Pursuing Family Medicine: MD vs NP

[Taux]

I have posted here time and time again about my questionable future, but I've never been this unsure. As I've explained in my previous posts, I'm an 18 year old college sophomore (soon-to-be-junior) struggling to make a decision between nursing and medicine.

I recently got a job at a hospital as a PCA and I've been able to observe exactly what it is that nurses, mid-level care providers, and physicians do on a daily basis. Through all of this, I have assuredly come to one conclusion: I would never want to be a hospitalist. I have also mentally checked off specialties I could not tolerate: oncology, radiology, and pediatrics being just a few. I've fallen out of love with the idea of working in a hospital as a physician or a surgeon and into love with the idea of working as a primary care provider, whether as an MD or an NP. I love the patients - I hate caring for someone one day only to find out they were discharged the next. I want to form relationships with my patients, not refer to them as "room twelve."

So, knowing this - knowing that I want a career in FM, should I pursue an MD or NP? Feel free to highlight the pros and cons of each. Thanks in advance.

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[deleted432032]

My personal opinion on this matter is that if you want to truly care for your patients to the fullest extent possible then you should get your bachelors degree, take the prerequisite courses, study and take the MCAT, and go to medical school. The best way to help your patients is to have the necessary skills sets and knowledge. This is best accomplished by learning all of medicine, not some of medicine.

just my opinion, I'm sure many more will follow.

 

[deleted87716]

knowing that I want a career in FM, should I pursue an MD or NP?

The real question should be whether you want to be a physician or a nurse.

 

[Taux]

The real question should be whether you want to be a physician or a nurse.

I should have clarified why I was asking for a comparison between the two. I'll quote from one of my other posts: Because NPs are in such high demand, especially as primaries in rural areas, would it be wiser for me to pursue an NP as opposed to an MD? Since I mainly want to work with underprivileged patients, my assumption would be that both the affordability and availability I would have as a NP would be invaluable to them.

But, I should also mention that while I love the holistic care that nursing epitomizes, I don't know if I'd be content with limiting my education. I want the knowledge of a physician, but with the caring, hands-on approach of a nurse.

 

[deleted432032]

I should have clarified why I was asking for a comparison between the two. I'll quote from one of my other posts: Because NPs are in such high demand, especially as primaries in rural areas, would it be wiser for me to pursue an NP as opposed to an MD? Since I mainly want to work with underprivileged patients, my assumption would be that both the affordability and availability I would have as a NP would be invaluable to them.

But, I should also mention that while I love the holistic care that nursing epitomizes, I don't know if I'd be content with limiting my education. I want the knowledge of a physician, but with the caring, hands-on approach of a nurse.

Many physicians have a very hands-on approach with patients, if you want the full education to help others then go medical school. If you are happy with limited medical knowledge and trying to help others then become a nurse.

However, what do you want to become? Physician or Nurse (as previously asked by Blue Dog)? Keep in mind a Nurse Practitioner is a Nurse. There are NO short cuts to practicing medicine, the only way to legally and safely practice medicine is to become a physician.

IMO

 

[Pleepl3us]

I should have clarified why I was asking for a comparison between the two. I'll quote from one of my other posts: Because NPs are in such high demand, especially as primaries in rural areas, would it be wiser for me to pursue an NP as opposed to an MD? Since I mainly want to work with underprivileged patients, my assumption would be that both the affordability and availability I would have as a NP would be invaluable to them.

But, I should also mention that while I love the holistic care that nursing epitomizes, I don't know if I'd be content with limiting my education. I want the knowledge of a physician, but with the caring, hands-on approach of a nurse.

NP's are not highly needed in rural areas, despite their best efforts to claim the desire to serve a primary care role in undeserved regions they do not. A simple search and you'll see they populate urban/suburban/rural areas at the same rate as real physicians.

Saying you want to go into primary care and comparing NP to MD/DO is like saying you want to play professional football without knowing the difference between a quarterback and offensive lineman.

Yes either way you'll be in the game but the training/responsibility/knowledge of the game plan is greatly varied as the two are NOT interchangeable. A very basic analogy but you get the picture.

