Emergency Physician or Nurse Practitioner

[Gunfighter]

Long post, reader beware.

Hey everyone, first post on SDN, so I'm hoping I'm posting this in the right location. I've been lurking the forums for some time and have gleaned quite a bit of information so far. I understand the role of both the NP and EP, but would like some honest advice in regards to which path would be most fulfilling for my situation.

I'm a 24 year old nursing student (halfway through ASN program) who has always had a passion for medicine. Originally started pre med in college, but let my extracurriculars get the best of me, dropping my GPA to 1.7. Had to switch schools and decided to try nursing after some family motivation. Brought my GPA up to 3.0, got accepted into nursing school, and after 2 semesters got it to a 3.04. Always wanted to be a physician, but find it hard to justify all the loans and time necessary to obtain. Add that to the fact that my GPA is lacking, and it seems I have a very slim chance of accomplishing it. On the other hand, I can already tell bed side nursing is not for me, which is why the added autonomy of being a NP is so appealing. My only qualm is that NP knowledge is far inferior to that of an EP. I would hate to waste my time in becoming a NP only to be stuck in the fast track handling "boring" cases.

I feel like I have the aptitude to handle either programs, but just can't seem able to decide what's best for me. So, dear posters of SDN, can you advise me as to what sounds most appropriate given my current situation? Opinions, advice, personal experiences, and criticism all welcome!

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[cozmokramer]

This will inevitably turn into the PA/NP vs. MD/DO debate. There is a large majority of the ED that a PA/NP can do. Same with a cardiology practice or surgery practice. Still NP's will mostly be reserved to filling fast track, abdominal pain, low risk chest pain (i.e. a lot of the patients in the ED). Yes I am sure a PA/NP will come and say they intubate, put in central lines, and do true medical resuscitation but these are rare and either reserved to the most experienced midlevel or places that are so rural that they can't recruit a doc.

Most of the midlevels time will be spent seeing fast track and low acuity patients. Most of the times if they venture out of the fast track they will be functioning like residents having someone look over everything they do. The big question you have to answer is if you want to handle the most critical patients on your own. That comes with the high salary but also the responsibility that an MD/DO gets.

Also you are 24 and really pretty young. Even entering Medical School, at say, 26, is maybe, at best, a bit above the average age of entering medical students. It isn't your age but more so of what you want of your career that should decide which career path you should enter.

 

[Birdstrike]

Long post, reader beware.

Hey everyone, first post on SDN, so I'm hoping I'm posting this in the right location. I've been lurking the forums for some time and have gleaned quite a bit of information so far. I understand the role of both the NP and EP, but would like some honest advice in regards to which path would be most fulfilling for my situation.

I'm a 24 year old nursing student (halfway through ASN program) who has always had a passion for medicine. Originally started pre med in college, but let my extracurriculars get the best of me, dropping my GPA to 1.7. Had to switch schools and decided to try nursing after some family motivation. Brought my GPA up to 3.0, got accepted into nursing school, and after 2 semesters got it to a 3.04. Always wanted to be a physician, but find it hard to justify all the loans and time necessary to obtain. Add that to the fact that my GPA is lacking, and it seems I have a very slim chance of accomplishing it. On the other hand, I can already tell bed side nursing is not for me, which is why the added autonomy of being a NP is so appealing. My only qualm is that NP knowledge is far inferior to that of an EP. I would hate to waste my time in becoming a NP only to be stuck in the fast track handling "boring" cases.

I feel like I have the aptitude to handle either programs, but just can't seem able to decide what's best for me. So, dear posters of SDN, can you advise me as to what sounds most appropriate given my current situation? Opinions, advice, personal experiences, and criticism all welcome!

The answer is simple, should you choose to answer it for yourself. It's right there in your post. Go with you gut. Go with your heart. Dive in and never look back. So where is your gut telling you to go? Where does you heart call you to go?

That's where you need to go. No douchetoggle on SDN (myself included) can answer this for you. Go with your heart and you'll have no regrets.

