NP Student, highly wanting to do med school?

Grande_latte04 · Dec 7, 2020

My most recent job I worked often with two providers: An MD and an FNP. They were equally knowledgable, equally experienced, and honestly I could not tell them apart aside from the fact that the NP was slightly older than the MD. Finish NP school and become an NP. As many mentioned, time is not on your side for all the things you wish to accomplish.

Rouge_bbase · Dec 13, 2020

Quick question - is your program a completely online-based NP Program? If so, maybe that's why you feel like there's a lot of fluff? I always wonder if there's more fluff when it comes to online NP programs (I.e., busy online work to replace the in-person learning/lectures) vs in-person NP programs. Not sure about those NP programs that are hybrid.

Anyways, keep in mind that most med schools will wonder why you didn't choose to work as an FNP for a few years. They might think you enrolled into FNP as a very expensive route INTO med school. I feel like they might also interpret this as you not knowing what you want to do - in their eyes, med schools can grant you admission and then you realize you don't want to be a doctor. So, it would look a lot better to work a few years as an NP so that you have an argument as to why it's not for you. Your argument for using the NP education while you were an NP student is not a strong argument since you haven't worked as an NP yet. I would recommend to work a few years as an NP, and then apply to med school (maybe 2 years minimum). But if you do that, keep in mind you'll have to take courses while working as an NP for these few years. Then apply to med school. Think about the workload and where you want to be in life (esp as a woman - I'm a woman too and I think about this. I'm also ALOT older). Age is not the issue here- it's more so knowing what you are capable of at an older age - will you still be as sharp and quick and less tired (I.e, my back hurts now LOL) while you're grinding against fresh 23 year olds in med school? Also, a lot of people don't emphasize this - but be aware of what you want in your PERSONAL life. If you want a family - factor that in.

FamNP123 · Dec 14, 2020

On 12/1/2020 at 10:17 AM, juan de la cruz said:

There are so many paths and variables involved in choosing between a career as a physician and an NP. Ultimately, it's a personal decision. However, I have a few stray observations based on the posts thus far:

1. OP is in an FNP program presumably with a goal to work in Primary Care. Earning potential is not widely different with a comparative Family Practice trained physician. Training is less for NP's which can be an advantage. However, OP's concern of the inadequate training may be remedied by additional training including a Primary Care NP fellowship which exists.

2. Many posters are PMHNP or are in a PMHNP program. That makes sense that the role is primarily the same and there is some wisdom in picking the NP route in that case especially with the existence of independent practice states.

3. I am an Adult ACNP and my practice environment is vastly diverse and geared toward specialty practice from ICU to Hospital Medicine to Cardiology, etc. Hospital based practice will always rely on physician leadership to some extent regardless of independent practice laws for NP's. The pay gap for NP vs physician will also be wide with physicians winning that battle for good reason because these are commonly multiple boarded physicians with lucrative specialties. However, it did take them years of training to get to that point.

The trend in hospital based practice even in academic medical centers is collaborative practice between physicians and NP's even with residents and other physician trainees around. Residents are temporary "workers" and are not always invested in their rotations for various reasons. NP's will always have a presence in the hospital setting and bring consistency to a medical practice. Perhaps this could be a role the OP could explore given that she is more interested in a collaborative practice, mentor-mentee relationship.

Yes, I have been realizing that hospital NPs have a much more collaborative role with physicians. I think this is because hospital oversight for patients is more strict, and physicians often need to sign-off on every note that an APP writes (at least at my hospital). The role of APP at my hospital involves the NP/PA rounding on the patient, putting in new orders for gaps of care or if RNs need simple orders, yet the physician kind of decides the ultimate route regarding consults, new medications, and discharge decisions. Whereas outpatient NPs are pretty much overseeing a lot of patient's overall care, and may ask the CP a question when needed in more complicated cases of patients they ultimately see over (at least that's what my preceptor does).

