Future Roles of NP & PA - Question...

Editorial Team / Admin · Oct 3, 2005

I've been exploring career options in primary care/family practice. Initially, I have been looking into D.O. schools and noticed that most DO graduates go into primary care or family practice.
However, I have been reading a lot about the expanded role of midlevels (NP and PA) as being the major providers for primary care in the future. Do you think this trend will continue, as it seems more cost effective ways of delivering health care is sought???
With the apparent dwindling compensation for FP physicians, it has made me question whether or not it is worthwhile to pursue a DO program. I understand I shouldn't be looking at it from a financial perspective, but with potentially 200k+ in student loans, it will be a major factor in my decision of going the DO route or possibly the NP/PA route.
Any insight or opinions would be appreciated.
Thanks in advanced.

:nurse: Hello, cosmicstarr and welcome to Allnurses.com:nurse:

If you desire to be a physician, then by all means, go for it.

The role of NP/CNS will always be around. There will always be a need for the physician extender especially in the rural areas. Many individuals are without adequate physician healcare and that is exactly where the NP/CNS role comes in to play. Yes, many other areas of speciality, but, to what your refer, you have a point. FP is the way for the NP, especially where I am located. I am able to care for all individuals form birth through death. It is most fullfilling.

If you choose the NP/CNS role, you will always have a very admirable and lucrative career.

I wish you well in your decision.

Izzygal · Oct 4, 2005

Great question... I am in the same boat with the same questions.... let's bump this up for more responses! :)

Izzy

Papadoc · Oct 4, 2005

Hey Guys!

I'm in the same boat. The only difference is I've already done 2 semesters of the med school in the Caribbean MD program), which just like D.Os are mostly match into IM/FP residencies, and stay in the primary care area. I defered my school, just so I have more time to think. The more I think about it, and talk to ppl currently doing FP (docs), the more it becomes apperent that going to med school was a mistake Many docs have told me that in the end it wasn't worth it, other than having a status of a "doc". Some even said they should've gone PA, have almost the same money, less headache, and a lot more of a life. I don't mean to discourage any of you who want to go that route, but... if you want to do primary care, or even some specialties, then the NP/PA thing is the way to go these days, IMHO. Yes, we absolutly must consider the major debt that accumulates after the med school, and living expences. And in primary care there isn't much of a differenceif any at all, in what NPs,PAs, MDs and DOs do. I'm an RN alredy

x 15 yrs, and at 35, and having a family going the FNP route is a much better fit for me. I've been also looking at the CRNA path, but there are lots of things I have to do before i could even be considered, namely 2 yrs of recent ICU exp, BSN (I have B.S premed track). So it's really hard to advise anyting on it, because there is no right or wrong decision. The only right one is what's right for you

Have a great one

Good Luck with your choices

JACKMAC · Oct 4, 2005

I agree with Siri, first decide if you want to be a physician. If you will always regret not going that route then please do it. Look at the sacrifice it takes to be a DO/MD, it is tremendous. I considered that route years ago and I have no regrets. My family life is just too important for me but I have nurse friends that regret not being an MD.

That said, there is an article about workforce trends with NPs/PAs on the aafp website. Here is the link http://www.aafp.org/afp/20051001/graham.html

It states that around 80% of NPs are in primary care vs. only 44% of PAs. I was surprised by those numbers and they make a statement.

Angie O'Plasty · Oct 4, 2005

A lot of what's been said here reminds me of the thought process I have gone through. I applied for medical school this past year and did not get in, despite good grades, MCAT scores and clinical experience as an EMT. This gave me time to think through the whole picture, such as what happens if/when I have a family, which until fairly recently I never thought I would have much interest in doing. However, I have come to the conclusion that I would like to marry and have children if I meet that great guy, and when that happens I want to be able to be there for them. And that can be really hard to do as a doctor, especially in my area of interest (cardiology). I also believe very strongly in prevention and patient education, and would like to have a good amount of time to spend with each patient to do that. Finally, I decided that I would be satisfied in a midlevel role. So I decided to look into direct-entry MSN programs to become an NP, as well as looking at PA programs a little. I decided I liked the nursing perspective with its focus on preventive care, and I'm taking the GRE tomorrow so I can apply to programs. There's even one right where I live, and during the masters portion people work part-time as RN's (required the first year, optional the second) to get clinical experience. Best of luck with your decisions!

arciedee · Oct 4, 2005

I had always been interested in the health professions and waffled back and forth between nursing and medicine for a long time. I chose medicine a few years ago and went back to work on my pre-reqs. I really loved my classes, but somehow it just didn't sit right with me. I couldn't help feeling that I was in a rush to get everything done, pre-reqs, applications, med school, etc. in the event that I got married and had children. Yet at the time I was single and felt it was silly to put my career on hold for something that might not even happen. It took a lot of soul searching but I began to research nursing more seriously and realized that it not only fit better with the lifestyle I wanted, but that the nursing role was more what I was looking for in my career (whether bedside or in advanced practice). And now that I'm actually planning to get married and expecting to have children in the next couple years I am very grateful for my decision.

