Advice for a confused college student!

[MM94]

So, I'm here looking for advice. Most of the folks in the Pre-Medical forum were just rude and couldn't stop telling me about how my numbers were wrong, so I'd figure I'd try things out in this section. Maybe will get some advice that's actually helpful in this place.

I've been interested in both dentistry and anesthesiology for a long time now, and have decided I wanted to work in the medical field since about middle school. The thing is, as I've become older, the money aspect has played into my choices a lot. However, with Obamacare coming along, physicians' salaries are up in the air. I recently talked to an anesthesiologist who literally said his pay would be cut from $400,000k/year to about $130k-150k a year. Please do not spend your whole reply telling me that that's inaccurate; the other anesthesiologist that popped in was also agreeing with the numbers. Obamacare requires less specialists, less people will get surgical procedures, cheaper anesthesia, more CRNAs, etc. It's a logical estimate. The CRNA I talked to loved her job and said her hours were great; she worked about 3 days a week and said she makes six figures. I read online that, with Obamacare, NPs and PAs are the "wave of the future" and that their pay could easily increase from to about $200k/year. I've become highly interested in being a PA due to the flexibility of the career ( moving around to different things like pediatrics, cardiology, etc.). Also, less schooling and still, great pay.

Considering pay under Obamacare, hours worked, etc., what is your opinion of everything? I don't know how much I want to begin my life in my 30's as a doctor. And it probably won't be too many years until dental coverage is added into Obamacare. But who knows. Some people just don't understand what a big change Obamacare will be with salaries, and to me, the money vs. time of school vs. debt is a HUGE deal to me. I want the most personally satisfying and beneficial career.

I'd love to hear from some people that currently are PAs or NPs or are in programs to become either of the two! I'm a rising sophomore in college and need to figure out what it is that I truly want to do with my life as well as what's best for me personally. Thanks!

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[pamac]

So, I'm here looking for advice. Most of the folks in the Pre-Medical forum were just rude and couldn't stop telling me about how my numbers were wrong, so I'd figure I'd try things out in this section. Maybe will get some advice that's actually helpful in this place.

I've been interested in both dentistry and anesthesiology for a long time now, and have decided I wanted to work in the medical field since about middle school. The thing is, as I've become older, the money aspect has played into my choices a lot. However, with Obamacare coming along, physicians' salaries are up in the air. I recently talked to an anesthesiologist who literally said his pay would be cut from $400,000k/year to about $130k-150k a year. Please do not spend your whole reply telling me that that's inaccurate; the other anesthesiologist that popped in was also agreeing with the numbers. Obamacare requires less specialists, less people will get surgical procedures, cheaper anesthesia, more CRNAs, etc. It's a logical estimate. The CRNA I talked to loved her job and said her hours were great; she worked about 3 days a week and said she makes six figures. I read online that, with Obamacare, NPs and PAs are the "wave of the future" and that their pay could easily increase from to about $200k/year. I've become highly interested in being a PA due to the flexibility of the career ( moving around to different things like pediatrics, cardiology, etc.). Also, less schooling and still, great pay.

Considering pay under Obamacare, hours worked, etc., what is your opinion of everything? I don't know how much I want to begin my life in my 30's as a doctor. And it probably won't be too many years until dental coverage is added into Obamacare. But who knows. Some people just don't understand what a big change Obamacare will be with salaries, and to me, the money vs. time of school vs. debt is a HUGE deal to me. I want the most personally satisfying and beneficial career.

I'd love to hear from some people that currently are PAs or NPs or are in programs to become either of the two! I'm a rising sophomore in college and need to figure out what it is that I truly want to do with my life as well as what's best for me personally. Thanks!