 

[Ddrumem]

As a former RN and current DO student going into EM and who's wife is an NP I would highly encourage you to pursue medical school if those are your thoughts. My wife will agree too that an NPs training is largely BS and involves little actual medically focused teaching. I too had crappy grades before getting my shhh together. Do well in prerequisites and MCAT and use it as your overcoming adversity story. I also started med school in my late twenties and justified it by telling myself "what else would I be doing?" Working as a nurse. Why not further your education sacrifice a few years and do what you ultimately want to do? If your responsible with your loans they're really not that bad compared to your lifetime earnings as an EM doc. PM me if you want more specific details about my situation.

 

[Makati2008]

As a former RN and current DO student going into EM and who's wife is an NP I would highly encourage you to pursue medical school if those are your thoughts. My wife will agree too that an NPs training is largely BS and involves little actual medically focused teaching. I too had crappy grades before getting my shhh together. Do well in prerequisites and MCAT and use it as your overcoming adversity story. I also started med school in my late twenties and justified it by telling myself "what else would I be doing?" Working as a nurse. Why not further your education sacrifice a few years and do what you ultimately want to do? If your responsible with your loans they're really not that bad compared to your lifetime earnings as an EM doc. PM me if you want more specific details about my situation.

Agree with this post. As a PA that went back, there are days I regret it( only due to $) but there are many more where I'm happy with my decision.

I used to do procedures as a PA, but I feel a lot more proficient as a Physician. Also the respect factor is so much lower for midlevels than docs, it's unbelievable.

Live frugally for a few years out of residency and you will be fine.

 

[racerwad]

My only regret is that I didn't stop second guessing myself and just go to med school sooner. I was a paramedic for waaaaay too long when I knew that this is what I'd rather be doing. As @Birdstrike said, the answer is quite clear when reading your post. Good luck.

 

[Gunfighter]

Thank you all so much for your replies!

This will inevitably turn into the PA/NP vs. MD/DO debate. There is a large majority of the ED that a PA/NP can do. Same with a cardiology practice or surgery practice. Still NP's will mostly be reserved to filling fast track, abdominal pain, low risk chest pain (i.e. a lot of the patients in the ED). Yes I am sure a PA/NP will come and say they intubate, put in central lines, and do true medical resuscitation but these are rare and either reserved to the most experienced midlevel or places that are so rural that they can't recruit a doc.

Most of the midlevels time will be spent seeing fast track and low acuity patients. Most of the times if they venture out of the fast track they will be functioning like residents having someone look over everything they do. The big question you have to answer is if you want to handle the most critical patients on your own. That comes with the high salary but also the responsibility that an MD/DO gets.

Also you are 24 and really pretty young. Even entering Medical School, at say, 26, is maybe, at best, a bit above the average age of entering medical students. It isn't your age but more so of what you want of your career that should decide which career path you should enter.

It is rather sad that it devolves to that argument almost every time. I would just like to care for all patients to the best of my ability, which as of now to me, seems most attainable by becoming a physician.

The answer is simple, should you choose to answer it for yourself. It's right there in your post. Go with you gut. Go with your heart. Dive in and never look back. So where is your gut telling you to go? Where does you heart call you to go?

That's where you need to go. No douchetoggle on SDN (myself included) can answer this for you. Go with your heart and you'll have no regrets.

I agree, and if I had to choose honestly, I'd say med school. It's what my heart is leaning towards, however, I have a very hard time with the financial aspect of it.

As a former RN and current DO student going into EM and who's wife is an NP I would highly encourage you to pursue medical school if those are your thoughts. My wife will agree too that an NPs training is largely BS and involves little actual medically focused teaching. I too had crappy grades before getting my shhh together. Do well in prerequisites and MCAT and use it as your overcoming adversity story. I also started med school in my late twenties and justified it by telling myself "what else would I be doing?" Working as a nurse. Why not further your education sacrifice a few years and do what you ultimately want to do? If your responsible with your loans they're really not that bad compared to your lifetime earnings as an EM doc. PM me if you want more specific details about my situation.

It's mostly where my thoughts have been of late. Though I do respect nursing as a profession, I feel a lot of what we learn in school is fluff work meant to legitimize certain aspects of the career. Care plans and nursing diagnoses, while useful, seem almost redundant when compared to the medical model. If only there was an ASN to DO program out there, lol.

