adventure_rn

I'm not in exactly the same boat, but I go by my middle name, and it always creates a whole to-do with job applications. For what it's worth, I use my first initial + middle name at the top of my resume and in my email signature, and it's never created an issue. I do try to give every recruiter, talent acquisition rep, and manager I speak to in the hiring process a heads-up about the discrepancy to avoid confusion. There can also be confusion if your references know you by a different name than the name on the application - I have to remind my references that they'll get a request for the legal first name they don't usually hear, and remind the hiring team that my references may call me by a different name than the one on my application. That said, when you're filling out applications, I would use your legal first, middle, and last name, and only put down a nickname if they give you a "preferred name" option. If you were to put your nickname down as your name on the application, it seems like it could create a huge headache with your license verification and NP credentialing (which is painful enough under the best of circumstances). With everything being electronic these days, I'm not sure changing your name on a resume will have much of an impact, since you'll still automatically show up as [legal first name] [legal last name] in the system.

I'm wondering if anyone else has experienced sexism in the workplace as an NP, especially compared to working as an RN? Perhaps it's because my field (NICU, peds) was so heavily female-dominated, but I only recall extremely rare instances of sexism from colleagues in the many years I worked as a nurse. Now in my specialty as an NP, there is a larger proportion of men in my workforce compared to nursing, and more than half of the attendings in my specialty are men. Even living in a very progressive area, I have noticed so many more examples of both subversive and overt sexism than I did as a nurse. I want to preface it by saying that the majority of the male APPs I work with are amazing. However, the vast majority of the thankless, back-end 'secretarial' style work that makes a lot of the clinics run tends to fall on the women APPs, especially in a shared workforce where a set of patients is jointly managed by several (male and female) APPs. In addition, the small handful of terrible male APPs I work with seem to be given a pass by the male attendings because they've got a chummy, 'boy's club' kind of vibe. I also see so many more examples of attendings making overtly sexist remarks to APPs than I did in nursing under the guise that it's a 'safe space just between us' where we're just 'joking around.' I understand that gender dynamics in nursing are extremely complicated, and that men face a lot of discrimination in nursing. I also think that the nursing and APP workforce benefits from having more equal gender distribution. Even so, I've been so taken aback by this gender dynamic because I've never experienced it until now. It is a new and frustrating part of the job that I never expected.

I agree, but I don't think it changes the current state at a lot of hospitals. I can only speak to pediatrics, but from what I've seen most of the "Top 10 World News & Report" hospitals have a mentality that you're lucky to work for them - if you quit because you feel like you're being mistreated, there's a line of people behind you (especially new grads) who are willing to put up with crap treatment for a couple of years to put it on their resumes. Ultimately, it's very short-sighted by the hospital admin because they have a lot of turnover, which increases costs and harms patient outcomes. But there will always be people to fill those roles, especially if they're trying to beef up their resumes for CNRA or NP school applications. Some people who aren't tied to a specific location or specialty may have the luxury of finding a more supportive work environment, but that isn't the case for everyone. In my last post I mentioned a brand-name hospital that has done away with straight day shifts - the next closest pediatric hospital is over an hour drive away across state lines. It may not be a big deal for people who are able to relocate, but for local nurses (especially those who use public transit), there isn't a reasonable alternative.

...Did an AI write this? ?

