2LT BSN to DO

[Dranger]

I am commissioning this year via army ROTC as an active duty RN, however I am been heavily considering DO school if at all possible sooner rather than later. I enjoy nursing and believe its a great career as well as probably one of the best undergraduate degrees available, but I would love the opportunity to attend med school.

As many of you ROTC grads on here probably know that I signed a nursing specific contract which must be fulfilled with active/reserve duty split (4+4). In the usual ROTC model for med school you need an education delay and acceptance to med school for them todelayed entry into the services. My question is, would they release me from my nursing contract at some point in my service time to possible attend med school (pending acceptance obviously)? I don't mind extending my service time. Would this situation be dealt with by branch or AMEDD?

I have completed roughly half of the pre-med curriculum so far and need to brush up on some physics/calc for the MCAT. Because of my degree background the bio/physiology and chem seemed like review for the most part. I was very comfortable with the bio questions I saw from practice tests and review material.

I guess my overarching question here is, is this doable? Would any of you attending docs recommend a RN with a possible CCRN and ICU experience (if I can't get released till my 4 AD contract is done) to med school? Or should I just do my time, finish my pre-med courses and wait till my obligation is over to pursue this course of action?

v/r

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[a1qwerty55]

Docs are getting f'd anyway - just go CRNA and you will get paid pretty well with a lot less hassle.

 

[J-Rad]

If you are reasonably young (22-ish), I would strongly consider just doing your time and getting out after the 4-year ADSO, sans any ties to milmed. Study and do well on the MCAT and apply to MD and DO schools, avoiding the ever increasing number of DO schools that should be...umm...avoided. Get into the cheapest, best-for-you med school (and I would think if your grades and MCAT are good, your experience as a .mil RN will be a nice, and relatively uncommon, bullet on your app and interview) and avoid the temptation to succumb to the Armed Forces HP"S"P loan (shark) program or Useless. If, in your .army.mil RN career every doc extolled the virtues of being an Army doc and you can't see yourself not joining their ranks, do the FAP after you've gotten your residency. And before you make any decision, spend some time as an Army nurse and hit up every Army/AF/Navy doc you meet in as many specialties you can, from as many sized/locationed hospitals as you can, and see if they would do it all over again. You'll be in a position not many people pondering committing to the .mil to fund med school are in your ability to do that.

 

[USAFGMODOC]

If I were you and were young...(say less than 26) I'd finish my commitment and then apply to school. CRNA is a pretty good gig and requires ICU/ER nursing type experience (so you should consider that). Also, FNP is not a bad gig... epsecially if you remain in the military and get promoted to Lt Col or Col by retirement...

In the end, You'll have to decide. I started Medical School at 33 after being a PA-C... Things are great and I was by no means the oldest in my medical school class.

 

[grotto]

Just stay in as a nurse and specialize. Probably a brighter future than as a physician with similar compensation and less training. Heck, physicians will probably be scrounging to get crna certifications soon.

 

[Dranger]

I appreciate all of the responses. I have considered CRNA and NP/PA but I thought I would least try the med route option since I am still in my early 20's. ICU/ER seemed like the best areas to get relevant medical experience in respect to furthering my medical education (or med-surg for a broader diagnosis/treatment perspective?). Any advice on what DO schools to avoid?

J-RAD- Thanks for the advice on USHUS and HPSP as they were my priority options and the benefits do sound really tempting.

Tired- AMEDD encompasses all of the army medical department including PT, veterinary, nursing, medicine etc. The current surgeon general/CG is actually a LTG nurse. However, you are probably right to say that the Nurse Corps would be the one to deal with my contract and not AMEDD in general. Technically I will be under AMEDD for CoC and unit affiliation, but so does pretty much everyone in any hospital.

Luckily I have had some clinicals at an army MEDCEN and met a medic turned RN turned MD who gave me some advice. I plan on picking the brains of all the docs I get stationed with or at BOLC. The purpose of my thread here was to see if my route was a reasonable course of action although I realize it is a long one.