Agree with this post. As a PA that went back, there are days I regret it( only due to $) but there are many more where I'm happy with my decision.

I used to do procedures as a PA, but I feel a lot more proficient as a Physician. Also the respect factor is so much lower for midlevels than docs, it's unbelievable.

Live frugally for a few years out of residency and you will be fine.

The money I feel would be my only regret, but like you said, frugality could assist with that. The respect and knowledge are also very important to me.

My only regret is that I didn't stop second guessing myself and just go to med school sooner. I was a paramedic for waaaaay too long when I knew that this is what I'd rather be doing. As @Birdstrike said, the answer is quite clear when reading your post. Good luck.

That's like my biggest fear. I'd hate to become an NP only to realize I could've become a physician in the meantime.

 

[racerwad]

Thank you all so much for your replies!



It is rather sad that it devolves to that argument almost every time. I would just like to care for all patients to the best of my ability, which as of now to me, seems most attainable by becoming a physician.



I agree, and if I had to choose honestly, I'd say med school. It's what my heart is leaning towards, however, I have a very hard time with the financial aspect of it.



It's mostly where my thoughts have been of late. Though I do respect nursing as a profession, I feel a lot of what we learn in school is fluff work meant to legitimize certain aspects of the career. Care plans and nursing diagnoses, while useful, seem almost redundant when compared to the medical model. If only there was an ASN to DO program out there, lol.



The money I feel would be my only regret, but like you said, frugality could assist with that. The respect and knowledge are also very important to me.



That's like my biggest fear. I'd hate to become an NP only to realize I could've become a physician in the meantime.

Yup. The time is going to pass one way or another. The question is: where do you want to be once it passes?

 

[HoosierdaddyO]

Yup. The time is going to pass one way or another. The question is: where do you want to be once it passes?

That was straight up mad insightful lol

 

[gro2001]

Long post, reader beware.

Hey everyone, first post on SDN, so I'm hoping I'm posting this in the right location. I've been lurking the forums for some time and have gleaned quite a bit of information so far. I understand the role of both the NP and EP, but would like some honest advice in regards to which path would be most fulfilling for my situation.

I'm a 24 year old nursing student (halfway through ASN program) who has always had a passion for medicine. Originally started pre med in college, but let my extracurriculars get the best of me, dropping my GPA to 1.7. Had to switch schools and decided to try nursing after some family motivation. Brought my GPA up to 3.0, got accepted into nursing school, and after 2 semesters got it to a 3.04. Always wanted to be a physician, but find it hard to justify all the loans and time necessary to obtain. Add that to the fact that my GPA is lacking, and it seems I have a very slim chance of accomplishing it. On the other hand, I can already tell bed side nursing is not for me, which is why the added autonomy of being a NP is so appealing. My only qualm is that NP knowledge is far inferior to that of an EP. I would hate to waste my time in becoming a NP only to be stuck in the fast track handling "boring" cases.

I feel like I have the aptitude to handle either programs, but just can't seem able to decide what's best for me. So, dear posters of SDN, can you advise me as to what sounds most appropriate given my current situation? Opinions, advice, personal experiences, and criticism all welcome!

I think more than anything it depends on your personality than on the different opportunities that the two career tracks provide. As others have said, there are some things NPs/PAs can do, and there are some they can't. Some of the things that are going to be almost exclusively in the realm of ED docs are pretty cool. The ED doc's income is also going to be higher. But the cost of going down that path is a lot higher, both in terms of time and opportunity cost/lost income while in medical school and residency.

I think for most people, the 'correct' answer from an objective, monetary perspective is NOT to go to med school/residency. It seems like that may be the case for you as well. However, if you are the type of person that is always going to be frustrated at missed opportunities, or somehow feel inferior for real or perceived knowledge deficiencies, or the image that you've attached to the idea of being a doctor is going to keep hanging over you, then you would be better off just biting the bullet and trying your hardest to get into medical school and go through EM residency. You just have to know your own level of emotional maturity and whether you need the external validation of the MD degree or you are ok with internal sources of validation (which come with much less debt).

