NP or MD/DO????

WhoniverseNurse · Jun 13, 2015

The whole DNP (Doctorate of Nursing Practice) requirement for NP's is not a requirement. The ANA was hoping to make it such, but due to a large NP and RN shortage, as well as a shortage of APRN's qualified to teach at that level, it is now simply a recommendation. At this point, MSN prepared NP's are still widely utilized and respected. I do not foresee this changing at all in the next 10-20 years. Depending on the state you live in, NP's can practice under the direct supervision of a MD/DO, work in collaboration with a MD/DO (like having one reachable by phone), or work completely independent of a MD/DO (a growing number of states already do this). Look into what state you plan on practicing in. In addition, if you are not sure, look into bridge programs. Try NP/PA out, and then there are bridge programs to MD/DO that usually take about 2 years after obtaining your NP/PA. In the facility I currently work (I work ER), NP/PA's work in collaboration and often take serious cases (the main exceptions being large traumas). I work in Wisconsin, which is a "collaboration" state. Good luck in any case, and wish you well!

synaptic · Jun 13, 2015

by the time you finish any of them outlook for md do will be better. There are positions for nps in er and trauma but if you really want the full experience of trauma or ER (along with much much higher pay (the er docs where i am make 3x the midlevel pay) i would go to md or do school

KatieMI, BSN, MSN, RN · Jun 13, 2015

The subject was discussed here just slightly more than ad nauseum but the summary looks like this:

- MD/DO: longer schooling (and please mind the fact that EM residency is currently super-competitive), guaranteed more loans unless you are independently very rich, more power, more overall responsibility, more business, more evidence-based stuff, possibly more money, more chances to get sued, no real chance to change specialty after residency.

-NP: go with the flow schooling, probably less loans, changing specialty possible but can be pricey, less power, probably but not always less acuity (which doesn't imply less interesting cases), more "humane" model of care, more bureaucratic hoops to jump through with dependent/independent care. Usually but not always less "science" , although nobody prohibits NPs reading the same textbooks and using the info where appropriate.

There is also PA pathway which looks like something sitting right in the middle of things except that PAs never will become fully independent providers in the eye of the law and can change specialties freely (can be very different in real life).

Only you can decide what is more appealing.You can become an excellent clinician and make pretty good money by taking either of these three ways.

P.S. again, EM is a super-competitive and difficult to get into specialty for MDs and even more so for DOs.

P.P.S. there not going to be total overhaul for DNPs only in the next decade at the very least. The same agade about LPNs is going on for like a quater of century for now and the end is nowhere near for very objective reasons.

thenightnurse456 · Jun 14, 2015

It sounds like you want to be an MD. if you're prepared to do the study and put in the time, go for it.

NPs in ED are amazing but they are always in fast track.

synaptic · Jun 14, 2015

Em isn't as competitive as you may think. I know several people that got in with decent step scores but nothing amazing. Of course I'm not a dr so I personally don't know but they are and said it wasn't so bad.

Also where here I work all the docs are fp and im that work er. In rural areas u don't need em cert and they make pretty good money in rural areas also

go be a doctor if you love trauma.

Trauma Columnist · Jun 14, 2015

Moved to student np forum

Kittenlove · Jun 14, 2015

Going into emergency medicine is not hard as what you think. I just completed my forms for medical school. I had to choose the top 3 specialties I wanted to practice. Trauma medicine and emergency medicine were my top. Per my navigator, it will not be a problem for me to be placed in one of those residencies. I will be placed in trauma medicine shadowing my first year, then have the option to continue.

Stay focused and do your research. If you have any questions, feel free to PM me.

Oh. There are a lot of loan payback incentives!!!

DrKim · Jun 15, 2015

While obtainment of the DNP is not a mandatory requirement for advanced practice nurses, top ranked graduate nursing programs are shifting in that direction (offering the DNP instead of the MSN) and that is usually very telling. Your degree of autonomy when practicing as an advanced practice nurse depends on the state in which you wish to practice. Some states are incredibly restrictive (like FL), and others are very relaxed (like CA). It depends on where you want to work when you're done. Do you want a top ranked, highly competitive magnet facility on the cutting edge of care? If yes, then I would say aim high and get the DNP.

Whenever I see clients oscillating between nursing and medicine, my question to them is always this: What is the feeling or emotion that you are chasing? A nurses' approach to health is different from a physician's approach. You originally chose to become an RN. Why are you contemplating medicine now? Usually, it boils down to a desire to feel respected and be in control of patient care. No? Then ask yourself, if you changed to a facility with a stronger shared governance and nurses had a louder voice, would you be considering this change?

Jules A, MSN · Jun 15, 2015

While obtainment of the DNP is not a mandatory requirement for advanced practice nurses, top ranked graduate nursing programs are shifting in that direction (offering the DNP instead of the MSN) and that is usually very telling.

It tells me they are interested in additional tuition. It is no secret they are also pushing the direct entry programs because they have a better chance of retaining students tuition income if they don't postpone school to practice.

DrKim · Jun 16, 2015

Actually, it's not that much of a difference in tuition from the school's perspective. Students have this unfortunate misconception that every check they write goes directly to the school. Each individual program actually gets paid last. Most nursing programs are funded heavily by other means. Many of the top ranked nursing programs are fortunate to have other means of staying afloat.

It's actually credentialing bodies (AACN, CCNE) and organizations like NONPF encouraging this push. When these organizations start "experimenting" with top ranked schools, there's usually something coming down the pipeline. As enrollment in MSN programs decline and enrollment in DNP programs increase, schools may do away with MSN programs as a means of preserving the limited faculty resources and preventing students from paying for 4-5 years of graduate education (MSN + DNP) when they could just pay for 3 (DNP).

Jules A, MSN · Jun 16, 2015

Actually, it's not that much of a difference in tuition from the school's perspective. Students have this unfortunate misconception that every check they write goes directly to the school. Each individual program actually gets paid last. Most nursing programs are funded heavily by other means. Many of the top ranked nursing programs are fortunate to have other means of staying afloat.
It's actually credentialing bodies (AACN, CCNE) and organizations like NONPF encouraging this push. When these organizations start "experimenting" with top ranked schools, there's usually something coming down the pipeline. As enrollment in MSN programs decline and enrollment in DNP programs increase, schools may do away with MSN programs as a means of preserving the limited faculty resources and preventing students from paying for 4-5 years of graduate education (MSN + DNP) when they could just pay for 3 (DNP).

Thanks for writing and the truth is I have no clue abut the fine details regarding who is initiating this push so this is interesting information to consider. It seems odd to me that the credentialing bodies or the boards of nursing would be pushing it when in fact they are still credentialing MS students. I agree 100% that the DNP is unlikely to go away but I still have to believe it is largely financially motivated. An extra years worth of graduate tuition for all nursing students across the board is a significant amount of income for universities, imo.