Why MD instead of NP?

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riverjib

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This question is directed towards those who have had enough clinical experience to work closely with MD's, DO's, NP's, and RN's. I had an interview today (not for medical school), and after I spoke about what made me decide to go into medicine, he asked me why MD? He really liked my answer, but as someone who is on an ADCOM, he said that I needed to polish it for med school interviews so that I don't stumble around as much to explain it, because it is evidently becoming a popular question...at least for non-trads and traditional students who have enough clinical experience to know the difference between the different roles.

So if you were asked this question, how would you respond?
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idk..
nurse practitioner v.s physician ....
two different fields that are inter-related..
its difficult to say.. i guess that you could say you believe you have the overall strength to take the responsibility of guarding and treating a human being and not just taking orders. That you can take a leadership role and the overall commitment towards putting in 7+ more years of your life for education and then the rest of your life is a big part in my mind of the physician v.s PA v.s RN v.s NP...
if your willing to let medicine become your life.. go physician
if your more willing to have a flirting relation with medicine go for pa/np.
 
NP doesn't nearly have the power of MD in impressing girls
 
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serenade said:
idk..
nurse practitioner v.s physician ....
two different fields that are inter-related..
its difficult to say.. i guess that you could say you believe you have the overall strength to take the responsibility of guarding and treating a human being and not just taking orders. That you can take a leadership role and the overall commitment towards putting in 7+ more years of your life for education and then the rest of your life is a big part in my mind of the physician v.s PA v.s RN v.s NP...
if your willing to let medicine become your life.. go physician
if your more willing to have a flirting relation with medicine go for pa/np.
Click to expand...

That's the thing--we all think of NP as equivalent somehow to PA. It's not. Both are great jobs with tremendous potential, but NP offers more autonomy than PA. My fiance chose PA because he wanted to just finish 2-3 years post-bacc and start working in the medical field, taking some orders but also having the autonomy to make some decisions. He'd prefer abbreviated (albeit difficult) schooling to the years it takes to pursue either MD or NP.

NP definitely is not a "flirting relation" with medicine. RN and PA aren't either, but they require less investment of time in school for the respective degrees. NP requires years of commitment beyond a bachelor's in nursing. I know the CRNA's (certified nurse anesthetists) have to have a bachelor's (or Master's?) in nursing, and five years of critical care experience before they can even APPLY to go to CRNA school, which takes at least another two years. I haven't done the research, but I believe the requirements are similar for NP's.

Anyone else have insight? It's interesting to hear what everyone thinks.
 
In many states NP’s and PA’s have a similar level of responsibility, many healthcare organizations credential them as equivalent levels of training (I know their origins are different, but their roles in medicine can be quite similar). In many areas they work under the supervision of Physicians (at least at some level); some even comment that they are the perpetual resident always reporting to an attending (though they probably get a little more respect).

As stated previously, MD’s and DO’s are held to a higher level of responsibility and hopefully have received a higher level of training, the buck stops with them (not the NP or PA). Example: Emergency Med residency grad on day 1 may be supervising NP’s and PA’s with 30+ years of experience, the doctor is expected to have the greatest body of knowledge, the answer to the question.

The way to answer this question is to define the differences between the two professions, and describe why you want what separates Dr's from NP's. Importantly, this is a personal response.

Good luck.
 
Because House and Scrubs both had MD's.
 
tremulousNeedle said:
In many states NP’s and PA’s have a similar level of responsibility, many healthcare organizations credential them as equivalent levels of training (I know their origins are different, but their roles in medicine can be quite similar). In many areas they work under the supervision of Physicians (at least at some level); some even comment that they are the perpetual resident always reporting to an attending (though they probably get a little more respect).

As stated previously, MD’s and DO’s are held to a higher level of responsibility and hopefully have received a higher level of training, the buck stops with them (not the NP or PA). Example: Emergency Med residency grad on day 1 may be supervising NP’s and PA’s with 30+ years of experience, the doctor is expected to have the greatest body of knowledge, the answer to the question.

The way to answer this question is to define the differences between the two professions, and describe why you want what separates Dr's from NP's. Importantly, this is a personal response.

Good luck.
Click to expand...

