RN to MD, now rethinking going PA route (warning: long and silly)

[wdwrn]

I am RN and have recently "committed" to going back for medical school; however, I use the term committed loosely, as lately I have been second guessing my decision. I already have my plan laid out, to take it slow and still work FT while going back to finish my courses piecemeal. The plan is to do this starting in January over the next 2.5 years, MCAT and apply in 2017, hopefully to begin in 2018. I'd be 31 when I start. I don't have any strong doubts about my plan and ability to finish the prereq/app process the way it needs to be done and get in, but I am having my doubts about the future lifestyle and the debt.

As far as why I want to get out of nursing, just know the decision is made and there's valid reasons - I'll spare you the rest. NP is not a route I will be considering.

My strongest doubts revolve around economic feasibility to support the goal of MD, as well as giving up time traveling and family. When I made the plan awhile back to seriously do this med school thing, one of my rationales for finally deciding it was because I am single, and do not want kids. When I speak of family, I am speaking of my siblings and mother, who all live out of state. We do have a lot of fun visiting each other when we can. I can't imagine not doing this. I also just got out of a long and seriously relationship, left a place I hated, and have reinvented myself in this new city that I love. I'm having a lot of fun exploring it (endless possibilities), being single, and making new great relationships. I absolutely don't mind giving this all up to start back in school if it's what I really want, because when I set my mind to something I want, I usually do well. However, I find myself questioning "is it going to be worth it?"

I'm exposed to the physician lifestyle everyday, have tons of friends that are physicians, and know how things work - so exploring more in depth isn't really an issue. I see the residents I work with put in over 100+ hours a week and I sometimes wonder if I'd get depressed and not be able to handle it. I see the med students come in at 4am and sit at the computers trying to wake up...blah. Being highly sensitive/emotional is what really makes me a good nurse and makes me think I'd make an amazing physician, but it also makes me wonder if I'm vulnerable to caving to the stresses of the MD route. I was reading in detail about the USMLE steps last night and got exhausted just thinking about it...

I want to go MD because I want to learn the medical model and be able to provide more for patients. I do I absolutely love to learn, and usually bring a very positive attitude to academics. The schooling is not my concern. It's the lifestyle - I'll be 40 when I'm done with residency, and dead broke. I also have no support whatsoever for school, so I'd have to take out loans for tuition and cost of living. I'm looking at realistically being in 1/3 a million dollars in debt when I'm done.

Oh also, my strongest interest is in primary care right now. This is what really makes me think about doing PA instead of MD. Dozens of doctors I speak with seem to tell me to consider the PA route and forego MD, that it's "not worth it". A small part of me also says go with my back-up career plan to basically leave bedside nursing for a career that would pay ~90K, I find the work fairly interesting, and could then buy myself a boat and do lots of traveling and eating/drinking my way around the world. Oh man, that sounds even nicer now putting in on paper

I could keep going on, but don't want you poor souls to have to read anymore for now. Thank you if you've read and can share your thoughts.

---

Members don't see this ad.

 

[Apoplexy__]

If you're confident you'll do primary care, then I'd definitely recommend PA over MD. Particularly with everything you mentioned about age, wanting to travel the world, etc.

I see the med students come in at 4am and sit at the computers trying to wake up...

I know dem feels...

 

[QofQuimica]

I didn't read through your entire post (sorry, not up for reading something "long and silly"), but if you're already an RN, why not become an NP instead of a PA or MD? That's almost certainly your best option in terms of time and expense.

 

[wdwrn]

I didn't read through your entire post (sorry, not up for reading something "long and silly"), but if you're already an RN, why not become an NP instead of a PA or MD? That's almost certainly your best option in terms of time and expense.

I suppose I shouldn't have said "silly", long is honest, however. I have long opinions about how I do not believe in the nursing model, and how I would like to move away from nursing. To put it quickly, I don't believe in nurses as diagnosticians (and this is not me saying I have disrespect for NPs - there are some great ones). I am not interested in treating patients without learning medicine. I am sure you can understand what I mean without me having to elaborate. The educational aspect is incredibly important to me.

 

[wdwrn]

To answer any subsequent questions on why I became a nurse, it's because at the time, it was the most economical way for me to get into patient care (which was the priority at the time).

