Please help me decide which route

[40er]

Hi I am new and excited to find this great forum.

A little about me: I will turn 41 soon and have house, wife and kids and am thinking about changing career to medical fields. I have BA degree and no credits for any bio/chem classes. I did quite bit research on what I would like to be and am uncertain about two routes:

A. Work on pre-nursing classes and then take on accelerated BSN program to become RN, and then work as RN in ICU for a year or two before applying for CRNA program.

B. Take pre-med courses, MCAT and in two years apply for Med schools, then go through 4 year + 4 year residency to be a specialty MD.

My wife is very supportive but feel unsure about all the time/relo involved with Route B, while I feel I really want to be a doctor without stressing my family too much. (My wife is a CPA). So here are my questions:

1. Considering my age, does it make financial sense for me to pursue a M.D.?

2. In reality how old is too old for a M.D. to practice while perceived as competent as younger peers? (when to retire as a norm?)

3. Since I will have to take pre courses in either case, what would be your advice?

I saw many helping hands here, please help me.

---

Members don't see this ad.

 

[DrMidlife]

1. Considering my age, does it make financial sense for me to pursue a M.D.?

No, it makes no financial sense whatsoever. If money is going to be a dealmaker/breaker issue, walk away now. Otherwise, join the rest of us who are doing it in our 40's with the willingness to go for broke.

2. In reality how old is too old for a M.D. to practice while perceived as competent as younger peers? (when to retire as a norm?)

Totally depends on your health and your plans for retirement. It's a rare doc who practices past 65, rarer still over 70, and phenomenally rare to practice over 75. You'll see more primary care docs over 65 than surgeons. I know a pulmonologist who still practices at 85. Don't look at average retirement age, because that represents all the kids who didn't know better when they became docs, and can't wait to get out before 50. My metric on this is that I want to have at least 1.5*X years to practice, where I need X years of training (I'm starting at 43 & my mom still works full time at 74).

3. Since I will have to take pre courses in either case, what would be your advice?

Nursing prereqs are NOT the same as premed prereqs. Big schools offer separate tracks. If you want some time to make up your mind, opt for the premed science classes for starters. If nursing wins, then you'll need to also take psych, nutrition, and A&P that aren't requirements for med school. These won't hurt you for med school, but they're not required. Also, for med school it's not recommended to take prereqs at a CC, but it's less of a stigma for nursing.

And for the love of all that's holy, get stellar grades. Stellar. Grades. STELLAR GRADES.

Best of luck to you.

 

[MSmentor018]

nursing and medicine are two completely diff routes. it's all depends on what your passion is, what do you see yourself doing? what do you expect out of being a nurse or doctor? are you ok with that? will you have any regrets? what are you willing to put up with? have you looked at other health fields, PA, AA, perfusionist...etc?

all will have pros and cons regarding how long it takes to get there, how much to spend to get there, and quality of life afterwards. I can easily say this, there are much more requirements and testing for medicine. whatever you choose, don't let your age or finance deter you. both will require at least college commitment, time away from family, and possibily loans. I am a non trad, trauma RN, ex military, now in med school so it can be done!

 

[packofneurons]

I myself just switched from nursing.

In a sense, the OP is right - some of the pre courses are the same. I had to take Chemistry, Biology, Anatomy + Physiology and Microbiology before applying to the nursing program. All of these subjects are considered pre-med as well - they are tested on the MCAT.

If you still can't make up your mind, why not try shadowing multiple MDs/DOs and CRNAs?

I looked heavily into the CRNA route as well, and use www.allnurses.com to talk with many of them. They seem happy, but some of them do regret not going to medical school because it is almost the same amount of time minus the residency part (BSN 4 yrs or 1.5 if you're accelerated, ICU exp 1+yrs, CRNA school 28 months).
To be honest, if putting your family in financial turmoil affects your decision, I would probably lean more towards the CRNA route. You are still getting great benefits with enough time to see your family.

Ask yourself if you want to put you and your family through residency. Residencies can definitely take a toll on your mind and your body.

A recent CRNA meeting I went to stated that their program requires about 80-100 hours/wk in studying/working. So, it would be 28 months of that vs 4 years.

Correct me if I'm wrong, but I think medical school pays itself off with more knowledge, research and challenges. This is why I chose medicine.

 

[DrMidlife]

In a sense, the OP is right - some of the pre courses are the same. I had to take Chemistry, Biology, Anatomy + Physiology and Microbiology before applying to the nursing program. All of these subjects are considered pre-med as well - they are tested on the MCAT.

Incorrect. As I said above, there are different versions of bio/chem/ochem for nursing vs. premed. The nursing versions, being less rigorous, will NOT prepare you for the MCAT, nor will they prepare you for med school.

