Looking for personalized advice- NP vs MD (I know it's been done before...)

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I know this may seem like it is beating a (very) dead horse, but I am looking for advice for my personal/unique situation..



I am an RN in my late 20s who has practiced only in mental health, in various settings (inpatient, outpatient). I recently took a position working as a psych case manager in a well known teaching hospital w/a teaching service comprised mainly of residents and fellows, and this has renewed my "MD envy" and interest in going back to med school/getting an advanced degree.

I started out pre-med, took a year off due to medical illness, and transferred to a local community college, where I obtained my ADN/RN. I didn't enjoy med/surg clinicals and for many reasons was disenchanted with my nursing program (and nursing as I saw it in the community hospitals I rotated through), so I applied to transfer to a 4-year school and entered with a major in biology the fall after finishing nursing school. I ended up working during winter break as a psych nurse, switching my major to psychology, graduating with a BA in psych, and taking a full time psych nursing job after graduation; this is what I've been doing since.

Trust me, this is an abbreviated version...


This summer I started working at a large teaching hospital w/a teaching service/group of psychiatry fellows and residents, and have started to think about med school again. I have also thought about NP school (as it would be cheaper, an easier transition, and require a lot less courses-- I have taken some of the prereqs for med school but most are at least 5 yrs old and I haven't taken physics or orgo, which I would enjoy the least), but have been thinking of med school for a few reasons:

1. I like the idea of the deeper & broader training that med students get through med school & residency. I am leaning towards psychiatry (that's another discussion, as I'm not 100% sure...) and feel that my lack of background in med surg would put me at a disadvantage as an NP, as psych pts are so medically complex these days. With med school, I'd get a solid background in basic medicine. Also there is more clinical training through residency, as NP residencies aren't widely offered.

2. Med school allows for rotations-- I have always wanted to work in the ED and am not 100% sure I want to do psych forever (vs. medicine or ED) so this would give me a chance to rotate through all specialties

3. An MD opens more doors in the sense of positions of authority at teaching hospitals, like the one I am at.

4. There is more "prestige" associated with the MD and I have always wanted some of that, although I don't like to admit it..

5. Although I like the holistic part of the nursing model, I really didn't enjoy the nursing theory portions of nursing school and felt like a lot of it was fluff -- I don't want to take out loans and spend 2 years doing NP school to be frustrated & dissatisfied w/my education (this is what happened after my experience at community college)

6. I hear a lot about NPs not making any more than RNs despite more education, which is disheartening



There are also a lot of reasons why an NP would make more sense:


1. It would build on my RN degree and would not require a crazy amount of hard science prereqs that I would not enjoy

2. It is generally a shorter, less expensive route, and I'd be more likely to get scholarships -- I am ~$30k in debt from undergrad , along w/some credit card debt. Avg. med school debt is ~200k PLUS I would have to take ~2yrs of prereqs, which would put me *another* $25-50k in debt if I went to a post bacc program with a solid advising/linkage program... I would make more $$ In the long run with an MD, although that's not the top priority

3. It would be easier to get in (no MCAT stress)

4. Less stress than med school-- less intensive science courses, less volume of information, less competitive classmates, etc. I tend to get competitive and stress about my grades, even though I am a strong student, and this has lead me to unnecessary anxiety in the past

5. I feel like I would be taking a step backward in my career (clinically) to have to devote 2 years to studying/memorizing chem, orgo, physics when I am already able to work with patients, assess, have worked in a leadership position in an outpatient program where I directed treatment plans (not medication, but still)

I am wondering if anyone has advice/thoughts.. I know I obviously have to make my own decision, but I wanted to solicit feedback from the experienced and accomplished folks in here who have been (or are) in a similar position.


Thanks in advance--😳
 
cinnamonstick said:
I know this may seem like it is beating a (very) dead horse, but I am looking for advice for my personal/unique situation..



I am an RN in my late 20s who has practiced only in mental health, in various settings (inpatient, outpatient). I recently took a position working as a psych case manager in a well known teaching hospital w/a teaching service comprised mainly of residents and fellows, and this has renewed my "MD envy" and interest in going back to med school/getting an advanced degree.

