NP to physician... is it possible?

[adventure_rn, MSN, NP]

I also struggled with the NP vs. MD question when I was first deciding whether to apply to NP school. I had a lot of self-doubt throughout my NP Program, but now that I'm out and working on a daily basis alongside residents, I feel like I dodged a huge bullet.

My current job has helped me to appreciate just how much you sacrifice (beyond money) to pursue medicine. In my role, I effectively work in a similar role to a hospitalist in a specialized peds unit, and perform literally the exact same role as the residents who rotate through as well as some of the attending hopsitalists. I work 36 hours per week and make ~$120,000; the residents work > 60 hours per week and make ~$60,000. I have a great deal of personal autonomy through self-scheduling; they are told a year in advance where to go when, and if that means working 18 consecutive days/nights in a row, they have to suck it up and take it. Unlike being an NP, their maternity leaves are cut short, and they don't have any opportunity to drop down to part-time. Looking back on it now, I think I'd be really frustrated with myself in the moment if I'd chosen that path (and I know a lot of the residents get really annoyed when they hear us talking about how we're paid so much more to work so much less).

Similarly, when comparing the finances, you have to consider all of the lost income you'd miss out on. Not only would you have some school debt for your fourth year, but you'd be missing out on your entire income for the four years of medical school, and you'd be missing out on the difference between your NP salary and your resident/fellow salary for the remainder of your training; in total, that will probably amount to at least $500,000 in lost income (even at $80,000/year salary), not including all of the interest you'd miss out on not being able to contribute to your retirement savings. Furthermore, in the past several years physician reimbursements have been decreasing while NP salaries are rising; you may find that in the long run, finding a more lucrative NP job now actually nets more total gain than putting your career on hold for med school then eventually being an attending (especially if you still want to work in primary care).

Another point that really changed my perspective on the extensiveness of the time commitment was something my dad (a physician) told me. I knew that if I pursued my MD that I would want to complete a fellowship peds cardiology. When I asked him if he thought it would be cool if I were to be a peds cardiologist, he joked, 'sure, but I'd probably be dead by the time you finish.' He's in his 60s now, recently retired, and in good health and I was about 30 when I was making the decision, but his comment helped me to appreciate how much your life can change in the time it would take for me to complete the process from start to finish (including retaking my outdated pre-reqs). Your priorities 15 years from now may be very different from what they are now. Like residents, fellows can have similarly horrendous pay and schedules, and I realized that as a fellow, 40-year-old me would be very frustrated being told where I could live (based on fellowship placement), what days/times/sites I had to work (including specialty areas that I dread), and whether or not I was allowed to take leave or ask for vacation; I'd be especially frustrated doing all of that for way less money than I'd be making as an NP.

I'm still occasionally envious of how extensive the training for the peds cardiac fellows is, but then I look at their quality of life and think that to me it wouldn't have been worth the sacrifice. Plus, at my hospital, I have access to nearly all of the learning opportunities, presentations, and conferences they get to attend, so if I really want to learn the content, I can do so on my own time.

To me, I wonder if you might be just as fulfilled with way less hassle if you can find a more satisfying NP job. I work at an academic medical center with a lot of NPs with extensive specialized training experts in their fields. At my hospital (per HR), we are less likely to be sued than physicians since people assume that physicians have more money than NPs. And with NP, as your priorities change, it is much easier to adjust your schedule than I will be as a med student/resident/fellow (I.e. dropping to part-time when you want, and picking back up to full-time whenever you're ready). The great thing about the NP role is that it is so diverse, and there are probably opportunities out there that would suit your interests and allow you to learn without feeling so burned out.

[FullGlass, BSN, MSN, NP]

Of course you can become an MD.  However, you must go to med school.  It is very hard to get into med school, so if you are serious, then you will have to go to the school that accepts you.  That probably won't be near where his residency  is.  To pay for it, you could join the military yourself.  There are also plenty of scholarships available.  I have known women who timed their pregnancy to occur in the last year of med school, giving birth after graduation.  The other option is to wait for a few more years, after your husband completes his residency.  It is not too late to start med school in your late 30s or early 40s - I've known people who did that, too.

