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[DocToBe1998]

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[Chip N Sawbones]

Have you talked with any midlevels about this? See if you can shadow one before you make any big decisions. There was a good thread about being a PA over on the nontrad forum a few months ago that a search might dig up.

 

[DocToBe1998]

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[thesauce]

I have - my mother (a nurse practitioner). Also, it seems odd to me to call an NP midlevel since midlevels answer to doctors and NPs can practice independently.

My mother hates that I am considering NP because of the lack of prestige and the less money. Ironically, she loves her job and my stepfather (a cardiologist) hates his.

Not everywhere. In some hospital systems, they staff their patients with an attending. What do you think they should be called?

 

[runlearnplay]

I'm struggling with this decision too. I think the only way to know what works for you is to shadow. Have you shadowed a PA or NP that isn't family?

 

[JustintheDoctor]

Too bad neither get to perform surgery. Only MDs and DOs

 

[cerno]

PA lacks autonomy.
NP is limiting in the scope of what you can do.

You are considering primary care - what if you change your mind and decide that you really wanted to do something like surg or rads?

 

[darklabel]

You'll get what you paid for. NP's (since PA's can't practice independently) can make the typical diagnoses; however, unless they actually get FM residency-like training, they will never be equal to having a family doctor. Currently, with the PPACA, if I have the choice to see an NP or an MD/DO, why would ANYONE choose an NP if the insurance will cover both?

4 years of medical school + 3 years of training can not be replaced by 2 years of nursing school (you would need a 2nd B.S. in Nursing) and 2 years as an N.P.

If you want to practice independently, become a physician. Look around at the myriad of Nursing -> MD or DO schools on SDN and you'll see that NP's aren't all they're cracked up to be.

I should know, my gf is currently in NP school and finding a job is VERY difficult; however, FM job market is smokin.

 

[DocToBe1998]

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[Mt Kilimanjaro]

I have had similar thoughts, mostly because I have a family and will have to be away from my family a lot during residency and accrue debt during school. I think you're very smart for considering the other options seriously. Most people don't and some of them end up bitter.

Here's why I'm going the MD route:

1) If I'm going back to school, I can't not be the boss. I know that I would always resent the 29 year old attending signing my charts if I became a PA. Honestly, I wish this were not the case, but I know I wouldn't be happy in that setting.

2) I'm interested in rural FM. There's a gajillion loan repayment programs and federal service opportunities that will never go away. If you or the "NPs will solve our problems" crowd thinks all those new NPs are gonna go live in Nome, Alaska and practice primary care, they're crazy. They want to live in suburban Chicago just like the docs. I don't.

For a taste of the options, check this list: https://services.aamc.org/fed_loan_pub/index.cfm?fuseaction=public.welcome&CFID=7563505

 

[tn4596]

Money- You have to take out loan to go to PA/NP school anyway. So the difference between the 2 routes would be 100k at max which is easily mitigated after a year of two of practice.

Flexibility - You don't have to specialize if you don't want to. Then you can go on fellowship later to learn more. PA/NP can switch between specialties but they do stuff that MD don't want to do (to put it bluntly); and they have tons of limitations on what they can and cannot do. MD can do anything if he/she put in the time/training.

Lifestyle: just work less. 60 hrs a week is not that bad really. And I am sure there are an amble amount of idle time in between. Most people I know who pull six figures salary work at least 60 hrs or more.

 

[beethousand]

I had this internal debate with myself as well, but ultimately decided md. I chose it because I want the broader scope and greater depth of training. While I think you can develop into a strong clinician as a midlevel, you just don't have nearly the same amount of training. Also in general as am md there is less of a glass ceiling financially and in terms of your role in health care. I am interested in potentially taking on more of a leadership role later in my career, and having the md definitely helps. In terms of lifestyle and flexibility that is a concern, and maybe I'm a bit naive but I feel like this is more practice and specialty dependant than it is whether or not you are a midlevel. Also, I know some rural family docs who have taken on tons of training later in their career and practice a very wide range of "specialty" so to speak, and I'm not sure this could have been done the same way as a pa or np. Also, correct me if I'm wrong but being an md does not limit your time spent with patients, that is more dictated by how the practice is operated, patient demand and insurance. Ultimately I think it's up to your long term goals, and I think being a midlevel is a superb career choice. Just don't do it as a replacement for an md, cuz it's not the same thing. Best of luck.