I started out pre-med, took a year off due to medical illness, and transferred to a local community college, where I obtained my ADN/RN. I didn't enjoy med/surg clinicals and for many reasons was disenchanted with my nursing program (and nursing as I saw it in the community hospitals I rotated through), so I applied to transfer to a 4-year school and entered with a major in biology the fall after finishing nursing school. I ended up working during winter break as a psych nurse, switching my major to psychology, graduating with a BA in psych, and taking a full time psych nursing job after graduation; this is what I've been doing since.

Trust me, this is an abbreviated version...


This summer I started working at a large teaching hospital w/a teaching service/group of psychiatry fellows and residents, and have started to think about med school again. I have also thought about NP school (as it would be cheaper, an easier transition, and require a lot less courses-- I have taken some of the prereqs for med school but most are at least 5 yrs old and I haven't taken physics or orgo, which I would enjoy the least), but have been thinking of med school for a few reasons:

1. I like the idea of the deeper & broader training that med students get through med school & residency. I am leaning towards psychiatry (that's another discussion, as I'm not 100% sure...) and feel that my lack of background in med surg would put me at a disadvantage as an NP, as psych pts are so medically complex these days. With med school, I'd get a solid background in basic medicine. Also there is more clinical training through residency, as NP residencies aren't widely offered.

2. Med school allows for rotations-- I have always wanted to work in the ED and am not 100% sure I want to do psych forever (vs. medicine or ED) so this would give me a chance to rotate through all specialties

3. An MD opens more doors in the sense of positions of authority at teaching hospitals, like the one I am at.

4. There is more "prestige" associated with the MD and I have always wanted some of that, although I don't like to admit it..

5. Although I like the holistic part of the nursing model, I really didn't enjoy the nursing theory portions of nursing school and felt like a lot of it was fluff -- I don't want to take out loans and spend 2 years doing NP school to be frustrated & dissatisfied w/my education (this is what happened after my experience at community college)

6. I hear a lot about NPs not making any more than RNs despite more education, which is disheartening



There are also a lot of reasons why an NP would make more sense:


1. It would build on my RN degree and would not require a crazy amount of hard science prereqs that I would not enjoy

2. It is generally a shorter, less expensive route, and I'd be more likely to get scholarships -- I am ~$30k in debt from undergrad , along w/some credit card debt. Avg. med school debt is ~200k PLUS I would have to take ~2yrs of prereqs, which would put me *another* $25-50k in debt if I went to a post bacc program with a solid advising/linkage program... I would make more $$ In the long run with an MD, although that's not the top priority

3. It would be easier to get in (no MCAT stress)

4. Less stress than med school-- less intensive science courses, less volume of information, less competitive classmates, etc. I tend to get competitive and stress about my grades, even though I am a strong student, and this has lead me to unnecessary anxiety in the past

5. I feel like I would be taking a step backward in my career (clinically) to have to devote 2 years to studying/memorizing chem, orgo, physics when I am already able to work with patients, assess, have worked in a leadership position in an outpatient program where I directed treatment plans (not medication, but still)

I am wondering if anyone has advice/thoughts.. I know I obviously have to make my own decision, but I wanted to solicit feedback from the experienced and accomplished folks in here who have been (or are) in a similar position.


Thanks in advance--😳
Click to expand...

I would do the NP, I've met a lot of DOs and they seem envious of PAs/NPs and pretty miserable. It's also about half the time and you still make bank.
 
Optomchick said:
I would do the NP, I've met a lot of DOs and they seem envious of PAs/NPs and pretty miserable. It's also about half the time and you still make bank.
Click to expand...

Have to disagree with you. Go MD/DO routes because otherwise you will question yourself. It's a short term pain for a long term gain. If your in it solely for $ then go to pa/np school.
 
Last edited:
Well, there are many things to consider. These are rhetorical questions, btw. Just food for thought.

Can you afford to pay for any of your continuing education or do you have to borrow it all? Have you already begun your retirement savings? Do you own your home? Is your car paid off? Do you have debt? Sufficient savings? Are you financially stable now?

Are you married/single? Do you have children?

The fact that you don't know what area of health care interests you is a disadvantage.