If you have the intellectual chops go to medical school, you'll be glad you did

 

[cbrons]

Rural family medicine.. this is probably what I want to do. There are a lot of specialized programs, even in medical school, for students interested in rural practice. Check out RMED program at the University of Illinois College of Medicine, for instance.

Personally I grew up in a big city. Hate it. Went to undergrad in a rural town. Loved it. I actually think doctors make more in rural areas (not to mention $ goes much farther).

 

[myhandsarecold]

sounds like you would make a great nurse. np is perfect for indigent care. goodluck

 

[deleted87716]

np is perfect for indigent care.

So, the indigent don't deserve doctors...?

 

[ghost dog]

I have posted here time and time again about my questionable future, but I've never been this unsure. As I've explained in my previous posts, I'm an 18 year old college sophomore (soon-to-be-junior) struggling to make a decision between nursing and medicine.

I recently got a job at a hospital as a PCA and I've been able to observe exactly what it is that nurses, mid-level care providers, and physicians do on a daily basis. Through all of this, I have assuredly come to one conclusion: I would never want to be a hospitalist. I have also mentally checked off specialties I could not tolerate: oncology, radiology, and pediatrics being just a few. I've fallen out of love with the idea of working in a hospital as a physician or a surgeon and into love with the idea of working as a primary care provider, whether as an MD or an NP. I love the patients - I hate caring for someone one day only to find out they were discharged the next. I want to form relationships with my patients, not refer to them as "room twelve."

So, knowing this - knowing that I want a career in FM, should I pursue an MD or NP? Feel free to highlight the pros and cons of each. Thanks in advance.

Sweet mother nature ! Have the noctors been advertising or something ?

Don't drink the kool aid, grasshopper. If you want to ride in the rodeo, be a cowboy, not a rodeo clown. 😎

As for the specific kind of medicine you are interested in; well this will likely change a number of times during medical school.

 

[JustPlainBill]

Sweet mother nature ! Have the noctors been advertising or something ?

Don't drink the kool aid, grasshopper. If you want to ride in the rodeo, be a cowboy, not a rodeo clown. 😎

As for the specific kind of medicine you are interested in; well this will likely change a number of times during medical school.

I like you...I really, really like you....here's a virtual frosty adult beverage of your choice, mi compadre....

OP - realize that some of the indigent don't want your effing help and take it as condescending when you profess how much your humanitarian angst caused you to help them.....when you see the Mom of 5 kids blinged out but griping because there's no 'free' orajel to help with kiddo #5's teething problems, it'll take a layer of 'I want to care for the underserved/indigent right off of you'....work at a county hospital x 3 years and you'll pretty much bag that idea...

As far as NP vs physician -- I'll just repeat a line that's been stated here ad nauseum --- Everyone wants to be a doctor but no one wants to go to medical school.....Remember that hour wise, your average "certified" NP has about as many hours as an MS3...do YOU really want them managing your chest pain?...I didn't think so...

 

[myhandsarecold]

So, the indigent don't deserve doctors...?

you can be theirs. have fun planning their dispo 👍

 

[RDlv]

This is from a nurse and a student NP:

At your age, if you have the intellectual/academic ability, the drive, and the resources, go the med school route. Whether you want to do "Primary Care" or Neurosurgery, be the absolute best you can be.

If you are in a sticky financial, social, or academic situation, have this drive but just cannot deal with a four-year degree + four years md school...get your nursing pre-reqs in (keep that GPA up!), get an associates nursing degree (call it 3yrs total), start making good $$$, then explore "non-trad" routes vs NP depending on your personal situation. If you just plain love nursing after this, great. If you still have the itch, you'll have options.

But for a young person with ability and resources, med school is a no brainer to me.

 

[Shinken]

you can be theirs. have fun planning their dispo 👍

The indigent need doctors too. I know it's challenging (as JustPlainBill already stated), but nobody is better equipped to treat them than a family physician.

