NP vs MD and other discussions...

[ivyleaf]

I know this has been discussed on other threads, but I am looking for advice for me personally..

I am an RN in my late 20s who has practiced only in psych. To give you some background, I did some brief work in inpatient psych, most of my work in community & crisis stabilization (small, step-down, unlocked psych unit w/less acute patients) settings, and currently work as a psych case manager in a hospital.

I started out pre-med at a private college, took a year off due to medical illness, and transferred to a local community college, where I obtained my ADN/RN. I didn't enjoy med/surg clinicals and for many reasons was disenchanted with my nursing program, so I applied to transfer to a 4-year school and entered with a major in biology the fall after finishing nursing school & taking my boards. I ended up working during winter break as a psych nurse, switching my major to psychology, graduating with a BA in psych in 2009, and taking a full time psych nursing job after graduation; this is what I've been doing ever since.

Trust me, this is an abbreviated version...

This summer I started working at a large teaching hospital w/a teaching service/group of psychiatry fellows and residents, and have started to think about med school again. I have also thought about NP school (as it would be cheaper, an easier transition, and require a lot less courses-- I have taken some of the prereqs for med school but most are at least 5 yrs old and I haven't taken physics or orgo, which I would enjoy the least), but have been thinking of med school for a few reasons:

1. I like the idea of the deeper & broader training that med students get through med school & residency. I am leaning towards psychiatry (that's another discussion, as I'm not 100% sure...) and feel that my lack of background in med surg would put me at a disadvantage, as psych pts are so medically complex these days. With med school, I'd get a solid background in basic medicine. Also there is more clinical training through residency, as NP residencies aren't widely offered.

2. Med school allows for rotations-- I have always wanted to work in the ED and am not 100% sure I want to do psych forever (vs. medicine or ED) so this would give me a chance to rotate through all specialties

3. An MD opens more doors in the sense of positions of authority at teaching hospitals, like the one I am at.

4. I hate to say it (*prepares for flaming*) but there is more "prestige" associated with the MD and I have always wanted some of that, although I don't like to admit it..

5. Although I like the holistic part of the nursing model, I really didn't enjoy the nursing theory portions of nursing school. And I hate nursing diagnoses (*prepares for more flaming*).

6. I hear a lot about NPs not making any more than RNs despite more education, which is disheartening

There are also a lot of reasons why an NP would make more sense:

1. It would build on my RN degree and would not require a crazy amount of prereqs

2. It is generally a shorter, less expensive route, and I'd be more likely to get scholarships (I assume, as there is less competition than for med school) -- I am ~$30k in debt from undergrad , along w/some credit card debt. Avg. med school debt is ~200k. PLUS I would have to take ~2yrs of prereqs, which would put me *another* $25-50k in debt if I went to a post bacc program with a solid advising/linkage program... I would make more $$ In the long run with an MD, although that's not the top priority

3. For me, it would be easier to get in (range of positions in psych nursing, including leadership and being @ a well known hospital)

4. Less stress (from what I have read) than med school-- less intensive basic science courses, less volume of information, less competitive classmates, etc

5. I feel like I would be taking a step backward in my career to have to devote most of my time to studying/memorizing chem, orgo, physics--- which, I'm sorry to say, I don't believe have a *direct* application to psychiatry (yes, it is good foundation material, but you know what I mean..)

I am wondering if anyone has advice/thoughts.. I know I obviously have to make my own decision, but I wanted to solicit feedback from the experienced and accomplished folks in here who have been (or are) in a similar position.

Another issue I'm considering is whether or not to eventually try to get an entry level RN position in the ED or med surg to try out those specialties before I commit to an NP program, if I go that route ... but I've probably said enough already!! I'll start a separate thread for that... ; )

Thanks in advance--

[lovingtheunloved, ASN, RN]

I hate nursing diagnoses too. I find them utterly useless in the real world.

If you really want MD after your name, I say go for it. There are a lot of cons like the ones you listed, but if that's really what you want, I say go for it. Don't let anyone try to discourage you from doing what you want. IF that really is what you want.

[mrmedical, ASN, BSN]

I'm kind of in the same spot you are. Been working the floor for a couple seasons now, and it's not enjoyable at all and I never feel at ease or comfortable. I mean I could do nursing in my sleep, but it isn't fufilling. I started my college career with the intent of going into medicine. I've been considering the NP route, but I don't think I'll be satisfied unless I become a doctor.

In the future NPs might get to bill and even get full hospital priviledges, but like you said their is a certain honor in being cream of the crop ie medicine and really having the best clinical basis in knowledge that you probably wouldn't get as an NP. Right now (as my feelings have changed about it many times) I'm thinking about going to a DO school because they seem to be more friendly to nontraditional students or second career students.