 

[J-Rad]

...Any advice on what DO schools to avoid?

J-RAD- Thanks for the advice on USHUS and HPSP as they were my priority options and the benefits do sound really tempting.

I'll crib A1qwerty's classic: "the DO metastatic schools" (which I think is actually a fair and accurate description of many of the new schools). That said, it's easier to say: stick with some of the older, more established schools that have a solid set of clinical rotations at predominantly academic centers with formal residencies within their core sites as opposed to being farmed out predominantly to non-academic preceptorships in community hospitals/clinics/offices in which you might be able to see and do some cool things on occasion, but are at the mercy of too much variability in quality and may never learn how to function in an academic residency setting until you actually get there and (heavens forbid) are trying to remediate your lack of functional skills. Resist the temptation to believe that those shiny new buidings/labs/wi fi/whatever edu-techno whiz-bang you get in your first two years will make up for significant deficiencies in your third (especially) and fourth years. The schools that I think you should stick with would be: Midwestern/CCOM, DMUCOM, KCUMB, MSUCOM, UMDNJ-SOM, UNECOM*, ATSU-KCOM, Western COMP, PCOM, OUCOM, NSUCOM, WVUCOM. There seems to be mixed word of mouth on Midwestern/AZCOM esp. in re clinical rotations, so I would dig a little deeper on that one.

*As an alum, I can say that I had a few poor quality rotations my third year at a highly sought after core site (RI). But the school did endeavor to ameliorate identified problems in the following year, so they were at least responsive, and I know most people had good experiences in their 3rd years.

BTW, I am not an anti-milmed crusader. I've actually been very lucky and things are going pretty well for me as a new staff member at my hospital. The problem is the luck part. There is too much opportunity to have bad luck in all the services, and costly bad luck (on multiple levels) at that. It's hard to see that aspect when you're looking at the slick brochure for the "scholarship" to see how much interest is going to be taken back by .mil for what is actually better described as a type of loan.

 

[Dranger]

I chuckled at the metastatic quip. Ya I know all too well and have seen the glossy brochures at every recruiting event we have or I see. However, every time it seems to be an NCO and not a physician/officer running the location so I am not always 100% sure on the info they give. What do you mean bad luck? Crappy station or job? My reasoning for staying army (as opposed to just doing my time and ETSing) is the residency opportunities and further education opportunities they have because AMEDD is so large.

A DO school just opened in my state and its location is kind of isolated and I was wondering how they got quality rotations in. Perhaps I will have to dig deeper on that one as well.

 

[notdeadyet]

A DO school just opened in my state and its location is kind of isolated and I was wondering how they got quality rotations in. Perhaps I will have to dig deeper on that one as well.

The MO of some of the lesser quality DO schools is to have classroom work the first two years, then force med students to rotate around the state and/or country for years three and four. Some even position this as a strength, saying students get to know many different hospital systems and tout their "relationships" with many hospitals (meaning, they asked if Acme Hospital accepts visiting medical students and ACME said yes).

This isn't limited to schools in rural locations either. A couple I looked at applying to were in bit city areas. They just didn't have a hospital to call their own. Buyer beware.

(Incidentally, this isn't necessarily limited to DO programs. I'd offer the same warning to any MD school that was set up this way. I have just never heard of any that are).

 

[narcusprince]

Why go DO? Why not apply to MD schools and DO schools. If your CV is legit you should be able to get in. Remember MD schools look for well rounded applicants. It boggles my mind why people do not apply to both. I went to one of the oldest Md schools in the country believe me the school was run flawlessly. How else do u explain a class of 300 med students with an average usmle score of 230.

 

[Dranger]

I have nothing against applying to MD school (as I plan on tossing my app at a few in state schools), however I tend be drawn to the osteopathic philosophy and subsequently will make up the bulk of my applications.

notdeadyet-Thanks, good to know

 

[pgg]

just go CRNA and you will get paid pretty well with a lot less hassle.

