RN vs Physician Assistant - Lifestyle Advice

Since we all have to work to fuel our trips, gas money, and gear addictions, hopefully this is this still on topic.

I am wondering who out there in MPland works as an RN or PA and how this impacts his/her ability to get out. The balance of work and play seems to always be the biggest crux for me. I was recently offered interviews for Accelerated Nursing and PA school in the same week, and it has been making me dig deep weighing the pros and cons of the two professions. The flexibility and security of nursing I see as very inviting, but the increased scope of practice, responsibility and earning potential of being a PA is where I tend to lean more.

Simply put, I love working in medicine but have seen too many people become burned out with 70hr work weeks. Any stories from experience out there? Thanks!

I don't know much about the admission process/requirements for either, but I work with nurses and PA's as an ER physician. The jobs are completely different, in my opinion, although both can provide the flexibility you're looking for.

Some people are really drawn to nursing. At least in the ER (and in most of inpatient medicine), nurses spend more time with the patients and their families. They also make the orders happen. I can order anything I want, but without good nurses, none of it is going to get done. Some nurses have very good procedural skills as well, e.g. ultrasound guided IV's, which make them especially valuable in a busy ER. There are also opportunities for advancement to more supervisory and managerial roles.

In contrast, PA's are making management decisions and are taught to think like doctors. They have to know a lot more pathophysiology. This makes it more rewarding for some people. The downside is possibly the limited opportunity for advancement. By definition, PA's are assistants. Surgical PA's get to do some procedures independently, but they're not surgeons. ER PA's generally see less acute, "fast-track" type patients while the MD's see the high acuity trauma and medical patients. In an outpatient setting, though, PA's and MD's jobs may not be all that different.

The bottom line is that either one will give you job security and flexibility. So it's really only a question of what job you would rather be doing.

My wife has her MSN from an accelerated program (RushU in Chicago). She loves being a nurse. The different opportunities, flexibility, and schedule can't be beat. She works in the ER now and does self schedule where she can get up to 7 days in a row off without using any actual vacation time. If you ever get sick of patient care you can move into management positions, or even work for insurance companies. There are a ton of opportunities in nursing, depending on what you're looking for and the money is pretty good. Nursing seems really easy to find a job in also once you get a little experience. It took her all of about 6 business days to find a job in Colorado.

Where are the interviews at? Where do you want to be? I wonder if PAs have to work more hours or choose to do so. I think the flexibility of being able to change departments would prevent the burnout syndrome, if that is the major issue.

Yes check to see if PA's have to be on call. As assistances I would assume they do... That will kill your time off. I don't mean to be trying to sway you, nurses have a ton of different schedules depending on what you get into. Some work 3 12's a week, others work 8's, some work 24 hour shifts like a fire department, etc. Another thing to look into which I'm not sure how it works out for PA's is overtime availability. I know where my wife works now she has access to as much overtime as she wants. Now that the weather is shitty she's been doing 1 to 2 overtime shifts a week, still only works 4 or 5 days a week but is making close to $50/hour on those shifts. I'm in a similar spot as you, I'm giving up a career in the fire service and going back to school. I'm torn between nursing and trying to become a physical therapist though.

Once you get your hands bloody, you can't wash that blood off. I somtimes suffer from insomnia, lucid nightmares, and deppression from years of working in the ER and out in the field. But, Nursing is cool, you can be a flight nurse, work in places like Antartica, travel gigs, ICU. Try and limit your time in a level 1 urban ER, unless your sick like me.

Dr. Fralich your my hero!

In our hospital, some surgical PA's take in-house call. There is always a trauma PA in-house, in addition to the trauma surgeon and surgical residents. The ortho and neurosurgery PA's have night call every 4th or 5th night, but usually stay at home until they get called in. Usually they just stay around for the rest of the night after being call in. Other surgical PA's like ENT and urology are never on call.

ER PA's work shifts just like any ER physician. In our hospital, the PA's do 12-hour shifts. Scheduling for shift work is typically very flexible. We also have medical ICU PA's that work weekdays only. Outpatient PA work is typically weekday work and there are plenty of options for part-time scheduling.

Rowdy...thanks. I sleep just fine at night though (or during the day).