 

[kate8822]

I'm going to agree to the idea of PA. Especially if you want to go into family practice/primary care. I just finished reading a huge front page article in my areas Sunday paper less then a month ago about how PA rights are being extended in many state's legislations due to the ACA, need for medical treatment and lack of MD's, etc... I wish I could find it! I may have to search and see if I can find it online for you.

PA sound the way to go, especially given you are single and concerned about the assistance you will have... financially and emotionally. Just my $.02.

 

[Jewels86]

Here's my thoughts...

I am a nurse, like you. I work in a hospital that is a resident based facility and like learning with them. I completely understand where you are coming from in regards to the medical model; to some of us, the medical model makes sense to how we individually process information. When I want to learn how a particular medicine works, nursing teaches us why it works this way; science teaches us the how behind the why it works. Both are very good; it's all about personal preference.

If you want to become a physician, MD or DO, just do it. NP is a great field but if you know deep in your heart what you want to do, just do it. At the end of the day, it's all about your individual path. Best wishes!!

 

[theseeker4]

I am RN and have recently "committed" to going back for medical school; however, I use the term committed loosely, as lately I have been second guessing my decision. I already have my plan laid out, to take it slow and still work FT while going back to finish my courses piecemeal. The plan is to do this starting in January over the next 2.5 years, MCAT and apply in 2017, hopefully to begin in 2018. I'd be 31 when I start. I don't have any strong doubts about my plan and ability to finish the prereq/app process the way it needs to be done and get in, but I am having my doubts about the future lifestyle and the debt.

As far as why I want to get out of nursing, just know the decision is made and there's valid reasons - I'll spare you the rest. NP is not a route I will be considering.

My strongest doubts revolve around economic feasibility to support the goal of MD, as well as giving up time traveling and family. When I made the plan awhile back to seriously do this med school thing, one of my rationales for finally deciding it was because I am single, and do not want kids. When I speak of family, I am speaking of my siblings and mother, who all live out of state. We do have a lot of fun visiting each other when we can. I can't imagine not doing this. I also just got out of a long and seriously relationship, left a place I hated, and have reinvented myself in this new city that I love. I'm having a lot of fun exploring it (endless possibilities), being single, and making new great relationships. I absolutely don't mind giving this all up to start back in school if it's what I really want, because when I set my mind to something I want, I usually do well. However, I find myself questioning "is it going to be worth it?"

I'm exposed to the physician lifestyle everyday, have tons of friends that are physicians, and know how things work - so exploring more in depth isn't really an issue. I see the residents I work with put in over 100+ hours a week and I sometimes wonder if I'd get depressed and not be able to handle it. I see the med students come in at 4am and sit at the computers trying to wake up...blah. Being highly sensitive/emotional is what really makes me a good nurse and makes me think I'd make an amazing physician, but it also makes me wonder if I'm vulnerable to caving to the stresses of the MD route. I was reading in detail about the USMLE steps last night and got exhausted just thinking about it...

I want to go MD because I want to learn the medical model and be able to provide more for patients. I do I absolutely love to learn, and usually bring a very positive attitude to academics. The schooling is not my concern. It's the lifestyle - I'll be 40 when I'm done with residency, and dead broke. I also have no support whatsoever for school, so I'd have to take out loans for tuition and cost of living. I'm looking at realistically being in 1/3 a million dollars in debt when I'm done.

Oh also, my strongest interest is in primary care right now. This is what really makes me think about doing PA instead of MD. Dozens of doctors I speak with seem to tell me to consider the PA route and forego MD, that it's "not worth it". A small part of me also says go with my back-up career plan to basically leave bedside nursing for a career that would pay ~90K, I find the work fairly interesting, and could then buy myself a boat and do lots of traveling and eating/drinking my way around the world. Oh man, that sounds even nicer now putting in on paper

I could keep going on, but don't want you poor souls to have to read anymore for now. Thank you if you've read and can share your thoughts.

My only concern with your plan would be whether you will be a PA and feel like you settled. Personally, I never even considered being a "mid level". I wouldn't have entered medicine at all if being a physician wasn't possible. I feel this way despite having a wife and child, so I am much more restricted in lifestyle and flexibility than your plans are. If you think you will feel this way, think long about whether you can "settle" for less than being a Dr. If you can, great, be a PA. If you can't, the path to an MD or DO might be long and hard, but better than regretting your choice in the end.