Sadly, FNPs do not have much of an option in my state to be in the hospital. I also would not feel prepared at all to round in a hospital. I do not feel confident in my education as it is, especially doing hospital work. My FNP program is almost fully geared toward outpatient option. My only option if I did not go to med school would be to get a post-masters ACNP certification. Yet after being weary about my current education, I'm worried that would just be extra letters after my name and not be actual rigorous education and clinical experience.

The other option is the Primary Care NP fellowship. I have seen there are quite a few, and I may look into them. There are few in my state, which would require moving for a year, which I would be willing to do, but worried it may be messy trying to get RN and NP license in a different state.

FamNP123 · Dec 14, 2020

14 hours ago, wp650 said:

Quick question - is your program a completely online-based NP Program? If so, maybe that's why you feel like there's a lot of fluff? I always wonder if there's more fluff when it comes to online NP programs (I.e., busy online work to replace the in-person learning/lectures) vs in-person NP programs. Not sure about those NP programs that are hybrid.

Anyways, keep in mind that most med schools will wonder why you didn't choose to work as an FNP for a few years. They might think you enrolled into FNP as a very expensive route INTO med school. I feel like they might also interpret this as you not knowing what you want to do - in their eyes, med schools can grant you admission and then you realize you don't want to be a doctor. So, it would look a lot better to work a few years as an NP so that you have an argument as to why it's not for you. Your argument for using the NP education while you were an NP student is not a strong argument since you haven't worked as an NP yet. I would recommend to work a few years as an NP, and then apply to med school (maybe 2 years minimum). But if you do that, keep in mind you'll have to take courses while working as an NP for these few years. Then apply to med school. Think about the workload and where you want to be in life (esp as a woman - I'm a woman too and I think about this. I'm also ALOT older). Age is not the issue here- it's more so knowing what you are capable of at an older age - will you still be as sharp and quick and less tired (I.e, my back hurts now LOL) while you're grinding against fresh 23 year olds in med school? Also, a lot of people don't emphasize this - but be aware of what you want in your PERSONAL life. If you want a family - factor that in.

My program is completely online. The classes are fast-paced, 7 weeks each. 7 weeks is fine for fluff classes (pop health, health politics, theory, ethics, etc.), but not for the foundational classes (pharm, patho, primary care). These need to be extended to give students more ability to dive deeper into material. Our tests are not proctored. I didn't cheat for any, but it is 100% possible to cheat on every test. This scares me.

If I could go back in time, I would have either 1) gone to med school, or 2) done more research to find either a hybrid or in person NP Program that is more rigorous. At the time, I chose online as I live somewhat rural and wanted to live with my parents and still be able to work. I'm seeing now how that doesn't set you up for the best education to be a provider. So now I am in 2 years too deep and not sure what to do (just accept my decision, do my best to be a great and competent provider, or pursue medical school).

I do love nursing, and I know that NP scope SHOULD be different that physician, yet it seems NPs are being pushed to be more independent even with physician oversight (seeing too complex of patients, not having a CP actually there at the office, taking on too many patients, not receiving formal training).

Family is 100% a large issue in this. If I were single, I would absolutely pursue medical school after NP school or shortly after (1-2 years). I am engaged and would like to have children, making medical school much more tough. Also, my fiance wants to do MD/DO versus PA and is applying to both next year, which would make it even more difficult. May have to just wait until he is done with the actual medical school portion if I still wish to pursue medical school.

FamNP123 · Dec 14, 2020

On 12/7/2020 at 10:54 AM, Grande_latte04 said:

My most recent job I worked often with two providers: An MD and an FNP. They were equally knowledgable, equally experienced, and honestly I could not tell them apart aside from the fact that the NP was slightly older than the MD. Finish NP school and become an NP. As many mentioned, time is not on your side for all the things you wish to accomplish.

Yes, I know that many NPs are great. But I do believe the medical school style sets you up for the best outcomes in terms of knowledge and experience prior to seeing patients independently. PA school even offers a more in depth, medical-style based curriculum. I know NPs are supposed to have a different scope and offer a unique style, but I often see NPs doing exactly what physicians do in the clinical role, especially in primary care.