Sounds like I may be the voice of dissent, but here goes... While I agree that rotating shifts are terrible for your health and mental well-being, they are an unfortunate reality in a lot of hospital systems, especially for new grads. I've worked in several different brand-name, top-tier children's hospitals, and about half of them required new grads in all inpatient areas to start out rotating. In those systems, the rotations weren't even split up into different weeks - within a single week, you could have to do a night, a day, and then another night (although the managers tried to make the schedules as reasonable as possible). A couple of the hospitals required new grads to rotate for at least a year before they could be put on a waitlist for straight nights or straight days. One of the largest, most well-renowned children's hospitals in the country recently decided system-wide that they're expecting all new hires regardless of experience to either rotate or work straight nights (no option to apply to straight days). Again, I agree that it's a terrible idea (which the administrators who make these decisions don't seem to understand), but depending on where you want to work, that may be the reality of working in an inpatient job. I would recommend checking out the hospitals and job market to get a sense for the opportunities in different hospital systems, especially if you aren't able to relocate. Additionally, your managers will likely be way more accommodating to you going to straight nights than straight days. I'm not sure if that's what you discussed with your managers, but offering to do nights would be an easier sell. Finally, check your hospital policies for expected notice time! Many hospitals expect that all clinical staff (including nurses) give at least four weeks. If you don't give appropriate notice, you could be labeled Do Not Rehire, and be blacklisted from any facility that is owned by or affiliated with your hospital. There often isn't anything you can do to get this changed (you can search on this website to see examples). This could have long-term repercussions depending on how big your hospital system is. If you're in a place where there's only a single large hospital, or the hospital system has bought up all of the local outpatient practices, or the hospital system is part of a larger system that operates over several states (HCA, Ascension), you could be limiting your employment options for the foreseeable future. You also never know when hospitals that are currently independent may be acquired by other groups in the future. Here's an example of a guy who got blacklisted at HCA (which owns hospitals in 20+ states) for breaking a contract. The nurse figured it out when they moved to a new state several years later, and had trouble getting a job because all of the local hospitals were owned by HCA. https://allnurses.com/blacklisted-hca-t724924/ All of that to say, I completely understand why you're frustrated and exhausted - your first year of nursing is hard enough, even under perfect conditions. But I'd recommend that you be very thoughtful about the decision, since it could impact you in the future in ways you wouldn't expect.

Since you're working on a full congenital cardiac lecture, might I refer you to another NICU cardiac discussion we had on this forum a couple of years ago: https://allnurses.com/lower-o-sat-parameters-babies-t712962/ If you have any NICU cards answers I'm happy to answer them to the best of my ability, it's my favorite topic.

