Physician Assistants and Nurse Practitioners: Keeping MSK Going

At Memorial Sloan Kettering, teamwork is the name of the game. It’s not just one professional taking care of a patient; care teams ensure that every person who walks through the doors is provided for and supported.

Vital members of a patient’s care team include physician assistants and nurse practitioners. But it’s easy to get their roles confused. Here, MSK physician assistant Unnati Patel and nurse practitioner Leigh McGrath explain the ins and outs of their professions.

What are your responsibilities at MSK?

Unnati Patel: My role predominantly is assisting with thoracic surgeries in the operating room and seeing patients throughout the hospital. Physician assistants take care of people on the inpatient floor and in the outpatient clinic. The PAs fill in wherever there is a daily need since we are trained to cover all areas.

Leigh McGrath: I’m a nurse practitioner on the ambulatory extended recovery (AXR) team. This is a service for patients who stay overnight after surgery. Our nurse practitioners help patients recover when they get out of surgery and make sure they’re meeting milestones to be discharged.

In 2018, the advanced practice provider (APP) division was formed at MSK, and positions like mine were opened up to both NPs and PAs. At MSK, NPs and PAs can do the same jobs pretty interchangeably, even though we are licensed differently by the state. The main difference is in the training. PAs often work in the OR, whereas that is not part of NP training or privileges. Legally speaking, NPs can function and bill independently, while PAs are supervised by a doctor.

Ms. Patel: PAs work collaboratively with a supervising attending physician, and they can conduct patient visits independently or with their attendings. MSK’s APP division is great because it has united the PAs and NPs. We essentially have the same role — we can diagnosis people, order studies, and create treatment plans. We can all solve the same problem — we just do it differently.

Ms. McGrath: We’ve really come together as a group. And I think it strengthens the level of care we’re able to provide.

What education is required for each profession?

Ms. Patel: To apply to a PA program you must have a bachelor’s degree, but it doesn’t have to be a Bachelor of Science. The program is two years of schooling based on the medical school model. There is a big emphasis on human anatomy. We have one year of classes and one year of clinical rotations in various specialties. Once we finish school, we take a national board exam to get certified.   

Ms. McGrath: All NPs are also registered nurses, and in order to be a registered nurse, you need to either get an associate’s or a bachelor’s degree in nursing. A bachelor’s degree is required to apply to a nurse practitioner master’s program. Many nurses will pursue their master’s while working. Like a PA program, the master’s program also includes time spent getting real-world experience in different specialties of patient care. Doctoral programs are now beginning to replace nurse practitioner master’s programs, but the doctoral degree is not yet a requirement.

Ms. Patel: In the past, PA programs provided different degrees once students completed the program. However, now all PA programs have transitioned to masters’ programs.

How did you both decide on your careers? Were there ever moments when either of you wished you took a different path?

Ms. Patel: When I was an undergrad, I knew I loved medicine, but I was unsure if I really wanted to commit so many years to becoming a doctor. It’s a long time before you actually start practicing. And to be an NP you have to be a nurse first. I just wanted to get out there, start working, and care for patients. I’ve been a PA for 10 years now and very happy with my decision. I did have moments when I felt limited in a specific role, but the best part of being a PA is how easily you can transition to different roles and learn different specialties. Moving to MSK, where there is a big emphasis on APPs, I’ve felt that opportunities to advance my career continue to grow.

Ms. McGrath: When I was 16 I decided I wanted to be a nurse. It seemed like a very rewarding profession and I was interested in working with people and not sitting at a desk. My first job out of school was at MSK. MSK’s nursing is so strong, and there have always been a lot of NPs here. MSK supports nurses going back to school and furthering their education. I chose to get my nurse practitioner degree because I wanted to keep taking care of patients. I loved seeing how the nurse practitioners were so involved in the patient’s care. I didn’t want to give that up.

What are the most gratifying and challenging parts of your jobs?

Ms. McGrath: The most satisfying part is seeing a patient do well on your treatment plan. Nothing beats seeing a patient improve hour by hour and day to day. The biggest challenge for me is managing the differences in physician care preferences. Each case is different and often managed differently by different doctors. Patient care takes a lot of coordination. The APPs are often the main connection between the doctor, nurses, and patient.

Ms. Patel: I’ve had a lot of great moments. It was difficult for me to leave the institution I came from. I had a great rapport with the people I worked with and thought, “Am I going to have this again?” You get stuck in your own way. Then I came to MSK. Not having much experience in oncology, I knew it would be difficult. But within three years, I think I’ve grown a lot as a PA and as a clinician in general. With the guidance from my colleagues and the patience of my attendings, I’m able to provide the excellent care that MSK is known for.