I like your answer. This what basically what I pointed out on my interview. I discussed the differences between different types of leadership in medicine. An administrator hires and fires people and manages budgets, an NP decides what to prescribe or the best course of treatment, but an MD manages the treatment of his/her patients. I'm not sure whether that's oversimplifying it or getting straight to the point. After ten years in the field, that's how I see the delineation.
 
TheProwler said:
NPs can't be surgeons.
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True...though they can be first assists, or right hand assists, like surgical PAs. I know a surgical PA who harvests leg veins for cath patients. I suppose you could do that with an NP as well.
 
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Higher earning potential, greater prestige (lol murse), leadership role, more intellectually challenging. I think the question would be why NP over MD besides time/money saved?
 
riverjib said:
That's the thing--we all think of NP as equivalent somehow to PA. It's not. Both are great jobs with tremendous potential, but NP offers more autonomy than PA. My fiance chose PA because he wanted to just finish 2-3 years post-bacc and start working in the medical field, taking some orders but also having the autonomy to make some decisions. He'd prefer abbreviated (albeit difficult) schooling to the years it takes to pursue either MD or NP.

NP definitely is not a "flirting relation" with medicine. RN and PA aren't either, but they require less investment of time in school for the respective degrees. NP requires years of commitment beyond a bachelor's in nursing. I know the CRNA's (certified nurse anesthetists) have to have a bachelor's (or Master's?) in nursing, and five years of critical care experience before they can even APPLY to go to CRNA school, which takes at least another two years. I haven't done the research, but I believe the requirements are similar for NP's.

Anyone else have insight? It's interesting to hear what everyone thinks.
Click to expand...

riverjib,
I just wanted to correct a couple of things in this statement really fast.

An RN only has to have 12 months critical care experience before starting a CRNA program. They have to have a bachelors degree, an RN and have worked for 12 months in a critical care environment (depending on the CRNA program, could include ER or PACU, but most don't).

As far as NP programs, I know that there are programs where an RN can basically go directly from getting her RN into her NP. They have accelerated programs. I know this to be true because my cousin is in one currently. Luckily, she has a good head on her shoulders and wanted to work in the ICU for a couple of years first before she finished up her NP, to get experience (she wants to do acute care NP). I think that this experience is key.

Regarding my personal decision on this, I looked at a mid level route quite a bit. It would have been MUCH easier on me, my bank account, and my family. In the end, I know that I wouldn't have been happy in that role for very long. I have had too many experiences in critical care that have made me realize how much I LOVE that environment. I wouldn't be exposed to very many of those situations as a mid level provider.

As cliche as it sounds, it boils down to if you want to practice medicine or nursing. There is absolutely NOTHING wrong with being a mid level provider, it's just not what I want to do. Best of luck to you!

-RT2MD
 
In one of those emergency moments out in the public, they always say "IS THERE A DOCTOR IN THE HOUSE?!" and never "IS THERE A NURSE IN THE HOUSE?!"
 
riverjib said:
That's the thing--we all think of NP as equivalent somehow to PA. It's not. Both are great jobs with tremendous potential, but NP offers more autonomy than PA.
Click to expand...

Actually in some places it's quite the opposite. It all depends on location and specialty and experience.
 
Personally, I like MD as opposed to NP or PA because of the level of autonomy and expertise that comes with the MD, although I will gladly admit I know several PA's and NP's who are very on top of the game when it comes to expertise in their various specialties. The ultimate decision for me, after talking to MD's, PA's, NP's, CRNA's, DO's was that my interests in emergency medicine generally require an MD/DO level of education.
 
bnp07 said:
Actually in some places it's quite the opposite. It all depends on location and specialty and experience.
Click to expand...

indeed. at my primary job we staff pa's in the e.d. and use np's only in urgent care.
this is location specific both in terms of state to state(there are pro-pa and pro-np states) and facility to facility within individual communities.
 
MD is something you puruse on the principle that you want to achieve the highest career career goal availible in healthcare, while NP and PA are alternatives that you pursue for practical reasons.
 
Autonomy, leadership, more career opportunities
 
bleargh said:
NP doesn't nearly have the power of MD in impressing girls
Click to expand...