I'm a peds cardiac NP with a background as a NICU nurse, so I can take a stab at answering this one. It's actually a really interesting question. Breaking it down into more manageable questions: 1) Why do we generally not use PGE? In a normal newborn, the PDA is supposed to close during transition as a) pulmonary venous pressure drops, and b) circulating prostaglandin levels (produced by the placenta) decrease in the baby's blood. Conversely, two main things tend to keep the PDA open after birth, either a) pulmonary venous pressure remains high (I.e. PPHN) and stents the PDA open, or b) you give exogenous prostaglandin (PGE) to intentionally keep the PDA open (I.e. for kids with ductal-dependent cardiac lesions). PGE isn't a mainstay therapy in PPHN because it isn't a particularly helpful treatment. It's a vasodilator, but it's not a particularly good one, and it has a lot of harmful side effects. In PPHN, the goal is to lower pulmonary pressures/PVR while maintaining systemic blood pressures/SVR. The reason inhaled nitric oxide and oxygen are the mainstays of therapy are because they are selective pulmonary vasodilators. In general, we don't give systemic vasodilators to a kid with PPHN in an attempt to lower their PVR, since we don't want to bottom out their systemic pressures. Rather, you only want to lower their pulmonary pressures relative to their systemic ones. At the same time, the only body part that PGE is particularly 'selective' for is keeping the PDA wide open, and a wide open PDA is actually going to increase your pre- and post-ductal O2 sat gradient. In PPHN, you have high pulmonary/right heart pressures (deoxygenated blood) and low systemic/left heart pressures (oxygenated blood). In severe PPHN where kids have a pre- and post-ductal sat gradient, they are only shunting right to left. The high PVR forces the deoxygenated blood across the PDA, and prevents it from closing. Pre-ductal (right hand) blood only reflects the oxygenated blood coming from the left heart, while post-ductal blood is a mixture of the oxygenated blood from the left and a ton of deoxygenated blood from the right shunted across the PDA. Of note, kids with bad PPHN don't have PPHN because of their PDA, they have a PDA because of their PPHN, since the high pulmonary pressures are stenting the PDA open. Therefore, giving a PPHN kid PGE isn't going to make their PPHN worse. However, keeping the PDA open even wider can make their pre- and post-ductal sat differential even greater. If you have a smaller PDA, there will be more resistance to the blood shunting right to left, and the less right to left shunting you have the smaller your pre-/post-ductal gradient will be. So to answer your first question: We don't give PGE to kids with PPHN because a) it won't really help (and has a bunch of side effects), and b) it will keep their PDA open wider, which could more right to left shunting, worsening their pre-/post-ductal gradient. That said, there is some new research about severe cases (like CDH) where we should use PGE, which is probably what your presentation is referring to: 2. Why might we use PGE in severe cases? The purpose of giving PGE to kids with extremely severe PPHN is to prevent right-sided heart failure and circulatory collapse. In a normal patient, blood leaves the right heart and goes via the pulmonary artery (PA) out to the lungs. In a baby with PPHN and a huge PDA, the blood leaves the right heart and has two options: it can either a) keep going (against high PVR) out to the lungs to pick up oxygen, or b) choose the path of least resistance and get shunted across the PDA out to the body. The blood going out to the body will be deoxygenated (blue), but you're still getting perfusion to your body and maintaining a blood pressure. Conversely, imagine a baby with severe PPHN and NO PDA: The blood would come out of the right heart and then just...get stuck. The pressure would be too high in the lungs for it to move forward, so instead it would just back up, and up, and up into the right ventricle, then right atrium, then the venous system. This is extremely dangerous for two reasons. First, your right heart is going to fail almost immediately. Second, if the blood getting is getting stuck at your lungs, then it can't move forward to your left heart, and then out to your body. With no forward blood flow, you have no cardiac output: no blood pressure, no end-organ perfusion (I.e. your brain), and no coronary perfusion (bradys and cardiac ischemia). The idea behind giving these severe PPHN kids PGE is that it's better to have a very blue baby with a whopping PDA and a right-to-left shunt with a huge pre-/post-ductal gradient than a baby with no blood pressure at all. Babies can survive being pretty hypoxic--fetuses in utero have O2 sats around 60-70% (hence the NRP targeted oxygen guidelines), and cardiac babies can live for months at around 60-70% sats. However, babies can't tolerate huge swings in their perfusion/blood pressure, which is a big cause of germinal matrix bleeds/IVH, watershed injuries in HIE, and NEC. For these kids, PGE helps to maintain the PDA as a 'pop-off valve' for the high pressure in the pulmonary arteries: instead of just getting stuck at the lungs, the blood can escape across the PDA over to the aorta, where it can go on to the body to maintain blood pressure and perfuse the other organs (albeit with low oxygen sats). Of note, the PFO is doing effectively the exact same thing inside of the heart. These kids will have a big right-to-left shunt at the level of the PFO: blood that gets stuck and the lungs and backed up into the right heart can escape across the PFO to the left heart, where it can perfuse the coronaries and go out to perfuse the body via the aorta. In the moment, maintaining the PDA (via PGE) can prevent circulatory collapse. Over time, it's also going to help prevent right heart failure, which is extremely difficult to treat. The right ventricle is very stiff and bad at compensating. Even when kids with PPHN survive, if their right ventricle is irreparably damaged as a result of their PPHN episode and they end up in chronic right heart failure, they're at high risk for sudden death. The presence of the PDA (via PGE) is going to offload the pressure backing up into the right heart by creating a pop-off valve to the aorta and the rest of the body, so at the time of the PPHN episode they're less likely to experience right heart failure. So to answer the second question: PGE might be used in severe cases because a hypoxic baby is better than one with no blood pressure (or as one of my attendings told me very bluntly, a blue baby is better than a dead one), and we also want to avoid right heart failure at all costs. Here are a couple of recent articles studying how PGE can be used in these severe cases. The primary outcome measures (BNP, tricuspid regurg, right ventricular systolic function, right ventricular afterload, lactic acidosis) show that that it improves right heart failure. The secondary outcomes (lack of systemic hypotension, no worsening in post-ductal hypoxemia) suggest that the addition of PGE doesn't cause any further harm. https://pubmed.ncbi.nlm.nih.gov/30442461/ https://pubmed.ncbi.nlm.nih.gov/37975485/ So to answer your question overall: in kids with mild to moderate PPHN where blood is still able to make through the lungs, PGE isn't necessarily very helpful (and it always comes with risks like apnea and hypotension). However, in kids with PPHN so severe that they are at risk of circulatory collapse or right heart failure (I.e. a huge CDH), it can prevent further harm. Thanks for posing the question!! It was super interesting reasoning through why we do/don't use PGE in PPHN, and I learned a lot from reading the articles!