Keep in mind that there is a lot of push by PAs to get wider scope of practice because so many are NOT satisfied with their current jobs. The current trend is toward expanding the independence, but who is to say how far that will go, and what PAs will be able to do 5 or 10 years from now? If you would be happy doing what a PA can do most places now, go for it, but if you want to pursue a PA degree because you assume your scope will be much wider when you start practicing, I personally wouldn't gamble on that.

Good luck!

 

[operaman]

My vote is for MD because medicine needs more people with a heart like yours.

I know it's more complicated and you ultimately must do what is right for you, but never underestimate the impact someone with your passion and experience can have.

My gut says that the reasons you don't want to do NP are the same that would ultimately make PA an unrewarding choice for you. The amount of actual schooling is not that different either as you will still need pre-reqs no matter what you do, and PA school is still ~2.5 years. If you start when you're 31, you would finish PA school at about 33/34 yo and finish MD school at 35. At that point, you would either start practice as a PA making ~90k per year OR you would start residency making ~55k /yr. After 3-5 years you would either 1) be a PA making ~90-110k /yr OR 2) be an attending MD making 150k-250k /yr (or more).

Either way, you'll still be 38-40 years old. Unfortunately, there's no career path that stops time!

The debt issue is real and you would owe substantially more if you go MD; probably about 2x as much. Depending on your field, you may be making 2-3x as much as an MD versus a PA, or you may be making 1-1.5x as much. That debt:income ratio is really hard to gauge because it will depend on too many variables you can't possibly nail down right now. Broadly speaking, I think the ratio will probably be fairly similar.

Depending on what you do, there may not be a huge difference in lifestyle between being a new PA and being a resident. It all depends on the specialty. If you're seeing residents hitting 100 hours a week and students in the door at 4am, then you're either on a surgical floor or an ob/gyn floor. As a student, those are the only times you'll likely be in at 4am unless you're finishing an overnight; the rest of the services are more 6/7am - whenever you finish. For the residents, surgical fields and ob/gyn (which has a substantial surgical component) are far more brutal than the others; the primary care residents are working more humane hours.

Ultimately it comes down to whether or not you love the work you're doing and find it fulfilling.

I'm not sure the PA route would allow you as much time off as you suggest. There are probably more options for MDs that would allow high income with lots of free time: hospitalists generally work 1 week on/1 wk off and make 200k+ and don't ever take call; ED docs also work shifts and make 200+. If you wanted to be a vagabond, you could do locums work around the country and around the world, make a little less but have more freedom. Lots of options.

And in all of them, medicine gets a person with real heart.

 

[jl lin]

My opinion is go for what you really want. Having said that, if you are wavering, perhaps it's an indication that the long marathon with all the hurdles isn't really fitting with your life and lifestyle. Whenever I read these kinds of posts, I wonder about the true commitment to taking the path of medicine--and that's OK. It's OK to want to have more of a life. It's OK to have less ridiculous hurdles to jump over and hoops to jump through. I mean, there is a rhyme and reason for them, but for someone interested in primary care, well, some of the hoops are completely superfluous. Thing is, it has to be that way, b/c many a student thinks they want primary care, and end up changing that to something else down the road.

For me, if I were younger, I'd probably go for peds, critical care, b/c it's been my interest and love--or ED. But neither of those is really realistic for me at this point in my life. Why I chose MS, if indeed it chooses me, over NP, is that there are so many complex cases--people with many serious comorbidities to consider while caring for them--even in primary care. Important stuff can get missed. I have seen--more than once. So, a solid medical education and residency is the better bet in terms of what I feel I should be able to give my patients in the future. That's another nurse's take on your post. If were more about money and a shorter path for me, I'd go for CRNA. But it's not, so. . .

 

[wdwrn]

Wow, thanks for your responses, so very much. Operaman, you really hit it home for me there. Thank you so much for the optimism, I had it a few weeks ago and it got lost somewhere...your response is so kind and humble, and I needed to hear that. TheSeeker4, this is of course, my big hesitation to doing PA - self-satisfaction at the end of the day. Good to hear it's not just in my head. The other responses are very thoughtful as well. At this time, I'm still going to continue my post-bac plan for MD/DO.

