Anyone heard of any NP to MD programs?

Specialties NP

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MikeyJ, RN

1,124 Posts

Specializes in Peds, PICU, Home health, Dialysis.

I am not an NP (I am merely only a BSN student scheduled to graduate soon). However, I do have thoughts on this subject matter. I am acquainted with many NP's and many MD's -- and I 100% understand the want to pursue an MD.

I have come to find that RN/APN/NP's who choose to pursue medicine do so to perhaps not only advance their career, but to also prove a point to themselves that they have the capability to do pursue something so challenging. Furthermore, I think many nurses pursue their MD because it is something they wanted to do when younger, but instead chose to take the less invasive route as a nurse. Now, many years later, they begin to see the potential in themselves and pursue their MD.

Yes, 4 more years of medical school with an additional 3 - 7 year residency does seem daunting to most. However, I would prefer to be happy with myself and my career/educational choices, rather than wondering for the next 7 - 11 years whether or not I would have done well performing as a physician. (As a side note, I know of an MD in his 50's who chose to pursue medical school in his 40's).

One last comment I wanted to input -- regarding the NP = MD debate, I agree with NP's providing primary care or perhaps even emergency care, in some instances. However, I honestly believe that NP's should rarely provide any type of specialized care. NP's have a far better bedside manner (in most cases -- not all), thus I would prefer to see an NP for my preventive and primary care issues. However, NP's (in my opinion) are not trained to perform specialized care. I would prefer to see an MD/DO who spent 4 years of intense medical training, along with a very intense residency to treat a specialized problem. There needs to be a clear line drawn between NP's and MD/DO's. I think far too many people are putting them in the same boat, when in fact, they are drastically differeing (just compare the educational requirements and curriculums). Just my thoughts. :)

Specializes in ICU.

sistermike... I don't understand your point. If you look at specialty areas of care it makes more sense for a NP to work there rather than in the area of internal medicine.

For example, there are about (in general terms) 5 reasons for chest pain. A cardiac NP is able to work from that in a mental flow chart and patient assessment to determine the cause of the chest pain and what treatment options are available. The cardiac NP would defer out any neuro, endocrine (except for dyslipidemia issues), respiratory, musculoskeletal, etc. to other specialists. They learn the basics in school then work alongside MDs to learn their special skill base. I'm not saying they don't apply their understanding of the other areas of specialty, but that they don't have to. There are specialists for every body function for a reason. If you look at internal medicine, the NP would have to have a broader knowledge base especially if working in family practice due to the large range of ages that it can incorporate. I spent time in clinicals with a hospitalist last semester and have huge admiration for their intelligence and wisdom. The amount of information they have to carry around and be able to practice it daily is simply amazing.

This is similar to the reasoning behind choosing a Family NP program over say Women's Health or Pediatric NP programs. If you pocket yourself into a smaller subsection of education then you cannot span out and would not be expected to. If you choose Family NP and sometimes Acute Care NP programs then your knowledge base is larger and the time in school is generally longer.

Many women prefer Midwives over OB/Gyns. This is a specialty area. Would you say the Midwife's expertise is less than that of a MD? Is a psychiatric NP worse than a Psychiatrist? Psych is psych. You learn the uniqueness of patients in clinicals and on the job. What about CRNAs? They are just as capable to work in the OR as is the Anesthesiologist. There just happens to be a shortage of MDs in this field. If we told APRNs they couldn't work as CRNAs what then? We fill a shortage and a need that is strongly in need.

I once thought I wanted to go to medical school, but chose nursing because of the flexibility in areas of specialization while working as a RN and the opportunities to advance myself as I desired. At the same time, I work with two MDs who were once RNs who, after 10 years in practice, went back to school to earn their medical degrees. It's all in what we choose in our lives. I saw the length of time for school, the hours of on-call time, etc. and decided it wasn't for me (little did I know this wasn't true for all MDs). But I'm not disappointed in my decision to study FNP. And the reason I chose that program was so that I could span out and specialize if I wanted to.

The possibilities are out there sistermike. You will find yourself with many opportunities to stretch your mind to its limits as a RN and may discover a specialty that you particularly enjoy. So does that mean if you decide to become a NP you aren't as worthy to continue working in that specialty simply because you didn't go to medical school? Good luck to you in your BSN program. Those were some of the best times in school! You grow such bonds with your fellow students that can never be replaced. :nurse:

caldje

177 Posts

For example, there are about (in general terms) 5 reasons for chest pain. A cardiac NP is able to work from that in a mental flow chart and patient assessment to determine the cause of the chest pain and what treatment options are available.

5 causes of chest pain!?! even in general terms... not even close to only 5.:nono:

:uhoh21: THAT is what the previous poster was talking about.

Specializes in ICU.
5 causes of chest pain!?! even in general terms... not even close to only 5.:nono:

:uhoh21: THAT is what the previous poster was talking about.