I don't see why PAs and NPs would see their wages increase to the extent you mentioned. If anything, I see them decrease a bit. Obamacare treats NPs better than PAs, and the PA forums are full of PAs right now talking about how they wish they could bridge to become NPs to glean the bennefits (all of them could bridge if they wanted to go to nursing school, but they all really would rather just do it all in a semester or so). While physicians will probably see some scaling back of income, it wont be ti the benefit of non physician providers... They will be included in the cutbacks. Anesthesia is a wierd place where this may benefit crna's, just because usin the at a cheaper rate than a doc makes sense to the bottom line, but demand would have to be fueled by a lack of them, and they are getting cranked out by CRNA schools like crazy. Younger folks are coming into the field, especially the PA field, which means that their first real job is the one they get out of PA school, and it's not always under the best terms. The same thing will happen if direct entry NP programs become more widespread. Both fields were better positioned when they were drawing from folks who had been in the workforce, and knew the lay of the land from having dealt with human resources departments in previous lines of work.

I have a close friend who is a dentist. He came out of school with close to 300k debt. Just to pay that off represents a lot of crowns. And just to put in a lot of crowns takes a lot of money for the crown machine. He makes decent wages, but not like the old days. Certain areas of the country are saturated. I don't think it's a bad career, but it's just not like it used to be. And dental care won't be added to obamacare anytime soon. They can't even get vital aspects of it off the ground, let alone make room for expansion. They will be lucky to deliver competant vital care, let alone make room for more goodies.

So I wouldn't expect a cash cow to be coming your way dressed in surgical garb. Training doesn't come cheap, and every dollar you borrow to get trained represents a dollar to pay back. The residencies for medical school that pay the big bucks are the most competetive, and expect that to get worse as money gets tighter.

 

[deleted6669]

any time physicians take a pay hit PAs and NPs will too. you won't see a pa making 200k working with a doc making 150k doing the same thing. subspecialist mds will take the biggest hit. spine surgeons for example who now make 500k + may see a large decrease in their salary. the role of pay for procedurws will likely decrease with an increase in pay for performance measures( lowered bp, quit smoking, etc)..
pa/np are good careers but you won't get rich as a pa/np in a world where docs are taking pay cuts.

 

[deleted6669]

. Obamacare treats NPs better than PAs, and the PA forums are full of PAs right now talking about how they wish they could bridge to become NPs to glean the bennefits (all of them could bridge if they wanted to go to nursing school, but they all really would rather just do it all in a semester or so). .

pa to np for a non-nurse would be 3+ years.
pa would first have to become a nurse(6-12 mo fastest route by online rn program or 1 yr 2nd bs option) then 2 yrs for np program. so call it 3 years. pa could become a DO in the same 3 yrs via bridge program.
I don't know of any np programs which would count pa clinicals even though they are equivalent or better than np clinicals.
np to pa would be at least 2 years(the full pa program).
it used to be that a pa( 20+ yrs ago) who was a nurse could take a course or 2 in nursing theory only and take the np exam. that option no longer exists.

 

[pamac]

pa to np for a non-nurse would be 3+ years.
pa would first have to become a nurse(6-12 mo fastest route by online rn program or 1 yr 2nd bs option) then 2 yrs for np program. so call it 3 years. pa could become a DO in the same 3 yrs via bridge program.
I don't know of any np programs which would count pa clinicals even though they are equivalent or better than np clinicals.
np to pa would be at least 2 years(the full pa program).
it used to be that a pa( 20+ yrs ago) who was a nurse could take a course or 2 in nursing theory only and take the np exam. that option no longer exists.

I'm not aware of any online nursing programs, even for PAs.

My point about bringing up the PA to NP bridge notion is that quite a few folks over at the PA forums are giving the impression that they feel like nursing should be a breeze, and they should be able to bridge over with no hangups because they (after all) are PAs, and nursing is down the ladder from them, so they should be able to skip a bunch of steps that not even NPs get to skip. Even DE NP programs require a period of training as an RN, so to think that because you have advanced knowledge as a PA doesn't mean youd be a good nurse any more than being a fighter pilot makes you qualified to drive NASCAR (or better, an RN that is qualified to be a paramedic without certain steps). Incidentally, there are states where RNs can sit for the paramedic exam, and even schools that provide for that. I've considered doing one and fast trackin for paramedicine, but I don't really have a reason to spend the money or few weeks it takes.