I appreciate all of you taking the time to read and respond more than you know!

 

[tmn]

As a former nurse I want to nit-pick a few things.

First off, the medical model of care vs. nursing model is a load of garbage. You want to know how an NP treats someone with pneumonia? With the same labs, images, medications, etc. that an MD would. There are certainly considerable differences in depth and breadth of education and experience. However, the nursing model of care thing as it pertains to NP is just imaginary. Difference in education? Yes. Difference in "models of care?" Nope.

Also, the bit that someone was saying about being more educated for the sake of your patients is crap. There is a fixed number of educated physicians per year (via med school seats and mainly by residency spots) regardless of whether you persue MD or not. So, pursue MD for the more advanced education if you want to for your own sake.

All that said, I say you go MD. It sounds like you will not be satisfied otherwise. I know I wasn't.

 

[deleted6669]

as the only PA responding to this thread I have to say Go MD/DO. yes, you may do many of the same things as a pa in primary care but for much less money and with much less respect. at several of my jobs I am scheduled interchangeably with docs. there is nothing they do that I don't except work 1/3 less for twice my salary.
there are now several med schools which have 3 year programs if you are willing to commit to primary care up front. loan repayment as a doc is much easier than as a pa. find a nice rural fp job after graduation and let them pay off all your loans then enjoy the rest of your life working 30 hrs/week. very doable as a doc. almost impossible as a pa. I know many docs making a great income on 2-3 days of work/week. most pas I know work 180+ hrs/mo and always are looking ahead to the next job just in case their current one decides not to use pas any more or radically changes their scope of practice on a whim.

 

[Jeremens]

My vote is for MD because medicine needs more people with a heart like yours.

I know it's more complicated and you ultimately must do what is right for you, but never underestimate the impact someone with your passion and experience can have.

My gut says that the reasons you don't want to do NP are the same that would ultimately make PA an unrewarding choice for you. The amount of actual schooling is not that different either as you will still need pre-reqs no matter what you do, and PA school is still ~2.5 years. If you start when you're 31, you would finish PA school at about 33/34 yo and finish MD school at 35. At that point, you would either start practice as a PA making ~90k per year OR you would start residency making ~55k /yr. After 3-5 years you would either 1) be a PA making ~90-110k /yr OR 2) be an attending MD making 150k-250k /yr (or more).

Either way, you'll still be 38-40 years old. Unfortunately, there's no career path that stops time!

The debt issue is real and you would owe substantially more if you go MD; probably about 2x as much. Depending on your field, you may be making 2-3x as much as an MD versus a PA, or you may be making 1-1.5x as much. That debt:income ratio is really hard to gauge because it will depend on too many variables you can't possibly nail down right now. Broadly speaking, I think the ratio will probably be fairly similar.

Depending on what you do, there may not be a huge difference in lifestyle between being a new PA and being a resident. It all depends on the specialty. If you're seeing residents hitting 100 hours a week and students in the door at 4am, then you're either on a surgical floor or an ob/gyn floor. As a student, those are the only times you'll likely be in at 4am unless you're finishing an overnight; the rest of the services are more 6/7am - whenever you finish. For the residents, surgical fields and ob/gyn (which has a substantial surgical component) are far more brutal than the others; the primary care residents are working more humane hours.

Ultimately it comes down to whether or not you love the work you're doing and find it fulfilling.

I'm not sure the PA route would allow you as much time off as you suggest. There are probably more options for MDs that would allow high income with lots of free time: hospitalists generally work 1 week on/1 wk off and make 200k+ and don't ever take call; ED docs also work shifts and make 200+. If you wanted to be a vagabond, you could do locums work around the country and around the world, make a little less but have more freedom. Lots of options.

And in all of them, medicine gets a person with real heart.

 

[Jeremens]

I read your advice and am really grateful for being clear on the paradox of becoming an MD vrs PA.

 

[NotAnOperator]

I'm in a similar-ish situation. Currently in healthcare, aiming for MD, considered PA route. I'm also married though with no kids. The ultimate reason I chose not to pursue PA and to just go for the MD (which will take about a decade longer) was because we only get one shot at life. The only reason I was considering PA was because it was a much shorter route and probably an easier one (not downing PA education/training). I see the PAs and the docs I work with and although the PAs have great lifestyles and an awesome job, I didn't want to settle. If I were to become a PA, my whole life I'd wish I would have went for the MD. I have a "go hard or go home" type of mentality; all or nothing. I like pushing myself to my limits, absorbing all the knowledge I possibly can, and climbing the tallest mountains in sight because the sense of accomplishment afterwards is the best part.

