Nurse Practitioner or Primary Care Physician?

[jpa1000]

Hello, I am a graduating senior with a B.S. in Chemistry and a minor in Business Administration. I graduated with a 3.7 and had worked hard to get into pharmacy school. Rocked the PCAT (89th%) and got into UK COP. However, with the recent job market saturation from all these idiot schools opening their doors I am abandoning my dream

That being said, I think I have the will-power and grades to get into med school....but is it worth it? I am seeing Nurse Practitioner plans for a LOT less $$$ that would have me practicing in only 3 years! Are Primary Care Physicians going to be a thing of the past as all of these new PA programs open? I don't want to get into med school and then the primary care market become flooded like the pharmacy market!

So: Nurse Practitioner or M.D./D.O.? Thoughts?.....

Thanks!

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[jpa1000]

Also, what does everyone on here think about Nurse Practitioners not even having to have taken Organic Chemistry?.....

 

[UrshumMurshum]

I think in order to be a NP you have to first go to nursing school to become an RN then go on to get your graduate degree. I don't think you can skip the RN part so I don't see the 3 years and practicing as realistic.

As to the question of whether or not NPs will replace PCPs, that's a question I'm not sure of the answer to.

 

[DrMediterranean]

 

[Perrotfish]

Hello, I am a graduating senior with a B.S. in Chemistry and a minor in Business Administration. I graduated with a 3.7 and had worked hard to get into pharmacy school. Rocked the PCAT (89th%) and got into UK COP. However, with the recent job market saturation from all these idiot schools opening their doors I am abandoning my dream

That being said, I think I have the will-power and grades to get into med school....but is it worth it? I am seeing Nurse Practitioner plans for a LOT less $$$ that would have me practicing in only 3 years! Are Primary Care Physicians going to be a thing of the past as all of these new PA programs open? I don't want to get into med school and then the primary care market become flooded like the pharmacy market!

So: Nurse Practitioner or M.D./D.O.? Thoughts?.....

Thanks!

1) You're not going to get a definitive answer on the future of any medical specialty or medical reimbursement structure. It's speculative. The practice rights of NPs might get beaten back, stay static, or expand. It would need to expand REALLY fast to eat the market for FPs, because our population is getting drastically older and sicker.

2) You might not be interested in Primary care once you finish your training. There's a reason so many people run to tertiary care: primary care is fairly forumlaic and what seems interesting when you first learn it can seem very repetitive. An MD has more options if you end up hating clinic.

3) You also don't know what's going to happen with the market in technology. In a decade primary care might be driven by techs with Watson style programs. An MD gives you a wider range of options if you need to retrain.

4) I wouldn't want to practice 3 years after graduating college and you shouldn't either. The NP degree was designed with the idea that experienced nurses would use the knowledge base they developed working on floors, in ERs, and in ICUs to replace the time they wouldn't spend training in medical school and residency. That premise alone is questionable, but these 3 year straight to NP programs (yes they do exist) are disgraceful. I've worked with one graduate from such a program an she functioned at about the level of a 3rd year medical student, which is not surprising since she had 3 years of training. I'm surprised nurses don't rise up against these programs for f-ing up their brand: just like you shouldn't be able to call yourself a doctor without being one you shouldn't be able to call yourself a nuse if you've never done and never plan to do any nursing.

I hate to be the melodramatic guy but this is a life and death profession. I've just finished four years of medical school and I'm horrified that they're going to trust me to be a very closely supervised Intern. If you think you're going to be ready to practice independently in less time than it took me just to feel this unprepared for an Internship I think you either need less confidence or more concern for your patients. If you want to be an NP I strongly believe you should plan to spend at least a couple of years nursing, ideally in a 'learning heavy' enviornment like the ER or an ICU.

Summary: I would be an MD. If only because you might end up really like surgery/gas/medical subspecialties. Failing that I would be a real nurse for awhile before becoming an NP.

Also, what does everyone on here think about Nurse Practitioners not even having

to have taken Organic Chemistry?.....​

There is no course quite as useless for your future medical career as organic chemistry. Good for them. ​

​

 

[bassvp]

Hello, I am a graduating senior with a B.S. in Chemistry and a minor in Business Administration. I graduated with a 3.7 and had worked hard to get into pharmacy school. Rocked the PCAT (89th%) and got into UK COP. However, with the recent job market saturation from all these idiot schools opening their doors I am abandoning my dream

That being said, I think I have the will-power and grades to get into med school....but is it worth it? I am seeing Nurse Practitioner plans for a LOT less $$$ that would have me practicing in only 3 years! Are Primary Care Physicians going to be a thing of the past as all of these new PA programs open? I don't want to get into med school and then the primary care market become flooded like the pharmacy market!