But back to the point, Contrarian put it best over there onetime when he said something to the effect of "if nursing school is so easy and full of fluff, the it should be no problem for PAs to blaze through a program with little to no effort, and then go on to blaze through NP school with minimal effort, and then practice with the benefits that NP affords". Yeah, it would be longer than doing medical school, but soooo much easier, right? I mean, most of the PAs (especially the fresh ones that brag about 35 patient days practicing gold standard medicine in the 15 minutes they can devote to each of their patients and miss nothing) over there at PA forums could probably work their full shifts and not even study for nursing school, and pass tests. So while it would be just as long as medical school, they wouldn't have to give up their hobbies or free time to do NP, so why doesnt even a single one of them go ahead and do it? Should be the easiest thing for the better trained PAs with far better clinicals, and far better coursework. That's the point, not that I'm holding that out as a real suggestion.

Fact is, the nurses are the ones that fought for what they have, and require NPs to have an RN foundation, and it's understandable that they see no reason to bend themselves into a pretzel to accomadate folks that come in insisting they deserve a shortcut that they don't offer anyone else based on a sense of entitlement. Many of those folks that would expect that kind of treatment are folks who could easily be fresh grad PAs with no prior HCE (or very weak hce as a a basic EMT, CNA, etc) , who now think they are superstars and can do a nurses job with the best of them.

Was nursing school easy? Relatively. For the most part, i didn't have time to study because I was working full time and also in a management role in my career field. I usually had one shot at the information, and didn't bother taking notes in lecture because I knew I wasn't going to have the time to review. Thankfully my solid knowledge in the sciences, as well as my hce made all the difference in allowing me to manage everything I did. So I could see how if someone feels like they are of advanced knowledge, it would allow them to make the task of navigating through an "easier" program a cakewalk. I was ready to cut back my work hours significantly if I started to flounder, but that need never arose. but I don't see anyone doing that in the PA world with all the "easy" nursing courses, and the excuse is usually "why would I want to waste the time and money to do that, not to mention that it wouldnt change much for me anyway, if I could just go be a doctor?" Well its the same reason one decides to be a PA instead of going to medical school... Because its easier, offers more leisure time, has less responsibility, requires less sacrifice, is cheaper, etc.

 

[deleted6669]

I'm not aware of any online nursing programs, even for PAs.

QUOTE]

the excelsior/regents program is "self-study", costs a mint and can be completed by any MA, lpn or paramedic in 12 months. this has been around for 20+ years. there were nurses in my pa program who had been medics before becoming nurses by this route.
http://www.excelsior.edu/school-of-nursing
2 er techs(paramedics) in my current job are doing it. one just passed boards and has a job already.
did I mention it costs a mint?
the only difficult part apparently is the single required practical which is failed on avg twice before passing at a cost of several thousand dollars/test.
this doesn't give you a bsn however. it grants an asn.

 

[pamac]

I'm not aware of any online nursing programs, even for PAs.

QUOTE]

the excelsior/regents program is "self-study", costs a mint and can be completed by any MA, lpn or paramedic in 12 months. this has been around for 20+ years. there were nurses in my pa program who had been medics before becoming nurses by this route.
http://www.excelsior.edu/school-of-nursing
2 er techs(paramedics) in my current job are doing it. one just passed boards and has a job already.
did I mention it costs a mint?
the only difficult part apparently is the single required practical which is failed on avg twice before passing at a cost of several thousand dollars/test.
this doesn't give you a bsn however. it grants an asn.

Interesting. Supposedly, its $6k, which is an excellent deal these days. Admissions requirements copy/pasted from the site:

"Licensed Practical/Vocational Nurses
Paramedics
Respiratory Therapists, Respiratory Technicians, Respiratory Care Practitioners.
Physicians trained and/or licensed outside of the United States.
Physicians or Physician's Assistants trained and/or licensed in the United States.
Licensed, Certified or Registered Midwives."

No MA's listed as allowed to attend, unless "physician's assistants" refers to MA's. But a poster on a thread at all nurses mentioned that they were an MA prior to attending, so maybe that list the school provided isn't exhaustive.