CRNA is a pretty good gig

CRNAs are being VASTLY overproduced. There are crappy strip-mall CRNA-mills churning them out left and right. There is essentially no quality control, and the left tail of the CRNA bell curve is getting longer and bigger. The CRNA job market ain't what it was just a couple years ago.

There are those among us, when we're not collectively freaking out about the ever-impending CRNA takeover of the anesthesia specialty, who are gently nurturing a little private schadenfreude as we watch them flood the market with marginal graduates.

When it comes to nurses eyeballing CRNA school, there are some popcorn-hunger-inspiring parallels to the pre-law undergraduate crowd.

 

[pgg]

however I tend be drawn to the osteopathic philosophy and subsequently will make up the bulk of my applications.

Exactly what does that mean?

There are some serious drawbacks to the DO degree when it comes to applying for a residency position. You may well be just as capable and qualified as an MD applying beside you, but you won't be given equal consideration.


Think long and hard before you voluntarily pass up cheaper in-state MD schools for a probably-much-costlier DO school. I promise you, every MD school in the country has plenty of room for your philosophy, whatever it is.

Unless you're really into that bone-cracking thing, I guess.


By way of full disclosure, I'm a MD and my brother is a DO.

 

[Dranger]

Thanks for perspective pgg, I will keep that in mind when the time comes to apply. I have heard that DO school schools consider past experiences (rather than huge emphases on GPA/MCAT) more so than MD but that might just be here-say. Early on at this point I want to keep all of my options on the table. I have talked to a few DOs and attended a few seminars and I liked what I saw, but as I said my goal is med school: MD or DO. However, first and foremost I need to do my commitment and knock the MCAT out. I am sure by the time I hit CPT after my years my perspective will have changed or just more informed.

A lot of docs during my clinicals suggested CRNA rather than going to med school. I realize they hold a lot less education than docs ( as well as clinical hours) but I haven't read any studies showing negative patient outcomes or slumps in their hiring. Correct me I am wrong.

 

[pgg]

A lot of docs during my clinicals suggested CRNA rather than going to med school. I realize they hold a lot less education than docs ( as well as clinical hours) but I haven't read any studies showing negative patient outcomes or slumps in their hiring. Correct me I am wrong.

The lack of such studies are the subject of many, many contentious troll-infested threads in the anesthesiology sub-forum and elsewhere.

My view, as an anesthesiologist, can be summed up pretty briefly in two parts:

1) Proper studies can't ever be done, because it would be horrendously unethical to randomize patients to genuine "nurse only" or "doctor only" anesthesia care. (Besides, no patient would ever give informed consent to participate in such a study.) In reality, CRNAs who get in trouble are routinely bailed out by anesthesiologists; these averted bad outcomes aren't measured. The "studies" that militant CRNAs point to are fatally flawed in many ways. Suffice it to say that there are many confounding factors pushing "less sick" patients in the CRNA direction, there are billing issues that cloud whether or not a case billed as "CRNA only" actually had physician direction/supervision/backup, retrospective design, etc.

2) Every time I, as an anesthesiologist taking 2nd call behind a "independent" CRNA get called in to do a case because the surgeon thinks the patient deserves a doctor, or the patient asks for one, or the CRNA doesn't feel comfortable doing the case, or the CRNA doesn't know how to place invasive monitors, or the CRNA doesn't know how to do a peripheral nerve block ... I see concrete evidence that CRNAs simply can't handle all comers to the OR. (This most recently happened a week ago when I was 2nd call on New Years Day - surgeon calls me directly, I ask if he's calling me because he wants me to do the case or because he didn't know the CRNA was 1st call - and he says "the patient has doctors in the ICU, don't you think she deserves one in the OR too?" and I went in to do the CRNA's case.) Yes, this is anecdotal and deserves some skepticism. It's still my oft-repeated experience, and I have no illusions WRT the quality of care the bottom quartile of CRNAs are providing.


