Current nursing student - psych NP vs psychiatry - reconsidering path

[priorities2]

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Hello all. I am a junior in college, 20 years old, and am completing my first semester of nursing courses and clinicals. I go to a top school and I'm in the honors program. My plan is to become a psychiatric NP, but since I'm still so young, I wonder if I shouldn't go for the MD/DO degree, since it provides more autonomy and money. If I were to do so, I would want to finish BSN school and then take the pre-reqs piece by piece after I graduate - it would take another 2 years. So, I wouldn't graduate with an MD/DO until 27, and then wouldn't be done with a psychiatric residency until 31. My main concerns are:

- Not being able to hack physics
- Not having enough free time in my twenties to enjoy life, travel, and learn how to be a good person
- Having kids/getting married during residency - would family be neglected?
- Needing to move across the country for four years at a time
- Loans
- Being reliant on my family longer for things like cell phones, rent, etc
- Spending hours memorizing chemical minutiae (though this is somewhat interesting to me)

If I were to not go for MD and stick with the NP path, I wouldn't have to worry about any of those things. I could graduate with my BSN at 21, maybe work for a year as an RN, then go back to a 4- or 5-semester graduate program completely focused on my area of interest, psychiatry. I would spend much more time focusing on psychiatry vs. other areas of medicine that are of much less interest to me, and I would have much more freedom in my twenties. But, the pay and autonomy levels would be lower for most decades of my working life.

Any thoughts? The path I'm on is pretty good, should I just stick with it, or will I regret that in the end?

 

[TheRiddler]

Seems like you have a pretty accurate view of the trade-offs involved in each choice. Only you know what's right for yourself.

 

[Nasrudin]

This is highly subjective and extremely personalized decision science you're asking about. The answers will be as variable as the respondents. In my opinion I can barely imagine learning enough medicine and psychiatry in the time it takes to get a medical degree and complete psychiatry residency training to be competent. If...you want to practice at a high level. You always have the option of not. Psychiatry is rife with this. You can always take the easy road. The NP training being just one of many.

But there's only one long, hard, right road. And it goes way beyond md/do degree plus residency. At least for those of whom I hold in the highest regard and seek to follow.

 

[PikminOC]

I know many nurses in medical school who have worked for 20 years and then went to med school. OP always has the option to go to med school at anytime.

 

[peppy]

Just wanted to point out a few things:
Life doesn't stop during med school and residency. People do get married, have kids, and do fun things during med school and residency. It's not a constant grim trudge, especially for those of us who are in psychiatry. As residencies go, psychiatry usually has pretty benign hours.
While most med students do rely on loans, you will make enough during residency to be able to afford rent and pay your bills without your parents' help. Residents make somewhere around $45k-55k/year depending on the location (obviously it's easier to live off this in the midwest than the coasts).

 

[shan564]

I've never met an MD/DO who thought that they'd rather go back and be an NP/PA. I'm not sure if the converse is true, since I know a lot more MD/DOs than NP/PAs.

As people have mentioned, the decision has to be very personalized. The question you should be asking yourself is - when you're in your 60s/70s and looking back at your life, which decision are you more likely to regret? Would you rather have more spare time in your 20s or would you rather have more independence/money in your post-20s?

I think the biggest argument against being an MD is the issue of starting a family while you're in your 20s. As others have mentioned, psychiatry is a relatively benign specialty for that purpose. A lot of psych residents are able to get married and have kids. You earn a comfortable salary and you generally work normal-people hours after you finish your intern year. And med school isn't so bad if you're interested in psychiatry, since you're not under pressure to get super-high grades/test scores.

 

[Psychotic]

.

 

[MacDonaldTriad]

If you have the drive and horse power to do the whole MD route, you should do it. Many people fall back on plan B, but very few fall forward. There will be a thousand times you will resent the med school grind during the process, but by the end, almost no one regrets doing it. Lots of people regret not doing it.

“A coward dies a thousand times before his death, but the valiant taste of death (dropping out) but once” at most, and perhaps never. Shakespeare's Julius Caesar

 

[Armadillos]

I wouldn't go the MD route just to fulfill some sort of need to take the more prestigious route, seems like awful advice. I would try to find psych NP's and psychiatrists practicing in the regions/states you want to live in and talk with them, a lot of the these things are kind of regional. Around here, on average, psychiatrists tend to practice more as generalists who treat the whole range of psychiatric illnesses and psych NPs tend to be more specific (like for example only do childhood ADHD). No idea if this is common across the country who just kind of a regional quirk.

 

[Nasrudin]

I wouldn't go the MD route just to fulfill some sort of need to take the more prestigious route, seems like awful advice. I would try to find psych NP's and psychiatrists practicing in the regions/states you want to live in and talk with them, a lot of the these things are kind of regional. Around here, on average, psychiatrists tend to practice more as generalists who treat the whole range of psychiatric illnesses and psych NPs tend to be more specific (like for example only do childhood ADHD). No idea if this is common across the country who just kind of a regional quirk.

Who said anything about prestige? No...it's about excellence being its own reward. Good advice about seeking out their camps for counterpoint. But from my point of view and as illustration of my point, I don't care what NP's do anywhere in terms of how they approach their training because it is not a mark of excellence as process in my estimation. From time to time I do get interested in the labor politics. But not because I would rather do their training.

 

[vistaril]

I think *right now*, there are some advantages to being a psychiatrist rather than a psych np. The difference in salary(and opportunities to moonlight during the last 2 years of residency) are such that they may make the extra cost of school/ training worth it. But in 10 years as the race to the bottom continues on, I doubt that will be the case. And that is the more relevant picture to you right now.