Ok, so that was a really bad example (and totally out of my league since I work in Neuro) :imbar . My MD preceptor always brings that up when discussing specialties so I used it (maybe that's why he's a hospitalist). Point being is NPs can excel in specialized areas and don't have to drift only towards internal medicine.

core0

1,830 Posts

sistermike... I don't understand your point. If you look at specialty areas of care it makes more sense for a NP to work there rather than in the area of internal medicine.

snip

I agree with you line of thought. I do think that your reasoning behind it is somewhat flawed. There is ample room for NPP's to work in specialty practice. The model is different than for primary care. First it is unlikely that cardiology will be working up a patient for chest pain. Either primary care, ER or medicine usually does the initial work up and turfs to specialists for further work up. For example ECG changes or increased Troponin would go to cardiology. A PE would be handled by medicine.

What I would state is that there is no place for an independent NPP to do specialty care. This happens at too high a level even for an experienced NPP to do by themselves. I have been doing GI for five years and my SP's state that I work at the level of a third year fellow. I can handle most problems by myself and see any consult that comes into the clinic. The model for specialties is twofold. For specialties that do lots of procedures such as cardiology or GI the NPP sees new patients to generate more procedures. In other specialties such as endocrinology or oncology the patient sees the physician for the treatment plan which is then executed by the NPP. Other possibilities are to provide episodic care for patients with chronic conditions or provide care for certain conditions within a specialty such as a CHF clinic within cardiology. The concept here is to provide access to the clinic when the physicians are booked.

As far as the type of NP that you are going to become, there are other threads that address this. There are advantages and disadvantages to all the NP specialties. These are more pronounced in the delivery of specialty care.

David Carpenter, PA-C

core0

1,830 Posts

Ok, so that was a really bad example (and totally out of my league since I work in Neuro) :imbar . My MD preceptor always brings that up when discussing specialties so I used it (maybe that's why he's a hospitalist). Point being is NPs can excel in specialized areas and don't have to drift only towards internal medicine.

Actually it's not a bad example. I learned this as four in my ER rotations.

Cardiac

Pulmonary

GI

Musculoskeletal

This is the order of danger to the patient and the order you should rule things out in. It all dependes on if you are a lumper or a splitter.

The thing that this should point out is that just like your specialty physicians you need to be good in internal medicine to practice in a specialty. There are ample opportunities for disaster if you do not pick up subtle signs of other disease systems. If you have a harried primary care send someone to you with another problem then you need to know when its not in your system. This is the reason that specialty care comes out of internal medicine or pediatrics not family practice. You need a deeper appreciation of the appropriate type of medicine as well as the greater experience in inpatient medicine.

David Carpenter, PA-C

caldje

177 Posts

Actually it's not a bad example. I learned this as four in my ER rotations.

Cardiac

Pulmonary

GI

Musculoskeletal

This is the order of danger to the patient and the order you should rule things out in. It all dependes on if you are a lumper or a splitter.

David Carpenter, PA-C

David, if we go by organ system than any complaint can only involve 5-10 things. You should add neuro into this as well, and derm. I think we can all name 10-20 cardiac problems alone that cause chest pain and a similar ammount of GI issues that cause chest pain,as well as pulmonary. All in all, the differential for "cheat pain" can include well over fifty into the hundreds of conditions. I know you know that David?

I wasnt arguing against NPPs in specialties, more so against the independent NPPs in specialties and I think FNPs may not be fully exposed to the poosibilities in each specialty. Im sure it depends on which school you go to but you will never see the full DDx of chest pain etc worked out if you've only ever been in an FP clinic as a student NP. which i think we actually agree on?

core0

1,830 Posts

david, if we go by organ system than any complaint can only involve 5-10 things. you should add neuro into this as well, and derm. i think we can all name 10-20 cardiac problems alone that cause chest pain and a similar ammount of gi issues that cause chest pain,as well as pulmonary. all in all, the differential for "cheat pain" can include well over fifty into the hundreds of conditions. i know you know that david?

i'm just a simple gi pa. as far as i'm concerned the only reason that the heart exists is to pump blood to the abdominal organs. it also occasionally mimics gerd. the point that i make is that there are different reference frames for a work up. yes you could include derm and neuro but these are true zebras. you can rapidly exclude entire systems with a few tests which is why i like this reference instead of a problem based system. this is the way i was taught and the way that i teach students when i give lectures. your mileage may vary.

i wasnt arguing against npps in specialties, more so against the independent npps in specialties and i think fnps may not be fully exposed to the poosibilities in each specialty. im sure it depends on which school you go to but you will never see the full ddx of chest pain etc worked out if you've only ever been in an fp clinic as a student np. which i think we actually agree on?

