Psychiatric NP or MD/DO?

[DOMD2be]

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Hello, everyone
I have been a long-time fan of SDN—even posted a few times before, so any feedback would be greatly appreciated.
I am in my early 40s, and I am currently completing a Bachelor’s in educational/clinical psychology but I have also been following the premed curriculum for the past few years. I am planning on taking the MCAT in spring 2023 and applying for med schools that same year. I am 3-4 courses away from satisfying the med school prereqs and I plan to start studying for the MCAT in April 2022.
Since I have been extremely interested in psychiatry-mental healthcare( with addiction and child/adolescent psychiatry as sub-specialities in mind), I have been wondering if a career as a nurse practitioner could be a better fit for me. Beyond my age—even if I have read many posts of people in their early 40s and older having succeeded as a medical student/resident/physician—the idea of not earning a paycheck until the first year of residency while I have a family is a demoralizing thought.
I am a former semi-pro soccer player, used to be a police officer and I have been a teacher/tutor for the past 6 years, but I have always had an interest in medicine.
I am not requesting for others to make a decision on my behalf, but I am asking for feedback and perhaps come across pros and cons that I have not thought of yet.
Of course, all of that is happening while I am also in the process of purchasing a house so I have been having constant migraines☺️.
Thank you for taking the time to read!

 

[Merovinge]

Hello, everyone
I have been a long-time fan of SDN—even posted a few times before, so any feedback would be greatly appreciated.
I am in my early 40s, and I am currently completing a Bachelor’s in educational/clinical psychology but I have also been following the premed curriculum for the past few years. I am planning on taking the MCAT in spring 2023 and applying for med schools that same year. I am 3-4 courses away from satisfying the med school prereqs and I plan to start studying for the MCAT in April 2022.
Since I have been extremely interested in psychiatry-mental healthcare( with addiction and child/adolescent psychiatry as sub-specialities in mind), I have been wondering if a career as a nurse practitioner could be a better fit for me. Beyond my age—even if I have read many posts of people in their early 40s and older having succeeded as a medical student/resident/physician—the idea of not earning a paycheck until the first year of residency while I have a family is a demoralizing thought.
I am a former semi-pro soccer player, used to be a police officer and I have been a teacher/tutor for the past 6 years, but I have always had an interest in medicine.
I am not requesting for others to make a decision on my behalf, but I am asking for feedback and perhaps come across pros and cons that I have not thought of yet.
Of course, all of that is happening while I am also in the process of purchasing a house so I have been having constant migraines☺️.
Thank you for taking the time to read!

The time horizon likely does not make sense for pursuing medical school.
Approximate that you turn 42 this year, start at age 44, finish 48, finish residency 52, CAP or addictions fellowship put you at approx 53 by the time you are an attending. If you are in great health and work until 70 that gives you 17 years of practice to pay off the significant loans and make enough to retire.

If you are particularly interested in mental health, you could consider psychology or becoming a masters level therapist. You likely would do well in the social worker domain given your time w/ the police and could complete a LCSW following.

If you do wish to become an NP, I would be very focused on finding both good training and a good system/doctor to work closely with following completion of your training. This requires much more individual effort on your part but would be a significantly faster pathway if you switch your coursing for the fall to nursing.

All the said if you simply cant stand the thought of not becoming a psychiatrist, world be damned, there are certainly people who do it in their 40's and remains a possibility.

 

[Sushirolls]

PA before ARNP. Clinical training of PA is far more superior to an ARNP.

 

[comp1]

Yeah, I think the time horizon is the huge deal here. I second the idea of a PA, although they are a bit rarer in mental health. The pathway does exist. For me, the work of a psychologist or social worker is so dramatically different from the medical model, I knew they weren't for me. However, you might consider them, depending on what exactly is attracting you to mental health. Their time horizons are much better. The problem with the NP is that you're not currently a nurse. So you're going to need both a BSN and DNP, plus a PMHNP residency cert. These are not short and very little of your current undergrad coursework will apply or transfer in any way. The debt burden from med school would be significant and the timeline even longer. Your paycheck in residency is something, but it's probably less than you're making now, definitely less than you were as a police officer.