I just have to take biochem and physics then I can sit for the MCAT. I'm just worried that if I don't do this I'll regret settling for less later on in my life.

[SFDRN]

I agree with the posters who say that if you really want the prestige, title, and the more in-depth knowledge of basic science, definitely go the medical school route.

I can say that as a second-year NP student in a very competitive and highly-ranked ACNP program, NP education is for the birds. I am so underwhelmed by the minuscule amount of patho and pharm in our curriculum (1 quarter's worth of each) and the lack of seriousness given to the clinical rotations. In retrospect I would have chosen a different path--probably PA or MD. But I've invested this much time and $$, so here I am. At least I'm getting a dual certification out of it (NP & CNS).

Whenever we students complain about the deficiencies in the curriculum, we are told, "well, you just need to do more self-study and don't expect to feel comfortable in your first job coming out of school."

Since when does a profession have such low expectations of its educational preparation that it leaves almost everything of value in the curriculum up to the student to "self-study," while placing much higher priority on one's ability to write "scholarly papers"? I've so had it with the nursing theories and paper-writing. The NP's that I've precepted with are diagnosing and prescribing, not writing ridiculous papers.

[Riburn3, BSN, MSN, APRN, NP]

I have a different perspective. Having worked directly with a psychiatrist, if psych is your thing, why wouldn't you just go the psych NP route and jump right in in 2-3 years doing what you love? Psych is a hugely in demand field, and I would argue of all the NPs of the world, Psych NPs are the most valued and have the most respect from their physicians. I also don't know what state you are in, but depending, you might not even need a Physician partnership to practice. Alternatively, if you go the MD route, you have to wrap up whatever classes you need to get into Med or DO school. Take your MCAT, and then actually get into a school. After that, it's 4 years of school, not 2 or 3. Likewise, once you finish school (and bass your boards), it's off to 4 year psych internship/residency often in a place where you have a limited choice of where you go (and psych residencies are very competitive). During this time you will be abused, work long hours, and make less than 50k a year. When finished its time for more boards! As an NP there's no residency, and Psych NPs where I work in Texas are being given contracts of 110k to start at hospitals, and the sky is the limit with private practices that are desperate. If prestige is really the determining factor for you, go the MD route and hope you end up in Psych medicine. If psych is really your passion, go the NP route and in 2-3 years you can be performing that same tasks and treating the same patients an MD would with the same efficacy and at a lower cost to the patient while being at the top of your profession (whereas as an MD you will be one of the horde). On top of it all, you will have a smaller debt load and still live a very handsome lifestyle.

[Trilldayz,RN BSN]

I have a different perspective. Having worked directly with a psychiatrist, if psych is your thing, why wouldn't you just go the psych NP route and jump right in in 2-3 years doing what you love? Psych is a hugely in demand field, and I would argue of all the NPs of the world, Psych NPs are the most valued and have the most respect from their physicians. I also don't know what state you are in, but depending, you might not even need a Physician partnership to practice. Alternatively, if you go the MD route, you have to wrap up whatever classes you need to get into Med or DO school. Take your MCAT, and then actually get into a school. After that, it's 4 years of school, not 2 or 3. Likewise, once you finish school (and bass your boards), it's off to 4 year psych internship/residency often in a place where you have a limited choice of where you go (and psych residencies are very competitive). During this time you will be abused, work long hours, and make less than 50k a year. When finished its time for more boards! As an NP there's no residency, and Psych NPs where I work in Texas are being given contracts of 110k to start at hospitals, and the sky is the limit with private practices that are desperate. If prestige is really the determining factor for you, go the MD route and hope you end up in Psych medicine. If psych is really your passion, go the NP route and in 2-3 years you can be performing that same tasks and treating the same patients an MD would with the same efficacy and at a lower cost to the patient while being at the top of your profession (whereas as an MD you will be one of the horde). On top of it all, you will have a smaller debt load and still live a very handsome lifestyle.

Totally agree!!!! Go with Psych NP! I'm in an FNP program and want to pursue a psych post graduate certficate afterwards

[myelin]

If you want psych, become a psych NP. There's no need to spend a decade + in order to achieve your career goal. I have worked with psychiatrists and psych NPs - they where interchangeable where I was working. I think people focus way too much on the type of training and not on what they will be doing day-in/day-out for their entire career... like I said, the psych NPs and psychiatrists had an identical scope of practice and psych NPs are paid very well compared to other NPs.

If you wanted to be a surgeon or something like that, then yes, med school would make sense. However, I think for psych there's no reason to put yourself through medical school. Not when the end result is pretty much identical to psych NP.