I an x ray tech and avid climber for many years. Id go with the Rn if you want more time off. You can still make good money and practically write your schedule once your expereinced. You can always go back and get your PA....PA's are mostly but boys anyway....holding the incision open in surgery and doing rounds for the DRs... mega call ..which is bad for a traveling climber type

ok here's the way to go:
Go the PA route but go into Anesthesia, It equals a Master's when it's all said and done. You're pulling 6 figures. None of the liability and decent hours. Good call pay, good benefits. Becoming a more popular career. A typical PA is on call and making an average of 50k. Please do yourself a favor and go AA, umm that's anesthesia assistant. Look it up if you don't believe me. Oh and CU is starting a program in the next few years....

My wife (an RN) said start as an RN and if you want the increased scope of practice and earning potential get your NP

I'm in nursing school now at CU and love it. I also work in the ICU at a front range hospital part time, so I have had pretty good exposure to both positions.

As mentioned above there are pluses and minuses. The thing that really attracts me to nursing is there are so many ways to advance and specialize your degree. For example nurse practitioners have quite a bit more autonomy than PA's in many settings with a similar scope of practice. Nurse anesthetists make really good money and have a fascinating job. Just being an RN can vary in its scope of practice immensely from specialty to specialty.

As a PA these options are limited, you have a fair amount of autonomy and make a bit more money, but can't really advance further as far as I can tell. RN is a more holistic profession as you spend much more time with patient care (generally, which can be good or bad depending on your values and attitudes) and PA is a more medicine oriented profession (diagnose and treat which can also be good or bad depending) although there is a lot of overlap between the two and while the schooling doesn't focus on Patho as intently as PA school RN's benefit immensely from further knowledge in this area as well as Pharm and I open my patho book on a pretty regular basis.

Minuses to being an RN are well a lot more exposure to less than desirable jobs (cleaning up shit), but it also depends on your specialty. The bottom line is that becoming either an RN or PA, you are on a pretty good route for a complex and fascinating profession provided you can take the good with the bad that inevitably comes with all forms of medicine.

-hope this helps

Thanks for everyone's input. Seems PA can offer more right out of school (assuming one can find a job) but nursing appears to offer more options and flexibility in the long term. I've been working as an EMT in a hospital emergency department for over two years now. When it's an actually emergency or someone is genuinely ill I feel greatly rewarded and love my job, but the unfortunate reality is that most cases drain my soul. Pill seeking, pain management, etc. Definitely quick road to burnout.

I plan on using the interviews to help base much of my decision, assuming I actually have the choice between the two. Seems clinicals largely influence where you end up getting a job, so that plays a large factor on lifestyle too.Thanks again for the advice everyone! Nice to bounce ideas off of people with a common interest.

The PA profession gives great job security and the job description and duties vary greatly from field to field and job to job. Average salary is NOT 50K and the average PA does NOT take call. That info is completely WRONG. Average stating salary is around 80K, and can be higher or lower depending on the discipline/field you are in. Most PA's, after 10 years, according to the recent census are, at least approaching a 6 figure salary.

I have been a PA for 4 years now, in Orthopaedic Surgery, and am ANYTHING but a "but boy". That is ridiculous. I work 4 days a week and don't take any call. I am in the OR 1 or 2 days a week, and do a hell of a lot more than just hold retractors. Other days are spent in the clinic, seeing my own patients, and making my own decisions. While I am only 1 person, I can tell you than what I just described is pretty typical for a PA in private practice.

Be sure to filter any info you get on these forums, as there are some very misinformed folks who think they are speaking the truth. Good luck and feel free to PM me for more info regarding schooling and lifestyle. Good Luck!!!

I'd do the PA route just for the chance at working more with science, getting a masters, and impregnating a few hottie docs. I may find a higher use for organic chemistry, yet.

Buff Johnson wrote:I'd do the PA route just for the chance at working more with science, getting a masters, and impregnating a few hottie docs. I may find there may be a higher use for organic chemistry, yet.

I'm in a nursing program, and I don't know much about PAs other than you may have to make a decision based on where you get in to school rather than where you want to live. Fortunately, I already married my hottie doc :)(no impregnation yet). If you want to practice based more on a medical/science model, it's probably PA city though.