 

[TexasPhysician]

I would move toward a nursing degree with the idea of going to medical school. Once you apply, you can evaluate your options.

Paths:

1. Get accepted to a state medical school with cheap tuition. Then get accepted to a psychiatry residency that allows you to moonlight early and often. You could begin clearing 6 figures at PGY-2 level. No debt by completion and have a great career.

2. Get accepted to an expensive private school. Then decide to go somewhere like MGH that is a wonderful program, but you work really hard in residency with high cost of living in Boston. You finish with tons of debt, but the diploma drips of prestige (priceless to some).

3. Forget medical school and find a really good NP program. The knowledge, prestige, and income will never match up with option 1, but it’s routinely mentioned as a top career for a reason. Fair pay, good work.

If it was me at that age, I’d probably think 1>3>2. If prestige and the journey are what matter to you, then 2>1>3. If you want to make a difference without the intensity and maximize family time then 3>1>2.

 

[hallowmann]

Hello, everyone
I have been a long-time fan of SDN—even posted a few times before, so any feedback would be greatly appreciated.
I am in my early 40s, and I am currently completing a Bachelor’s in educational/clinical psychology but I have also been following the premed curriculum for the past few years. I am planning on taking the MCAT in spring 2023 and applying for med schools that same year. I am 3-4 courses away from satisfying the med school prereqs and I plan to start studying for the MCAT in April 2022.
Since I have been extremely interested in psychiatry-mental healthcare( with addiction and child/adolescent psychiatry as sub-specialities in mind), I have been wondering if a career as a nurse practitioner could be a better fit for me. Beyond my age—even if I have read many posts of people in their early 40s and older having succeeded as a medical student/resident/physician—the idea of not earning a paycheck until the first year of residency while I have a family is a demoralizing thought.
I am a former semi-pro soccer player, used to be a police officer and I have been a teacher/tutor for the past 6 years, but I have always had an interest in medicine.
I am not requesting for others to make a decision on my behalf, but I am asking for feedback and perhaps come across pros and cons that I have not thought of yet.
Of course, all of that is happening while I am also in the process of purchasing a house so I have been having constant migraines☺️.
Thank you for taking the time to read!

I cannot endorse PMHNPs because their curricula are wildly variable and I have not seen good things from virtually everyone trained through that pathway that I've interacted with in psychiatry. As for PAs, at least you get medical training initially, and then can complete a PA psychiatric "residency" all in less time than it would take you to complete medical school.

That said, if you truly wish to do child and adolescent psychiatry, I would strongly consider going to medical school and residency. The training you need to do that work well really requires a lot of knowledge from both a medical standpoint and an experience standpoint and I don't know that a PA path will get you there. Now, when I say this, I mean getting into the cheapest medical school you can, getting into a residency in a low COL area, and moonlighting early like TexasPhysician describes in option 1 above, in order to offset the age differential.

Also, I'm not sure what your school timeline is like, but if you only have 3-4 more courses to complete and are planning to study for the MCAT in April 2022 (i.e. this year), I would really consider applying for the upcoming 2022-2023 cycle. You do not need a year to study for the MCAT, a dedicated 3 months with the material from pre-reqs fresh in your mind should really be enough. You could always apply both PA and MD/DO and see what you get then decide at that point which path you want.

 

[calvnandhobbs68]

Here's the issue with the NP thing OP is that if you've already done most of a "pre-med" undergrad, you're probably going to have to go back and do most of undergrad again. You need an RN (which these days vast majority of the time means getting a BSN) which is a totally different undergrad requirement-wise than most pre-med tracks. So you're gonna spend a couple more years at least now going back over all the nursing pre-req requirements.

On the other hand, PA schools have a lot of the same pre-reqs as medical school, so you might match up a lot more in terms of requirements there. May be another reason to go for PA.

 

[WisNeuro]

For those advocating the psychologist route due to the time horizon, it makes no sense considering your argument about time for med school. To get into a legitimate program, OP will likely need a year or two of decent research experience. Then, if they even get in the first go round, they are looking at 5 years of grad school, 1 year of internship, and at least a 1-year postdoc. Not sure how this route saves them time comparatively.