Ultimately, when faced with the same choice, I made my decision because it was pragmatic. I was much older than you are when I began, and I had significant responsibilities, and many other pre-existing commitments. . We own our home free and clear and do not want to move. So while there are two medical schools in a reasonable distance, leaving for a residency in another area would be out of the question. What if I hadn't matched at either of those?

We didn't have any debt, nor did we want any. We could afford to pay for most of my NP tuition out of pocket, but obviously could not do that for medical school. I only worked about 8 hours a week in NP school; it wasn't a lot, but that was $10,000/y more than I would have made not working at all as a medical student! We had our children's education to consider, and our retirements to fund. It is hard to do that with debt. In the end, as a co-parent of a large family, with a house, elderly parents and in-laws that need help nearby, PTA, scout den mother, soccer coaching, etc, medical school was impractical for our family, all things considered.

Yes, I could have given those things up. I could have told my in-laws to check into assisted living and told my siblings to take over caring for our parents. Told my kids I'd no longer be the room Mom, no longer coach soccer. But those things are important to me, to all of us. More important than my paycheck, and more important than my career. I love our 3 weeks camping in Yosemite every summer, and the two weeks my husband I spend alone on various excursions all over the world. In the end, I knew I could not give that up, my heart isn't in it. I can't make that sacrifice. It wasn't practical, and I'm just too selfish I guess. I simply don't care to spend that kind of time away from my family either in school/studying, or during residency, or working. And I certainly wasn't going to borrow 6 figures for the privileged of leaving my family for 80 hours a week!

At my age, the only people I care about impressing are my kids. So long as they admire me, I'm happy. Some days they do, some days they don't. It isn't shangri-la over here at our house! But I'd rather be the ogre they are furious at for standing over them making them do their homework, than the absentee parent who has no idea what their homework was. The only female physician in my office is miserable. She is a year younger than I am and is always unhappy because she misses everything her kids do. She also says they can't afford to do anything because of their student loans (her husband is a physician also). They still live in a condo. She has a Mercedes station wagon. I have a Volkswagen station wagon. They are both the same model year. She makes payments. We paid cash for mine. I am sure she has more "prestige" in most circles than I do (I am pretty much hot **** among the cub scouts, lol, I have their vote sewn up).

I am not impressed. I see behind the curtain. She cries all the time She told me she feels like she has failed at the most important job in her life. I've met her 2 kids, they seem fine; they aren't flunking school or doing drugs or anything as far as I know. It isn't as though they are little disasters. They attend a very well regarded private school here in town. 5 of my kids go to the same school, but we pay less tuition because we volunteer more hours at the school and attend church there. She tells me at least twice a week she would switch places with me in an instant. I try to say reassuring things and make light of it, but the truth is, I would never, ever, trade places with her in a million years. She earns about 50% more money than I do, but I'm on salary and hers is dependent on clinic performance. I get paid no matter what. If the clinic loses money, she may not get paid. If she takes time off, she doesn't make any money, so she won't take three weeks off to take her kids to Yosemite and they have never seen it. She views it as entirely too expensive. She cannot afford to not see patients for three weeks. I can, so off we go. Of course, to be fair, the reverse it true as well. It the clinic makes megabucks, she will get a share of that and I will still get my salary. But this is primary care, so the likelihood of that seems slim, lol. Maybe the moral of this story is don't go into family medicine! 😉

However, there is no getting around the fact that she has a better (medical) education than I do. (I have a much better, more well rounded undergrad/liberal arts education). I am certain she knows more chemistry, fine anatomy, and microbiology than I do. I had a patient test positive for Blastocystis last week. I'd swear up and down this never came up anywhere in my education and that I had never heard of it before, but she knew what it was right off the top of her head. She said it was obscure and wasn't surprised I didn't know what it was. But still, it's allegedly obscure and she knew exactly what it was! She's a medical rock star, lol.

You are young. If knowing what blastocystis is is important to you (i.e., having the better education, not knowing that obscure stool trivia per se, lol), and you do not have reasons not to go to medical school as I did, then what is stopping you? However, there are lots of good reasons to make other choices. Only you know if they apply to you and your situation.

good luck, whatever you decide!
 