If you could see yourself as becoming a PA and loving life, go for it. It's a fantastic, prestigious career where you help people, and are paid well to do it. If you feel like you'd be settling or the only reason you're considering PA is because it's less of a hurdle, go MD.
You've got one life to live so get what you want while you're here and don't ever settle for anything less.

 

[jl lin]

As a former nurse I want to nit-pick a few things.

First off, the medical model of care vs. nursing model is a load of garbage. You want to know how an NP treats someone with pneumonia? With the same labs, images, medications, etc. that an MD would. There are certainly considerable differences in depth and breadth of education and experience. However, the nursing model of care thing as it pertains to NP is just imaginary. Difference in education? Yes. Difference in "models of care?" Nope.

Also, the bit that someone was saying about being more educated for the sake of your patients is crap. There is a fixed number of educated physicians per year (via med school seats and mainly by residency spots) regardless of whether you persue MD or not. So, pursue MD for the more advanced education if you want to for your own sake.

All that said, I say you go MD. It sounds like you will not be satisfied otherwise. I know I wasn't.

So disagree on "Also, the bit that someone was saying about being more educated for the sake of your patients is crap." Completely false. I do not have the time to write all the cases of incomplete or misdiagnoses and less than effective treatments, b/c the person with less education did not have the breadth of knowledge to understand the complications of various comorbidities--and many, many patients are struggling with the conflicts of co-morbid conditions--this is true for both the pediatric population very often, as well as the adult population. Education goes far beyond MS--the nuts and bolts of the application comes through a great residency/fellowship program and experiences. And to be honest, some people excel at both the art and science of medical application, and some do not; but it's false to suggest that education, both didactic and clinical, will not make a difference for patients. Sorry. Hogwash.

 

[tmn]

So disagree on "Also, the bit that someone was saying about being more educated for the sake of your patients is crap." Completely false. I do not have the time to write all the cases of incomplete or misdiagnoses and less than effective treatments, b/c the person with less education did not have the breadth of knowledge to understand the complications of various comorbidities--and many, many patients are struggling with the conflicts of co-morbid conditions--this is true for both the pediatric population very often, as well as the adult population. Education goes far beyond MS--the nuts and bolts of the application comes through a great residency/fellowship program and experiences. And to be honest, some people excel at both the art and science of medical application, and some do not; but it's false to suggest that education, both didactic and clinical, will not make a difference for patients. Sorry. Hogwash.

I was referencing your post here:

So, a solid medical education and residency is the better bet in terms of what I feel I should be able to give my patients in the future.

Residency spots are capped by the federal government. Every year there will be a fixed number of physicians entering the field regardless of whether OP is one of them. OP's pursuit of MD will have zero effect on what doctors are "able to give [their] patients in the future." OP getting an MD does not somehow increase the number of educated providers among the pool of physicians. In fact, one could argue that if a person is truly concerned about being educated "for the sake of their patients" or because "their patients deserve it" or some junk like that, then that person should pursue NP or PA. The number of providers entering those fields isn't capped by the government. Pursuing MD does not increase the number of healthcare providers available to patients. Pursuing NP or PA would increase the number of healthcare providers available to patients.

In short, OP getting an MD does nothing to increase the number of educated physicians.

Which is why I said that OP should pursue the longer, more intense educational path of MD only if OP wanted to for their own sake.

I never said education will not make a difference for patients. Education (read: med school, residency) does matter. However, it doesn't matter if OP is the one getting that education or if it is someone else.

 

[Elizabethx89]

.

 

[deleted623580]

Go MD. You might regret it in the future if you picked PA and you're not satisfied.

 

[Morsetlis]

If you want to practice medicine, NP and PA are both good routes with very satisfying lifestyles. Medicine needs more NP's and PA's "with heart" (or not) too. Have you seen how many people fill up a NYC ED? Even with residents and scribes and Fast Tracks the waiting time is still terrible.