Uh that's why I'm going to med school...to snag me a doctor hubby. You gotta show them you got goals too, ya knows?
 
I'd rather walk into a room and say "Hello, I'm Doctor So-and-So" and earn the immediate trust of my patient than say "Hello, my name is Bob. I'm a PA/NP" to which the patient responds, "So when do I see the doctor?". Let's be honest with ourselves - any premed who tells you that the prestige and respect that comes with having an MD or DO after their name is not at least part of the reason they want to go to medical school is lying.
 
The Enchanter said:
I'd rather walk into a room and say "Hello, I'm Doctor So-and-So" and earn the immediate trust of my patient than say "Hello, my name is Bob. I'm a PA/NP" to which the patient responds, "So when do I see the doctor?".
Click to expand...
This doesn't happen. Rather what happens is that I introduce myself as the RN and the Patient unloads his life story on me and asks me what my plan of action is. It also happens with CNAs, and respiratory therapists.....and all other ancillary staff. Posters around here give Patients farrrrrrrrrrrrr too much credit. This is directly related to lack of significant real world hospital/acute care/medicine experience.

I *believe* the statistic is that Patients forget at least 50% of what you tell them by the time they leave your office/you leave the room. This includes what little letters are after your name. Want proof? google it.


and as far as earning immediate trust with the patient.....thanks for the hearty chuckle. Now I have to clean the fluid that came shooting through my nose off my computer screen and pick myself up from rolling around on the floor. :lame:
 
You know, I hear autonomy thrown around a lot when talking about one of the benefits of being a doc. Maybe it's the part of being in medical school and dealing with academic practice and a few private practitioners that work with students and being married to a BC internist, but...

I don't see a lot of autonomy. Call schedules are set by the division (or practice) administrator. You want vacation, you put in for it 3-6 months in advance and hope no one else in the practice has already asked for the same dates. You want to give drug ABC but the hospital pharmacy gets a better price on XYZ which has a similar mechanism so hospital policy is to use XYZ first-line. You think the patient needs to stay another day, but billing and coding is telling you to discharge because they have determined the patient "doesn't meet inpatient criteria." And don't get me started on insurance company limitations and the fight with their medical directors to approve treatment you feel is necessary. The higher ups think your clinic isn't making enough money, so they add two more patient per half-day to your schedule. Of course your contract with the group says you'll give 3 months notice before leaving, so you're stuck with the changes for a while even if you want to quit and find work somewhere else. Sure you don't take orders from someone, but policies, guidelines, and standard-of-care dictate a large part of the way you practice. I guess I can choose if I want to auscultate before I percuss the lungs on this patient.

If autonomy is your big pull to the M.D., I think you'll find yourself sorely disappointed.
 
I hate questions like this, and the Adcoms that ask it are setting themselves up for a 15 minute, drivel-infused, sermon filled with words like "diversity", "under-served", "altruism", not to mention lots of "reaching", "feeling", and "sharing". Bleh

We pick MD over NP and PA because we want to be IN CHARGE. We want to be the final say, to have control over what is done. We don't want to have to spend the rest of our careers answering to someone else.

Nobody will ever say that in an interview though.

That is the nice thing about being in Med school. No more false pretenses, no more phony "do-gooderisms". Now I can be straight and honest.

Premed lecturing me on the right reasons to be a doctor in 4...3...2...
 
Captain Fantastic said:
You know, I hear autonomy thrown around a lot when talking about one of the benefits of being a doc. Maybe it's the part of being in medical school and dealing with academic practice and a few private practitioners that work with students and being married to a BC internist, but...

I don't see a lot of autonomy. Call schedules are set by the division (or practice) administrator. You want vacation, you put in for it 3-6 months in advance and hope no one else in the practice has already asked for the same dates. You want to give drug ABC but the hospital pharmacy gets a better price on XYZ which has a similar mechanism so hospital policy is to use XYZ first-line. You think the patient needs to stay another day, but billing and coding is telling you to discharge because they have determined the patient "doesn't meet inpatient criteria." And don't get me started on insurance company limitations and the fight with their medical directors to approve treatment you feel is necessary. The higher ups think your clinic isn't making enough money, so they add two more patient per half-day to your schedule. Of course your contract with the group says you'll give 3 months notice before leaving, so you're stuck with the changes for a while even if you want to quit and find work somewhere else. Sure you don't take orders from someone, but policies, guidelines, and standard-of-care dictate a large part of the way you practice. I guess I can choose if I want to auscultate before I percuss the lungs on this patient.

