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Serving Underserved Commuities NP or MD?

Discussion in 'Rural & Underserved Communities' started by mmliu, Nov 6, 2008.

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  1. mmliu

    mmliu

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    I don't know which path I am suppose to take...becoming a nurse practitioner or medical doctor.

    In the future, I would like to have my own independent practice in an underserved community. It will be a clinic not only for medical care, but I would also like to provide workshops and counseling for low-income families and minorities. I am also worried that people who do not know about nurse practitioners might think that they are not as credible as doctors.

    What would I have to do to reach my goal? Will becoming a nurse practitioner be sufficient?
  2. NewmansOwn

    NewmansOwn

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    Well, actually, I think one will come to that conclusion even if they are educated. NPs are indeed not as credible (in a medical sense) as doctors, as they have exponentially less training. NPs can practice independently in some states, but if you truly desire flexible autonomy and wish to give the broadest and most comprehensive care possible, becoming a physician is the answer. If autonomy is a secondary concern for you and you are more concerned with the educational side of things than more intense medical issues, an NP degree is probably sufficient.

    I should add that if you desire a high leadership position in public health, it might be a bit of an easier road to travel if you have a medical degree.
  3. simpler2

    simpler2 person

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    As for your worries about people not thinking an NP as credible as a DO/MD, my perception in the indigent care settings I have been in is that the patients don't really care what your title is so long as you are going to help them. Especially after establishing yourself in a community, I don't see credibility in the eyes of your patients as being an issue. The Dr. title may be more helpful in seeking out grant money and support for your future venture.

    If your driven enough, either path will allow you to provide health care for indigent patient populations. In your shoes, I would consider the other aspects of each route. For instance, if you don't really like the idea of academics and just want to get to work then NP might be better. The Physician route will be rather hellish if you really abhor the nerdy details. If there is doubt that you will personally feel inferior as a NP in the future MD/DO may make more sense (reality is some people will simply consider you inferior without asking your personal reasons for going NP). If you are seeking to work in underserved settings and are flexible, either route wont really cost you anything thanks to loan repayment / scholarship programs so money isn't really an issue.

    My motivations in medicine are similar to yours I think, though they change a bit as I have become more familiar with our current health care system. Feel free to PM me if you have any similar questions.
  4. finally there

    finally there FNP student

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    mmliu,

    My goals are very similar to yours. I live in a very rural, underserved area and volunteer as an R.N. at a local free clinic. I am presently in a family nurse practitioner program. What simpler2 says is true. In a free clinic, no one cares whether you are a physician or a nurse practitioner. They are just grateful for the care, and I see this among many clients at some of the regular clinics as well. I can also tell you that there is a lot of emphasis in nurse practitioner programs on patient education, health promotion, and community programs.

    That said, I wish every day that there were a med school nearby and that I could be working toward an MD rather than the FNP. I was originally pre-med before raising a family. I am very, very grateful that there is a totally online FNP program in my state (local clinical experiences) to try to increase the availability of NPs in the rural areas, since I am placebound, as are many others (my husband owns a business), but I really, really miss the depth I would have liked to have. There really is a difference in the scope of what you are able to do. I wish I could do more, but am glad for what I will, in fact, be able to do.
  5. hurdlepup

    hurdlepup Surviving Intern Year

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    The NP is not as credible. Read around for the differences in training.

    NPs should not be practicing independently. Read around SDN.
    Last edited: Jul 22, 2010
  6. cabinbuilder

    cabinbuilder

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    Let me just tell you after spending the last year in rural and underserved communities this goal is quite the lofty one. You would need to be independantly wealthy or very money savvy and have no student loan debt to pull this off. Most folks in rural settings are the super poor and have no money. Almost all of them are on medicaid which WILL NOT PAY THE BILLS - won't even come close which is why most docs only take 2-3 medicaid patients a month. Most rural communities have a critical access hospital that is federally funded since no one can pay for services. It's most likely you would be an employee of one of these facilities in order to see the patient group you desire without going broke yourself.
  7. greggth

    greggth Senior Member

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    Why not set up a Federally Qualified Health Center in a rural area?
  8. cabinbuilder

    cabinbuilder

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    So who has 250K in their bank account to do this? I sure don't. Easier said than done. Call up Zuckerberg and see if he will fund you?
  9. emidesu

    emidesu Senior Member

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    If you enjoy spending time teaching patients and dealing with psychosocial issues, NP might be a better choice- less debt and more of an interpersonal orientation. I went to med school because I wanted the higher level of education but in retrospect I kind of wish I had taken the NP route. Medical school only gives you two years of classroom education; the clinical years are just that- clinical, where it is up to you how much you put into reading and studying. There are a lot of anti-intellectual attitudes. Many if not most of us come out more cynical, less curious and less sensitive toward others' needs (not to mention less patient).
    My understanding as of a few years ago was that NP's gave just as good primary care as docs. Don't forget that this forum is geared toward physicians and medical students, and NP's can be seen as an economic threat to physicians. Ultimately those already working in the field know most; I would try to interview as many clinicians of different backgrounds as possible.
  10. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    If you genuinely believe this, I am very sorry for you. Because it indicates that you had a poor and limited experience with primary care as a med student.
  11. emidesu

    emidesu Senior Member

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    This was evidence-based, having nothing to do with my personal experiences.
  12. teacherman84

    teacherman84

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    Reference then?
  13. emidesu

    emidesu Senior Member

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    Look, I said as of a few years ago.
    I am not sufficiently invested in the subject or this discussion as to be willing to search Pubmed, but I'm sure the OP would find it useful which is the whole point.
  14. teacherman84

    teacherman84

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    You claimed it was evidence-based so I was just asking where you found the evidence...not saying youre wrong or that it doesnt exist. Just curious
  15. Dharma

    Dharma

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    Here's a somewhat recent thread regarding the "study" emidesu is referring to. They were published in a journal called "Nursing Economics," the self-proclaimed "Journal for healthcare leaders." I think that says it all...

    http://forums.studentdoctor.net/showthread.php?t=845137

    I think it goes without saying that an MD/DO would be the better prepared/more knowledgable practitioner. Not knocking the NP, but there's no comparison, no matter how it's spun.
    Last edited: Feb 25, 2012

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