FNP vs. GP MD - starting to have doubts...again

zenman · Mar 25, 2006

What you're looking for is right in front of you.

Do you want to be a gardner or mechanic?

Do you want to be a healer or have the title of doctor?

Do you want to work with modern science or the Western stuff?

Do I need to slap the s**t out of you, LOL?

Papadoc · Mar 25, 2006

Here's a little background: I was pre-med in my undergrad and I got the opportunity to go to Korea for a year to learn acupuncture and get independent study and honors undergraduate credit for it. It was going to be an interesting and unique experience that would also make getting into a good medical school that much easier. Well the plan fell through on the other end, things happened...and then I graduated. The original plan was to go to DO school, but I was still interested in acupuncture. So after much debate, I decided to go to acupuncture school first for several reasons - I figured I wouldn't have to fortitude or time to go to three years of acupuncture school after DO school, and I also knew myself and figured I would be unable to make a paradigm shift after seven more years of reductionistic medicine.
So I went to acupuncture school with the plan of going on to DO school afterwards. But then life happens...got married, got divorced, and then found the perfect girl. After I graduated with my master's in acupuncture, I started researching DO schools but I wasn't too engaged since I was heading to China for a five week acupuncture internship. I figured I would take a fresh look at the situation when I returned.
Two weeks after I got to China, my girlfriend told me that I was going to be a daddy.
After some serious thought (while drinking very cheap Chinese beer), I realized that another seven years might be too much. By chance, one of my fellow classmates was a FNP. We talked a bit and I realized that I could fullfil my dream of having a integrative family practice by going the NP route. The benefits (shorter duration of the program, less intense program, program is essentially paid for by the hospital, more time at home after the program, less overhead costs) far outweighted the negatives (not a doctor, no residency, less training, much fewer patient contacts). Well, at least it did initially.
I am hoping that somebody here might be able to give me some of their insight or possibly point out some variable(s) that I am missing. I know it would be rough on my family to go to medical school, but my fiance is on board with either choice.
Any input would be greatly appreciated.
Edit: I am leaning more towards MD than DO now (thus the thread title).
J

Hey Josh,L.Ac

Good to hear from you buddy!

You and me both,huh. Restless minds. The thing to realize is this: If time of becoming a doc scares you off, basically it's not an issue. You will become older either way. But the regret of "shoulda/coulda" will catch up with you. Do not sattle for anything. If you truely want to be a doc, then just go for it

BTW I almost allways agree with zenman, but I'd bage to defer on this MD/DO vs NP thing. They are not mutually exclussive. Not all docs are "body mechancs", and not all NPs practice holistically. check out http://www.ACAM.org

for starters. there is enough place under the sun for everyone, IMHO. Question is do you want to do it at physician level, which will give you some leverage. I don't mean to hot shot ppl with your "doctor" status. But there is simply no comparison in the knowledge base, and the length of training. But if you are going to be doing things which will require to go outside the box, expect oposition, and competition on any level. Don't make any rushed decisions. Take your time, and take it easy. You may not be able to find the "right" answer, but the "right" answer will find you.

Good Luck

Josh L.Ac. · Mar 25, 2006

What you're looking for is right in front of you.
Do you want to be a gardner or mechanic?
Do you want to be a healer or have the title of doctor?
Do you want to work with modern science or the Western stuff?
Do I need to slap the s**t out of you, LOL?

I want to practice integrated medicine with full autonomy and the ability to decide which modality or combination of modalities will work best for each patient. This requires an extensive knowledge of both TCM and modern biomedicine. It also requires having freedom in terms of scope of practice.

My concern is whether or not being a FNP in either Kansas or Missouri will meet these requirements. The number of patient contacts that I would see in NP school averages about 500 (for comparison, I saw 400 to graduate from acupuncture school). Now if they had a NP residency...

...and a better scope of practice in these two states.

Slap away. I get hit in the head on a weekly basis sparring MMA. I can take it.

zenman · Mar 25, 2006

I want to practice integrated medicine with full autonomy and the ability to decide which modality or combination of modalities will work best for each patient. This requires an extensive knowledge of both TCM and modern biomedicine. It also requires having freedom in terms of scope of practice.

The greatest carver

does the least cutting.

- Tao Te Ching

You have probably heard the story about the Oriental Medicine doctor who was the envy of other physicians. It seems his patients did better than anyone else's and the other physicians were determined to find out why.

They observed the master physician for a while and discovered several interesting things. First, the master physician didn't really enjoy being a physician. Secondly, he did very little for his patients, usually just talking and laughing with them. He might occasionally insert a few acupuncture needles or prescribe a few herbs, but that was all.