If autonomy is your big pull to the M.D., I think you'll find yourself sorely disappointed.
Click to expand...
Excellent points....

The bolded section is especially true. Most posters around SDN think that they are all going to magically own their own practice...as if it were so easy and profitable that all other doctors own their own practices. Furthermore, posters rarely talk about contracts.....which go along with generally every practice/private group, can require years of stay or not applying to any other practice within a certain distance after leaving for a certain amount of time, and the fact that you have to buy into a lot of practices now days.

ohhhhhhhh they'll learn soon enough I suppose. :meanie:
 
seelee said:
We pick MD over NP and PA because we want to be IN CHARGE. We want to be the final say, to have control over what is done. We don't want to have to spend the rest of our careers answering to someone else.
Click to expand...
In certain settings NPs work independently and don't have to answer to any MDs/DOs...
 
Hoody said:
In certain settings NPs work independently and don't have to answer to any MDs/DOs...
Click to expand...
Yup, and it's a little scary! :scared:

Edit: To stay on topic, I want to go the physician route because I want the breadth and depth of knowledge that a physician gains through training. There are no shortcuts to this. I want to be able to handle whatever walks through the hospital doors (with regards to my specialty).
 
Last edited:
I agree with many of the people who posted here. However, my interviewer was an NP, and I'm not sure how to articulate why MD is a better path than NP without alienating "mid-level" practitioners. In NYC, NP's have a tremendous degree of autonomy, approaching (but not equivalent to) MD's. How would you word it so as not to downplay the roles of NP's?
 
riverjib said:
I agree with many of the people who posted here. However, my interviewer was an NP, and I'm not sure how to articulate why MD is a better path than NP without alienating "mid-level" practitioners. In NYC, NP's have a tremendous degree of autonomy, approaching (but not equivalent to) MD's. How would you word it so as not to downplay the roles of NP's?
Click to expand...

To illustrate my point from above. The only way you can answer that question is by spewing out a bunch of malarky like "NPs have a very important role in medicine, but my real passion is medicine." But that is not the real answer. Everybody who is honest about it will have to conclude that a physician's training makes him more capable to diagnose and treat disease and that mid level providers (despite what NY says) function best when working under the supervision of an MD/DO. We choose MD, because we want to be in charge, and we are willing to go through the extra training to get to that point.
 
Hoody said:
This doesn't happen. Rather what happens is that I introduce myself as the RN and the Patient unloads his life story on me and asks me what my plan of action is. It also happens with CNAs, and respiratory therapists.....and all other ancillary staff
Click to expand...

Yeah, that sounds familiar. I get asked to give pain meds (Let me call your nurse), why are you drawing blood (your doc ordered it... probably because you just delivered a baby yesterday, or had surgery, or are on coumadin...or he just orders the same labs on every single one of his patients), when do I go home (when you're feeling better), can I get a bath (let me call your CNA), and on and on and on. Once every 10 patients or so, I'll get a real talkative one that wants to tell me all about how they ended up in the hospital and what's been done so far and how his/her nurse/doctor hasn't seen them at all...

If nothing else, I've learned what not to do to piss patients off...

And I chose MD because the quality of education, in my opinion, is better. I've had classes with BSN students. They're not the sharpest tools in the shed, in general.
 
Hoody said:
True...though they can be first assists, or right hand assists, like surgical PAs. I know a surgical PA who harvests leg veins for cath patients. I suppose you could do that with an NP as well.
Click to expand...

A first assist is not a surgeon. Even remotely.
 
My buddy who is an MS1 currently got asked that question in an interview. "Why MD? Why not choose to be an NP?" He answered "Um....because I want it to be my show."
 
RT2MD said:
riverjib,
I just wanted to correct a couple of things in this statement really fast.

An RN only has to have 12 months critical care experience before starting a CRNA program. They have to have a bachelors degree, an RN and have worked for 12 months in a critical care environment (depending on the CRNA program, could include ER or PACU, but most don't).