I also do have quite a bit of self doubt in my ability to be a great and competent NP. This is due to 1) I have only been an RN for 3 years. 2) My program is online and not difficult. So, it's not that these insecurities reflect the NP profession per se, more so my personal situation and poor choice to leap into NP school without really considering much or gaining more RN experience (although many argue you don't need RN experience to be a competent NP, which I do think is not completely true, it depends on the individual highly).

db2xs · Jan 17, 2021

@RNAudrey123 I already responded to your original post and wanted to point your attention to this article from JAMA about Carl Allamby, MD, who owned an auto repair shop for 25 years and has recently graduated from medical school at age 47! Never let age be a deterrent ?

FamNP123 · Jan 22, 2021

On 1/17/2021 at 11:56 AM, db2xs said:

@RNAudrey123 I already responded to your original post and wanted to point your attention to this article from JAMA about Carl Allamby, MD, who owned an auto repair shop for 25 years and has recently graduated from medical school at age 47! Never let age be a deterrent ?

Wow, amazing! I can’t wait to read it. Thank you for the encouragement and resource ?

db2xs · Jan 22, 2021

11 hours ago, RNAudrey123 said:

Wow, amazing! I can’t wait to read it. Thank you for the encouragement and resource ?

This or this might be better. The JAMA article requires a subscription.

Bluefamily, MSN · Jan 24, 2021

Hi OP,

#1. What was your reasoning for becoming first a nurse and then to pursue an advanced practice degree? Reflect on your original intent.

#2. With only 2 years of experience as an RN, why would you feel self-assured to diagnose following a 2 year's MSN NP Program? It's a good probability you haven't clocked enough clinical depth and breadth of experience. There are APRN fellowship programs available.

#3. If you are referring to "fluff" classes as health politics, research and population health---you've really still got a lot to learn about the position NPs hold within those landscapes.

In med school, you still have to do your own studying and your own homework. No one is taking your tests for you. The med students have to know the details, so do the NPs. Why aren't you holding yourself accountable for not taking the educational opportunity seriously?

Reconsider your original intent for nursing. Reconsider your expectations for the APRN program you chose. Good luck.

Psychiatrist · Feb 18, 2021

I am new. I noticed that there are a lot of misconceptions posted about what is taught in medical school, acquiring additional knowledge, etc. From reading through the posts, I can only offer that you are going to be older regardless, and have to ask yourself where do you want to be at a given age.

In terms of the job market, a good starting point is looking at which government agencies are offering student scholarships. If none are being offered in a particular specialty, it is indicative of ease of recruitment for that specialty (hence, no need to offer anything extra to potential hires). For those agencies that offer a "fellowship," it is cheaper than paying for tuition and associated costs. However, it is still indicative of a shift of softening demand due to the lesser incentive.

Before anyone asks, I am on this forum because I started precepting PMHNP students from a program that I would prefer not to name. After precepting previously several years ago from the local university, I am shocked by the caliber of students that I have had to date from this program. After I complete the other students that I have agreed to precept, I have to re-evaluate my approach to this role, and I joined this forum to educate myself.

FamNP123 · Feb 18, 2021

On 1/24/2021 at 4:26 PM, Bluefamily said:

Hi OP,

#1. What was your reasoning for becoming first a nurse and then to pursue an advanced practice degree? Reflect on your original intent.

#2. With only 2 years of experience as an RN, why would you feel self-assured to diagnose following a 2 year's MSN NP Program? It's a good probability you haven't clocked enough clinical depth and breadth of experience. There are APRN fellowship programs available.

#3. If you are referring to "fluff" classes as health politics, research and population health---you've really still got a lot to learn about the position NPs hold within those landscapes.

In med school, you still have to do your own studying and your own homework. No one is taking your tests for you. The med students have to know the details, so do the NPs. Why aren't you holding yourself accountable for not taking the educational opportunity seriously?

Reconsider your original intent for nursing. Reconsider your expectations for the APRN program you chose. Good luck.

I went into nursing because 1) I want to help make a difference in people’s lives, 2) I am interested in health and improving health outcomes 3) I am interested in anatomy, physiology, & pathophysiology & 4) I enjoy caring for others and I enjoy the business of nursing that allows you to still be there for patients.