 

[Nasrudin]

I think *right now*, there are some advantages to being a psychiatrist rather than a psych np. The difference in salary(and opportunities to moonlight during the last 2 years of residency) are such that they may make the extra cost of school/ training worth it. But in 10 years as the race to the bottom continues on, I doubt that will be the case. And that is the more relevant picture to you right now.

Wow. Did not see this coming. At all.

 

[Armadillos]

There are a lot of people out there who taking the NP/PA route makes a lot more sense to, I've talked to a couple surgeons with kids who say they really, really wished they would have gone the PA route so they could come in at 9, first assist on surgeries for a couple hours and then hang out in clinic till they leave to go get their kids to their soccer games.

This sort of shift towards not viewing your profession as the thing that defines who you are is also evident with medschool. You see all these oldschool attendings scratching their heads as to why many medstudents/residents are no longer motivated like "medstudents back when I was school" to stay extra hours after their regular hours to see X procedure or something

 

[Nasrudin]

There are a lot of people out there who taking the NP/PA route makes a lot more sense to, I've talked to a couple surgeons with kids who say they really, really wished they would have gone the PA route so they could come in at 9, first assist on surgeries for a couple hours and then hang out in clinic till they leave to go get their kids to their soccer games.

This sort of shift towards not viewing your profession as the thing that defines who you are is also evident with medschool. You see all these oldschool attendings scratching their heads as to why many medstudents/residents are no longer motivated like "medstudents back when I was school" to stay extra hours after their regular hours to see X procedure or something

Good point. But...this is psych. So even the big name, service heavy powerhouse programs are not surgical in nature. Lives are generally acceptable. But idk. I've already lived a fruitful, youthful life. I'm ready to commit myself to acquiring skills and knowledge for the rest of my time here. Sure I like to goof off just like anybody. But it doesn't appeal to me to take a less challenging road than this and to claim a win for less effort. Just wouldn't sit right. Believe me I got tempted by the middle roads much more than most. It was quite expected of me that that was the sensible path by almost all who came to advise me.

But I feel much more inspired by macdonaldtriad's sentiments that vistarils. Always have been. Always will. These are just as much fundamental make up questions as practical ones.

 

[MacDonaldTriad]

"But in 10 years as the race to the bottom continues on.."

I’m not sure I agree that we are racing to the bottom right now. I have it on good authority that our grandparents were saying the same thing about our parents when they were entering into medicine.

“Our youth now love luxury. They have bad manners, contempt for authority; they show disrespect for their elders and love chatter in place of exercise; they no longer rise when elders enter the room; they contradict their parents, chatter before company; gobble up their food and tyrannize their teachers.”

― Socrates

 

[Armadillos]

“Our youth now love luxury. They have bad manners, contempt for authority; they show disrespect for their elders and love chatter in place of exercise; they no longer rise when elders enter the room; they contradict their parents, chatter before company; gobble up their food and tyrannize their teachers.”
― Socrates

Might want to check the source on that one 😉

 

[whopper]

I came into medical school wanting to be a psychiatrist already with a degree in psychology and a having almost completed a master's in pharmacology.

I knew what I wanted to do. Medical school, while needed to be a psychiatrist, was frustrating for me in the sense that I spent 3.75 years of it spending time memorizing things that had little direct connection to mental health.

Of course, this stuff is needed and does become useful as a psychiatrist. As one, you need to be a physician, but the process was frustrating. Having to memorize the Krebs cycle yet again, and then again, and then again.....

 

[vistaril]

"But in 10 years as the race to the bottom continues on.."

I’m not sure I agree that we are racing to the bottom right now. I have it on good authority that our grandparents were saying the same thing about our parents when they were entering into medicine.

“Our youth now love luxury. They have bad manners, contempt for authority; they show disrespect for their elders and love chatter in place of exercise; they no longer rise when elders enter the room; they contradict their parents, chatter before company; gobble up their food and tyrannize their teachers.”

― Socrates

wasnt referring to medicine in general(although there are a few other areas imo trending towards a race to the bottom), but psychiatry.

 

[MacDonaldTriad]

Wow, you are

Might want to check the source on that one 😉

right, I looked up Socrates quotes and there is a discussion.
The quote is commonly attributed to Socrates, but apparently there is
no conclusive evidence that he actually said it. The Library of
Congress notes that this quote is "attributed to Socrates by Plato" in
a 1950's book the name of which escapes me.

The quote may have come from Plato's Republic Book 4, where Socrates
is quoted saying the following regarding things that he thinks have
been neglected: "I mean such things as these: ? when the young are to
be silent before their elders; how they are to show respect to them by
standing and making them sit; what honour is due to parents; what
garments or shoes are to be worn; the mode of dressing the hair;
deportment and manners in general. You would agree with me? ? Yes."

 

[eastcoastdr]

Considering the burden and stress of med school (emotional, financial, etc), I would only go to med school if its the ONLY thing you would be happy doing. If you have other attractive career options that you think you would be happy with then go for those. I couldn't see myself doing anything besides practicing medicine as a physician so I went to med school.

It sounds like the only downsides to being a NP for you is $$ and autonomy. Well unless you own your own practice as an MD you won't have full autonomy anyways. And how important is $$ to you? Yeah an NP alone might not make the big bucks but since you plan on getting married/having a family you would have another person contributing to the household so I don't think you would be struggling per say. Let me just say that $$ is not a good enough motivator for medical school. Also if you do go to medical school and take out full loans, you will be debt for a looong time. So you make a decent amount of money but depending on your situation you may owe most of it back to the gov't. For some people this is worth it, for some it's not.

 

[PikminOC]

I entered medical school not knowing what I wanted to go into. I enjoyed learning everything and am happy I ended up in psychiatry! It's a great field.
OP can take the MCAT without committing to anything.