The role of an NP in the ED

[level1]

Hey guys.

I'm currently in a bit of a pickle, I can't decide whether I'll be happy being an ENP or should go to med school to be an ED physician.

My backstory:
-25yo
-3.3cGPA, 3.0 sGPA
-UIUC Psych major with MCB minor, graduated 2012
-outstanding prereqs: Ochem and Biochem
-no MCAT yet

Currently:
-working as a transporter (2 years exp) doing CNA class now so I can be an ED tech while in school
-got accepted into a nursing program and not 100% sure I want nursing over medicine

Basically, I see myself wanting to be in an involved role with the intense cases coming into the ED. I'd like to be on the forefront of the MIs, GSWs, penetrating wounds, STEMIs, stroke, etc. I want to be allowed to perform procedures like chest tubes, PICC, etc. I did some research to find out what role the NP plays in level 1 and level2 EDs. From what I can find, ENPs play a bigger role in following a trauma throughout their hospitalization rather than assessing and typically get overtaken by the MDs/DOs on the more serious stuff. Can anyone testify as to how much NPs can actually do in a trauma setting or to the more severe patients?

At this point, nursing school seems more appealing to me. After working in the ED, I can return to school to become an NP and gain more autonomy. However, if my privileges are still quite limited, I would be crushed that I hit the ceiling and would have to do it all again and try to enter med school (i'd be so old by then). Yet, if I wanted to go start for med school now, I feel like I'd have to do a post-bacc to get my GPA up and do all the necessary pre-med stuff to try to get into a DO program (doubt I'd have any shot at MD). The restraint is primarily financial and education investment. I can't see myself spending 2 years and taking out loans to do a post-bacc with the hopes of getting in with the probability of rejection so high. If I choose option C, I'll at least have a fall back. Any advice would be greatly appreciated.

In a nutshell;
A: get GPA up -->try to get straight into med school now
B: ED nurse --> ENP
C: ED nurse --> part-time work/post bacc-->try to get into med school

---

Members don't see this ad.

 

[swamprat]

Become a doctor if you want to deal with big cases. In my EDs we have NPs and PAs in fast track seeing ESI4 and 5s. They still constantly come over to our side to curb side attendings for questions. Their knowledge is very limited in my opinion. Your also young.. Average age was 24 starting my M1 year. Oldest person in my class was 43.

 

[namethatsmell]

As an NP you will not be leading the charge on any of the patients you described unless you are willing to work in a very rural/lower volume place.

If you really want to manage the sick patients, become a physician.

 

[styphon]

At a local level I trauma hospital - the NP/PA would manage the "fast track patients" and also pick up the "level 3/4" patients when the doctors were falling behind. Major traumas were handed by the MD's and trauma team. In our regional childrens hospital the NP/PA did fast track, lacerations, minor skeletal injuries. Major traumas/sepsis/drownings were handed by ER MDs.

"following a trauma throughout their hospitalization" - would not be an ER MD or a ER NP job, this would either be a hospitalist (which could be an NP) or someone on a specialist/surgery team (which may also be a midlevel).

 

[beethousand]

If you are set against md/do you might consider becoming a pa as well. The trauma pa's at the hospital I work at follow patients throughout their admission and do the majority of the pre-rounding and rounding on those patients. They do little in the way of operations as that is largely deferred to the attending's. Ultimately however they are not in charge and there is always a and attending supervising the case. If you feel like you want to be at the "forefront" then I would say go M.D./DO

 

[Psai]

your gpa will probably make it hard to get into medical school. but it's not impossible so if you want to actually understand why you're doing what you're doing, be a doctor

 

[goodoldalky]

Can anyone testify as to how much NPs can actually do in a trauma setting or to the more severe patients?

Having worked in two level 1 trauma centers, NPs are not involved in these cases

 

[RuralEDDoc]

Agree with above. I work at a rural ED that could not function without our PAs and NPs; they primarily manage half of all patients that come into the ED. It's the low acuity half, however, and they don't get involved in the Septic Shock/Trauma/respiratory failure cases that you seem to be interested in.

 

[The White Coat Investor]

What would your science GPA be if you aced Ochem and Biochem? If not significantly higher, you probably can't get in to med school now, but who knows. But don't go to nursing school if you don't want to be a nurse. Go to PA school. Better preparation in my opinion. NP is only better if you're already a nurse IMHO. If you're starting from scratch, PA school is the way to go. But you're hardly a shoe-in there either with your relatively low GPAs and minimal experience. Transporter doesn't count. Those schools are looking for nurses, medics etc with regards to experience levels. PA school isn't all that much easier to get in to than med school, and these days, not all that much cheaper either relative to salary.