So: Nurse Practitioner or M.D./D.O.? Thoughts?.....

Thanks!

Just be good at what you do and screw job market saturation. It pushes out the weak.

 

[JESSFALLING]

OP: I suggest you read this thread http://forums.studentdoctor.net/showthread.php?t=905440

 

[Perrotfish]

Just be good at what you do and screw job market saturation. It pushes out the weak.

This is what every PhD student says when they start their program. Talk to them in 10 years.

 

[jpa1000]

1) You're not going to get a definitive answer on the future of any medical specialty or medical reimbursement structure. It's speculative. The practice rights of NPs might get beaten back, stay static, or expand. It would need to expand REALLY fast to eat the market for FPs, because our population is getting drastically older and sicker.

2) You might not be interested in Primary care once you finish your training. There's a reason so many people run to tertiary care: primary care is fairly forumlaic and what seems interesting when you first learn it can seem very repetitive. An MD has more options if you end up hating clinic.

3) You also don't know what's going to happen with the market in technology. In a decade primary care might be driven by techs with Watson style programs. An MD gives you a wider range of options if you need to retrain.

4) I wouldn't want to practice 3 years after graduating college and you shouldn't either. The NP degree was designed with the idea that experienced nurses would use the knowledge base they developed working on floors, in ERs, and in ICUs to replace the time they wouldn't spend training in medical school and residency. That premise alone is questionable, but these 3 year straight to NP programs (yes they do exist) are disgraceful. I've worked with one graduate from such a program an she functioned at about the level of a 3rd year medical student, which is not surprising since she had 3 years of training. I'm surprised nurses don't rise up against these programs for f-ing up their brand: just like you shouldn't be able to call yourself a doctor without being one you shouldn't be able to call yourself a nuse if you've never done and never plan to do any nursing.

I hate to be the melodramatic guy but this is a life and death profession. I've just finished four years of medical school and I'm horrified that they're going to trust me to be a very closely supervised Intern. If you think you're going to be ready to practice independently in less time than it took me just to feel this unprepared for an Internship I think you either need less confidence or more concern for your patients. If you want to be an NP I strongly believe you should plan to spend at least a couple of years nursing, ideally in a 'learning heavy' enviornment like the ER or an ICU.

Summary: I would be an MD. If only because you might end up really like surgery/gas/medical subspecialties. Failing that I would be a real nurse for awhile before becoming an NP.

There is no course quite as useless for your future medical career as organic chemistry. Good for them. ​

​

There's just such a large cost $$$ difference. Yes, I of course from an academic standpoint would like to think that an MD is MUCHHHH better qualified to treat patients. I've worked in a pharmacy for a couple years now and see some really dumb things on the prescription pads of NP's. But, where I'm from (in Indiana) they have full prescribing rights, operate their own practices without MD's, and generally are doing alright with patient care it seems. Can I justify the extra $100,000 and 4 years of schooling to become an MD over a FNP?​

 

[jpa1000]

This is what every PhD student says when they start their program. Talk to them in 10 years.

Yes, I've given up hope for pharmacy. It's sad, because in my years working in a pharmacy I've seen some really good pharmacists really help some patients, particularly when their MD's were clueless about what was going on. However, until insurance companies realize that the PharmD.'s are actually helpful for patient care, and not just a pill pusher, things will keep falling down the proverbial cliff....

 

[JESSFALLING]

Can I justify the extra $100,000 and 4 years of schooling to become an MD over a FNP?

MD/DO would be one extra year of schooling, right? I don't consider residency 'schooling' since you're getting paid. ~$50k/year isn't a ton of money, but it's a reasonable amount to live on for a few years.

Have you looked at the 3-year MD/DO programs? There aren't a lot of them (one in TX, LECOM, a few new ones coming), but they might be worth a look. At least, then, you can get residency training....which is at least 7,000 more hours of supervised training than you will get with NP.

Personally, if I were interested in Family Practice, I would be questioning if the three years of residency training is enough to prepare me to treat such a diverse patient population....especially since I want to work in a rural environment where I won't be surrounded specialists.

 

[Perrotfish]

There's just such a large cost $$$ difference. Yes, I of course from an academic standpoint would like to think that an MD is MUCHHHH better qualified to treat patients. I've worked in a pharmacy for a couple years now and see some really dumb things on the prescription pads of NP's. But, where I'm from (in Indiana) they have full prescribing rights, operate their own practices without MD's, and generally are doing alright with patient care it seems. Can I justify the extra $100,000 and 4 years of schooling to become an MD over a FNP?