I feel like this should be repeated for the people in the back. First of all, multi-state licenses for work for people like travelers who are taking temporary positions; if you move to the new state full-time, you need to be licensed in that state or your multi-state license will become void (reverts to single-state only) and you'll be practicing in your new state without a license. Second, it's a moot point since Nevada isn't a compact state anyway. Correct. Nevada is not in the multi-state license "compact," so the multi-state licenses aren't valid. Also, you must be a full-time resident of the state in which you have your multi-state license in order to retain "multi-state" status; for instance, if you have a multi-state license in Arizona, but you move away from Arizona to Nevada, your multi-state license reverts back to an Arizona single-state license.

I don't think NICU will be as hard to move out of as you expect if you change your mind down the road. Yes, there will be a very steep learning curve going from NICU to adults (the same way there is going from adults to NICU), but if it's a question of actually getting hired into another unit I think you'd be fine, especially if you were to apply for a lateral transfer to another unit in your current hospital down the road. NICUs can be hard to break into because the staff often have greater longevity than a lot of specialties, so there's generally less turnover. On occasion, unpopular management decisions can definitely cause a mass exodus in some NICUs and make it extremely easy to get hired (though often into a crappy situation), but that's true of any unit. By contrast, it seems like adult ICUs have a pretty consistently high turnover between people getting burned out and those just putting in a couple of years to get into CRNA/NP school, so they're probably always hiring. Again, it can be a rough transition since you have to 'unlearn' all of the weird niche NICU habits that only exist in NICU, but if you approach it with an open mind and are willing to put in the work, it's definitely doable. If your heart is in NICU and the ANM in neuro ICU is a jerk, I'd definitely lean toward NICU. I'd see if you can shadow on each unit to get a sense for the overall culture - adult ICU and NICU tend to self-select for different personality types. You probably have a good sense for what types of patients and medical management style you'd like based on your float background. I will say that in NICU vs. adults, the outcomes are generally happier, the families are generally kinder/more appreciative/less difficult, and the messes are always smaller.

I always have, the only circumstance as a nurse in which I wouldn't is if I were a travel nurse. A couple of random tips: Depending on how much you make, both H&R and TurboTax have a 'free' version. I think the income cutoff is around $75,000-ish, but it changes every year. You should *always* start with the free version (not the regular version). If you start with the free version but don't qualify, it will prompt you to upgrade to the regular. However, if you start with the regular version and it turns out you qualify for the free, it won't notify you - if you then realize on your own that you qualify for the free, it will force you to complete the entire process again from scratch (since they obviously prefer that you use the paid version). I usually find the free versions every year by googling 'TurboTax free' and 'H&R block free'. Also, this is a little bit over the top, but I always complete my taxes on *both* TurboTax and H&R Block every year, then only submit using the one that's a better value. Some years it's TurboTax, some years it's H&R Block. I do this for a couple of reasons. First, they each have different prices every year (especially if your state has an income tax), and you may qualify for the free version in one system but not the other. Second, I use it as a double-check to make sure my taxes are filed correctly. If one system says I'm getting a slightly larger refund than the other (~$100-$200), I'll pick the one with the larger refund. However, if the numbers are vastly different (>$1,000), it tells me that one of them didn't get filed correctly, and I need to figure out which part is incorrect. The first year you get set up on each system it takes a little bit longer (maybe 1-1.5 hours each), but every subsequent year when you log in it saves all of your information so it's much faster - for me it only takes about 20 minutes per system, though I take the standard deduction instead of itemized which is much easier. Nowadays, the systems can pull most of your tax info in automatically - you just type in one of the numbers on your W2 is imports the entire thing, and if you have any investments through your bank, retirement accounts, or investment companies, it will sync with your bank and pull all of that info in, too. It seems really intimidating at first, but once you've gone through it a couple of times, it becomes much easier.