 

[darklabel]

FM job market is smokin from what I have heard, but there's no telling that it'll be good in 8 years when I graduate. I personally know several people who choose to see an NP over an MD because they prefer that NPs spend more time with them. Im not saying you aren't right for most people, but you make it sound like there is no place for NPs when there definitely is.

The presence of nursing > MD individuals is interesting but only slighlty worrying to me. I would, however, be very interested in seeing their reasons for making the switch an would consider those reasons for myself.

I apologize for my "absolutism" and I'm sure if I mentioned this to my s/o, she would argue just like you have, but I do have a slight bias for MD over everything else (SDN is mostly for premed/medical students).

Hopefully previous nurses can help you answer that question since my gf loves what she does and doesn't regret her decision at all.

 

[Omppu27]

PA/NP practicing rights differ state by state, MD/DO doesn't. MD/DO is also internationally recognized and I'm pretty sure PA/NP isn't. PA/NP doesn't lock into a specialty, but once you work in a certain field for a while, you usually dont switch since you've already learned everything about that one specialty. So for that reason, I dont think the specialty flexibility really matters.

 

[Xenops]

Arguments FOR midlevel:

1. Little to no malpractice insurance. I know this is the case for PA's, not sure about NP's.

2. PA's don't get sued; their attending does.

Arguments for MD/DO;

1. International recognition of degree. Of course MD is accepted anywhere with a proper application to practice in country. DO degrees are only considered legit in certain countries (i.e. Italy but not France). PA's are recognized in some English speaking countries, and that's it. NP's, to my knowledge, do not exist outside of America.

 

[dsoz]

My decision was based on the multiple things, and I am probably going to be criticized because I used logic to chose to go to medical school over the other alternatives.

To enter MD/DO school, I had to do a little bit of shadowing, and some volunteer hours. All my prerequisite classes were already completed in my degree. I did take a couple of classes because I was told I need to prove that, as a non-traditional, I am not "brain damaged."

To enter PA school (in my hometown) there was a requirement of having a HUGE number of clinical hours prior to application (2000 hours). This was not something I could do while working full time in a field that was not health care. I would have to quit my high paying job and get an entry level position as an EMT, scribe, ED tech, phlebotomist, etc.

To enter nursing school, I would need to retake classes to get better grades. The nursing schools in my area are saturated with people that have 4.0 GPA in their pre-nursing classes. If they get a lower grade, they re-take the course and have grade replacement. Then I would need to take a pay cut from my current salary to work as a nurse for a few years (or even start as a CNA to get experience). There are three nursing schools in my area, they make the job market here over saturated. Nurses cannot find jobs here, they must move away to get jobs.

There was only one choice for me that made sense. I needed a job that would allow me to maintain my income level, pay back loans, plan for retirement, good job prospects, etc. MD/DO fit those qualities. PA and NP did not.

Good luck with your choice.

dsoz

 

[deleted480308]

+1 to dsoz......

I'm a non-trad career changer. Going NP simply didn't work because it would have been years of nursing classes to work my way up to NP....then I'd be limited in income/practice. To go PA would take just as many pre-reqs as med school for me and I'd give up 3yrs of income to make 80-120 for the rest of my life. When evaluating med school, I count residency as a wash financially because I make that money now. So med school is giving up 4 years to make 150-300 for the rest of my life, plus getting to be the one in charge of treatment. It was a no brainer for me.

