could use some advice

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If any of you isn't entirely sick of 'what should I do with my life?' posts, please help me try to figure some of this out.

Some background: I'm a 27-year old mother of a toddler who has a Ph.D. in developmental psychology and has decided to pursue a career in health care. I love what I've studied and done so far, but I want to be a clinician (at least primarily, I might like to stay involved in research to some extent) and would like to work with more than mind/behavior. I don't have a lot of experience in non-mental health care (have worked in medical settings in mental health though), but some events in my personal like also make me certain that health care is for me (my child has some fairly minor but chronic medical conditions, I had the best imaginable experience with prenatal and delivery care with a group of midwives, spent a lot of time in the hospital with my mom before she passed away, and now have recently dealt with the diagnosis and treatment of Grave's disease in myself). I find that I spend a lot of time using the medical library at the university I work for to research and understand all the different aspects of the problems I and others are experiencing, and I love talking to health care providers just because I like learning whatever I can from them.

The dilemma: I could go to medical school (have the family support and $ necessary), but I don't think it will give me the lifestyle I want and may not be fair to my child. So, I'm about 90% sure that I won't get an MD. Then, I'm left looking at PA and NP programs. [[i don't mean to drag up a whole debate about which is better; I'm just looking to fill in some gaps in my understanding of NP education and specialization.]]

I think I understand the education and training process of PAs pretty well. The benefits I perceive of the PA route, for me, are that I'd rotate through everything before having to know what I want to specialize in, and I would get more clinical hours during training than I likely would in an NP program. For my situation, the downsides of the PA route are: I'd have to move my family (and my husband loves his job), I'd have to wait an extra year before starting and don't know how to spend that year, it seems fewer PAs than NPs work in peds like I'd probably like to, and I sort of like the idea of considering going into private practice some day far into the future and couldn't count on that option as a PA.

Now for the pros and cons of NP training in my particular situation:

Pros: There is a brand new MEPN with an FNP option in my area that I could probably start in one year, it is the least costly and burdensome option for my family, I like the idea of working as an RN during the second and third year of school and possibly after that for a bit too, and I like the overall flexibilty of being a nurse and that I could shape my career in any number of ways over time.

Cons: I know that FNPs can do all sorts of things, but I don't want to be pushed out of peds primary care or especially peds specialties because I wouldn't be a PNP without moving for a different program; I keep hearing rumors that NPs can't find jobs, and I'll admit that it would really bug me to get this training and then not use it (I think being an RN for awhile would work for me, but I do worry about getting 'stuck'); and I don't know for sure yet that I don't want to work in midwifery/OB, and as an FNP that'd be out, whereas there are PAs who work in OB, so I'm putting pressure on myself to make the call about whether to try for midwifery programs (which brings along all the complications of moving, waiting an extra year to start, etc.).

I know this will all get worked out in time, but I'm pretty antsy to decide what path I'm on. It will affect which prereqs I take this year (but too not much) and possibly what type of clinical experience I try to get this year. Mostly though, it's that I really loathe the idea of committing to one path, getting a third advanced degree and then realizing that I made the wrong choice. I'd love to hear from any of you about what you might do if you were in my situation and whether any of my concerns about becoming an FNP are unfounded. Many thanks.

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You can do ANYTHING as an FNP. An FNP is like a general practitioner. The other specialties are what are limited. You also can work in OB as an FNP, you simply cannot deliver babies. (In fact, I work in a family practice that sees OB patients at this very moment). However, I do not think that PAs can deliver babies either unless they are a midwife also. Now it is true that you won't get as much training in any particular specialty as you would if you were in a program that was for a particular specialty. For instance, you will get peds training and will be certified to work with peds as an FNP, but a PNP will, of course, have more training than an FNP in pediatrics. When you graduate, however, you will legally be able to see any child that a PNP will see. It sounds like FNP would be the best choice for you since you do not have a specific area that you are passionate about (at this point). The only people that I would recommend a specialty area to are those that KNOW that they ONLY want to work in women's health or peds. Remember, the FNP programs are longer than the specialty programs are. Hope this helps!

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Thanks for your reply. It is reassuring, and it makes sense for me to choose something that will allow me to decide after I've had more experience exactly which area to work in.

I guess it's just hard because all of the options in front of me have pros and cons, but I won't know for sure until I'm in school and/or working if I definitely made the right choice.