Thats actually a really good deal overall at $6k, provided your state allows licensure based on that school (some dont), and provided you dont need to have extensive training on assessment techniques. I think over 90 percent of what I got out of my RN program could have been delivered online. I dont know how clinicals would have worked out well the excelsior way. For the most part, it sounds like its utilized as an LPN bridge. From all the folks struggling that you know, it sounds like its less than a cakewalk for some. Kind of reminds me of that online PA program along the lines of having specific in person skills exams.

But yeah, if a PA didnt have enough drive to go to an MD program, then why not blaze through what they feel would be an exceedingly fluffy RN and NP program (and rather affordable at that), and do so in the time that they would otherwise spend watching television commercials for 3 years, then end up with practice rights that they envy NPs for?That would be a good deal for a PA that knew they wouldn't ever be interested in MD school, which would be aprox 95 percent of PAs. Some of the folks on the PA forums struggling with practice restrictions and clinic ownership that are openly envious of NPs lot in life should look into that. Most of them want to do things in ways that don't require any of the "nursing" parts of Nurse Practioner training.

 

[deleted6669]

I agree that it would make sense for someone who was in a state with poor pa practice rights and/or someone who was fed up the rules governing outpt pa practice.
for someone working in an inpt setting it wouldn't help at all as most places consider pas/np folks the same when working in a hospital setting(ie nps need cosigs even in independent state, etc).
for me the big issue is respect/acceptance not money and no degree other than md/do will get you the level of respect I am thinking of. I don't mean respect from non-medical folks on the street in a bragging type of way, I mean when you can a specialist on the phone at 3 am and start with hi, I'm john doe, a pa in xyz, and tthey shut you down right then and there....that doesn't happen when you say "dr smith".

 

[AnnoyedByFreud]

If I remember correctly only some states recognize Excelsior grads.

 

[deleted6669]

If I remember correctly only some states recognize Excelsior grads.

correct...but...all states recognize reciprocity...so get degree from excelsior, work in state which accepts this for a while then get a license via reciprocity to your state of choice....know a few folks who have done this in the pacific nw. oregon recognizes but wa does not.

 

[Shinken]

I recently talked to an anesthesiologist who literally said his pay would be cut from $400,000k/year to about $130k-150k a year. Please do not spend your whole reply telling me that that's inaccurate; the other anesthesiologist that popped in was also agreeing with the numbers. Obamacare requires less specialists, less people will get surgical procedures, cheaper anesthesia, more CRNAs, etc. It's a logical estimate.

 

[MM94]

I think maybe you're just laughing because you're possibly sad that you chose the wrong career due to the fact that socialized healthcare is finally happening? I understand it'll be hard to pay off loans on the salary you'll be making.

I'm sorry for you, but I hope it all works out!

 

[Makati2008]

He's laughing at you because all of this is "guessing" honestly. Anesthesia has been singing doom and gloom for decades and yet its still a competitive speciality....

You can laugh at me too bro but I will only be 16k in debt from medical school

 

[pamac]

I think maybe you're just laughing because you're possibly sad that you chose the wrong career due to the fact that socialized healthcare is finally happening? I understand it'll be hard to pay off loans on the salary you'll be making.

I'm sorry for you, but I hope it all works out!

If socialized medicine "finally happens", taxpayers will end up covering medical school because otherwise doctors will vote with their feet... Leaving medicine (and us as patients) high and dry. You'll then be frustrated that your child can't get seen in a timely manner, let alone by a needed specialist, because the folks that are left to practice medicine all went into something that appreciates them more. Instead of mocking the doctors that we felt were greedy, we'll suffer wait times to be seen by civil servants who get paid salary whether they hussle or not. But that's just speculation on my part as well. I can't get over the notion that any savings that comes from the pockets of doctors isn't going to be invested in any meaningful way that will make up for the flight of talent that it has potential to cause. I don't think it's wages that play much if a role compared to the cost of adhering to excessive overhead and regulation compliance.