The other physicians were dumbfounded! It seems they were doing as much as they could for their patients, inserting many needles and prescribing many herbs and other remedies. Why didn't their patients do better than his?

If our bodies are designed to heal on their own and when we as healthcare professionals get in the way and interfere too much, we do more harm than good.

You are already skilled in an energetic modality which is right there with the latest sciences...quantum physics. Now you want to integrate another modality. If you do that (take a little here and a little there), are you getting the full benefits of either approach or is this just hodge podge medicine? Is it better to stick with one framework to looking at your patient's problems and develop that approach to a high level? What is it we can do that helps patients the most? And who has full autonomy in today's medicine? Is the most effective person the one with the most autonomy?

My concern is whether or not being a FNP in either Kansas or Missouri will meet these requirements. The number of patient contacts that I would see in NP school averages about 500 (for comparison, I saw 400 to graduate from acupuncture school). Now if they had a NP residency...
...and a better scope of practice in these two states.

Don't know anything about these two states except that they have great steaks. What's to keep you from asking an NP school, assuming you went the NP route, if you could keep paying them money and extend your residency for as long as you wanted?

Slap away. I get hit in the head on a weekly basis sparring MMA. I can take it.

Now we're starting to get a handle on your rattled thinking, ROFLMAO! Can you take a slap to ST 9?

By the way, I'm still asking myself many of these questions. But, I get to do FNP post-masters so it's relatively cheap and not as time consuming and I enjoy going to school. But I keep asking, "What will work when modern medicine doesn't?" And I really think about what if I had nothing but my hands and my voice to practice with...no medicine or diagnostic aids...

Josh L.Ac. · Mar 27, 2006

I've been running a similar thread to this in the student-doctor forums to get a broader perspective on the issue. There are many points of contention that could be raised on this topic, but I'll focus on those that relate to my situation.

Do any of the NPs on the board feel that they could honestly and legitimately work as an autonomous FNP? To clarify:

I am going to an accelerated BSN (1 year), which would be followed immediately by NP school (while working as a RN full-time). In the context of a 1 year RN program + 3 years working as a RN + 2.5 years of NP school, would I be able to perform effectively enough in a fully-autonomous role?

Now the legal climate in KS or MO would not permit this, but I'm trying to determine the best case scenario. Part of this best case scenario would be that I am in the top of my class in both nursing school and NP school, as well as being a very good RN.

Thoughts?

BTW, I personally feel that acupuncture point / nerve cluster attacks are over-rated when attempted on a trained fighter. One of my training partners tried using these attacks on me when I took him to the ground to grapple (it was his only skill on the ground). I thought to myself "gee, these pressure points hurt". Then I went about putting him in bad position, slapped him a bit, then put him in a chokehold.

Why work on a risky and low-probability pressure point attack when a right hand works just fine?

Editorial Team / Admin · Mar 27, 2006

Josh L.Ac.
Do any of the NPs on the board feel that they could honestly and legitimately work as an autonomous FNP?

Yes. I do.

I am going to an accelerated BSN (1 year), which would be followed immediately by NP school (while working as a RN full-time). In the context of a 1 year RN program + 3 years working as a RN + 2.5 years of NP school, would I be able to perform effectively enough in a fully-autonomous role?

It is a good start, but IMHO, no. Not yet. You would need actual experience as an NP to practice as a fully autonomous HCP. And, that takes actual hands-on experience, often years.

Josh L.Ac. · Mar 27, 2006

Yes. I do.
It is a good start, but IMHO, no. Not yet. You would need actual experience as an NP to practice as a fully autonomous HCP. And, that takes actual hands-on experience, often years.

Thanks for the reply. What would you think about a self-imposed residency of some sort, or working directly under a physician for a few years as a NP before going off solo?

Editorial Team / Admin · Mar 27, 2006

The latter is a good idea, yes. Employed with a physician or a group of physicians for a time and see a variety of patients.

I started out employed with one physician in OB/GYN. Worked a while there. I was OB-GYN NP at the time. Then, after getting FNP, I worked with two physicians, peds and FP. A little more confident and branched out with my responsibilities.

Now, I am associated with 6 physicians, internal medicine, surgeon, peds, FP, and rheumatology....... and have complete autonomy. I do ED call as sole HCP and have a thriving practice. But, I have no desire to "hang out my shingle" despite my physicians asking me to do so. I can. But, choose not to.