As far as NP programs, I know that there are programs where an RN can basically go directly from getting her RN into her NP. They have accelerated programs. I know this to be true because my cousin is in one currently. Luckily, she has a good head on her shoulders and wanted to work in the ICU for a couple of years first before she finished up her NP, to get experience (she wants to do acute care NP). I think that this experience is key.

Regarding my personal decision on this, I looked at a mid level route quite a bit. It would have been MUCH easier on me, my bank account, and my family. In the end, I know that I wouldn't have been happy in that role for very long. I have had too many experiences in critical care that have made me realize how much I LOVE that environment. I wouldn't be exposed to very many of those situations as a mid level provider.

As cliche as it sounds, it boils down to if you want to practice medicine or nursing. There is absolutely NOTHING wrong with being a mid level provider, it's just not what I want to do. Best of luck to you!

-RT2MD
Click to expand...

Thanks for the input, RT. When I was working in the field full-time, CRNA's still needed years of experience in ICU or another critical-care field.

I'm fairly certain that you'd be exposed to the same situations as a "mid-level provider," even with "too many experiences." There certainly is "NOTHING wrong with being a mid-level provider" in your words, but I never said I was interested in any other path than becoming an MD.

For future reference, I'm not even a "mid-level provider" (AKA nurse) and I find your answer to be demeaning. Without even using proper language, you've managed to denigrate the careers of nurses and nurses practitioners. Before you apply to medical school, work on how you word things.
 
You're right. Nobody will say that on an interview. Did you?

We won't, because their are far too many out there who say this:

Hoody said:
This doesn't happen. Rather what happens is that I introduce myself as the RN and the Patient unloads his life story on me and asks me what my plan of action is. It also happens with CNAs, and respiratory therapists.....and all other ancillary staff. Posters around here give Patients farrrrrrrrrrrrr too much credit. This is directly related to lack of significant real world hospital/acute care/medicine experience.

I *believe* the statistic is that Patients forget at least 50% of what you tell them by the time they leave your office/you leave the room. This includes what little letters are after your name. Want proof? google it.


and as far as earning immediate trust with the patient.....thanks for the hearty chuckle. Now I have to clean the fluid that came shooting through my nose off my computer screen and pick myself up from rolling around on the floor. :lame:
Click to expand...

Unfortunately, people do believe they're going to be amazing doctors when they are completely clueless as to what it means to be a good doctor.

I'm not looking for the relentless dribble than pops up all the time here. I was simply seeking an answer to the question, "why MD not NP" that wouldn't paint NP's in an inferior light. Like it or not, they are first providers in patient care who also do research.

So there is a better answer than "I want to be an MD so that I'm in charge." It's apparent that I won't find it among a group of pre-meds and first-year med students, so I'll look instead to professionals and those who can provide some real insight. Thanks anyway.

seelee said:
I hate questions like this, and the Adcoms that ask it are setting themselves up for a 15 minute, drivel-infused, sermon filled with words like "diversity", "under-served", "altruism", not to mention lots of "reaching", "feeling", and "sharing". Bleh

We pick MD over NP and PA because we want to be IN CHARGE. We want to be the final say, to have control over what is done. We don't want to have to spend the rest of our careers answering to someone else.

Nobody will ever say that in an interview though.

That is the nice thing about being in Med school. No more false pretenses, no more phony "do-gooderisms". Now I can be straight and honest.

Premed lecturing me on the right reasons to be a doctor in 4...3...2...
Click to expand...
 
riverjib said:
So there is a better answer than "I want to be an MD so that I'm in charge." It's apparent that I won't find it among a group of pre-meds and first-year med students, so I'll look instead to professionals and those who can provide some real insight. Thanks anyway.
Click to expand...

What answer would that be? The differences are all self serving... less training time, "in charge" as a physician, and the respect. Everyone seems to oooh and ahh over the doctor, but no one gives two ****s about the nurse. You don't hear parents bragging about their nurse son.
 