Just don't do one of these: http://whitecoatinvestor.com/big-debt-without-an-income-a-med-school-disaster/

 

[hoot504]

PA school isn't all that much easier to get in to than med school...

Let's not get crazy

 

[The White Coat Investor]

Let's not get crazy

Well, here are UTSW PA school's admission requirements: http://www.utsouthwestern.edu/educa...ssistant-studies/admissions/requirements.html

Minimum science GPA of 3.0.

The acceptance rate to US medical schools in 2014 with a total GPA (not science) of 2.8-3.0 was 12%. https://www.aamc.org/download/321508/data/factstable24.pdf

I'm just saying, PA school admission isn't a shoe-in. My spouse applied for a couple of years way back when and didn't get in despite significant clinical experience and excellent grades.

 

[RustedFox]

Give the Caribbean schools a look. I'm a SGU grad (www.sgu.edu). I had a GPA of 3.5 and a sGPA of 3.4. I had more than a few classmates with stats like yours. 90%+ of them are excellent, happy physicians.

 

[The White Coat Investor]

Give the Caribbean schools a look. I'm a SGU grad (www.sgu.edu). I had a GPA of 3.5 and a sGPA of 3.4. I had more than a few classmates with stats like yours. 90%+ of them are excellent, happy physicians.

Just realize the match rate for a US resident in a foreign school is under 50%. That's a heck of a risk given the tuition.

 

[RustedFox]

Just realize the match rate for a US resident in a foreign school is under 50%. That's a heck of a risk given the tuition.

"Foreign school" is a broad brush to paint with. Check out the SGU match list.

https://postgrad.sgu.edu/ResidencyAppointmentDirectory.aspx?year=2014

I have a lot of buddies from Ross, AUC, SABA, St. Eustatius (went to residency with one of their grads) that are all very good docs.

I know docs from Ivy-League schools that have had multiple run-ins with the boards and had their licenses yanked.

Any truly educated person knows that its not where you go to school, but its what you do with your time there and the investment that you make in yourself that really matters.

I'll elaborate on my own story if anyone wants.

 

[hoot504]

"Foreign school" is a broad brush to paint with. Check out the SGU match list.

https://postgrad.sgu.edu/ResidencyAppointmentDirectory.aspx?year=2014

I have a lot of buddies from Ross, AUC, SABA, St. Eustatius (went to residency with one of their grads) that are all very good docs.

I know docs from Ivy-League schools that have had multiple run-ins with the boards and had their licenses yanked.

Any truly educated person knows that its not where you go to school, but its what you do with your time there and the investment that you make in yourself that really matters.

I'll elaborate on my own story if anyone wants.

I would love to know what the match rate is for graduates of the more well known Caribbean schools. Even if it's 75%, which would put it significantly above average for graduates of foreign schools, that would still seem to be an unnecessarily high amount of risk given how expensive those schools are. I've also heard that the washout rate is fairly (read: extremely) high, and the word refund is not in these instutitions' vocabulary.

The list you posted is impressive.. I don't think it tells the whole story though.

 

[RustedFox]

I would love to know what the match rate is for graduates of the more well known Caribbean schools. Even if it's 75%, which would put it significantly above average for graduates of foreign schools, that would still seem to be an unnecessarily high amount of risk given how expensive those schools are. I've also heard that the washout rate is fairly (read: extremely) high, and the word refund is not in these instutitions' vocabulary.

The list you posted is impressive.. I don't think it tells the whole story though.

Fair concerns and criticisms, you state. I can't offer statistics on the other Caribbean schools, and yes - SGU is expensive; but so is... medical school anywhere you go.

I'm willing to wager that 90%+ of the folks that I partied with in my first term made it all the way thru to graduation in the usual timeframe. Those that didn't... number so few that I can only remember TWO of them by face.

Also, you use the word "refund" as though some refund should be due to the students that don't make the cut. Do the US MD/DO schools offer refunds to their "washouts"? Didn't think so. I failed O-chem 2 once in undergrad. Got an "A" on it the next term. Didn't get a refund.

Again, its up to the student to shine or shame.

 

[The White Coat Investor]

I agree, it's up to the student. But when you owe $400K and can't match, that's a very bad place in life to be. That's HALF (actually slightly more) of the US residents attending a foreign medical school and attempting to match.

Obviously some schools are better than others. But I think the 6% of US school graduates who don't match is high. I can't imagine 1/10 not matching, much less 1/4 or 1/2.