To offer another point of view, I'm sure that for every over worked and unsatisfied doctor out there, there is probably a well adjusted one who is happy with their choices. I knew a psychiatrist who was making a six figure salary working part time out of her home. She had two kids, a beautiful home, and husband who was an ER doc.

I think it depends on who you ask. If you ask a nurse they'll probably say that nursing is the best option. If you ask a doctor or medical student they will probably try to sway you toward medicine. You'll have to pick the path that is right for you or else you'll probably be unhappy with it in the end.
 
Makati2008 said:
True but i meant something care wise obviously...,
Click to expand...

I understood that, but it still rings as faulty logic. PA/NP = less pay for about the same hours worked (some specialties excluded). The glass ceiling is in place. Quick money should not be the motivator.

I agree with your first statement about MD/DO "short term pain for long term gain". I just don't think money should be in the equation if there is a realistic opportunity for the OP to go to med school.
 
Will352nd said:
I understood that, but it still rings as faulty logic. PA/NP = less pay for about the same hours worked (some specialties excluded). The glass ceiling is in place. Quick money should not be the motivator.

I agree with your first statement about MD/DO "short term pain for long term gain". I just don't think money should be in the equation if there is a realistic opportunity for the OP to go to med school.
Click to expand...

Not faulty but I am biased. I was using my personal experience as well as my friends( I have a few making in the 200s and one that hit 285). I didn't hit that high but was close to 200. Also my debt load was 10k so I had a very good ROI for what I put in.

Also I am not in it for the money but I just love to learn and I wanted to challenge myself at the highest level and live without regret.

Are you PrePa or PreMed,
 
Makati2008 said:
Not faulty but I am biased. I was using my personal experience as well as my friends( I have a few making in the 200s and one that hit 285). I didn't hit that high but was close to 200. Also my debt load was 10k so I had a very good ROI for what I put in.

Also I am not in it for the money but I just love to learn and I wanted to challenge myself at the highest level and live without regret.

Are you PrePa or PreMed,
Click to expand...
To make 200k as a pa you are working lots of overtime or working somewhere like afghanistan( civilian pa contractors there right now make 205k/yr).
a good friend of mine is an em pa who makes 200k/yr but he is working 20+ days/mo, basically 1.5 fte..
160-180 is doable for a senior em, surgical, or derm pa under the right situations for a 40 hr work week but for most folks the range is more like 90-110ish without overtime..
 
emedpa said:
To make 200k as a pa you are working lots of overtime or working somewhere like afghanistan( civilian pa contractors there right now make 205k/yr).
a good friend of mine is an em pa who makes 200k/yr but he is working 20+ days/mo, basically 1.5 fte..
160-180 is doable for a senior em, surgical, or derm pa under the right situations for a 40 hr work week but for most folks the range is more like 90-110ish without overtime..
Click to expand...


I was working 20+ days a month(because my job was 8-5 M-F (I know odd hours) with a day of call per week and one weekend a month where I honestly slept the majority of the time, talking to my wife, or surfing the net). I was lucky to see 20-30pts a week at the job where I made that amount.....

My other friend doesn't work nearly that many days and makes a ton more but he can ask a premium due to being a PA for a very long time and having a lot of connections I wish I had.

The big thing I have found out about the $ aspects of being a PA personally is if your willing to move in not the most desirable locations then you can make a good chunk and I wouldn't go to afghanistan for 205 that is TOO little if it is dangerous as I am thinking? Or are they pretty safe now?
 
OP, my advice is to think about what lets you sleep at night. It's good to make the pro/con list like you did, but a decision like this comes down to the very few things that mean the most to you in a way that only you know.

For me (30 year old new father), the "responsible" choice would have been the PA route: less debt, more time for family. But I know that everything about being a PCP is what makes me happy: exhaustive science training; best position to lead a clinical team; best stance to provide community health leadership; and finally to be a louder voice during all of the healthcare changes coming in the next twenty years. I can find these things in other healthcare jobs, but not the combination of all of them in one place. To pay for this, I will happily work under huge debt loads for years while watching the prospect of material reward dissipate with time. I won't win any parent-of-the-year awards, but in my experience it's more important to have good role models than hyper-involved parents anyway.

