profession was founded during a period of primary care physician shortage so that medics, who had received considerable medical training during their military service, could work alongside physicians to improve access to care. Things have changed and not all PAs and PA students have a military background, however patient care experience is STILL a requirement. And while there are minimum amount of hours, usually the amount of experience of accepted applicants if much higher.
3. “On the other hand even a nurse who graduated and goes straight to NP school has 2 years prerequisite, 2 to 4 years nursing school and then 2 to 3 years NP school.” Lets do some math. Using the information above it looks like NPs have potentially 6-9 years of training. Two years of prerequisites is not always a necessity, there are nursing programs that accept students straight out of highschool, so that is not a constant. This brings us down to 4-7 years. Two to 4 years of nursing school is comparable to the required 4 year degree of all PA programs. Now, it’s 2-3 years for NP programs compared to the minimum 2 years for PA programs (many programs are increasing the length of programs to 28 months to allow to more clinical experience). NP training is online and this allows the student to work, would this be considered full time? Contrast this to PA education which is 8 hours per day, 5 days per week for the majority of the program (maybe 1-2 week breaks during the first year). All the programs I know of state on their websites that it is not feasible for the student to work during their program due the intensive time requirement. I should also note that there are PA residencies for those interested in specific fields of medicine, e.g. emergency medicine, psychology etc.
4. “Clinical time is required in all nursing rotations”. This point must be a joke. NP programs generally involve 500-750 hours of clinical rotation. Minimum standard for PA education is 2000 hours of clinical rotation.
5. “In addition most nurses work at bedside while pursuing advanced degrees”. This is true, and I work with some fantastic NPs that were ICU nurses for 7+ years before beginning NP programs. However with the proliferation of NP programs, newly graduated nurses are starting programs with no nursing experience, and from what I have experienced working with some of these nurses is that they have no interest in patient care as a nurse, only in getting there NP degree as fast as possible. I know anecdotal evidence is some of the weakest out there but this is my experience, take it with a grain of salt.
6. “NPs treat the whole patient, PAs are just what the title says an assistant to a physician or physician extender.”. I don’t know if the commenter has ever met a PA or is sure of our function. My training emphasized treating the whole patient, not just disease. In fact, I often read that “the nursing model treats the whole patient, while the medical model just focuses on the pathophysiology of disease”. My program shared a majority of its coursework with the medical students, and we were all taught to treat the whole patient. In my current position, I certainly am not just an assistant to a physician; I carry my own patient load, write my own notes, do my own admissions. I have to admit, having the word ‘assistant’ confuses a fair number of people, apparently even some in the healthcare world.
7 “An NP is an independent practitioner with some states requiring physician oversight. Please do not lump us together the education and practice are not the same”. Just because a state law grants NPs independence does not mean that you SHOULD have independence. Especially for new graduates. There should always be some degree of collaboration with physicians because, as much as we can argue about whose education is more rigorous, NP and PA education does not compare to that of a physician. PA and NP are two different routes to the same kind of position.
I know this is a long comment, but I will not apologize for it. Misinformation like that of the original commenter only works to pit NPs and PAs against each other.
As a physician, the insecurity by PA’s here is astonishing. Dr. Al-Agba was only stating that it’s not correct to misrepresent yourself and to not reveal to patients that you are trained much differently from physicians. It was well-written and her critique of the PA in question was restrained and fair also.
I’m sorry you feel that way. “Vitriol” is a very strong word to use when I’m simply asking for you to advocate supporting an open dialogue, and understand how your article title, while not your own, may shut that down. Again, you could not have allowed the title change if you also disagree with it.
As for the subject matter – we should all be very clear about our licensing and skill set. This can be complicated in actual daily practice but it doesn’t change our responsibility to be clear about who we are and correct patients when they are confused about credentials. I fully support that level of transparency and make effort to do so in my daily practice as well.
Furthermore, while I work with NPs and feel very strongly about them as colleagues, NPs are very clearly forging ahead in an effort for continued autonomy of practice. Many states already allow them to function independently, as well as the VA, and essentially all NP programs are now becoming doctoral level degrees. On the other hand, our professional organization, the AAPA, just reaffirmed our dedication to team based practice with the endorsement of “Optimal Team Practice” language. This was in response to initial planning around “full practice authority” (essentially what NPs have in many states). Rather than forging down that path, PAs embraced the physician lead healthcare team as we always have. So I ask you – given these facts, who among us is mostly likely to misrepresent their training, intentionally or otherwise?
Finally, while it isn’t the same example, in what way is a physician who overbills for unnecessary procedures any better or worse than the PA referenced in this article? Consider the various stories of physicians committing Medicare fraud as a result of such practices.
Whatever the case, we have a responsibility to our patients. Any example that undermines the trust of these folks in a notable way should be identified and examined in an effort to do better.
So, where is Ms. Kidd? No comments? Has she changed her misrepresentation? She must know the shock wave she has sent through her profession…does California have a law against false advertising?
