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CATEGORY
PHYSICIAN ASSISTANT
NURSE PRACTITIONER
Definition Health care professionals licensed to practice medical care with physician supervision. Registered nurses with advanced education and training in a clinical specialty who can perform delegated medical acts with physician supervision.
Philosophy/
Model
Medical/physician model, disease centered, with emphasis on the biological/pathologic aspects of health, assessment, diagnosis, treatment. Practice model is a team approach relationship with physicians. Medical/Nursing model, Biopsychosocial centered, with emphasis on disease adaptation, health promotion, wellness, and prevention. Practice model is a collaborative relationship with physicians.
Education Affiliated with medical schools. Previous health care experience required; most require entry-level bachelors degree. The program curriculum is advanced science based. Approximately 1000 didactic and over 2000 clinical hours. All PAs are trained as generalists- a primary care model and some receive post-graduate specialty training. Education is procedure and skill oriented with emphasis on diagnosis, treatment, surgical skills, and patient education. Currently, more than 50% of programs award Masters degrees and all are currently transitioning to the masterís level. Affiliated with nursing schools. BSN is prerequisite; curriculum is bio-psycho-social based, based upon behavioral, natural, and humanistic sciences. Approximately 500 didactic hours and 500-700 clinical hours. NPs choose a specialty training track in adult, acute care, pediatric, womenís health or gerontology. Emphasis on patient education, diagnosis, treatment and prevention. Generally not trained for surgical settings and are not taught procedural skills. NPs generally have Masters degrees.

Certification/
Licensure

Separate accreditation and certification bodies require successful completion of an accredited program and NCCPA national certification exam. NCCPA certification is the gold standard. Nursing accreditation and multiple nursing certification agencies. Masterís Degree required to sit for exam. The national certification is voluntary and utilized for advanced nurse prescribers within their specialty training.
Recertification Recertification requires 100 hours of CME every 2 years and exam every 6 years. Recertification is comparable to family physicians. All PAs are licensed by their State Medical Board and the Medical Practice Act provisions. Recertification requires 75 CEUs every 5-6 years. No exam is required. NPís practice under their basic RN license under the Nurse Practice Act.
Scope of Practice The supervising physician has relatively broad discretion in delegating medical tasks within his/her scope of practice to the PA in accordance with Maryland regulations. PAs in Maryland may prescribe Schedule II-V controlled substances if the physician delegates this. On-site supervision is not required. Under recently passed legislation, NPs may be listed as providers at HMOs, providing the supervising physician is indicated to the patient. The practice agreement with the physician must contain the protocols as well as the medical acts which will be delegated. NPs may prescribe controlled substances. On-site supervision is not required.
Third Party
Coverage and
Reimbursement
PAs are eligible for certification as Medicaid and Medicare providers, Commercial payer reimbursement is currently variable. NPís are eligible for certification as Medicaid and Medicare providers, and generally receive favorable reimbursement from commercial payers.
For further info...

Maryland Academy of
Physician Assistants

American Academy of
Physician Assistants
Maryland Board of Physicians

Nurse Practitoner Association
of Maryland
American College of
Nurse Practitioners
Maryland Board of Nursing

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