Why MD instead of NP?
My reason for MD/DO has always been clear because of my love for Pre-Hospital Medicine. Meaning my goal is to be a Medical Director for a EMS system and conduct EMS/Critical Care related research. To my knowledge the path of MD/DO is only way to do this ( I understand research is able to be done various health care and non health care workers). So in the end I want to be a EM Physician while a Medical Director for EMS system.:xf:
To be clear there are EMS Directors which is quite different then Medical Directors.
To be clear this is not my only reason for becoming a physician but the reason for physician rather than any other NP,PA,ETC
 
riverjib said:
Thanks for the input, RT. When I was working in the field full-time, CRNA's still needed years of experience in ICU or another critical-care field.

I'm fairly certain that you'd be exposed to the same situations as a "mid-level provider," even with "too many experiences." There certainly is "NOTHING wrong with being a mid-level provider" in your words, but I never said I was interested in any other path than becoming an MD.

For future reference, I'm not even a "mid-level provider" (AKA nurse) and I find your answer to be demeaning. Without even using proper language, you've managed to denigrate the careers of nurses and nurses practitioners. Before you apply to medical school, work on how you word things.
Click to expand...

Wow. Thank you for the critique. I don't know what made you so angry, but I suggest that you work on that issue before you apply as well. I am 90% sure that the CRNA programs never required more than 12 months experience, it was just that, because of more applicants than slots, a lot of programs wouldn't take nurses unless they had several years of experience. That could be where the confusion was coming from.

I don't know for sure what point your second paragraph is attempting to make, but I believe that you are saying that a NP/PA would have the same experiences as a physician. You also said that you have no desire to become anything other than a physician. I wasn't trying to insinuate that you were wanting to be anything other than a physician, however your initial post was regarding the question "Why MD instead of NP". I was actually debating the difference between medical school and AA school (not an NP, obviously, but a similar mid-level role), so my thought process regarding this question was still fresh in my mind. Therefore, I attempted to express my own thoughts as they pertain to your initial question.

I also respectably disagree with your certainty that a mid-level provider and a physician provider would have similar work experiences. If a patient is crashing in the ICU, who are they going to call - a board certified intensivist, or a nurse practitioner? This is not meant to be a slight to nurse practitioners, they just usually aren't the ones managing the incredibly sick people - which is what I want to do... therefore my not being happy with the mid-level route.

For future reference, you might realize that the overall "tone" of an internet posting might be meant differently than you take it. You don't need to get all defensive. If the term "mid-level provider" was the target of your rage, please check this link. That term is widely used, and is not meant to be derogatory. I again am wondering what got you so angry. My initial post was meant to clarify some points, as well as convey my thoughts regarding "MD instead of NP". I re-read it and didn't see anything that was demeaning. Please elaborate how I denigrated the careers of nurses and nurse practitioners.

Best of luck to you in your future endeavors.

-RT2MD
 
The Enchanter said:
I'd rather walk into a room and say "Hello, I'm Doctor So-and-So" and earn the immediate trust of my patient than say "Hello, my name is Bob. I'm a PA/NP" to which the patient responds, "So when do I see the doctor?". Let's be honest with ourselves - any premed who tells you that the prestige and respect that comes with having an MD or DO after their name is not at least part of the reason they want to go to medical school is lying.
Click to expand...

Yeah, thats a silly reason to go to med school. Patients dont know anything, and often they trust their nurse more, because they see them much more.

Anyway... MD vs. NP.

Something nobody mentioned... and one of my biggest deciding point - Flexibility.

1. If you think you might ever want to teach or do research, go for an MD. NP is a crash course in the most common diseases, and their most common treatments. MD is a broad medical doctorate, and includes 2 years of basic sciences. NP doesnt give you the basic science background that would get you interested in, or qualified for serious research. Teaching is not a popular career choice for nurses, as demonstrated by the severe shortage in nursing schools. Also the NP certification or Masters degree probably won't qualify you for a professorship in anything besides nursing itself.

2. You have to decide what you want to specialize in BEFORE you go to NP school. Pediatrics, Acute Care, Family, Psych, whatever.... each one is a different NP program with a different curriculum. Its difficult to change your field, once you have such a specialized scope.

3. NPs are trained to treat the most common diseases with the most common treatments. If something isnt working as expected, they have to refer the patient to an MD. Me? I'd want to stick it out and figure out whats going on. Thats the part when it gets exciting.
 
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