Okay let’s reel that one in a little bit. Don’t forget the history of the PA profession is one of battlefield medics being converted to civilian medical providers. Yes our field has evolved tremendously since that time, but there is still an enormous number of second career folks, many from the medical field. Regardless, admission to PA school, subsequent training, clinical rotations, and certification are extremely rigorous. Please do not insinuate otherwise. This is not a competition among license types. With respect to education and training, the typical PA program, while similar in length to NP training programs, averages 1000 classroom hours and 2000 or more hours in a clinical setting. The average NP program, comparatively, requires about 500 classroom hours and between 500 and 700 clinical hours. Furthermore, NPs have no ongoing certification maintenance requirements outside of CMEs (75-150 hours) and clinical hours (1000 in their field of practice) per 5 years. PAs require 100 hours CME every 2 years and must recertify thru examination every 10 years (this was recently revised from 6 years to be more consistent with our physician colleagues). Again, this is not about the measuring stick here, but there are very significant differences in the extent of our training programs such that a statement like “I do not believe PA’s and NP’s should be referred to in the same breath” doesn’t hold water. Regardless, I work side by side with awesome NPs in my practice, and ones that I’m sure wouldn’t make these erroneous accusations about PAs and our training.
I deeply admire your patience with all of this. During several years of “Blogging,” I have never seen such a fuss. As I write, I usually listen to some of my favorite composers, mostly classical. The level of creative purity usually leaves these issues in the dust. Tonight, its the Choral Fantasy by Beethoven. The search for truth, left unattended, is no longer an alternative when the choral ending occurs.
So true
My fnp practicum is 1800 hours in addition to my 26 years of practice in peds peds ICU, nnicu, adult ICU, cicu, rapid response, nurse supervisor, dialysis, EP lab, home health and ltac!
What you do and what a physician does are NOT identical. Physicians have training in many areas, they do rotations in all aspects of health care then pick a specialty and do a fellowship. That knowledge cannot be gained during a PA program. As a bedside nurse and NP student I see the knowledge physicians have. Many times I get a call at 2am from a physician who has been up all night trying to figure out why a patient is not responding to care as they should. When they call they may have found an ebp article and suggest a different treatment. Sometimes I have heard of a treatment in my studies and I run by the doc. Sometimes we try any idea. I believe most physicians have confidence in RNs.
Always transparency
Respect does go both ways. I respect the knowledge if all physicians I work with. Hell, I helped raise many of them from baby docs to attendings. Those physicians also respect me and my knowledge. They have said they will be sorry to see me leave bedside but look forward to collaborating with me. I have had a long bedside RN career in many areas of nursing, I have physicians already asking if I want to partner with them.
NPs in many states and federal facilities do not need physician to practice. Even in my state of South Carolina, I do not need physisn on site just available within 45 miles
I believe some think it is an attack article due to the fact that the first paragraph talks of unsupervised PAs and NPs
I personally do not know any NPs who do not correct pts when they are referred to as “doc”. Even DNPs tell pts their doctorate us in nursing not medicine. As I’ve said previously, if I wanted to be a physician I would have gone to medical school
I must reiterate, an NP is not a physician helper but is an independent practitioner. A PA is a physician assistant.
I am truly sorry you have stopped precepting NP students! NPs are usually very open to learning and criticism. We are the only advanced practice who have to secure our own preceptor. I hope you will agree with me that most NPs do not want to be physicians, if we did we would go to med school. Most NOs take a cut in pay when they leave the bedside and many still pick up shifts at bedside to make up for that cut in pay. We are paid less but able to spend a little more time with patients, this is because physicians are forced to see a patient every 10 to 15 minutes. NPs collaborate with physians for the best care if the patient.
Aside from everything else discussed here, taking the medical advice of a Kardashian/Jenner is a recipe for disaster.
I do not believe PA’s and NP’s should be referred to in the same breath. I agree PAs must have doctor oversight at all times, unless employed by a federal program. They only need a BA in any subject, ex: art history. Then they attend PA school. It used to be they didn’t need any clinical before they began practice. Now at least clinical hours are required. On the other hand even a nurse who graduated and goes straight to NP school has 2 years prerequisite, 2 to 4 years nursing school and then 2 to 3 years NP school. Clinical time is required in all nursing rotations. In addition most nurses work at bedside while pursuing advanced degrees. I, for example, had 2 years pre reqs, 3 years for my associate in nursing. Practiced for 15 years, then 3 years for my BSN. Still practicing , 2 more years for my MSN and now in an FNP program. I have been practicing at bedside for 26 years. You cannot compare an NP to a PA. NPs treat the whole patient, PAs are just what the title says an assistant to a physician or physician extender. An NP is an independent practitioner with some states requiring physician oversight. Please do not lump us together the education and practice are not the same;
As I said, I’m happy with my PA, and apparently are most other people. This article shows their value, and as noted, most go into primary care – a much needed practice.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4730953/