I pursed an advanced practice nursing degree to learn more about the human sciences & to have a bigger impact on patients and be able to follow patients & build a rapport with them.

With all due respect, I think in my post I did point out that I do want to hold myself accountable. Hence why I am supplementing covering a lot of material and extra studying resources that my school doesn’t cover.

I’m not asking for an easy way out. If I was I would be happy my program is not rigorous or doesn’t cover the minuscule details. I know I made a decision to prematurely pursue NP. That doesn’t mean I won’t make it or I can’t make up for my few years of nursing experience if I bust my butt. I don’t believe that more years of nursing automatically makes a better NP. I was saying that we definitely take as many “fluff” classes as we do classes that apply to direct patient decisions and outcomes. I believe that’s a problem. I’d rather have a gross anatomy class than a leadership class, or a longer pathophysiology course rather than (yet another) nursing theory course. So, yes, I am disappointed in my decision.

Psychiatrist · Feb 18, 2021

This is to give you an idea of medical education should you choose to take this route. I also included my residency training as an example (I am a psychiatrist).

Prereqs: General Biology I and II (including labs). General Chemistry I and II (including labs). Organic Chemistry I and II (including labs; general Chemistry is the prereq). General Physics I and II (including labs). Some schools require Calculus and some do not (calculus and physics are complimentary). Highly recommended: Biochemistry (organic Chemistry is the prereq) and Physiology (General biology, physics and usually cell and molecular biology or a similar class)

Years 1-2: Clinical sciences. This is where you learn the detailed how's and why's. My school used a systems-based approach (and many medical schools have since adapted this model). The topics were not divided by specific discipline, but were integrated into the systems. For example, nutrition was not a specific topic, but was integrated through out the curriculum (To a previous poster who observed that psychiatrists do not discuss nutrition with patients, I am shocked by this since psych meds have varying side effects that can affect weight and metabolism and discussing this was engrained in our residency training and we do it in practice every day); organic Chemistry is the basis of life and pharmacology while biochemistry integrates these two at the biological level; the laws of physics apply to everything; the need to know acid-base Chemistry cold to appreciate kidney function, renal metabolism and all the issues that come with kidney dysfunction, etc. All of the above prereqs that may seem useless are completely relevant for a full understanding of how the laws of nature impact human health and disease (which makes it easier to think on your feet at 2AM or during a psych crisis which requires acute medication intervention). During year 2, you take Step 1. This assesses your understanding of the underlying mechanisms of human health and disease. You cannot progress to year 3 without passing step 2. When I was in school, there were 3 chances to pass step 2. After the 3rd unsuccessful attempt, a student was dismissed because no state would grant a medical license.

Years 3-4: This is here you integrate the clinical sciences with patient care. Knowing the hows and whys learned during years 1 and 2 make this a much easier time (makes many things foreseeable during medical decision making because you have a better understanding and appreciation of the interrelatedness of the body systems). You do not have duty-hour limitations. You work on the schedules of your attendings and residents. We would see the patients first, present our findings to the residents, round with the residents to see the patients, present to the attending, the residents then present to the attendings, then we round with the attending, then we discuss the cases after we round, then we would do notes. When on call, we would repeat this process for any patient we have to see. Year 3 consisted of internal medicine, pediatrics, psychiatry, family medicine, psychiatry, neurology, general surgery, and OB/GYN. Year 4 consisted of ICU, cardiology and electives to focus on what we wanted to specialize in (I specialized in psychiatry). I did electives in radiology (with a neuroradiology emphasis), internal medicine and various psychiatry electives. Electives are typically spent at places where you want to train and we use this time to "audition" for a residency slot there. During year 4, you take Step 2. You cannot graduate or start training without passing step 2. When I trained, Step 2 had the same parameters as Step 1, with dismissal after the 3rd unsuccessful attempt.