I too get discouraged when I see a 20 y.o. woman come to the free clinic with 5 children from 5 different fathers, and she has cigs in her pocket, a Coach bag, and an iPhone and complains about the $5 antibiotic her child with otitis media needs.

You have to look beyond that and provide good medical care regardless. I'm not here to judge patients, as difficult as that can be sometimes.

 

[ghost dog]

The indigent need doctors too. I know it's challenging (as JustPlainBill already stated), but nobody is better equipped to treat them than a family physician.

I too get discouraged when I see a 20 y.o. woman come to the free clinic with 5 children from 5 different fathers, and she has cigs in her pocket, a Coach bag, and an iPhone and complains about the $5 antibiotic her child with otitis media needs.

You have to look beyond that and provide good medical care regardless. I'm not here to judge patients, as difficult as that can be sometimes.

How often do you peeps see this ?

I don't work in the ER or do walk in care anymore, as I have my own practice ( and am not accepting new patients). I guess I lead a sheltered life!

 

[deleted87716]

How often do you peeps see this ?

Personally, almost never. I'm in private practice, and don't participate in Medicaid.

I do have some self-pay patients, but they don't have the "entitlement mentality" that I so frequently encountered with my Medicaid patients in residency.

 

[Shinken]

How often do you peeps see this ?

Luckily, my private patients are not like that, since most are insured and employed, so they have a different mindset and attitude.

I do, however, volunteer time at a free clinic, and patients occasionally have a huge entitlement mentality. Not all, but enough to discourage you sometimes.

Cleveland has a large indigent / uninsured / underinsured population. Volunteering at a free clinic is a great way to help them and keep them out of the ER.

 

[GoodmanBrown]

Hey Taux, as you can tell, opinions can be charged on this topic. I have several friends who are NPs, and I can undoubtedly say that you will learn more as a med student than they learn in school. Some of their knowledge deficiencies are a bit startling to me, and I'm just wrapping up my 2nd year in med school.

That said, I'm sure large tracts of my current knowledge will gradually fade into oblivion as time passes. I have a pretty solid background in embryology and histology that I can't imagine I'll take much advantage of. Sure, there will be some general pointers (congenital defect of the uterus increases the chances of a renal congenital defect), but all my knowledge about Shh and Wnt signaling in 7 week old fetuses will quickly die a deserved death.

Likewise, when I rotate on anesthesia or neurosurgery, I'm guessing there will only be a few take-home points that I'll keep with me if I end up in FM.

So, I guess one question is whether you're willing to learn some stuff you didn't need to know in order to be more certain you know the things you should know. That process takes time, commitment, and money.

One thing other people haven't really mentioned is that NPs don't really operate completely independently in most situations. My friend is a family NP who works with underserved populations, and in her working environment, the doctor:NP ratio is about 2:1. So, if she ever has a question or feels like she's missing something, there's a doctor around for her to call on. Earlier in her career, I think she had a bit more "shoulder peaking" where a doctor would have her just run through a case and talk through it with her. I think she has a bit less of that now as she's gained more experience. In that way, her first couple years on the job were probably a bit like residency, albeit more focused and less time-consuming.

In the end, in most situations, the buck will stop with the MD, not the NP. If my friend asks an MD for help on a case, the MD will take over and probably dictate the end result of care. That's just the pecking order.

Regarding cost for the patient, I don't think that should really factor into your decision. Costs are all relative in care. Patients with Medicaid don't pay different sums for seeing a physician vs. an NP. Patients visiting a federally-subsidized clinic don't either. Patients visiting free clinics certainly don't. Patient cost should be a non-issue for your choice.

Anyway, best of luck with your decision. I chose MD school over PA school and haven't regretted it yet.

PS: I agree with others regarding the whole "truly caring for your patients" vs. "seeing them as a disease." My school heavily emphasizes treating the whole patient and understanding their biopsychosocial issues. It's more about what you go into med school wanting, rather than what med school produces.

So, knowing this - knowing that I want a career in FM, should I pursue an MD or NP? Feel free to highlight the pros and cons of each. Thanks in advance.