I want to do gender affirming care, looking at NP/PA/DO.

[eggcustardtamale]

I realized my career outlook in plant science was dismal.

I didn't want to work for a private corporation to pay my bills and I was missing the human interaction I love. A lot of my friends are trans and I've seen them struggle through the healthcare system, especially as transwomen. I'd like to be able to provide care for them or be involved in research to improve their care.

I talked to my pre-health advisor at my university and she told me my future could be a mix of psyche and some other specialty. Not totally sure. She seemed to think NP was a good route for me, doing an accelerated BSN and then going on to specialize. I am hesitant to go down this path because of all the smack I've read about NP's on the internet, which sounds silly but I don't really get why its so pervasive.

In your opinion, what track should I be looking at?

Quick and dirty about me

1. GPA - 3.15, BS in Plant Science
2. HCE - Just volunteering in Urgent Care and for the National Association of Mental Illness. Looking for higher yielding opportunities with the local Aids Resource Center or a Women's Health Clinic.
3. Job Experience - Part time Program Assistant for a Medical Journal. This is a remote job that is extremely flexible. Trying to understand what sort of job I should shoot for. I've applied for a scribing position, CNA training is expensive around me 800 - 1400.
4. Need several pre-reqs for all of these paths.

What I need to be happy

1. Being an authority in my field/being a source of knowledge
2. Being around other people who are passionate/pursuing projects of their own
3. Making enough money to support myself and my partner
4. Good work life balance with time to visit foreigns countries for pleasure or professional enrichment.
   1. I speak Spanish, Italian and Japanese.

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[deleted480308]

I realized my career outlook in plant science was dismal.

I didn't want to work for a private corporation to pay my bills and I was missing the human interaction I love. A lot of my friends are trans and I've seen them struggle through the healthcare system, especially as transwomen. I'd like to be able to provide care for them or be involved in research to improve their care.

I talked to my pre-health advisor at my university and she told me my future could be a mix of psyche and some other specialty. Not totally sure. She seemed to think NP was a good route for me, doing an accelerated BSN and then going on to specialize. I am hesitant to go down this path because of all the smack I've read about NP's on the internet, which sounds silly but I don't really get why its so pervasive.

In your opinion, what track should I be looking at?

Quick and dirty about me

1. GPA - 3.15, BS in Plant Science
2. HCE - Just volunteering in Urgent Care and for the National Association of Mental Illness. Looking for higher yielding opportunities with the local Aids Resource Center or a Women's Health Clinic.
3. Job Experience - Part time Program Assistant for a Medical Journal. This is a remote job that is extremely flexible. Trying to understand what sort of job I should shoot for. I've applied for a scribing position, CNA training is expensive around me 800 - 1400.
4. Need several pre-reqs for all of these paths.

What I need to be happy

1. Being an authority in my field
2. Being around other people who are passionate/pursuing projects of their own
3. Making enough money to support myself and my partner
4. Good work life balance with time to visit foreigns countries for pleasure or professional enrichment.
   1. I speak Spanish, Italian and Japanese.

If you want the be the authority, become a doctor

 

[eggcustardtamale]

If you want the be the authority, become a doctor

Is that really worth it if I want to be a primary care provider/very specific psyche provider? Is that the most time effective/cost effective option?

 

[deleted480308]

Is that really worth it if I want to be a primary care provider/very specific psyche provider? Is that the most time effective/cost effective option?

I responded to your stated priority being the authority. If you want to be the best trained and most capable to provide the highest standard of care to your patients, be a doctor

 

[Ho0v-man]

Is that really worth it if I want to be a primary care provider/very specific psyche provider? Is that the most time effective/cost effective option?

Under what you need to be happy, the rest can be fulfilled by becoming an NP. But if you need to be an authority in your field, you should become a doctor.

This hinges greatly on your ability to become a doctor though, so you’d have to see if you can hang in the pre-reqs anyway. If you can’t, then NP is a viable option.

I’m not sure on the specifics of your degree and how it lines up with these paths, but I would imagine if you already have a biology type BS like plant science you likely have most of the pre-reqs anyway for med school. In the time you take to become an NP, you could be a resident or at the very least close to it.

Edit: obviously those who‘ve posted thus far are going to be biased toward becoming a physician. I tried to be impartial and lay out options but I’m sure I’ve shown what I would do. I presented it like that because when I was in your situation, part of me almost hoped to be pushed toward being a midlevel because I knew it would be easier. Just trying to show you the time investment isn’t too crazy here.

 

[eggcustardtamale]

Under what you need to be happy, the rest can be fulfilled by becoming an NP. But if you need to be an authority in your field, you should become a doctor.

This hinges greatly on your ability to become a doctor though, so you’d have to see if you can hang in the pre-reqs anyway. If you can’t, then NP is a viable option.

I’m not sure on the specifics of your degree and how it lines up with these paths, but I would imagine if you already have a biology type BS like plant science you likely have most of the pre-reqs anyway for med school. In the time you take to become an NP, you could be a resident or at the very least close to it.