At the moment yes. There is still a hefty difference between the national average salary for MD driven primary care and NP primary care that would allow you to recover both the real and opportunity cost of your education. Again, will that change? Maybe. On the other hand it may change in the other direction, and NPs might find themselves unemployed. It's hard to predict the future.

Also are you 100% sure you want primary care? Again, I came in thinking I wanted to to Orthopaedics, transitioned to wanting to do Family Practice, then Pysch, and now I'm deadset on a Pediatric subspecialty. The average earnings for specialist physicians is still so high that it could make up your opporunity cost of medical school vs NP school in a single year. If you decide you want to do that you could make have a much more financially rewarding career and maybe be much happier at the same time

and generally are doing alright with patient care it seems.

You aren't in a position to judge this yet, btw, but I promise you the ones who are graduates of 3 year degree mills are often not doing 'alright' in terms of patient care. They're disasters, and without menotrship or oversight they'll remain disasters. I think the reason this hasn't become a scandal yet is that not-really-nurse Practicioners are a very recent phenomenon, and haven't really become a significant part of the workforce yet. Most NPs are still battle hardened nurses who jumped a level after working a few years.

If you cause a death because of your insufficent training its going to hang over you for the rest of your life, and I don't just mean legally. Don't skip the training you need.

 

[jpa1000]

@perrotfish,

I really appreciate your insight. Like I said, I've just recently decided to decline pharm school (haven't even notified them yet haha). Trying to wade through all the options for med school, preparing for the MCAT, trying to line up shadowing experience....it's all overwhelming. How many shadowing hours do I need to be safe? I mean, I have a ton of pharmacy experience, which taught me an awful lot about drug therapies, but I think Med School admissions committees are going to want more than that, right?

 

[Perrotfish]

@perrotfish,

I really appreciate your insight. Like I said, I've just recently decided to decline pharm school (haven't even notified them yet haha). Trying to wade through all the options for med school, preparing for the MCAT, trying to line up shadowing experience....it's all overwhelming. How many shadowing hours do I need to be safe? I mean, I have a ton of pharmacy experience, which taught me an awful lot about drug therapies, but I think Med School admissions committees are going to want more than that, right?

There's no absolute rule (and since you can make up the numbers no one looks that closely) but I think it's good to be able to talk about seeing patients in a few different enviornments. An ER, an outpatient clinic, an inpatient hosital ward, and surgeon who lets you see the OR is an ideal combination, two or three of those is probably good enough. An LOR from one of them never hurts, since its at least verification that you're honest. Basically you want to show them you shadowed enough that the initial novelty would wear off, and you were still interested in the profession. 100-200 hours, maybe?

The biggest issue is that you're short on time if you want to apply this cycle (to start in 2014) Medical school applications are rolling, which means that applicants who apply when everything opens in June have a much better chance than ones who apply in September. By December its too late unless your application is stellar. You need to study for the MCAT, take it, and get it graded by early September at the latest. If you want to apply this year you need to schedule an MCAT and an MCAT review course NOW. The review for thist test takes awhile. I took a semester, and 6 weeks is lightning fast. Thats assuming you have all the prereqs done.

That being said a bad MCAT can haunt you, they don't just take the highest scores. Don't take the real test until you're satisfied with your score on multiple practice tests. You're in a strong position with your GPA, so a broad (20 + mostly midrange schools) application with a decent MCAT could get you through despite a relatively late application.

I know its overwhelming, but you've already done 90% of the work getting that GPA. There are just a few more hoops to jump through.

 

[biomaj]

I just had a discussion with a PA I work with about this. Although PAs are starting to edge their way into primary care, they will still always need physicians for these careers. Same thing with NPs in the sense that, they are pretty limited in the recognition as primary care providers. In the clinic I work in for example, there are around 40-50 providers. Two are PAs and Two are NPs out of the entire provider population here. I don't think you should worry about finding a position in primary care if you went for MD.

 

[armybound]

I'd stick with pharmacy.

 

[RedSox10]

NP's will pretty soon need a doctorate, so it's not going to save you any time. Also, are you certain about primary care? If so, an NP isn't a bad decision, however a lot more doors will open up for you if you can get into a US MD/DO program.

 

[sc4s2cg]

Hi,

I was a Nursing major and this (Google Docs)is my standard reply to people curious about Nursing.

As to NP, first you need to become an RN (Registered Nurse). There is more info here (wiki).