Per your mdapps, you go to Wayne State. If you look at Wayne State's premed course list, and its BSN prereq list, you'll see that there's very little overlap in chem, bio and ochem.

You can see the subject lists for the MCAT here.

 

[40er]

Thank you MidLife, Pack and MSMentor for your thoughtful reply. I really like the independence part of being a specialty doctor, but I truly fear that I would bring financial turmoil if my years of practicing is very limited (finishing residency around 52 or 53?) If I were 10 years younger, I would sure pursue MD without hesitation.

Although a few people would get into the profession even the end result will make them broke, I obviously don't want to be one of them. That is why I asked whether it make financial sense to go MD route.

CRNA is attractive to me due to the shorter time involved and no need to relocate my family. I know being a MD means a lot of more work but I think I would be able to handle both route academically.

More inputs are appreciated.

 

[NTF]

I'm biased being a non-trad myself. I still think 41 is plenty young enough to do the medicine subspecialty thing, though it's not without it's costs.

At 41 w/ no prereqs you'd be lucky to start med school by 43.
You'd be 47 at the end of med school. 50 at the end of residency. 53 at the end of fellowship. Ready to make attending salaries at 54. That gives you 11 years to practice until 65.
I still think 11 years is a significant career and if you're lucky and stay healthy especially if your subspecialty isn't physically demanding (ex. surgery) or require hours and hours of intense focus (ex. anesthesia, surgery) you could still practice easily past 65.

The PA/NP route has the advantage of getting you to clinical practice faster. You pick a specialty area while you're in the program. For the first six years you'll actually be making more than your MD counterparts, though not enough to write home about. Most NPs or PAs start at 45k to 60k and can cap out at 120k in some places (after many years of experience). MDs make 35k-40k usually as residents on up to high 40s/low 50s for fellows. MDs can supplement their salaries with the occasional moonlighter shift, though some programs explicitly forbid it.
Your debt load will probably be higher as an MD, but in the long run I don't think that matters as much as people think. The PA/NP route isn't without it's debt load either.

But it's all about how much autonomy and responsibility you want. I actually do think that NPs and PAs have a really great lifestyle. They work 9-5, make good money, and really do as much as they're willing to do. They write scripts, put in orders, do procedures. If you're the self-educating type, there are plenty of NPs and PAs that are pretty much experts in their specialty and discuss patient plans w/ MDs on an equal footing, even though technically they work under an MD's supervision. I have heard NPs and PAs complain about the lack of knowledge base they have, hemming them in sometimes. But again, it goes back to what you want.

The time line for the NP/PA route would be let's say 2 years for prereqs (you're 43.), then two or three years (fast track programs) for NP/PA (you're 45/46). You'll probably make anywhere from mid 40s to mid 50s to start out with periodic raises. That gives you probably 20years to practice in your field.

But like I said, it all depends what you want. I'd rather do 11 years of what I want, rather than 20 years of somethin I kind of want.

Honestly, your best bet is to shadow an NP and then an MD on the same service.

Good Luck to ya!

 

[40er]

At 41 w/ no prereqs you'd be lucky to start med school by 43.
You'd be 47 at the end of med school. 50 at the end of residency. 53 at the end of fellowship. Ready to make attending salaries at 54. That gives you 11 years to practice until 65.

Thanks nontradfogie for your timeline mapped for me. My current understanding is 3-year residency for FP, IM etc while specialties require longer residency. Does fellowship a must if I pick a specialty (non surgery or anesthesiology)? 11 years of practicing sounds a little too short to make this effort worthwhile to me. What specialty will still be easy until 70?

Sorry if I am ignorant here.

 

[bradt9881]

CRNA is attractive to me due to the shorter time involved and no need to relocate my family. I know being a MD means a lot of more work but I think I would be able to handle both route academically.

More inputs are appreciated.

If CNRA is appealing, you might want to look at anesthesia assistant. AA does the same work, and there is no requirement to do at least a year of nursing critical care prior to applying....

http://www.anesthesiaassistant.com/

 

[bradt9881]

I
Most NPs or PAs start at 45k to 60k and can cap out at 120k in some places (after many years of experience).....

But it's all about how much autonomy and responsibility you want. I actually do think that NPs and PAs have a really great lifestyle. They work 9-5, make good money, and really do as much as they're willing to do. They write scripts, put in orders, do procedures. If you're the self-educating type, there are plenty of NPs and PAs that are pretty much experts in their specialty and discuss patient plans w/ MDs on an equal footing, even though technically they work under an MD's supervision.

I will finish PA school in 2 months.

Average starting salaries for PA grads in 2006 was 70K, with the surgical specialties higher. Not all PAs have the luxury of 9-5 either; many work in the hospital ER and many others work as a hospitalist, and then there is that on darn call schedule.