 

[Boatswain2PA]

No brainer, but it's not easy: Go to med school.

EP route: 10 years of hard work getting the "gold standard" of education that you will rely on to save lives for the rest of your career while you make $200-$300/hour

NP route: 3 more years of much easier work getting a poor education where you will not be prepared for any of the truly sick patients you encounter, and you make $60-$80/hr.

Disclaimer: I'm not bashing nurses or NPs. I love nurses (I married one), and there are some terrific NPs. But NP education is a joke, and the terrific NPs out there have overcome their poor NP education by working hard to continue their education after graduation.

 

[Lord Humongus]

No brainer, but it's not easy: Go to med school.

EP route: 10 years of hard work getting the "gold standard" of education that you will rely on to save lives for the rest of your career while you make $200-$300/hour

NP route: 3 more years of much easier work getting a poor education where you will not be prepared for any of the truly sick patients you encounter, and you make $60-$80/hr.

Sure, but the question is whether the $200-300/hr will still be there in 10 years when the OP would actually start collecting paychecks. EM is red hot right now and that is a secret that is out of the bag. Most of the applicants I spoke with during my interviews had EM in their top 3 choices heading into med school. The number of residency spots is ballooning, and what makes this worse is that EM attendings are a relatively young bunch and very few of them are retiring, so each class of graduating residents is basically a net increase in the number of attendings. We're talking around 1800 net new attendings a year assuming no/negligible retirements.

Then we have whatever the impact bundled payments will have on EM salaries, which may or may not decrease compensation but certainly won't raise it. Finally, it's pretty clear at this point that there is collusion between the government and the corporate class to transform the US health system into a discount product at full price, allowing the corporate class to pocket the difference. Ironically, this means the OP would be able to get much more bang for his buck with the midlevel degree than may currently be the case, since the transition to substandard medical care mandates the use of substandard providers for an ever growing share of that care.

So I'm not saying this to paint a bleak picture, but since the OP expressed concern over the financial implications of choosing one route over the other, it's important to not take the decision blindly. It's very possible that in 10 years EM docs will still pull $300/hr (well, it'd have to be like $400 adjusted for inflation lol) but a lot can happen in 10 years and that Beta has to be taken into consideration when making the decision. On the other hand, the OP could start making that $80/hr as a midlevel in 2 or 3 years, and there is much less that can happen in 3 years than in 10. Not to mention that midlevels are the heroes in the current zeitgeist and are thus far less likely to see their salaries attacked.

 

[Boatswain2PA]

Agree (especially the part about "midlevels are the heroes"....never thought I would hear THAT on SDN! )

But more importantly than money is the education/training, especially if the OP wants to work single coverage.

 

[cbrons]

Long post, reader beware.

Hey everyone, first post on SDN, so I'm hoping I'm posting this in the right location. I've been lurking the forums for some time and have gleaned quite a bit of information so far. I understand the role of both the NP and EP, but would like some honest advice in regards to which path would be most fulfilling for my situation.

I'm a 24 year old nursing student (halfway through ASN program) who has always had a passion for medicine.

You won't get to practice medicine without going to medical school

 

[Lord Humongus]

Agree (especially the part about "midlevels are the heroes"....never thought I would hear THAT on SDN! )

But more importantly than money is the education/training, especially if the OP wants to work single coverage.

Just to be clear: I'm not saying midlevels are the heroes, just that they're being construed as such in a move to push physicians out of healthcare and centralize control and profits with the corporate types.

 

[sameas]

I was in your spot 10 years ago and I joined SDN to get answers and agonized with the decision NP/PA or MD/DO. I ended up choosing neither. I dropped out of an post-BA nursing school and had a period of 2 years of hand-wringing over whether I should try for MD. Like you, my GPA was 3.1 -- pretty lackluster, but worse I had few prereqs under my belt. I knew I had a lot of ground to cover.

I've been obsessed with medicine since I was 17, but not cut out to be a practitioner. But, I was too stubborn to admit I'd make a lousy doc until I spent 3 years volunteering in an ED. That sealed my fate. I gave up on the dream.