once again your mileage may vary. it really depends on the acuity of the clinic and the patient population. i do agree that this is one of the problems with certain educational programs. it is the difference between specialty nursing models and medical models. i did one cp work up in 400 hours of fp. i did 15 in my first week of em. the other thing that you miss in working up conditions in fp is the feedback loop. usually in fp you may do an ecg and some other tests before you send them packing to the hospital. in em or inpatient medicine you can see your troponin come back, see what you ct shows etc. this is one reason that i think that any provider should be exposed to em, fp, inpatient medicine, surgery, psych, and ob. you need to be abled to recognize emergencies in those fields to be good at your job.

struggling to actually address the title of the thread so as not to incur the rath of siri:rolleyes:, this is the reason that you will probably never see a np to md program. honestly this is why you will probably never see a pa > md program either. the educational models are too different. the md educational model uses a diversed educational model with exposure to multiple fields of medicine in both medical school and residency. there is simply not enough exposure in the standard np program to provide the entering wedge here. similary the pa program is very focused on clinical medicine. in the case of the np, one is trained in nursing and the other is trained in medicine (regardless whether the practice is different). this is one of the current criticisms of some fp programs. by focusing the residency on outpatient medicine they are not getting sufficent exposure to acutely ill patients and lose the ability to rapidly diagnose rapidly evolving patient conditions.

david carpenter, pa-c

kb12345

14 Posts

Hi Sistermike...

Thank you for your words of encouragement and infact, some of what you said about why one might want to pursue an MD was on the money for me. I always wanted to be a psychiatrist but life happened, I got married, joined the militay, (who, by the way is willing to pay for medical school and pay me monthly at the same time), and I had children. I didn't want to sacrifice my time when my children were smaller for the rigors of medical school so I instead chose nursing school (as a stepping stone) to my ultimate goal. I eventually want to conduct research in psychopathy/sociopathy. I want to work in the field of forensics with the "criminally insane". I am a behaviorist at heart and want to know why people do what they do, you know, the nature v nurture issue. I have yet to find a way in as an NP but I know for sure I have a way in as an MD. As much as I and others would love to believe that MD's and NP's are "equal" we are not and in alot of forums (mostly by colleagues, sometimes by patients) we are not. That's a fact.

Hi Yellow finch, in this forum you stated....."If you choose Family NP and sometimes Acute Care NP programs then your knowledge base is larger and the time in school is generally longer". Where is this program at because all of the individuals I went to school with all went the same length of time as me. We all started off in general course work, then specialized our last year of school and all graduated together. I was in class with soon to be psych NP's, pedi NP's, FNP's, etc and no one got anymore schooling than anyone else. I noticed a trend throughout your postings, you try very hard to make a pitch for MD's and NP's as "being the same", but we aren't on so many levels. In the end, if someone wants to pursue medical school, then why not?...

APRN

kb12345

14 Posts

Hi DC2RN,

I totally hear you...but it's what I want, what IV'e always wanted for myself in the end. I also feel as i have stated before, that there are some doors closed to me in terms of my professional goals because I am only masters prepared that an MD would open.

The assuption that I would be "giving up 8 years of my youth" is totally incorrect. I wouldn't be giving up anything, only gaining/attaining what I want. In 8 years I will still be me, it's where I want to be-that's what I want to affect. As I stated in an earlier post...I have been in the military now for over 10 years and they are certainly willing to pay for school and pay me as well, obviously not without a "price". I will owe 4 years of service, I get to choose if it will be on active duty or reserve status, amongst other things.

APRN

Editorial Team / Admin

sirI, MSN, APRN, NP

17 Articles; 44,729 Posts

Specializes in Education, FP, LNC, Forensics, ED, OB.
"giving up 8 years of my youth" is totally incorrect. I wouldn't be giving up anything, only gaining/attaining what I want.

Well said.

We all must make the choice. It is an individual thing. All said and done I'm sure many if not the majority of most NPs at one time or another, considered med school. I know that I did.

If this is what you desire, don't let a thing stand in your way.

Specializes in ICU.

kb12345 and others... Thanks for pointing my comments out. I was really tired when posting what I did and may not have described the NP process as well as I could have. My point was only that we all learn just about the same in school mainly because it's standardized. Depending on the specialty we choose to follow will determine how much we use of that education. We never lose our knowledge, but have the opportunity to consult other specialists when necessary. I've learned through clinicals that the internal medicine specialists continue to apply a spectrum of understanding and consult specialists for those areas they do not attack. The same goes for each person who comes by to see the patient. No one area is better than the other. My point was more that NPs are just as capable to specialize as they are to go into family practice or internal medicine. It's all challenging and we work so hard to do what we do. I, for one, cannot lower the importance of a graduate degree and have high respect for MDs with their education and experience. At the same time we can't forget how far we've gone to get to where we are right now.

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