If you are an NP making $84K per year (I'm assuming you are not in an NP residency), then you are way underpaid.  NP pay varies based on location.  The SE US pays terrible.  The Western US pays the best, especially CA.

It sounds like you don't like your NP job.  If it is that bad, then look for another one.  

Besides becoming an MD, another option is to get a post-grad certificate in a better NP specialty.  I'm a PMHNP, work from home, and make over $200K per year.  No overtime, I work my 8 hours, maybe 20 min extra, and I am done.  No on call.  I also work in CA.  If you are in an NP specialty that lends itself to telehealth, you can live anywhere and work for a place that pays well, as long as you have the required state license.  There are PMHNPs that make $250K-$500K per year as contractors.

There are other NP specialties that pay well, also,  In addition, at least on the West Coast, pay for FNPs has been going way up and is approaching that of specialist NPs, often with great benefits.

In CA, there are RNs making $200K per year!

[Starfish111]

Of course you can. But know that 84K is low pay for an NP and that you can/should be earning 100K+. Unless you will regret not going to medical school, in my opinion you ahould maximize being an NP since this job is IDEAL for balancing work life with having children. 

[Snowranger19, MSN, APRN]

What would becoming an MD do for you that additional training/education as an NP wouldn't?  That is a lot of extra cost, training, and "starting over".  There is always CME, additional certifications, etc. that you could do if it really is about having more knowledge.

Your pay is very low... it is below what I made when I was an NP resident with the VA.  Are you sure its not just your current position/job that is making you feel this way?

[lifelearningrn, BSN, RN]

I'm a believer in doing what is in your heart. You say you want children. How many children do you want? While I know people put off having kids until after their careers are established, however, it's not always easy, especially when fertility rates decline rapidly after mid-30s.  With all the moving parts here, this is the one I'd focus on. Once you have children, your career goals may change completely.  You can always go back to school, but the clock is ticking on having children.  JMO 

[Simplebeauty1, RN]

Hi famNP123, you have received some very good feedback. I'd like to add from the perspective of a veteran/current mil spouse and mom who is getting my FNP right now. First, I also wrestled with the same dilemma and FNP won out. I did have my kids and get them self sufficient prior to focusing on my career and going back to school. If you have a mother's heart, then you'll likely want to do the same. You only get one shot raising your babies and no do overs. You want to put all you can into it and them, it is so worth it. 

Next, and really important,  your husband's GI Bill will NOT pay for your 1st three years of medical school. GI Bill is capped at a certain amount every year. I use it for my FNP program and the capped amount pays for 1 semester. Now, it depends on your schools cost but from what I understand most medical school tuition is more than about $26,000, which is about what the cap is. Yellow ribbon helps out after that but it will not cover everything. Now as one poster has stated you can join the military and likely get it all paid for with a military committment, which may also interfere with your desires for raising a family. A two military member household could mean various deployments and leaving the kids with trusted family members. 

I agree that you probably just need to find your niche using your FNP. Get something with a good work life balance and have and raise your babies. If you still feel the tug, then go for it cause you won't feel satisfied until you sate the desires of your heart. 

 

 

[CuriousConundrum]

It sounds like you'd be ceasing your perceived low income for many years, followed by some very deep debt or other obligations (military, USPHS, etc.), and then at about 55 years, you may start making the living you dream of.  

I would get a different NP job.  Develop a side hustle - some sort of NP contract work or other income stream entirely - and live your life.  

Comparison is the thief of joy.  

[offlabel]

Best thing to do is speak with docs that are mom's as well. It's also a specialty sensitive answer, ie, a CT surgeon who is a mom (pretty rare IME) would probably give a way different answer than a family practice doc. 

[Thanksforthedonuts, MSN, APRN]

I feel that your current frustrations are with your low paying job and high amount of responsibility. Do you feel that being an MD would dramatically change this situation? 

Are you able to leverage your current practice by either finding a different job with better pay or finding a niche market to serve? Many PMHNPs make 3-4x the amount you are currently making, have you thought about a post-masters? Or maybe esthetics? 