 

[PikminOC]

For those advocating the psychologist route due to the time horizon, it makes no sense considering your argument about time for med school. To get into a legitimate program, OP will likely need a year or two of decent research experience. Then, if they even get in the first go round, they are looking at 5 years of grad school, 1 year of internship, and at least a 1-year postdoc. Not sure how this route saves them time comparatively.

Lots of psychology diploma Mills.

 

[WisNeuro]

Lots of psychology diploma Mills.

You can shave off a couple years of that timeline with the mills, but then you add 6 figure debt which pretty much obliterates that advantage. Not too mention the difficulty obtaining internships, postdocs, and many places of employment. OP would be better off pursuing a career as a naturopath than a diploma mill "psychologist."

 

[ToliBro]

Accelerated BSN programs exist. They can take your Bachelors and spit you out as a RN in 16 months. You probably have the pre requisites. From there, a 2 year MSN gives you a PMHNP, for what its worth.

From someone who is a nurse, not super thrilled about the quality thereof, but it's an option I guess. If speed is most important PA probably gets you there faster than the nursing route.

 

[reca]

From there, a 2 year MSN gives you a PMHNP, for what its worth.

Vanderbilt's PMHNP program is 12 months.

 

[nexus73]

It depends. If you absolutely want to do medical school and if you can go for free or very cheap (like you have rich relatives to pay your tuition), go for it. I had a classmate finish med school at 50, went into psych, fast tracked into child, then did a forensic fellowship. I don't think he's worried about money and just doing what he loves.

 

[nexus73]

Vanderbilt's PMHNP program is 12 months.

Must be 36 hours days, 8 days a week.

 

[Merovinge]

For those advocating the psychologist route due to the time horizon, it makes no sense considering your argument about time for med school. To get into a legitimate program, OP will likely need a year or two of decent research experience. Then, if they even get in the first go round, they are looking at 5 years of grad school, 1 year of internship, and at least a 1-year postdoc. Not sure how this route saves them time comparatively.

I was thinking more like PsyD, but definitely understand the concerns in that domain as well. No one hear doubts the difficulty and time requirements of being a clinical PhD psychologist, we almost all wish we were flush with more of them to refer our patients to.

 

[WisNeuro]

I was thinking more like PsyD, but definitely understand the concerns in that domain as well. No one hear doubts the difficulty and time requirements of being a clinical PhD psychologist, we almost all wish we were flush with more of them to refer our patients to.

If you look at time to completion of many of the legitimate PsyDs, they're still averaging 5, and sometimes longer, years in grad school. Some may be able to get them there at 4 years to shave off one year, but that's also possible in PhD programs for very well motivated and efficient students. My general point was that if they are pursuing a legitimate route to psychologist, the timeline is still fairly lengthy given their current position. And, if they choose the illegitimate mill route, any savings in time are more than offset in terms of cost.

 

[FlowRate]

Are you independently wealthy? A step down, but do you have a police/public pension? (Seems you're too young for that) Do you actually have a family currently or was that comment for potential future state? How much do you want to spend time with your family/prioritize staying married? How certain are you that you want to do something in the mental health space? How devastated would you be if that didn't pan out? Why medicine/medications and not therapy as others mentioned?

 

[MisterKitty]

Just become an NP, if you want to do psych it makes little sense to go to med school at your age. NPs will inevitably be able to practice independently in all 50 states and are pushing for equal pay from insurance right now.

NP will eventually be the new DO. They will be relegated to less competitive nonprocedural specialties initially. Then will will bitch until they are able to sit for USMLE. Then they’ll bitch until the can apply for physician residencies. Then they’ll bitch about not being as competitive as MDs/DOs. Then they will bitch about the NP bias in the match.

 

[Sushirolls]

Just become an NP, if you want to do psych it makes little sense to go to med school at your age. NPs will inevitably be able to practice independently in all 50 states and are pushing for equal pay from insurance right now.