There will always be people bragging about having something that you've given up: family time, prestige, money, leisure time. No one can have it all, but if you have what's most important to you, then you'll feel like you have it all no matter what. Good luck figuring that out 🙂
 
Makati2008 said:
Also I am not in it for the money but I just love to learn and I wanted to challenge myself at the highest level and live without regret.

Are you PrePa or PreMed,
Click to expand...

Totally agree with that and good on you.

To answer your question, I am Pre-PA, but just got picked up for a program; today actually.
 
OP two thoughts:

1. FYI, the first two years of med school are pretty disconnected from patient care. So you would have to be willing to step away from patient care for the length of undergrad plus the first 2 years of med school.

2. Most of med school isn't psychiatry. 95% of it is just plain medicine. There is some psychiatry/psychology stuff in most curriculum, but don't do medical school if you are not interested in anything but psychiatry.
 
Blue Dog said:
Fixed that for you. 🙄
Click to expand...

LOL

I think my stream of consciousness there is confusing and fails to make much of a point! What I was trying to illustrate was that my friend/colleague and I are about the same age, and doing essentially the same job. She makes more money than I do, but works about 15-20 more hours a week and has more administrative responsibilities and carries an extraordinary amount of debt. This state recognizes NPs as independent providers, so for all practical purposes, we are equals. She has a more comprehensive medical education than I do, no doubt, but she had to sacrifice an awful lot to get it. For the reward she is appreciating, I don't think the sacrifice seems worth it. She doesn't seem to either. However, I agree with your points Blue Dog and Tobi, that she certainly could make/have made a myriad of other choices that would pay off much better obviously, literally and figuratively, and relieve the day-to-day stress she feels that seems to be making her so unhappy.

Generally speaking, I think making the choice to go to medical school as a 25 year old single person without major responsibilities vs. as a 45 year old married mother of 6 who is also responsible for the care of her aging unwell parents and in-laws are two very different things! It wasn't the right choice for me or my family; it simply would have taken too much from everyone and the reward would not have been compensation enough. I have no idea what the OPs circumstances are, and should not have projected my situation or my co-workers onto him/her. I don't think there is a best way. there is just what is best for one's individual interests, goals and circumstances. I could not have gone to medical school, raised this family, and done all of the other things we've done. We homeschooled our kids, paid off our home, have seen all 50 states and 22 countries. We had to choose and we don't have regrets. But a lot of people don't want to have 6 kids, lol, so don't feel tempted to skip professional school options in favor of eating hamburger helper and being pregnant almost constantly for 20 years. :laugh: Different strokes and all of that.
OP, listen to your gut. If you want to go to med school, don't let anyone talk you out of it. If you really don't want to, don't let anyone talk you into it.
 
I would look into Mental Health NP. Many work in private offices under MDs and make great $. allnurses.com website has a forum where you can ask any questions you have about that specialty. I am new to this site and find it interesting that there seem to be huge debates between RN vs MD. It's like comparing apples to oranges-completely different focuses. I am finishing up my MSN and am researching either DNP programs or DrPH. Would never consider MD school.
 
Manda, can I ask why you would never consider MD school? I'm applying to BSN programs and planning to go to psych NP school after, but I'm also kind of thinking about MD/DO. I'm not very informed on the differences.
 
Makati2008 said:
Not faulty but I am biased. I was using my personal experience as well as my friends( I have a few making in the 200s and one that hit 285). I didn't hit that high but was close to 200. Also my debt load was 10k so I had a very good ROI for what I put in.

Also I am not in it for the money but I just love to learn and I wanted to challenge myself at the highest level and live without regret.

Are you PrePa or PreMed,
Click to expand...

Are those MD/DO salaries or CRNA? There are a couple of CRNAs around here pulling in $250-300k.
 
AnnoyedByFreud said:
Oh, I remember seeing that movie. I found it pretty depressing.
Click to expand...

I found some aspects of the movie a sad turn of events, but ultimately, that's how life plays out. Eventually we all get old and are no longer at the top of our game. Our goals change, life direction changes, etc.