Luckily, I was genuinely interested in the field and spent years trying to teach myself medicine and public health. That odd hobby turned into a medical writing career after some years of dues paying. Talk about a lifestyle job in healthcare. I work from home, set my own hours and spend one month a year writing on the beach. The pay isn't special--but I earn $125-$150 an hour freelancing. Not too shabby. I live well on that.

Your situation is different in a lot of ways. You are 24 and have fewer limitations. But you are going to be in a world of financial and emotional hurt for many years to come. If you can't see any other option than going MD or DO, then go for it. As for finishing nursing school, you probably should if you want to leave the NP door open. Also, dropping out is something you'll have to explain. Believe me, I know.

You can always change directions as you move along your journey. Don't worry too much about the outcome. Just brace yourself for lots of twists, turns and crushing disappointments along the way. But really, that's just life.

I owe so much to SDN for my happy writing career. I thought I'd pass along my story. Good luck!

 

[MSmentor018]

i am an ex RN, 17 yrs later now an EM attending. no regrets. look at my previous posts. lots of opinions from myself and others about the subject of MD or NP. feel free to pm me

 

[Boatswain2PA]

Just to be clear: I'm not saying midlevels are the heroes, just that they're being construed as such in a move to push physicians out of healthcare and centralize control and profits with the corporate types.

Nope, no take-backs. You already said it, and I quoted you before you could pull a Birdstrike and delete it!

 

[polygonal]

I was an RN who went to NP school. Quite frankly, I thought NP school was a joke. Over half of the curriculum was "fluff." The "medical courses" were taught by other NPs who clearly did not understand the material they were teaching.

I decided to go to medical school. I'm so glad I did. I would not have been happy as an NP. I actually loved medical school. You can't even compare NP school to medical school. It was like kindergarten compared to graduate level college.

There is some good advice here. In my experience, every NP/PA/CRNA I know that really wanted to be a doctor was unhappy and many had a chip on their shoulder.

The time is going to tick by either way, do what you want to do. If you decide to go to med school, make it a 100% effort. Put in the work, kill all your classes (try for all A's because of your history), study hard for the MCAT and you will be OK. Good luck.

 

[DrRBF]

Sure, but the question is whether the $200-300/hr will still be there in 10 years when the OP would actually start collecting paychecks. EM is red hot right now and that is a secret that is out of the bag. Most of the applicants I spoke with during my interviews had EM in their top 3 choices heading into med school. The number of residency spots is ballooning, and what makes this worse is that EM attendings are a relatively young bunch and very few of them are retiring, so each class of graduating residents is basically a net increase in the number of attendings. We're talking around 1800 net new attendings a year assuming no/negligible retirements.
=

As a nurse who is debating between NP and DO school (accepted and just several months to decide), the increasing competition scares me. Many medical student friends have advised that I may have to fight hard for EM. Now in regards to EPs, 10/12 EPs that I work with discourage medical school and/or EM, but they simply can't get out. Is there a positive light in this tunnel?

 

[Makati2008]

As a nurse who is debating between NP and DO school (accepted and just several months to decide), the increasing competition scares me. Many medical student friends have advised that I may have to fight hard for EM. Now in regards to EPs, 10/12 EPs that I work with discourage medical school and/or EM, but they simply can't get out. Is there a positive light in this tunnel?

It's a hard choice either path can give you autonomy(one a limited version of it at least).

 

[Angry Birds]

OP - I don't want to be the Debbie Downer here, but I think you should honestly think hard about whether or not you can realistically (1) get into medical school, and (2) survive medical school. This is not meant to be mean, but rather so that you set realistic goals for yourself and exert your energies to that ends.

I can't answer that question for you. I've even heard of people with far worse GPA's improving their GPA's tremendously, getting 4.0's in post-bacc programs, etc.... and then getting into medical school. But usually those are people who were lazy/distracted/immature/family problems, etc. and then at some point in time they turned their engines on, put the throttle to full, and then were able to decimate their classes to revive their GPA's.