Edit: obviously those who‘ve posted thus far are going to be biased toward becoming a physician. I tried to be impartial and lay out options but I’m sure I’ve shown what I would do. I presented it like that because when I was in your situation, part of me almost hoped to be pushed toward being a midlevel because I knew it would be easier. Just trying to show you the time investment isn’t too crazy here.

So maybe at this point, angling towards medical school while interacting with different types and levels of providers is the best route for now.

I'm afraid of the commitment level of medical school. It would take a long time and I feel like I'm late to the game (25) because people have been preparing their entire lives for such a thing and that intimidates me.

How did you ultimately decide on medical school, if you were in the same boat?

 

[Goro]

So maybe at this point, angling towards medical school while interacting with different types and levels of providers is the best route for now.

I'm afraid of the commitment level of medical school. It would take a long time and I feel like I'm late to the game (25) because people have been preparing their entire lives for such a thing and that intimidates me.

How did you ultimately decide on medical school, if you were in the same boat?

25??? Some of my all time best students have been in their 30s and 40s! I graduated a stellar one at 50 and she's now an attending.

 

[Ho0v-man]

So maybe at this point, angling towards medical school while interacting with different types and levels of providers is the best route for now.

I'm afraid of the commitment level of medical school. It would take a long time and I feel like I'm late to the game (25) because people have been preparing their entire lives for such a thing and that intimidates me.

How did you ultimately decide on medical school, if you were in the same boat?

I felt the “need” you also describe. I worked with NPs/PAs/docs and it was just clear who had a stronger command of the material to me. It’s not even close. And I don’t mean that as some inflammatory insult toward them or anything, especially since I’m on their sub forum. It’s just reality and has nothing to do with raw intellect or whatever. The person who trains harder and longer is just going to be better almost 100% of the time. That’s just true of anything.

It’s a big commitment. It’s expensive, it’s hard, it’s long and it’s psychological torture at times. You’d be nuts not to second guess yourself. That apprehension just means you’re not stupid. People def prepare their whole lives for it. But people also go on a whim it seems too believe it or not. Most are somewhere in the middle. I started in my early thirties and am definitely not the oldest in my class. You’re not too old.

Figure out if that’s what you want. It really sounds like you’re worried about trying and failing. But is that worse than never trying? Only you can answer that.

 

[RM38]

One thing you need to realize is that if you become an NP the scope of what you can do will largely be limited by the physician supervising you. If you want to do gender affirming care, you will need to find a practice that is comfortable managing that. That will not be an issue if you are a physician as you could open your own practice and do what you want. My cousin is an FP NP that works with the transgender population and she found a practice that is happy to both prescribe the medications and spend the time need to talk to the patients about what to expect. Many practices may not be comfortable with this though. Also you need a good amount of time to talk to those patients, and the practice is expecting you to see 25 people a day, it will be difficult to do. I agree med school is a huge commitment and you will probably have to take more classes and get your grades up as a 3.15 is not very competitive for US schools unless you do very well on the MCAT. I would say the average age of students in my class was 26 or 27 for my M1 year back in 2008. Lots of people started in their late 20's and early 30's. One guy was in his 50's.

 

[KeikoTanaka]

I am going to put it out there that if you want to have the biggest impact on lives of Transgender Individuals, I strongly suggest doing DO. Your GPA is not high enough for MD. If you get a 507 minimum on the MCAT, you can be somewhat competitive for DO school, especially after you get your scribe experience.

The reason I say this is because, while right now you're thinking about aiding transgender individuals on their "mental health needs" - a huge, huge, huge, huge, huge, HUGE impact on the mental health of a transgender individual actually comes straight down to the medical care they're able to receive. You can tell someone to "think positively" and "dream big" and that's fine and dandy, but until they're able to truly live out their lives the way they want, no amount of psychiatric support will help them. It's like telling someone without a leg to just try hard enough and maybe someday they can walk. It's not going to happen. Living like your body is a prison is not a walk in the park, and feeling like every medical professional is judging you, and feeling like you cannot be honest with them out of stigma only exacerbates the problem.

As a Family Medicine Primary Care Physician, you can get enough exposure to Psychiatry, Endocrinology, Urology, and OBGYN to make a huge impact in these individuals lives. You would be able to truly help them transition, and you would know exactly what problems they have WITH ALL THEIR MEDICAL NEEDS. You may identify as a female, but if you still have male parts, you need to know everything that can go wrong with all those parts and how any hormone therapy/antibiotics/any other medical problems that requires therapy is going to have a long-term effect on your patient. Conversely, females have higher rates of autoimmune diseases, so understanding that even a transgender man is going to be susceptible to said conditions, you will need to understand how to adjust rheumatologic, endocrinological, and psychiatric drugs for your patients ultimate well-being.

Psychiatry, Endocrinology, OBGYN, Urology, General Medicine as fields are all very complex fields in their own right, and while an NP can do a great job as an extender in any of these fields, to really be adequate enough in all of them to be able to tackle the whole spectrum of what a transgender patient truly needs, is to be a physician.