Honestly, you may want to apply to both types of programs if you have all the pre-reqs done. As a warning, many nursing programs are heavily impacted and every PA candidate I've met has had to leave state to get into their program. Which is cool if you are an unattached rolling stone.

Here in Reno, people are moving up from Southern California just to get a chance at nursing school, so "falling back" on nursing school is not going to be as easy as you may think. I scored high on the entrance exam and got a 4.0 in all the pre-req classes to beat out a sizable field of applicants. More pre req classes are added yearly, pre reqs time out, and the programs are not all doctor impregnating and rainbows once you get in.

Working in health care kicks ass, the schedule is highly flexible, the people who work in it are fucking crazy (in a good way), and you'll learn more the human condition than you ever thought possible. Whatever route you choose, good luck!

sstrauss wrote:A typical PA is on call and making an average of 50k.

Ya that is complete bs.

Everything you need to know, from salaries in different work settings to nature of the work.
Physician's Assistant
RN

Says the median income for first year PA grads. is $74,470, and median for full time clinical practice is about $85,000. Not quite six figures, but still good money.

Marcy wrote:In AZ, there is a lot of hype about the nursing shortage, but this really applies to experienced nurses. Seems that between state universities, private colleges, and community colleges (which some say will be phased out for RN degrees) there is an imbalance between new grads and positions available.

Why the phase out for RN degrees at the community college level? It seems like associates degrees in nursing are the poster child for community colleges across the nation. I had heard there was a push to mandate the BSN as the standard for all RNs, but that kind of fizzled.

Matt Salter wrote:The PA profession gives great job security and the job description and duties vary greatly from field to field and job to job. Average salary is NOT 50K and the average PA does NOT take call.

This is correct. It sounds like you work for a private orthopedic group, so there is often no true "call" for anyone in this type of practice. The surgeon may be called or paged at night for issues with post-op patients but they probably won't be called in to operate. Thus, the PA's are probably never called for anything.

In contrast, trauma centers MUST have an orthopedic surgeon on call 24/7. If an open fracture or some other emergent OR situation arises, they have to come in and operate. In a system which utilizes PA's (like the hospital where I work), the PA also has to come in. Similarly, if there's a femur fracture that requires placement of a Steinmann pin, the PA has to come and do it, although the surgery (and the surgeon) may wait until the morning.

So while it is true that most PA's do not take call, there are certainly jobs that require it.

Marcy wrote:My understanding is that it is part of a drive elevate nursing as a 'profession' rather than a 'job' (perhaps more similar to PTs, RTs, MDs).

Heh. Even in my associates program we're hearing that talk. There are so many associate degree holding registered nurses though, it would be hard to imagine it would change without a stink. Especially when the shortage actually occurs once people who didn't retire (or came out of retirement) because of the recession actually do retire.

The fact is that with the increasing hurdles to get in the programs, the associates degree is effectively becoming a four + year degree anyway.

Marcy wrote:I guess it would be similar to how diploma degree RN programs were phased out. My personal thought is that it's not going to happen tomorrow (if at all). In AZ it's also pretty common for CC nursing programs to have waiting lists that span years.

Yes, I was on that waiting list. I stayed on it too even when I got out of state just to see how long it took to get in. I got in at exactly the same time it took me to re-up my A&P class, establish residency in NV and get into the program here ;).

I'll probably do the BSN transition route down the line. One step at a time. Ugh. Gotta finish a paper....

I'm not a PA or RN, but as an MD (hospitalist) I work a lot with both. Both professions are in extremely high demand so I think that if you set flexibility as a priority you'll be able to write your own ticket as far as schedule goes. The more limitations you place on the type of work setting you're in (ER vs Office vs OR vs hospital floor), and the more money you want to make, the more limited you're going to be in your schedule choices. But if all you care about is "maximize weekdays off" you'll be able to climb a huge amount in either job.

You didn't ask, but from my viewpoint the two jobs are very, very different, and I think that if you'd be happy in one of them, you probably wouldn't be happy in the other one. I'd be happy to elaborate on that in a PM if you're interested, but even better would be to ask some RN's, PA's, NP's, and MD's you know about the differences.

Good luck,
David