If you want to become a physician, you have to ask yourself why. Everybody is vulnerable to the stresses you enumerated and I think the entire forum by now know the economic realities of primary care medicine and crushing student loans especially for non-traditional students.

The physician is an educator, a scientist, a healer. They do not just practice medicine. They advance medicine. They are the pillar of community health, whether that be a village or merely a few city blocks.

Go whatever route you prefer, but don't rely only on the first nice-sounding forum advice you see to make your decision

 

[ddmbmom]

Really thoughtful responses here. I was dead set on becoming a PA when I left a rural area where I was the sole diabetes educator and was graciously allowed to write my own orders for insulin and oral agents as I gained a strong reputation over the course of 17 years practicing. I have 6 very good friends who are PAs who sent me all their patients with diabetes to manage that part. Then we moved to a city where I was scolded for attempting to suggest insulin regimens in the hospital I worked at and among several other issues, I finally pursued PA. with a 3.6 and 22 years as a diabetes educator with outstanding LOR from the MDs and PAs I worked with in the rural area, it was absolutley heartbreaking to not be accepted. The school was unwilling to meet with me other than giving me an email saying "we just don't think you're cut out for PA, you should try MD". I won't go into the long story of how I handled, or mishandled, that upsetting news. Anyways, 3 years later, I finished the remaining 5 pre-reqs, got the MCAT hammered and am now at 25years professional experience and the med school has been so very warm to me and friendly, I just cant say enough how excited I feel about making this big decision, and I really feel I am going to get in. I will be 54(!) when I am all done with family practice residency and I anticipate working at least 20 years in the field! BTW, I learned that the PAs in this city where I live make what I made in 2004 as a diabetes educator - sad! I have learned the reason is because there is a local FNP school that graduates 60/year, and those 60 are taking basic pay because they just want to stay in the area. NOT at all intending to be disrespectful here, but by basic pay, I mean $25/hour - for a master's degree - geez! Thoughts?

 

[giantswing]

For what its worth, my class mates in med school who want to travel and spend time with family have had a hard time with how much of a commitment med school is, time wise. They say they want a life during med school, and those who have taken time off for family or travel have paid in board scores, grades, or both.

 

[the_fella]

Have you considered getting a DO? I believe most DOs go into primary care, though they can practice the full range of medicine. The DO is equivalent to the MD. I don't want to do the PA route b/c as I understand it, PAs don't practice under their own license; they must have a formal agreement with a physician. Even NPs don't have that requirement.

 

[brainnurse]

Really thoughtful responses here. I was dead set on becoming a PA when I left a rural area where I was the sole diabetes educator and was graciously allowed to write my own orders for insulin and oral agents as I gained a strong reputation over the course of 17 years practicing. I have 6 very good friends who are PAs who sent me all their patients with diabetes to manage that part. Then we moved to a city where I was scolded for attempting to suggest insulin regimens in the hospital I worked at and among several other issues, I finally pursued PA. with a 3.6 and 22 years as a diabetes educator with outstanding LOR from the MDs and PAs I worked with in the rural area, it was absolutley heartbreaking to not be accepted. The school was unwilling to meet with me other than giving me an email saying "we just don't think you're cut out for PA, you should try MD". I won't go into the long story of how I handled, or mishandled, that upsetting news. Anyways, 3 years later, I finished the remaining 5 pre-reqs, got the MCAT hammered and am now at 25years professional experience and the med school has been so very warm to me and friendly, I just cant say enough how excited I feel about making this big decision, and I really feel I am going to get in. I will be 54(!) when I am all done with family practice residency and I anticipate working at least 20 years in the field! BTW, I learned that the PAs in this city where I live make what I made in 2004 as a diabetes educator - sad! I have learned the reason is because there is a local FNP school that graduates 60/year, and those 60 are taking basic pay because they just want to stay in the area. NOT at all intending to be disrespectful here, but by basic pay, I mean $25/hour - for a master's degree - geez! Thoughts?

Thoughts are.. Way to go! Almost every single NP I've spoken to on my floor say they wish they hadn't become one. They say the increase in pay from RN to ARNP is highly exaggerated, specially when compared to the amount of debt one has to incur to become a nurse practitioner. PAs, on the other hand -- I don't hear a lot of complaints from them. Then again, I don't work with as many PAs as I do NPs.