 

[Dejavu]

If socialized medicine "finally happens", taxpayers will end up covering medical school because otherwise doctors will vote with their feet... Leaving medicine (and us as patients) high and dry. You'll then be frustrated that your child can't get seen in a timely manner, let alone by a needed specialist, because the folks that are left to practice medicine all went into something that appreciates them more. Instead of mocking the doctors that we felt were greedy, we'll suffer wait times to be seen by civil servants who get paid salary whether they hussle or not. But that's just speculation on my part as well. I can't get over the notion that any savings that comes from the pockets of doctors isn't going to be invested in any meaningful way that will make up for the flight of talent that it has potential to cause. I don't think it's wages that play much if a role compared to the cost of adhering to excessive overhead and regulation compliance.

This.

OP...Listen, if you don't really, really want to become a physician, don't. The pathway, rightly, is too hard.

I did it as a 38 yr old, and am glad I did, but it was a b*itch. I was a nurse and CRNA for a decade first. There is no comparison between the two educations for rigor or depth of content. And there is no comparison to the quality of the two practitioners, regardless of what people say. I have been both, I know.

Oh, OP, by the way, no way in h*ll your salary cut for physicians will happen. If it does the quality of physician will plummet since all the smart people will go into something else and, once again, Americans will get what they deserve after voting for the people who made Obamacare possible.

 

[pamac]

This.

OP...Listen, if you don't really, really want to become a physician, don't. The pathway, rightly, is too hard.

I did it as a 38 yr old, and am glad I did, but it was a b*itch. I was a nurse and CRNA for a decade first. There is no comparison between the two educations for rigor or depth of content. And there is no comparison to the quality of the two practitioners, regardless of what people say. I have been both, I know.

Oh, OP, by the way, no way in h*ll your salary cut for physicians will happen. If it does the quality of physician will plummet since all the smart people will go into something else and, once again, Americans will get what they deserve after voting for the people who made Obamacare possible.

Yep... There's nothing to gloat about when you end up no top quality doctors. You get what you pay for.

 

[PAorMDhopeful]

This.

OP...Listen, if you don't really, really want to become a physician, don't. The pathway, rightly, is too hard.

I did it as a 38 yr old, and am glad I did, but it was a b*itch. I was a nurse and CRNA for a decade first. There is no comparison between the two educations for rigor or depth of content. And there is no comparison to the quality of the two practitioners, regardless of what people say. I have been both, I know.

Oh, OP, by the way, no way in h*ll your salary cut for physicians will happen. If it does the quality of physician will plummet since all the smart people will go into something else and, once again, Americans will get what they deserve after voting for the people who made Obamacare possible.

Dejavu, do you mind if I ask about your quest back to medical school? I am not sure if you have discussed it previously elsewhere on the forum, but I am curious as to why you went back (and was there anything that made you hesitate? Did you have a family, children, debt, etc)?

Thanks!

 

[Dejavu]

Dejavu, do you mind if I ask about your quest back to medical school? I am not sure if you have discussed it previously elsewhere on the forum, but I am curious as to why you went back (and was there anything that made you hesitate? Did you have a family, children, debt, etc)?

Thanks!

Before going back to Med Sch, I thought I had a solid reason why I did it, but I haven't been sure since if I had a good reason or not.

Back then they were talking about CRNAs vanishing as an entity, so I didn't want to be out of a job. Lord knows that didn't happen.

I realized that the physicians around me were better educated than I was, and I wanted to be the best I could be.

On a simplistic, visceral level, I wanted to be "invited into the Doctor's Lounge", if you will. Or some analogy like that.

I did have a very supportive wife and an older son. This perhaps was my biggest regret about going back. Moving your son in the middle of high school is a mistake. He is 42 now and, I think, still a little angry about it. I believe all three of us were clinically depressed from the disruption of our lives.

From being able to work as a CRNA during the first years of Med Sch, my wife working, and living fugally, we got out of MSch without any debt. I borrowed all the interest-free money I could and, at the end, when they wanted payment with interest I was able to write a check for the entire original amount. I was blessed in that regard, because one has to remember that for years and years, you do not earn anything or very little, gambling on a big payback later on.