The CRNA hiring slump and salary stagnation/drop is a relatively recent development ... last year or so. But it won't deter any would-be CRNAs ... just as the glut of lawyers doesn't deter any undergrads with dream$ of biglaw.

 

[notdeadyet]

I have heard that DO school schools consider past experiences (rather than huge emphases on GPA/MCAT) more so than MD but that might just be here-say.

More or less. As a whole, DO schools are more lax with GPA/MCAT requirements than MD schools. That's it. They value past life experiences, but so do most MD programs. I was given interviews at some MD programs I had no business interviewing at due to being older and having some life experience. I also met a good number of DO folks with worse numbers who were fresh out of their undergrad having followed the pre-med path who were getting interviews at DO programs despite subpar marks.

DO programs tend to have lower GPA/MCAT requirements than their MD counterparts, but this does not mean that life experiences are looked on with less weight at MD programs. They just have a higher cut-off for evaluation.

Early on at this point I want to keep all of my options on the table.

Good idea. The best strategy is to apply broadly and early and see what happens. The cost of application may seem high, but it's a drop in the bucket compared to applying twice or being stuck going to a program you're not as excited about or overpaying for.

 

[narcusprince]

You must be from the Rocky Mountain area. Where I grew up there was a preponderance of DO's in community practice. So many of the states Wyoming/Colorado/New Mexico/Arizona have few state medical schools. The most 90% of the people who went to medical school from my undergrad went the DO route. Going DO can be great for primary care fields however once you apply to the more competitive fields you will be at a loss and asked to score higher than your MD counterparts. I do not want you to get the impression that DO=MD + well rounded experience + OMM. Where I came from the lay attitude was precisely this. In reality MD students on average have higher MCAT scores higher GPA's and are also very well rounded. Also, most MD schools have been around for many years while some DO schools RVUCOM opened up in the last two years. Go MD if you can and as a backup go DO.

 

[Dranger]

Pgg- My experience with the army CRNAs was rather good since many of them had been around anesthesia for 20+ years ( I only got to see TAPs, spinal epidurals and blood patches though), but I see where you are coming from.

Narcus+notdead- Thanks for the insight regarding DO and MD comparisons.

 

[a1qwerty55]

Pgg- My experience with the army CRNAs was rather good since many of them had been around anesthesia for 20+ years ( I only got to see TAPs, spinal epidurals and blood patches though), but I see where you are coming from.

Narcus+notdead- Thanks for the insight regarding DO and MD comparisons.

I love being a doc and would not discourage you from pursuing medical school. The best doc I've worked with actually as a former BSN turned DO. That being said, I have an NP and he/she performs better, with less bitching that some of the physicians. If I were in private practice no doubt I'd hire an NP over a physician or a PA. The NP's usually are eager to prove they belong while the docs sometimes phone it in and bitch 1000% more.

Since you have a BSN - a valid approach is to pursue CRNA or NP and take less pay but have more options and a better lifestyle. It isn't getting better for docs in America, only worse, and the new Healthcare bill if you can call it that places a heavy emphasis on NP's with a focus on NP run, independent practices. Not saying I agree but that is the landscape. As far as CRNA - I don't want them doing my anesthesia but the average American has no clue and the average HMO is willing to suck up the risk.

 

[Dranger]

I love being a doc and would not discourage you from pursuing medical school. The best doc I've worked with actually as a former BSN turned DO. That being said, I have an NP and he/she performs better, with less bitching that some of the physicians. If I were in private practice no doubt I'd hire an NP over a physician or a PA. The NP's usually are eager to prove they belong while the docs sometimes phone it in and bitch 1000% more.

Since you have a BSN - a valid approach is to pursue CRNA or NP and take less pay but have more options and a better lifestyle. It isn't getting better for docs in America, only worse, and the new Healthcare bill if you can call it that places a heavy emphasis on NP's with a focus on NP run, independent practices. Not saying I agree but that is the landscape. As far as CRNA - I don't want them doing my anesthesia but the average American has no clue and the average HMO is willing to suck up the risk.