These guys say 68% of Ross graduates matched:

http://www.valuemd.com/ross-university-school-medicine/174713-ross-grads-pre-match-match.html

That's pretty darn scary to me.

 

[RustedFox]

I agree, it's up to the student. But when you owe $400K and can't match, that's a very bad place in life to be. That's HALF (actually slightly more) of the US residents attending a foreign medical school and attempting to match.

Obviously some schools are better than others. But I think the 6% of US school graduates who don't match is high. I can't imagine 1/10 not matching, much less 1/4 or 1/2.

These guys say 68% of Ross graduates matched:

http://www.valuemd.com/ross-university-school-medicine/174713-ross-grads-pre-match-match.html

That's pretty darn scary to me.

Limited idea what's going on there over at Ross. Back when I was a pre-med, the prevailing notions were SGU >>> Ross >> AUC > SABA. Also, that thread that you linked to is from 2009. I hate to think about it, but we're 6 years beyond that. (Time flies, eh?)

Here's what it really comes down to... you have to make an honest-to-God assessment of your own academic "merit" and your likelihood to succeed given the circumstances. If at any point... you doubt your ability or motives... then don't freaking do it. Duhh. Its like anything else in life. Medical education isnt "sacred", and worshipping at the altar of 'school' doesn't guarantee you success. I could pray to Luke Skywalker (or Neil Walker) every day to grant me the ability to hit home-runs, but it won't happen. I'll hit home runs after I've scratched up the snuff to face MLB pitching, first.

To post my own experience... I had a killer MCAT score (34) and a medicore GPA/sGPA. I knew that I could "have done better", but I spent my undergrad years as far away from sniveling, mouth-breathing, hypercompetitive pre-meds as I could. I remember being in biochem with those nerds. If a contest were held to measure who had the smallest penis, they would have cheated to win.

I remember the day where I sat with my advisor and said: "Yeah, medical school seems like a good idea." His first words were; "Well, you need to have the medical school application committee look at your record and approve your... whatever."

"Medical school application committee?"

"Yes. For a small fee, these people will review and process your applications and give you feedba-"

"Thanks, pointdexter. I don't need to pay a committee of people to do my own paperwork for me."

I wanted to punch that guy in the mouth. But I didn't; punching people in their mouths is wrong. Even if they need it.

To the OP: Be real with yourself about your abilities. Then, see what doors are open to you.

 

[The White Coat Investor]

I spent my undergrad years as far away from sniveling, mouth-breathing, hypercompetitive pre-meds as I could.

"Thanks, pointdexter. I don't need to pay a committee of people to do my own paperwork for me."

It's good that you were able to reach your career goals without ever feeling like you had to play any games. However, I'm not sure that's the best advice for someone who wants to go to med school. Sometimes it is better to figure out what the rules of the game are so you can win it. That doesn't mean you have to step on anyone else, but I can tell you this- nobody in my med school class was sweating the match unless they had failed classes (rare) or were trying to get into derm. Playing a few "games" in undergrad so I didn't have to sweat a 68% match rate seems worth it to me.

 

[gro2001]

I am an FMG. While I think the training at some schools is great (and horrible at other schools), in retrospect I would not advise any US citizen/permanent resident to go abroad for medical school. It's better to not go down the path at all (and avoid incurring the debt, stress and opportunity cost).

Also, looking at match % and even specialty specific match lists in insufficient to understand the hurdles of the students from these schools. What you want to know is how many of those folks self selected into less competitive specialities because of their FMG status. That information is obviously not going to be available, but subjectively speaking, there is a lot of self selection going on. When I was deciding, I knew there were certain specialities that were virtually off limits to me because of where I went to school. I love EM and probably wouldn't do any other specialty, so in that sense I lucked out, but some of my classmates did not and are stuck in specialities that still feel as a second choice to them.

 

[WilcoWorld]

If you can be happy doing anything other than being a doctor, do that.

If you can't, welcome to the club.

 

[DrYoda]

Currently:
-working as a transporter (2 years exp) doing CNA class now so I can be an ED tech while in school
-got accepted into a nursing program and not 100% sure I want nursing over medicine

Basically, I see myself wanting to be in an involved role with the intense cases coming into the ED. I'd like to be on the forefront of the MIs, GSWs, penetrating wounds, STEMIs, stroke, etc. I want to be allowed to perform procedures like chest tubes, PICC, etc. I did some research to find out what role the NP plays in level 1 and level2 EDs. From what I can find, ENPs play a bigger role in following a trauma throughout their hospitalization rather than assessing and typically get overtaken by the MDs/DOs on the more serious stuff. Can anyone testify as to how much NPs can actually do in a trauma setting or to the more severe patients?