 

[mnc1521]

I work as a scribe and when I first got the job I was leaning toward PA but now I am working on getting into medical school. A lot of the ER docs where I work said if you are young, do medical school (which I am young, I am only 19). Also, about the debt, there are a few medical schools that offer some students full rides and have good scholarships for their students. I am going to apply to University of Toledo medstart program at the end of this year and then if I do not get in that program, I am going to apply next year to multiple schools. University of Toledo is just one medical school that gives pretty decent scholarships. However, some schools don't really give any financial help besides loans (like most in FL which is where I live and would prefer to stay). Also, an ER doctor said some places during residency give you the option to moonlight so you can make extra money there to help pay back loans. In EM, residents make about 48-50k from what I have seen. That is definitely enough to live on and start paying back loans since you said you have lived on little income (and that number will increase if you moonlight).

 

[DocToBe1998]

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[mcloaf]

I work as a scribe and when I first got the job I was leaning toward PA but now I am working on getting into medical school. A lot of the ER docs where I work said if you are young, do medical school (which I am young, I am only 19). Also, about the debt, there are a few medical schools that offer some students full rides and have good scholarships for their students. I am going to apply to University of Toledo medstart program at the end of this year and then if I do not get in that program, I am going to apply next year to multiple schools. University of Toledo is just one medical school that gives pretty decent scholarships. However, some schools don't really give any financial help besides loans (like most in FL which is where I live and would prefer to stay). Also, an ER doctor said some places during residency give you the option to moonlight so you can make extra money there to help pay back loans. In EM, residents make about 48-50k from what I have seen. That is definitely enough to live on and start paying back loans since you said you have lived on little income (and that number will increase if you moonlight).

FWIW, when you are making your calculations about debt you should NOT plan on getting any sort of merit-based scholarship. Students with these scholarships are a very small minority of those in medical school, and plenty of schools don't give out merit aid period. Need-based will obviously depend on your family circumstances and the amount of money any particular school has to give out.

 

[thesauce]

I work as a scribe and when I first got the job I was leaning toward PA but now I am working on getting into medical school. A lot of the ER docs where I work said if you are young, do medical school (which I am young, I am only 19). Also, about the debt, there are a few medical schools that offer some students full rides and have good scholarships for their students. I am going to apply to University of Toledo medstart program at the end of this year and then if I do not get in that program, I am going to apply next year to multiple schools. University of Toledo is just one medical school that gives pretty decent scholarships. However, some schools don't really give any financial help besides loans (like most in FL which is where I live and would prefer to stay). Also, an ER doctor said some places during residency give you the option to moonlight so you can make extra money there to help pay back loans. In EM, residents make about 48-50k from what I have seen. That is definitely enough to live on and start paying back loans since you said you have lived on little income (and that number will increase if you moonlight).

I wouldn't count on getting a full ride. If you do, great, but setting yourself back a year in hopes that you'll get one is unwise.

Moonlighting opportunities are rapidly disappearing because they count toward the 80hr work week. Not to mention that most programs don't allow it anyway.

 

[thesauce]

Thanks for all the great answers.

After reading through everything I guess my questions are:

• What opportunity do physicians have to work 40 hours a week? That is the main long-term draw for PA to me: not having to be on call and whatnot and working a normal work week.
• What is the difference in scope of practice for a PA doing primary care VS an MD?

As a PA I will likely be making $80k in 2 years, with $50k in debt. As a physician (PC) I will be making ~$150k in 7 years, with $300k in debt. That debt is going to make my first 5 years as an MD brutal. So really it is 12 years minimum of pain to be an MD and 2 for PA.

I'm not trying to influence you either way, but residents are paid around $50k/yr. That shouldn't be excluded from your calculations. Also, can you explain how the physician debt "is going to make my first 5 years as an MD brutal?" There are many reasons this might or might not be the case.

 

[thesauce]

I don't mean to intrude in any way, but what do you people think about Dentistry? They make more than PA/NP and have a better lifestyle than MD/DO's. With your stats you can get into Dental school, and dentists aren't too bad in the respect department either.

Just a suggestion for the OP. Thoughts?

Again, this isn't necessarily the case. It depends on the specialty and practice setup of both the physician and the dentist. The dentists that you hear about that are making a killing are putting in crazy hours running/growing their business.