NP will eventually be the new DO. They will be relegated to less competitive nonprocedural specialties initially. Then will will bitch until they are able to sit for USMLE. Then they’ll bitch until the can apply for physician residencies. Then they’ll bitch about not being as competitive as MDs/DOs. Then they will bitch about the NP bias in the match.

I get what you are trying to say. I'm following your logic.

However, the history and timeline of the DO profession is completely different than ARNPs and really just doesn't compare. Equating ARNPs to be 'the new DO' is about the worst of DO insults I've encountered. There have, and are, and always will be far more similarities between DO/MD than there ever will be with ARNPs.

 

[EmilKraepelin55]

Just become an NP, if you want to do psych it makes little sense to go to med school at your age. NPs will inevitably be able to practice independently in all 50 states and are pushing for equal pay from insurance right now.

NP will eventually be the new DO. They will be relegated to less competitive nonprocedural specialties initially. Then will will bitch until they are able to sit for USMLE. Then they’ll bitch until the can apply for physician residencies. Then they’ll bitch about not being as competitive as MDs/DOs. Then they will bitch about the NP bias in the match.

That’s a very cynical way of putting it. I would certainly hope a fellow physician doesn’t view DO’s as bitchy NP pluses.

 

[MisterKitty]

Wasn’t exactly trying to be offensive just saying that they will continue lobbying until the DNP is essentially equal to the MD/DO in a legal sense. And in 50 years the field will be having the same conversation with NPs about how offensive it is to call their credentials less competitive.

 

[MacDonaldTriad]

You are senior, but just know when issues come up between LSCWs, Ph.Ds, NPs, and PAs, the MDs win in my experience and for not unfounded reasons. Just have a good conversation with yourself about this career change. Can you be second fiddle and happy in medicine or not. If not, you need to go for it and do the math. If it is just about providing service and no wish to climb the career ladder, go more mid level and be happy.

 

[deleted1100659]

Hello, everyone
I have been a long-time fan of SDN—even posted a few times before, so any feedback would be greatly appreciated.
I am in my early 40s, and I am currently completing a Bachelor’s in educational/clinical psychology but I have also been following the premed curriculum for the past few years. I am planning on taking the MCAT in spring 2023 and applying for med schools that same year. I am 3-4 courses away from satisfying the med school prereqs and I plan to start studying for the MCAT in April 2022.
Since I have been extremely interested in psychiatry-mental healthcare( with addiction and child/adolescent psychiatry as sub-specialities in mind), I have been wondering if a career as a nurse practitioner could be a better fit for me. Beyond my age—even if I have read many posts of people in their early 40s and older having succeeded as a medical student/resident/physician—the idea of not earning a paycheck until the first year of residency while I have a family is a demoralizing thought.
I am a former semi-pro soccer player, used to be a police officer and I have been a teacher/tutor for the past 6 years, but I have always had an interest in medicine.
I am not requesting for others to make a decision on my behalf, but I am asking for feedback and perhaps come across pros and cons that I have not thought of yet.
Of course, all of that is happening while I am also in the process of purchasing a house so I have been having constant migraines☺️.
Thank you for taking the time to read!

I think your decision should be heavily influenced by your age and current net worth. Meaning if you don't have a lot of assets and you have a family, taking on a huge amount of debt doesnt seem like a great idea so PA may be the better route in that scenario.

It is feasible to pay off >300k in loans in 5 years. At the rate im paying, I should accomplish this. Its annoying at times, but feasible

That being said, I had people in their 50s and 60s in my medical school class but I think financially they were in a good spot.

 

[Merovinge]

I think your decision should be heavily influenced by your age and current net worth. Meaning if you don't have a lot of assets and you have a family, taking on a huge amount of debt doesnt seem like a great idea so PA may be the better route in that scenario.

It is feasible to pay off >300k in loans in 5 years. At the rate im paying, I should accomplish this. Its annoying at times, but feasible

That being said, I had people in their 50s and 60s in my medical school class but I think financially they were in a good spot.

Yup, the 40 something year old in my medical school class (there was only one), drove a Porsche to school. Made a bunch of money in finance and decided she wanted to be a net positive to the world, it was tough for her but I believe she's an attending FM doc now, making less money but substantially happier.