I primarily work at an inner city trauma center. A few months ago one of our PAs who has worked here for more than five years saw her first GSW ever ("leg pain" triaged to fast track). Reason being that even minor GSWs go to the trauma bays (assuming one is available or at minimum to the high acuity zone) and the midlevels don't pick up patient's in the trauma bays or high acuity area. So as other's have said you won't be running the show on the super sick people as a NP/PA. When someone wander into fast track that requires an LP, chest tube or other big procedure our PAs get one of the MD/DOs to do it. As far as working in rural or otherwise low acuity EDs, a real sick person that roles into these places gets everyone's attention fast and the physician is going to be all over whatever room they roll into. And this is by no means to be negative, but just an honest look at how things work. So, if you really want to be slamming in chest tubes and lines and what not into trauma patient's med school is really the only way to go. Now if you will be happy doing more minor procedures (abscess drainage, laceration repair ect) a NP/PA is a good choice.

As far as Caribbean med schools go I have a hard time recommending it to students. The match has gotten rougher on IMGs with all the new US schools opening and no new residency spots opening. Of course some people do succeed by this route and I'm sure there will always be people that will, but this depends on your risk tolerance. The one option not on your list is a special masters program (SMP) which I admittedly know little about other than that they exist. They are expensive as **** (but so are Caribbean schools) one year masters programs that are affiliated with medical schools and often give preference or guaranteed spots to students meeting a minimum academic criteria in their programs. Like I said super expensive, my med school had one and it was like 8ok for one year. If you want more information on them there is an area of this site on them that has more detailed information and posters that know more about them than I do.

 

[Boatswain2PA]

As others have said, if you want to do a "lot" of trauma/critical care interventions, then MD/DO with residency is what you want.

If you want to work autonomously as a PA/NP, and see anything that rolls in through the ED, then you will be limited to rural EDs. However rural EDs are NOT "low acuity" centers. I work almost stricly locums ED in rural areas, and I sometimes have shifts where I have an 80% admit or ship-to-tertiary-care rate. Last shift I had a PCA aneurysm bleed and a high-speed rollover with difficult extrication and lengthy transit time to my little ED...plus a stage 4 lung CA, a urosepsis, and a stemi. You won't get to handle these types of cases in a tertiary center because either the attendings, or the residents, will scoop them from you.

Your best bet would be try to get into MD/DO programs. If that fails, then PA programs. If that fails, then nursing program with goal of becoming an NP. You might as well set the bar high and see what you make.

 

[filhodeinferno]

What would your science GPA be if you aced Ochem and Biochem? If not significantly higher, you probably can't get in to med school now, but who knows. But don't go to nursing school if you don't want to be a nurse. Go to PA school. Better preparation in my opinion. NP is only better if you're already a nurse IMHO. If you're starting from scratch, PA school is the way to go. But you're hardly a shoe-in there either with your relatively low GPAs and minimal experience. Transporter doesn't count. Those schools are looking for nurses, medics etc with regards to experience levels. PA school isn't all that much easier to get in to than med school, and these days, not all that much cheaper either relative to salary.

Just don't do one of these: http://whitecoatinvestor.com/big-debt-without-an-income-a-med-school-disaster/

I second this....go to PA school over NP school if you are just starting from scratch. I feel like PA school trains you how to think like a provider/clinician, whereas NPs still tend to think like nurses.

As far as clinical experience goes, he would ideally need more. It's funny you mentioned transporters, though. My brother got into the arguably best PA school in the country, and his only clinical experience was a transporter. His GPA was also significantly higher than the OP's, though, so I digress.

 

[The White Coat Investor]

I second this....go to PA school over NP school if you are just starting from scratch. I feel like PA school trains you how to think like a provider/clinician, whereas NPs still tend to think like nurses.

As far as clinical experience goes, he would ideally need more. It's funny you mentioned transporters, though. My brother got into the arguably best PA school in the country, and his only clinical experience was a transporter. His GPA was also significantly higher than the OP's, though, so I digress.

How is that clinical experience? You'd get more out of shadowing a doc for a few hours.

 

[Boatswain2PA]

Its not. Unfortunately many PA schools now put academic grades over real clinical experience.

 

[filhodeinferno]

How is that clinical experience? You'd get more out of shadowing a doc for a few hours.

I dunno. You'd have to ask the admissions committee.