Imagine if you do the NP route, and now you need to utilize more physician specialists to aid you in your diagnostics just because you don't have quite all the training to do it alone - You're going to be sending a highly vulnerable individual who might already have an extreme fear of Doctors due to Stigma to more and more physicians than they already would have had to have gone to. Furthermore, LGBTQIA (Especially the T) individuals unfortunately have immensely high rates of drug abuse, smoking, alcoholism, and overall very poor health due to low SES (especially LGBTQIA POC) so being able to be an advocate for them for all their needs is so important, they may not be able to afford even going to a specialist.

Plus, as a Physician, you will be able to market yourself in anyway and make yourself known as the expert/authority in this field.

I know this is the PA/NP/RN subforum, I truly hope not to offend anyone with these comments, I just think that given the complexity of these patients and the vulnerability of these patients, they truly deserve someone who can be a one-stop-shop so to speak.

P.S. for what it's worth, if you wanted to do Primary Care, it's the shortest route in Medical School, if you are 25, get accepted at 26, attend at 27, you can be done with residency by the time you're 35. If you want to retire at 65, that's 30 long years of practice. If you want to retire at 75, that's 40 long years of practice! You have nothing to lose and everything to gain, even if it takes you longer, like 2 years to get into DO school, I really think it'd be worth it for you.

 

[TyPsych]

Good luck on whatever path you choose. If you go the NP route, you should look at The Keith Haring Nurse Practitioner Postgraduate Fellowship in LGBT+ Health at Callen-Lorde in NYC.

The Keith Haring Nurse Practitioner Postgraduate Fellowship in LGBTQ+ Health - Callen-Lorde

 

[Dr G Oogle]

I do transgender care as part of my practice and have NPs and one PA as part of a multidisciplinary team. The leader of the team is a specialy trained urologic oncologist who does TG care as well as post cancer reconstructions, I assist him sometimes and also do vaginal recon and non-reconstructive hysterectomies/BSO. Hormones are managed by endocrinologist and an REI. Mental health by a 2 psychologists and 1 psychiatrists. The PA is primarily a surgical assist, the np does care coordination and non-complex and long term follow up. There are more rural places where literally anyone can prescribe hormones but to really manage/hep these patients you need a multidisciplinary team at a tertiary medical center.

 

[liquidwizdom]

THis

25??? Some of my all time best students have been in their 30s and 40s! I graduated a stellar one at 50 and she's now an attending.

This motivation is what I am looking for, I am an older applicant... Thank You!!

 

[scoopdaboop]

Gender affirming care is dangerous, and should not be allowed. Aren't some of these kids asking for surgeries / hormones like in their teens? Lmao. I wouldn't touch any patient like this until they're well in their 20s. Unfortunately, the tranny mob has infiltrated all walks of life from education and especially medicine, where doctors will be breaking "conversion therapy" laws if you try to suggest to a teen asking for hormone/surgeries they might have underlying anxiety/depression/ some form of psychiatric dysfunction, and they get that treated FIRST. This is supported in research BTW. Gender dysphoria is a real thing and happens really early on in a kid's life (not teens), yet in today's age you see massive numbers of teenage girls trying to be transgender, that you didn't see say 50 years ago. Not bashing actual adult transgenders who transition when their life is stable etc., just the ones that will push even teenagers to go ahead and transition as if that's just okay.

Now, whether to be a NP/PA/DO. If you want to be a DO, you need to be open to the fact that you will spend 2 years of your life learning medicine, then doing rotations another 2 years in most areas of medicine, then finally you can be a FM/Psych/Pediatric doc and will have to be okay with the fact that you will inevitably have to treat other patients that aren't just gender affirming patients. Also, I truly believe you need a certain amount of ego to get through medical school; that is you want to be the "final decision maker" of patient care, and if you are working with other LLP/MLP you will be.

NP will probably get you to where you want to be faster, and it requires relatively low mental effort and is likely the best option for you, because you wouldn't have to move if you do an online degree etc. But, you have to be okay to be seen as a low level/mid-level provider. Also, you have to realize that the job market for NP's that go to an online degree is vastly different than one that goes to a decent program with connections etc. and you might have to work where you might not. Whereas as a physician, you can basically work anywhere granted you make salary cuts, especially as a FM doc, which is one of the most recruited docs around these days.

 

[peregrino]

After seeing this thread, I did a bit of Googling and came up with this surgeon who has decided to devote her practice to doing transgender gender-affirming care and surgeries. Christine McGinn, Papillon Center. She is transgender herself and her own struggles to get accepted in her new identity and to get into a competitive plastics surgery residency as a DO are enlightening for others who want to follow her path. Maybe this would help you in your decision? As as OPs have said, go the physician route; you'll be able to do more.

 

[mariajane]

GPA prob too low for DO school. It might even be too low for NP school, truthfully (if it isn’t, it should be!). Get your GPA up. If dead-set on MD/DO then you should have aced the pre-reqs and had excellent MCAT.