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Discussion

accurate information on scopes of practice

As many other ore-health students, I'm currently contemplating between becoming an NP or an MD (leaning more towards an MD though), but finding accurate information is SO difficult because both professions are so insecure about scopes of practice and such. To give you guys some background, I want to be a health care provider and serve my community, probably not in Family Practice, most likely in a paediatric or internal medicine subspecialty (cardiology, neurology, ICU, Infectious diseases all interest me) or maybe something surgical/procedural (Inteventional cards, interventional oncology, surgery, etc). I've gotten some experience in both internal subspecialties and surgery and loved both. I don't have any interest in being a nurse, but the NP is appealing to me, since you can do a lot of things doctors do. I have been having so much difficulty finding information on the differences between the two professions, I'm hoping some of you NPs and RNs will help me better understand the roles of both providers.

Here's what I know based on other health forums (This includes the turf war and stereotypes for both professions)

NPs

Pros:

-According to some studies can provide better outcomes, (Is this true? I'm somewhat doubtful)

- More holistic

-Lower admission requirements

-Less time required

-Very high pay (80 000 - 120 000)

-Easier to switch specialties

-Can work part-time while in NP school

-Less debt (I'm getting a scholarship currently so this for either professions won't be too bad/ no accumulated debt)

-May dominate certain sectors of healthcare (Primary care?)

Cons:

-Higher barriers in certain specialties: internal med adult/peds, surgery, rads onc, rads, etc.

-Limited scope of practice (How extensive these limits are is a mystery to me)

-less pay than physicians

-Either non-existant to severe lack in clinical knowledge (Again, conflicting opinions)

-Less leadership roles than physicians

-Usely don't take on complex cases (Is this one true?)

-Very inconsistent educational standards

Is what I listed true? Do you have any corrections/additions?

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    • Featured Replies

    Bless your heart. You do too much reading on forums! Get out! Talk to some people. Shadow a nurse first, then a nurse practitioner before you make some crazy wild generalizations. I'm glad you are attempting to get some advice, but, seriously, this is an internet forum....

    I can't leave you hanging though. These forums are quickly succumbing to facebook groups. You should attempt this conversation there. Here's another student's perspective on these things. I'll graduate with a dual MSN degree this spring (FNP/ACNP)

    NPs

    Pros:

    -According to some studies can provide better outcomes - This is the very first link on Google -->

    http://www.mc.vanderbilt.edu/documents/nursingoap/files/Quality%20of%20Primary%20Care%20Advanced%20Practice%20Nurses.pdf

    -More holistic - Sometimes. That concept is in the nursing curriculum.

    -Lower admission requirements - Can't speak to med school requirements. NP schools can vary.

    -Less time required - depends if you do direct entry vs bedside experience, if you count that as "time"

    -Very high pay (80 000 - 120 000) - way too low on the top number - I've got an offer straight out of school for 150k

    -Easier to switch specialties - maybe, haven't done it

    -Can work part-time while in NP school - or full time and do part-time school.

    -Less debt (I'm getting a scholarship currently so this for either professions won't be too bad/ no accumulated debt) - Possibly; however, if you've got the pedigree to have no debt, why is this a "pro" for you?

    -May dominate certain sectors of healthcare (Primary care?) - Possibly

    Cons:

    -Higher barriers in certain specialties: internal med adult/peds, surgery, rads onc, rads, etc. -It's all in who you know and how well you do. Specialties aren't that difficult to get into.

    -Limited scope of practice (How extensive these limits are is a mystery to me) -

    -less pay than physicians - Specialties, yes. Primary care...not so much.

    -Either non-existant to severe lack in clinical knowledge (Again, conflicting opinions)- BAHAHAHAHAHAHAHAHAHAHAHAH "non-existant." keep trolling bro.

    -Less leadership roles than physicians - Nope

    -Usely don't take on complex cases (Is this one true?) - depends on the situation. I'm in rural Appalachia. There are no specialists here. Next endocrine appt is 4 months away, et al. Yes, we do have to "take on complex patients."