I enjoyed seeing the full scope of an MD career. Often we only see and hear about pre-med, getting into med school, landing the first job (after all the training) with the big paycheck, but we don't usually see what happens afterwards.
 
Makati2008 said:
Neither PA.
Click to expand...

Sounds like experienced PAs. We don't know many, the few we know are in the early phases of their careers. One just graduated and pretty pissed off at their spouse that the RNs where they work make more than they do as a PA.
 
FireCloud9 said:
Sounds like experienced PAs. We don't know many, the few we know are in the early phases of their careers. One just graduated and pretty pissed off at their spouse that the RNs where they work make more than they do as a PA.
Click to expand...

There is truth to that. I know PAs on salary that put in 50+ hours a week plus have to take call and make only 10-15 grand more than an RN working 36 hours. And the nurse gets better benefits and vacation/sick time off. And if it's a nurse who played their cards right, they don't have 100k of PA school debt to work off. Don't get me wrong, most PAs I know do well, but between debt, weaker benefits through their SPs practice, and by getting shorted on hours worked by being paid salary vs hourly, it gave me pause when I crunched the numbers. A nurse working 3/12s and pulling an additional shift prn with prn differential could be within shouting distance of what many primary care PAs make. But it all depends on what job makes you happy. For some folks, only being a PA will do.
 
FireCloud9 said:
Sounds like experienced PAs. We don't know many, the few we know are in the early phases of their careers. One just graduated and pretty pissed off at their spouse that the RNs where they work make more than they do as a PA.
Click to expand...

Hmmm are you in Cali, NYC area(or areas near those). The PA's in those markets are getting screwed very well even the one's doing ER. I had an EM offer at a big NYC hospital and they only offered 80ish(after the recruiter lied and said I would be making a ton more). I had another offer in New York that was truly RN pay which I also declined. Down south I don't know of very many PA's making less than 90/low 100s(I know they are out there though). Also I personally made 120ish at my first job out of school doing EM work(although the greater bulk was fast track/UC type stuff.)
 
pamac said:
There is truth to that. I know PAs on salary that put in 50+ hours a week plus have to take call and make only 10-15 grand more than an RN working 36 hours. And the nurse gets better benefits and vacation/sick time off. And if it's a nurse who played their cards right, they don't have 100k of PA school debt to work off. Don't get me wrong, most PAs I know do well, but between debt, weaker benefits through their SPs practice, and by getting shorted on hours worked by being paid salary vs hourly, it gave me pause when I crunched the numbers. A nurse working 3/12s and pulling an additional shift prn with prn differential could be within shouting distance of what many primary care PAs make. But it all depends on what job makes you happy. For some folks, only being a PA will do.
Click to expand...

I will agree about the benefits and sick pay if the PA is working for a Private Physician but if they are working in a University System/Hospital then they will be just as good if not a tad better according to the difficulty of recruitment of MLPs.

I do agree with PA education debt. If I would have had 100k looming in PA debt when I applied I would have went directly to medical school(I went to a state PA school and graduated with 9-10k debt total->Would have been less but I took out 2k and blew on stuff I didn't need.)
 
Makati2008 said:
I will agree about the benefits and sick pay if the PA is working for a Private Physician but if they are working in a University System/Hospital then they will be just as good if not a tad better according to the difficulty of recruitment of MLPs.

I do agree with PA education debt. If I would have had 100k looming in PA debt when I applied I would have went directly to medical school(I went to a state PA school and graduated with 9-10k debt total->Would have been less but I took out 2k and blew on stuff I didn't need.)
Click to expand...

There is a big difference between how hard you have to work as a nurse to make what an average PA makes where I am. 90-100-105k is the norm for most PAs and NPs. 60k-75k is the norm for experienced RNs. But the state PA programs are as definately not 10k.... That's how much nursing school costs. So for me, according to the numbers for my region, it would take 6 years to break even with getting my RN. In 6 years I'll have my NP anyway, so it really would never have been worthwhile to do PA from strictly a financial standpoint. Counting lost income from my full time job that I haven't had to quit to go to RN school, as well as the RN school I haven't had to pay for, then PA school would have been >200k. I'll be 200k ahead when I become an NP.
 
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