That's encouraging to hear about your experience with competent NPs. If the medical school just does not come to fruition I will definitely be looking into NP/PA route. I am hesitant to mention NP on these boards because they always seem to be held in a negative light due to lack of schooling as well as of a lack of residency (weak differential diagnosis capabilities, weak patho/pharm knowledge, too much empiric treatment etc). In my everyday life I see NPs as well as physicians and haven't really noticed a difference at the usual general practice level (i.e. usually strep/cellulitis and I ask the provider for Aug or Amox or Keflex and go on my way). However, I am sure with more medically complex patients the difference becomes more obvious. I have seen NPs catch things other providers missed and vice versa. I guess it just depends on the individual right?

I am not really into the whole independent NP thing but, I believe they have a purpose for a majority of the population.

I am re-taking O-chem and physics (last pre-med course if all goes to plan I will have a 3.5 gpa in the required coursework) this summer because its been a while and hopefully take the MCAT before the end of the year. Its a shame that my pathophysiology course doesn't count for med school since it was NURS and not biology even though a PhD from the biology dept taught it. My question is, how long are MCAT scores good for since I have 4 years AD time I have to finish?

 

[pgg]

I guess it just depends on the individual right?

Well, ultimately everything everywhere comes down to the individual.

We've all met excellent midlevels, and horrible doctors. Outliers make great anecdotes, but they're still outliers.

There is a very roughly bell-shaped competency curve for NPs, and one for physicians. The good tail of the NP curve overlaps with the bad tail of the physician curve. How much overlap there is, is debatable to some degree.


You're really cruising out into delusion territory though, if you think that by being an exceptional individual ('cause we're all exceptional 😉) who works really hard, that you can go to school to become a NP/PA/CRNA/whatever and be "as good as" much less "better" than any but the most mediocre of physicians.

There is absolutely nothing wrong with becoming an advanced practice nurse, PA, or other flavor of midlevel. They are excellent careers that offer good pay, job security, and personal reward. But they are not doctors. They just ... aren't.

My experience with the army CRNAs was rather good

My opinion, as a military anesthesiologist who moonlights at civilian hospitals with pseudo-independent CRNAs:

Military CRNAs are not representative of the CRNA population at large. The military CRNA training programs are excellent. They get some training in regional anesthesia, OB, and other subspecialties, all of which can be severely lacking in civilian-trained CRNAs. Admission standards are higher. The applicants, as military officers who have had some required work experience in critical care, tend to be better people. The programs are willing to fire bad students (whereas many CRNA mills are happy to cash tuition checks and push anyone through).

There are some terrible CRNA programs out there, and the AANA has done an incredibly poor job of quality control. There are some bad anesthesiologists out there who've slipped through the cracks, but you could drive a truck through the tuition-dollar-lubricated chasm that lets bad CRNAs enter practice.

In my experience, limited as it is at this point in my career, military CRNAs take up most of the space on the right side of the CRNA bell curve. Be very careful taking your encounters with experienced ex-Army CRNAs and applying them to the rest of the CRNA world ... or assuming that you'll get training and opportunities comparable to what they had.


But I digress. What I meant to say was, if you want to practice medicine, you should go to medical school.

 

[buffdoc]

I am commissioning this year via army ROTC as an active duty RN, however I am been heavily considering DO school if at all possible sooner rather than later. I enjoy nursing and believe its a great career as well as probably one of the best undergraduate degrees available, but I would love the opportunity to attend med school.

My question is, would they release me from my nursing contract at some point in my service time to possible attend med school (pending acceptance obviously)? I don't mind extending my service time. Would this situation be dealt with by branch or AMEDD?

My 2 cents...if you would love the opportunity to go med school, go for it. And the sooner the better. When you get accepted, they will more than likely delay your commitment, but they will not release you from your contract. You would just owe the time as an MD/DO later down the road.

When you get accepted, go to an AMEDD recruiter...but also be courteous and let your command know.