I pride myself in the fact that I am a good diagnostician. That has been a plus for me. And, the dual certs didn't hurt. If I was a little younger, I might do that. Now, I'm not interested. Besides, I am working on my own business as medical-legal consultant as well as clinical practice.

Josh L.Ac. · Mar 27, 2006

Thanks Siri for your input. If I am understanding you correctly, you are saying that, for a person with my timeline of getting the NP degree + working as a RN, I would need [at least] several years of working under a physician before I was competent enough to see patients on my own. This makes sense to me, but it does raise the following question:

If becoming a competent autonomous FNP requires over 6 years (1 year accelerated BSN + 2.5 years NP school while working as a RN + 3 years working under a physician), what would be the benefit [professionally - not in terms of time, money, family] of taking this route over becoming a FP MD (4 years medical school + 3 years residency)?

Editorial Team / Admin · Mar 28, 2006

Josh L.Ac.
If I am understanding you correctly, you are saying that, for a person with my timeline of getting the NP degree + working as a RN, I would need [at least] several years of working under a physician before I was competent enough to see patients on my own.

No, that's not what I meant. To be totally autonomous one should have plenty of experience. "Plenty" is different to different people. I felt competent after a short time in practice. I felt totally autonomous after a few years in practice. Big difference. You can see patients on your own now (after graduation). But, do you really and truly want to be solo with zero actual experience post grad??? Really? You will get theNP experience post grad not as a student. Take my word for that.

If becoming a competent autonomous FNP requires over 6 years (1 year accelerated BSN + 2.5 years NP school while working as a RN + 3 years working under a physician), what would be the benefit [professionally - not in terms of time, money, family] of taking this route over becoming a FP MD (4 years medical school + 3 years residency)?

You cannot start counting your ability towards competency until after graduation and during your work as an NP. You receive the training during your program and are exposed to several patient situations, but the actual experience is garnered while you are actually practicing as an NP. Autonomy will come later with experience.

I guess what I am trying to say is (and, there will be some here who disagree) iin order for an NP to be totally competent and autonomous and be anyway equal to a physician, the NP will need to have the experience under his/her belt.

The time required for each to reach that time cannot be measured and indeed is different for each and every NP.

And, if you desire to be MD, then that is exactly what you should do. I considered it after years as an NP, was accepted into med school without any problem and decided at the last minute I wanted to continue my career as an NP. I've never looked back. But, that moment of indecision.........

Josh L.Ac. · Mar 28, 2006

No, that's not what I meant. To be totally autonomous one should have plenty of experience. "Plenty" is different to different people. I felt competent after a short time in practice. I felt totally autonomous after a few years in practice. Big difference. You can see patients on your own now (after graduation). But, do you really and truly want to be solo with zero actual experience post grad??? Really? You will get theNP experience post grad not as a student. Take my word for that.
You cannot start counting your ability towards competency until after graduation and during your work as an NP. You receive the training during your program and are exposed to several patient situations, but the actual experience is garnered while you are actually practicing as an NP. Autonomy will come later with experience.
I guess what I am trying to say is (and, there will be some here who disagree) iin order for an NP to be totally competent and autonomous and be anyway equal to a physician, the NP will need to have the experience under his/her belt.
The time required for each to reach that time cannot be measured and indeed is different for each and every NP.
And, if you desire to be MD, then that is exactly what you should do. I considered it after years as an NP, was accepted into med school without any problem and decided at the last minute I wanted to continue my career as an NP. I've never looked back. But, that moment of indecision.........

Gotcha. I have a similar thread to this on a student-doctor website and forgot to post on this one that my time estimates are for the best-case scenario. A graduate-level biological statistics class ruined my brain to the point where I have to estimate the time-frame for the best-case, the average case, and the worst-case. I really don't know why...

Back on point. Obviously it also takes a physician a certain amount of time after residency before they are competent to be fully autonomous, so attempting to determine which will take longer is probably not very significant. So this makes me wonder why become a FNP? If the time involved, or the money required, or the stress on the family, or the difficulty of the program is not an overriding factor, then why would someone choose to be a FNP instead of a FP physician? Is there something I'm missing (since I'm not a nurse or physician yet)?

On this board, I've seen an enormous amount of debate between the nursing model and the medical model. I've also seen a large amount of debate between nursing theory and medical theory. But what does this really all mean? And if a FNP practices effectively as an autonomous provider, are they practicing the medical model or the nursing model?

Part of my confusion is that I have a recently developed skepticism for the semantic differences between groups. This is further compounded by the fact that many people respond with soundbites when asked about the differences in characteristcs of two groups.

Help please.