More school doesn't automatically equal higher pay. Learn to leverage your degree. Don't work for your degree, make your degree work for you. I make seven figures with an RN degree only (I am a business owner). I chose to pursue PMHNP degree to leverage myself into another business. I would say it's all about your mindset. 

About me: I am 32 with 6 children (all biological). You can do it. 

[FiremedicMike, BSN, RN, EMT-P]

I don't have family members who are physicians, but my job role at the FD puts me in direct contact with physicians outside of their typical hospital duties.  They are strong and dedicated, generally available 24/7, and never have an off switch.  This is what ultimately convinced me to forego medical school - because I know I'd have that same work ethic, and I have realized that I want to slow down at some point in my life. 

If I went to medical school now, I wouldn't even be able to think about slowing down until I was at least 65.. 

 

[adventure_rn, MSN, NP]

I know I already responded, but I was looking back through some of your prior posts and had another thought. By your own admission, it sounds like you probably jumped into your FNP program a little sooner than you should have before you really knew what you wanted.

Based on what you've written, I wonder if you'd be happier in acute care working at a teaching hospital. I know you said that you'd feel more fulfilled if you had more learning opportunities and mentorship, and in an academic medical setting you can find that more easily. My attendings know that I'm a new grad, and they go out of their way to incorporate teaching into rounds, like discussing patients' anatomy and how that impacts surgical planning and potential complications, or pulling up echos/cardiac MRIs/caths to walk me through the imaging findings. They check in frequently throughout the day to bounce ideas off of or answer questions when I'm stuck, and I learn so much from my interactions with them on a day-to-day basis. I have told them explicitly how much I appreciate their teaching, and I think they appreciate that I am more enthusiastic to learn than many of the residents who are only doing our rotation because it's required. On days that I work with residents (about half of my shifts), we have semi-structured teaching built into the day since the residents need to learn the specialty basics during their rotation. Eventually the experienced NPs become so knowledgeable about the specialty that they end up actually teaching the residents. We also have a near-constant stream of continuing education in my specialty (several times a week we have surgical conferences, transplant conferences, neonatal conferences, M&Ms/case conferences, plus very frequent subspecialty and research presentations by our attendings and visiting speakers). I'm sure it varies significantly by institution and specialty, but you may find that you thrive in a hospital setting where you have a team-based dynamic with your attendings rather than essentially flying solo in primary care.

If you do decide to pursue a post-masters certificate to become certified in a second specialty, like adult-gero acute care, I would suggest you go to the very best school you can find. I know some NP schools get a bad rap for not teaching enough medicine, but I went to one of the top-ranked NP schools in the country, and I learned a tremendous amount in a very short period of time. Our instructors held us to an extremely high standard, the level of detail in our coursework went far above and beyond the bare minimum to be able to pass our boards, and our lectures were taught by some insanely smart people (for instance, many of our neuro lectures were taught by neurocritical care PICU attendings from our affiliated world-renowned children's hospital). I know this probably makes me sound like a total snob (and I usually wouldn't brag about it just to brag about it), but I truly believe that my school delivered on its reputation (and pricetag) and I received an exceptional education. I graduated school feeling extremely well-prepared to hold my own in an acute care setting.

Really strong programs, especially those at private schools, may also help set you up with the best possible clinical experiences. I think one benefit of attending a school that coordinates your clinicals is that they are more likely to recognize your clinical areas of weakness and push you out of your comfort zone. I'd always worked with babies, and my mentors intentionally put me in clinical sites with adolescents; I didn't love it, but I sure learned a lot, and it has been very helpful in my NP practice. By contrast, if you're finding your own clinical sites it's easier to pick sites that are either familiar to you, or are the only sites that you're able to find.

I don't know about their adult programs, but all of the Duke peds programs (acute, primary, and neonatal) are fully online with only occasional campus visits, and they set up your clinical sites even if you're out of state. If you've got some GI bill money burning a hole in your pocket, you might see if they offer a post-masters certificate you're interested in. I didn't go to Duke for NP school, but I know several people who did and had excellent learning experiences (in peds, at least). It usually only takes about a year full-time to complete a post-masters program in a new NP specialty, since you're only completing the clinical sequence for that specialty.  It would be a much shorter time commitment than going all of the way back through the med school route.