 

[Dranger]

pgg- Ya I figured this was due to the army having the #1 CRNA program in the US. I have no experience with CRNAs outside of the military besides my own surgery. I appreciate the context.

buff- Ya I have no problem with extending service time, I was just wondering if I could transfer that time to after I graduate med school. During my RN time I am hoping to make as many doc connections as possible and enlist their advice to better my chances for acceptance.

 

[buffdoc]

pgg- Ya I figured this was due to the army having the #1 CRNA program in the US. I have no experience with CRNAs outside of the military besides my own surgery. I appreciate the context.

buff- Ya I have no problem with extending service time, I was just wondering if I could transfer that time to after I graduate med school. During my RN time I am hoping to make as many doc connections as possible and enlist their advice to better my chances for acceptance.

I think for you it will be rather straight forward. To better your chances, just do well in your pre-med/post-bac classes and do well on the MCAT. Your military experience and your RN experience will automatically set you apart from most other applicants. Also, most med schools specifically require letters of rec from faculty at universities and at the very most (some schools don't allow them at all) one letter from a doc that you worked with or shadowed. Be sure to get to know the professors from whom you will be taking your remaining pre-med classes from. Go their office hours at least once or twice, even if you are not having trouble with the material, just so they will get to know you. It makes it much easier to get a good LOR that way.

 

[DD214_DOC]

CRNAs give me the willies. I'm sure there are great ones, but I have had what I presume to be bad experiences with them. I may be totally wrong because I never rotated through anesthesia, but a CRNA tried to start an epidural on my wife during labor -- while she was symptomatically hypotensive in the supine position prior to getting any fluid bolus at all. I may have been totally wrong, but at the time I thought this wasn't a great idea. Luckily my wife wasn't comfortable with it and told her to stop (after I already pointed out my concern).

During my surgery rotation, the surgeon regularly had to manage whatever the CRNA was supposed to be doing. I also saw a CRNA get fired because she refused to do anesthesia on someone with Ehlers-Danlos, whichever subtype isn't all that bad.

A little tangent.

 

[Dranger]

CRNAs give me the willies. I'm sure there are great ones, but I have had what I presume to be bad experiences with them. I may be totally wrong because I never rotated through anesthesia, but a CRNA tried to start an epidural on my wife during labor -- while she was symptomatically hypotensive in the supine position prior to getting any fluid bolus at all. I may have been totally wrong, but at the time I thought this wasn't a great idea. Luckily my wife wasn't comfortable with it and told her to stop (after I already pointed out my concern).

During my surgery rotation, the surgeon regularly had to manage whatever the CRNA was supposed to be doing. I also saw a CRNA get fired because she refused to do anesthesia on someone with Ehlers-Danlos, whichever subtype isn't all that bad.

A little tangent.

Wow that seems odd especially in OB that he/she didn't pay attention to BP. I always thought the SOP was to recheck every 5 min after the initial dose of fentanyl or whatever the drug was and hold meds if the pt was hypotensive. I know supine can induce temporary bouts of hypotension because of the pressure on the vena cava. Was there no fluids ordered? NS or dex with pitocin?

As I said above the CRNAs I saw seemed to do their job fine, but that evidence is only anecdotal.

Ehlers-Danos? Isn't that a blood vessel/joint damaging condition?


Buff- I plan on doing what I can this summer to talk to my profs as much as possible. This is something I really want. In clinicals I spend more time talking to docs then my nursing instructors, the thought process behind diff diagnosis and pathology really interests me.

 

[Dranger]

Update: My branch manager offered me a chance to go reserves instead of AD which means I could finish my pre reqs full time and directly apply to med school. Should I take the reserve slot or do the four years of .mil ER/ICU nursing (slowly chipping at pre reqs) then apply?

 

[J-Rad]

Update: My branch manager offered me a chance to go reserves instead of AD which means I could finish my pre reqs full time and directly apply to med school. Should I take the reserve slot or do the four years of .mil ER/ICU nursing (slowly chipping at pre reqs) then apply?

Yes.