    -Very inconsistent educational standards - agreed.

    I hope this helps. Pardon my sarcasm, it comes from a pure heart. I hope some NPs will chime in on this.

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    • Experts

    I agree with above poster: talk to some NPs in your area.

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    • Experts

    I'm currently contemplating between becoming an NP or an MD (leaning more towards an MD though), but finding accurate information is SO difficult because both professions are so insecure about scopes of practice and such. I'd disagree with this as being the reason and it sounds a bit like you are looking to add some controversy to your post but hopefully you are sincere and I would also urge you to talk to real life professionals. I do agree that particularly with NPs our scopes can be both vague and varied from stated to state. Usually the board of nursing is place for this information although in my state they attempt to shy away from dictating scope which I don't understand.

    Pros:

    -According to some studies can provide better outcomes, (Is this true? I'm somewhat doubtful)-yeah I doubt the quality or relevance of many of them also and prefer to believe the evidence indicates NPs provide adequate care

    - More holistic That NPs wear this as a badge of honor is huge pet peeve of mine because I think it makes us sound like a bunch of brow mopping, hand holding, inefficient providers spending hours with patients which isn't or shouldn't be the truth. If going for the technical meaning, as I understand it, all providers should, and the MDs I know do, consider the "whole person".

    -Lower admission requirements Hell to the YES, at the risk of sounding dramatic its heartbreaking to me

    -Less time required yes but not as less than I would have guessed

    -Very high pay (80 000 - 120 000) I'd say decent pay with the ability, if one is shrewd and good at their craft, to make an excellent living. I also started at $150,000 and even with significant increases still make about $100,000 a year less than my MD peers. My opinion is if you are young and bright enough definitely pursue medical school.

    -Easier to switch specialties Possibly

    -Can work part-time while in NP school It was easy enough for me to work full time through 2 NP programs

    -Less debt (I'm getting a scholarship currently so this for either professions won't be too bad/ no accumulated debt) Yes, but if you are able to have MD tuition paid I wonder why you'd ever consider being a NP, just my opinion

    -May dominate certain sectors of healthcare (Primary care?) I don't believe this to be true

    Cons:

    -Higher barriers in certain specialties: internal med adult/peds, surgery, rads onc, rads, etc. not necessarily with appropriate background and training although there are tasks we aren't able to perform

    -Limited scope of practice Minimal in my experience although I'm sure specialty specific to an extent

    -less pay than physicians Way less pay than physicians see above

    -Either non-existant to severe lack in clinical knowledge (Again, conflicting opinions) I think we need significantly increased admission requirements and more indepth education but feel as in your lead-in statement rather salacious again hopefully just worded poorly

    -Less leadership roles than physicians Depends on where you are although in general MDs are the big dogs

    -Usely don't take on complex cases (Is this one true?) It should be true in my opinion although relative as MDs also seek consults which I believe is only prudent regardless of your role.

    -Very inconsistent educational standards 100%, it is embarrassing to me.

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    • Author

    Thanks for you input! Just to clarify: by non-existent to severe lack in clinical knowledge, I meant that some sources say that NPs have just as much knowledge on a given medical disease/disorder as the doctor does, so their lack in clinical knowledge is non-existant.

    Also, I mentioned the scholarship just to avoid people reminding me the NP route is cheaper, since for me at least, the cost of medical school won't be too bad since i'm not paying a cent of my undergrad and am elligible for in-state scholarships for medical school. To my knowledge there aren't any NP school scholarships.

    I haven't had the chance to shadow any NPs since there aren't that many in my area and unlike doctors, most don't seem to shadow that much. I would never use forums for information if I had other sources available. I would've decided on the medical route without hesitation if it wasn't for my mother, who's an ER nurse, suggesting it as another option to explore. She didn't know much about the option either. Just trying to explore a little more before commiting to one, especially if they lead to the same goal.

    That's cool that you get to do some specialty work, since you're in the field, what's the difference in terms of scope of practice between you and your physician colleagues?

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