HOWEVER, if you find that medicine is what you really want to do, then go for it! Only you can decide which is the right path for you. Be sure to research all your possibilities thoroughly and be honest with yourself about what it is you want out of both career and life. For myself, I found that I was stuck on having the title, either to make people proud or because it was what was expected. Obviously not a good reason to choose a career. Conversely one should not go for an NP or PA simply because it is shorter or less expensive if he or she really desires to be an MD/DO.

Good luck in your decision.

Angie O'Plasty · Oct 4, 2005

I had always been interested in the health professions and waffled back and forth between nursing and medicine for a long time. I chose medicine a few years ago and went back to work on my pre-reqs. I really loved my classes, but somehow it just didn't sit right with me. I couldn't help feeling that I was in a rush to get everything done, pre-reqs, applications, med school, etc. in the event that I got married and had children. Yet at the time I was single and felt it was silly to put my career on hold for something that might not even happen. It took a lot of soul searching but I began to research nursing more seriously and realized that it not only fit better with the lifestyle I wanted, but that the nursing role was more what I was looking for in my career (whether bedside or in advanced practice). And now that I'm actually planning to get married and expecting to have children in the next couple years I am very grateful for my decision.
HOWEVER, if you find that medicine is what you really want to do, then go for it! Only you can decide which is the right path for you. Be sure to research all your possibilities thoroughly and be honest with yourself about what it is you want out of both career and life. For myself, I found that I was stuck on having the title, either to make people proud or because it was what was expected. Obviously not a good reason to choose a career. Conversely one should not go for an NP or PA simply because it is shorter or less expensive if he or she really desires to be an MD/DO.
Good luck in your decision.

That sounds somewhat like my situation--I was all set to reapply after getting rejected (from eleven schools!!), and realized that it just "didn't sit right" when I thought about the idea of having a family and the way I would like to raise my children if/when I have them. I went through the same process of "it's silly to make a decision based on something that may or may not happen" and realizing that a little bit of my struggle did have to do with the ego thing and making people proud. And like you, after some research I realized the nursing perspective was a good fit for me with the emphasis on prevention and teaching patients how to maintain good health. And advanced practice allows more autonomy than most regular nursing positions, which appeals to me.

Izzygal · Oct 4, 2005

This sounds like everything I'm constantly thinking about! The issue of when to have a family, how that would work while I was in med school... it's all so much to think about, but honestly, I think I would just be overall much happier as a NP or PA. I just wonder of those two, which I would like more... decisions, decisions! :rolleyes:

Izzy

Papadoc · Oct 4, 2005

Hi all again!

Interesting discussion, but I have to jump in here to play the devil's advocate :devil: :chuckle . First, if you don't get into US med or osteopathic schools, then some reputable Caribbean schools, or European ones are definitely viable optons. We as a family decided that I would go to the island alone, and they'll just visit me, or I'll visit the. But I saw many, many families with children, where only one or both spouses were the students. There are options. But in my case, the more I studied the less I could answer the question "Why?" It wasn' t clear to me anymore why I wanted being a doctor. Most definitely I was hung up on the status "MD" and being called Dr. ... As a guy, I'm still a little sickened by comments like "male-nurse?" I know in this day and age it's silly to even react to it. It means nothing, other than I'm probably dealing with folks who's been in the cave for pretty damn long time :angryfire. But I also went to the nursing school in another country, and it was only ment to be a stepping stone, and to help me get into med school. But after comming to the States it was a sure, and very stable thing as far as making a living. I guess I'll never know for sure what could've or should've been if I became a physician. But in all honesty I'm not willing to pay that price to become something I probably didn't want in the first place,IMHO

Good Luck with your soul searching everybody

Papadoc

cosmicstarr · Oct 5, 2005

Thanks everyone for all the replies and opinions. Family practice appeals to me because I like the idea of being a generalist and being able to treat all types of patients. As someone previously stated, it would be most rewarding. I'm still uncertain about rural care only because I would prefer to live in a more metropolitan environment, but maybe that will change as I get older.

Since I am still single and really have no obligations, I suppose I am leaning more towards the medical school route. I can understand that for those with families and children, this route is exteremely difficult. I am amazed at those who are able to get through it and succeed.

But I will try to shadow some NPs to get more exposure. So far, I've only encountered PAs in hospitals where I am, so I would have to actively look for NPs to shadow. I find the nursing model appealing as a means to providing patient care. It seems some of the philosophies of D.O. training incorporates this holistic approach to patient care as well.