I just wonder that after two semesters at a nursing school, your GPA went up 0.04, even when this was after you had some motivation (although it was *family* motivation, which is much different than being personally motivated). I will tell you that nursing school should be a cake walk to you compared to competitive/intensive undergraduate (pre-medical) programs and certainly medical schools.

Again, I may be the bad guy here, but I'd rather you be realistic with yourself. I may be totally wrong, and there may be some missing element here. You may all of a sudden "turn it on" and excel in life and become a neurosurgeon. I just want you to be realistic about it.

This is of course an underlying difference between MD's and NP's. MD's have--generally (not always)--been at the top of their class, from kindergarten to high school to college. On the other hand, I've heard the saying a lot, "C's make nurses."

That being the case, it only makes sense that the scope of practice of NP's would be much different than that of an MD. Yes, you would likely focus on Fast Track sort of patients. Keep in mind, however, this may not be a bad thing at all. Trust me, as you get more advanced in your career, boring becomes nice, and intense becomes tedious. I was attracted to trauma before, but now I hate when a trauma rolls in since it means I'll fall behind on my other patients.

So, yes, there is a difference between the scope of practice of an MD and an NP. However, (1) you need to assess if you can realistically become an MD, and (2) you may enjoy the lifestyle and career of an NP, which is an important and rewarding job in and of itself.

This is advice I gave to a close relative who was in a similar situation as you, who I think was in dream world about their chances of getting into a medical school. It may--or may not--apply to you.

Good luck.

 

[throckmortonDO]

EM is my 3rd career. I worked in another specialty in medicine first, and something not in medicine before that.

I'll be the first one to tell you that there are always second chances in life, and if you work hard enough you can get what you want (assuming you have the predilection and ability to get it done). Several med school class mates in my school were second career types with grad degrees, PA's, lawyers, pharmacists, etc, some in their 40's and even 1 in 50's, so age isn't the factor you think it is.

"choosing" to go to med school isn't quite as easy as it sounds. I think the published statistics someone said on this forum was somewhere between 1/50 or 1/150? applicants with "appropriate stats" get accepted. You'll see some underdog stories, but in reality they are pretty rare. You are up against rock stars in college, and hard sciences classes. You have to crush the MCAT. You have to be really committed to get this all done. Pre-med classes are called "weeders" for a reason. just be prepared for that. head on over to the pre-allo/pre-osteo forum for more of the "what are my chances" type of thing for some opinions.

I'd be the first one to tell you everyone should pursue their dreams and never live with regret. I'd like to encourage you but I think you should think about it maybe from another perspective - rather, not *can* I do it, but *should* I.

I missed several milestones in my older childs life, away rotations were stressful, step exams sucked, and both med school and residency is a time suck. My wife asked my older child the other day what she wanted to be when she grows up, she said "not a doctor like dad". When asked why, she said " well he's always gone and always studying even when hes home". You may want to do EM now, but once you get through med school you may change your mind, which you have to be ready for. My buddy who's a general surgery attending married with young kids told me a story, he had a nice weekend off, and and at the end of the night when he tucked his kids into bed they said to his wife "can daddy come visit again someday".. Ouch. Medicine is stressful, you take care of peoples lives, and when it goes bad it eats at you. Politically physicians are in trouble, and increasingly we are being commoditized and managed. Our educational debt is off the charts, and our salaries, litigation risks and specialty outlooks are quite variable depending on innumerous factors.

I'm not saying other jobs don't have that as well, but you just have to decide if it's worth it to you to pursue this job.

As one other poster alluded to, currently job outlook for PA/NP is very favorable, and time and educational debt is much less. I have a friend who is a CRNA who works locums and makes 250k. That's more than several physician specialties make.

something to consider.

 

[Boatswain2PA]

You won't get to practice medicine without going to medical school

Sorry for resurrecting a 3 week old thread, but I just saw this post and wanted to point out that this statement "You won't get to practice medicine without going to medical school" is inaccurate.

PAs practice medicine.

 

[cbrons]

Sorry for resurrecting a 3 week old thread, but I just saw this post and wanted to point out that this statement is inaccurate.

PAs practice medicine.

True