The one thing I'd caution you about is that when you first go back into an academic hospital setting, you'll probably initially get some FOMO working alongside residents/fellows (that's how I felt at first). It can be hard seeing how much they're learning and knowing that you're certainly smart and dedicated enough to do what they're doing. However, I think once you work directly with them in a comparable frontline role (and see their crappy 60+-hour work weeks and frequent mandated 24-hour call shifts), you might start to experience some of the relief that I described in my earlier post that you're done with training and are being well-paid.

With acute care/procedural areas you'll almost certainly make more money than outpatient, although part of that is because you're expected to work some off-shifts (nights, weekends, holidays). I also appreciate that with an acute care degree, you have a lot of flexibility to work inpatient but also in some specialty procedural and outpatient settings with more predictable schedules (like IR, cath lab, etc.)

Just some food for thought.

[FNPRCPR, BSN, MSN, NP]

These answers are incredible!

I do want to add from the perspective of witnessing a classmate who is a close growing go through this similar turmoil in decision making.  I had a classmate who joined my class (BSN-MSN) after delaying school coursework mid -program in order to gain more nursing experience for an additional year. Classmate is brilliant and engaged; ended up graduating with us and went onto work in the ED for about two years. The last year. Had the itch to go to medical school. Fast forward about six years now that classmate is finishing up  third year of medical school. My classmate is extremely happy of the choice and thankful for the RN and NP experience as well. Keep in mind classmate is a male and he plans to go onto residency then fellowship and has time. He hopes to find a wife along this journey but is in no rush. Some may say you can buy time with fertility treatment there are no guarantees in anyway.
 

everyone's comments above illustrated some really great points for potentially improving your current situation.

I've had the struggle between MD vs NP. The MD longing for similar reasons in terms of the trainings but as a 'seasoned' FNP and now finishing up my PMHNP certificate and doing this all while  being a mother to two small children , wife, seeing amazing patients in an academic setting's chaotic safety net hospital  primary care clinic-developing our department's group classes with key and untraditional stakeholders- in the purgatory data collecting stage for my paper (expected publication 2025), building my private practice, developing homeschool curriculum, planning for having our last child,  while taking additional courses in integrative medicine I can say that I am satisfied with my choice in these circumstances. And I hope it displays some of  the many opportunities NPs have.  I must say even today the MD longing occurs with diminishing fervor (it comes in smaller less frequent waves and intensity). Plus I told myself there is always the PhD much later if the itch won't scratch.

Also, I work 'part time' but if I worked full-time officially,  I would make about $140,000 a year according to my salary statement in an academic setting on the East Coast  are you in a southern state? Is your pay typical for your area?.  as soon as I complete my PMHNP program this Summer, I'm going full throttle with my private practice and decreasing my hospital job hours as I've been an FNP (worked in GI for years and completed a fellowship- my first love; and transitioned to primary care due to schedule flexibility for family/personal) for several years and am incorporating everything I've learned to go into my integrative medicine practice that is telehealth and in person (I have secured  two offices locations, clearance (legal and admin). 
 

Are there ways to optimize your current situation?
The comments about the significance of continuing education is critical to be a knowledgeable practitioner. I've taken so many courses and my library is filled is several medical texts and even USMLE reviews which helped me understand more. In my clinic I'm the primary  person that see the physicians in the clinic and hospitaland their children as I give comprehensive care just like ALL the NPs in my clinic but we all have different interests and skills . The physicians ask me about GI related matters for their patients. It's what you do with the time you have. Plus another benefit of being an NP is you can transition to other specialties more easily.  The learning and financial opportunities for both avenues are potentially  limitless and the satisfaction you gain is immeasurable in the right conditions. 

All to say , I totally feel where you're coming from and I have no advice either way, but I must say even doing this one year PMHNP program with small children being the type of mother and wife that I am and want to be (involved/engaged and will homeschool this Autumn) has been very challenging and extremely draining and I could not imagine this experience going through the medical school/residency route for years .  we're all built different and we all have different strengths and when push comes to shove I'm sure you can make it work either way just plan as best as you can for the reality you choose. Plus in life you can always change your path. Good luck to you 🍀!