I could see inpatient RNs in CA possibly making that much if they were getting shift diffs and picking up a boatload of overtime with incentive differentials (I know my east coast hospital mid-pandemic was giving up to $115/hr on top of your base salary + shift diffs for overtime night/weekend shifts when they were super desperate). Doesn't sound likely with a county job, though. I wonder if she was getting any bonuses and including those in her total? If she's salaried, she might have taken her gross annual income and divided it by 2,000 to get her 'hourly pay.' Still sounds shady, though.

Not sure about outpatient, but for what it's worth my classmate (also a new grad acute care PNP) just got offered an inpatient PICU position in CA starting at $200,000, plus $20,000 in signing/relocation bonuses. Probably not the norm in CA (even for inpatient jobs), but in this job market and depending on your specialty, it might be possible.

I have to agree with @offlabel, I think you're making a few bold and sweeping generalizations. I think your points about the financial benefits of going through the ADN route are entirely valid. I also think that people who go through the ADN route can absolutely have equal or even superior clinical skills compared to BSNs, and that after a certain amount of hands-on experience, the place where you went to school ultimately doesn't affect your clinical practice. That said, just because he's planning on applying to CRNA programs doesn't mean that he'll get in, or be as competitive of a candidate as someone who went to a really reputable BSN program. I'm sure that there are plenty of ADNs out there who completed reputable RN-BSN bridge programs, got great grades, and have gotten into CRNA school. But I know with certainty that there are ADNs exactly like 'Jeremy' who started with ADN, got 5+ years of ICU experience, completed a middle-of-the-road online RN-BSN bridge program, and can't get accepted into CRNA school because I have personally met a handful of them. And they are pissed that they have far more years of hands-on ICU experience than the new grad BSNs who are getting accepted into CRNA school with only 2 years of ICU experience, but they keep getting rejected year after year when they apply. CRNA school is extremely competitive, and because of that, the place where you completed your undergrad is far more important than in less graduate competitive programs (like FNP or CNS). I'm not saying it can't be done, but an ADN with a 3.2 GPA who completes their RN-BSN through a notriously crappy online program is going to have a way harder time getting into the school of their choice than a BSN with a 3.2 from a highly regarded brick-and-mortar BSN program, assuming they have equivalent clinical experience. The place where you completed your undergrad is also the only thing on your CRNA application that you can't change. You can always get more ICU leadership experience, more CRNA shadowing experience, and better references, but the place where you went to school (and the grades that you got) will always be the same. If the school where you completed your undergrad is the main thing holding you back on your CRNA school application, the only way to make your application stronger is to complete further graduate-level coursework on your own time and with your own money to prove that you can get excellent grades in demanding science courses like organic chemistry. CRNA school requires great ICU clinical experience/judgment, but it also requires extremely strong academic skills. And with a less competitive academic track record, you might have a harder time convincing CRNA programs that you can actually handle the graduate level coursework. No offense to 'Jeremy,' but the level of smugness and condescension in this post is seriously rubbing me the wrong way, especially because in certain circumstances this advice may be empirically wrong.

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.

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.