General comments about medical school: My school did not allow us to work and would dismiss us if they found out we worked. Peers who went to other medical schools told me about policies like my school; other peers told me that employment was heavily discouraged and was grounds for dismissal in the event of a section and/or step failure. Medical school is time-consuming and very demanding. For anyone to be successful, it is prudent to have solid time-management skills from day 1. Many of my peers had children during medical school and still completed their studies on time. The key is time-management and good support system. In regards to debt, I would not take on any debt higher than my expected first year salary, unless I was doing a loan forgiveness and/or service payback program. (I stuck to this in medical school and my first job out paid me more than I owed in loans). During years 1-2, I averaged 4-6 hours of sleep/night (depending on the section) during the week and on Fridays and Saturdays 6-8 hrs/night (depending on the section). During years 3-4, I averaged about 6 hrs/night, not necessarily continuously (7 days/week).

Residency: General psychiatry residency is 4 years. The first year consists of internal medicine (some people do a month of IM time in peds if they are interested in child), neurology and inpatient psych (some programs may start with outpatient psych first). I also did ER psych in my first year. Second year, outpatient psych (programs that start with outpatient psych will do inpatient psych), consult-liaison, outpatient psych, substance, geriatrics, inpatient psych, neurology, and child psych. I also did more psych ER this year. Third year was all outpatient clinic with your own patient panel (I averaged 10-12 patients/day, depending on the clinic). Fourth year was substance, inpatient, outpatient, and electives (I did child, inpatient and more substance). By fourth year, we were expected to function as the attending and were treated as junior attendings. During years 1-4 we also did call after a regular work day and/or on weekends (when I trained, our call was 24 hrs on of patient care +6 hours to complete any admin tasks and we were entitled to 1 day/week off). During residency, you take Step 3, which has the same parameters as Steps 1 and 2. After successful completion of Step 3, you can apply for your medical license (and medical boards ask about attempts for the steps). Most states require at least 1 year of residency training before allowing someone a medical license after the completion of Step 3.

Fellowships: With the exception of child, all psych fellowships require the completion of the psych residency. Child psych is 2 years. Some people do child during years 3-4, then complete their general training after year 4 (5 years total), some do it during after completing their third year of general psych training (child during years 4-5) and other complete the 4 years of general psych training and then do 2 full years of child (there are pros and cons to each approach). I completed a non-child psych fellowship after my training.

Moonlighting: Some programs allow it, some don't. My program allowed internal moonlighting with faculty supervision as long as you made satisfactory progress in the program and did not violate duty hours. During first year, you learn pretty quickly how to think on your feet which translates to greater efficiency during subsequent years. Hence, moonlight was doable in small doses (many people maximized moonlighting during their vacation time).

General thoughts about residency/fellowship: Residency is the great equalizer. As long as residency slots are fixed, you will have a job. Some specialties have periods of minor saturation, but residency programs adjust by re-allocating to other needed areas of training. People tend to think this is due to trying to control the supply of physicians. This is not true. The truth is much more complicated: Residency slots are based on the apprenticeship model, with the resident being the "apprentice." By law, Attending physicians can only supervise x number of residents at a time because the patients really belong to the Attending physician and he/she has to be ready to jump in at any moment to assume care. Many physicians have no interest in teaching and many facilities do not take a lot of residents (if any) because of the hassle of the CMS regulations. While this makes great patient care, it also causes a bottleneck with physician training. The great thing about residency is that you quickly learn what you don't know, and most physicians are okay with this (in any profession, there are outliers, but this is typically the norm), which is why they are okay with referring when they deem necessary and tend to stick with areas that they are most comfortable with (for example, all psychiatrist can treat children, but many of them will not do so outside of an emergent situation and will refer to a child psychiatrist).

It's not a matter of NP or Psychiatrist. It is just a matter of what you ultimately want to do and how you see yourself doing it. Just a word of caution in reference to a previous poster's comment about how he/she was able to help the patient more when psychiatrists at high-rated places were not: Take comments like those from psych patients with a grain of salt. Many psych patients are notorious splitters (even the higher functioning ones). They will love you as quickly as they start to hate you. Psych is one of those specialties that has stricter boundaries more than any other specialty.

Disclaimer: I did not proofread prior to submission and I apologize for any grammatical errors.