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pas do deliver babies and there is also a post-grad residency for ob/gyn pas that specifically trains in deliveies/intra-partum care. good luck on your decision.

arrowhead ob/gyn pa residency program

arrowhead regional medical center

dept. of women's health

400 n. pepper ave. colton, ca. 92324

colton, ca 92324

program director: christine sims, pa-c, mms

[email protected]

909-580-6320

length of program12 monthsclass size4-6application deadlinejune 1 (flexibility permitted)interviews:june through august (flexibility permitted)starting date:august 1st, october 1st, january 1st

program description:

this is a 12-month full-time postgraduate residency program offering intensive training in inpatient and outpatient obstetrics and gynecology. the program is housed at arrowhead regional medical center which is one of southern california¹s premier teaching hospitals with 373 beds, approximately 3,600 obstetrical deliveries per year, and more than 30,000 visit encounters to the hospital¹s outpatient women¹s health center annually. the pa residents are trained along with the ob/gyn physician residents, working 70-80 hours per week, and are exposed to the management of complicated and non-complicated antepartum, intrapartum, postpartum, postoperative, acutely ill, and well ob and gyn patients. upon completion of this residency, the pa should be competent in performing lady partsl deliveries, 1st assisting in cesarean deliveries and gynecological surgeries, and performing colposcopies and other common gynecological procedures.

curriculum:

the didactic portion consists of daily morning rounds, biweekly lectures by attending physicians, monthly journal clubs, morbidity and mortality conferences, assigned readings, and self-directed learning. the clinical portion consists of training and experience in labor and delivery, obstetrical ultrasound, l&d triage, er consults, or assisting, and the management of high and low risk obstetrical and gynecological patients.

costs/benefits:

there is no fee or tuition for the program. benefits include a stipend, , medical insurance, 15 days vacation, and 50 hours of category i cme. housing and the initial on-site interview expense are the responsibility of the resident.

credentials awarded:

upon graduation from the residency, the physician assistant receives a certificate of completion of a postgraduate ob/gyn residency from arrowhead regional medical center. an option to obtain a master of science in health sciences-health professions education concomitantly at western university of health sciences is available, but admissions, tuition, and coursework are independent from the ob/gyn pa residency (for more information, please call 909-469-5540).

applicant qualifications:

graduate from arc-pa accredited physician assistant program

california state licensure or eligible for california state licensure

nccpa certification

admission requirements:

completed application

curriculum vitae

personal statement

three letters of recommendation

national certifying examination scores

copy of pa program diploma/certificate

copy of pa education transcript

copy of current cpr certification

copy of california state licensure

on-site interview

for more information and an application packet, please contact:

jasmine cervenka, dept. of women's health

400 n. pepper ave.

colton, ca 92324

909-580-6320

[email protected]

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Also, here is the link to the organization for PAs in OB/GYN.

http://www.paobgyn.org/faq.html#babies

also understand that many places who have both NPs and PAs assign them the same responsibilities and group them together, such as this one.

https://www.urmc.edu/obgyn/residency/womensHealth.aspx

this is the society for PAs in pediatrics.

http://www.aapa.org/spec/SPAP/

and an issue brief.

http://www.aapa.org/gandp/issuebrief/pediatrics.pdf

once again, good luck and PM me for any further info if you'd like. The good thing about your situation is there is essentially no wrong choice. they are all great careers.

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Specializes in ICU, ER, HH, NICU, now FNP.

And - if you can't FIND a job - there is always the possiblitly of CREATING one.

Surely some doctor in your area would like to partner up and make some money!

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Thanks for the encouraging replies. They're just what I needed; I'm feeling more excited than anxious about my career change again now.

Cladje - thanks for those links. I'm going to look into what the PA role in OB looks like more I think. I like that PAs have access to formalized residency training.

Does anyone know if there are programs like that for new NPs?

I talked to a public health nurse I work with yesterday, and she knows some of the professors in the nursing school here and will put me in touch with them so I can find out more detail about the masters entry program. This will help a lot. I guess I'll be weighing my options for awhile still, but it is true that they're all good options. :)

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There are a few midwife/FNP programs out there. I know that Vanderbilt does (in Nashville) and I know that the Frontier Nursing School in Kentucky does also. I know about these programs because they are both close to where I went to school in Knoxville, TN. I think that they are usually geared toward NPs that practice out in the middle of nowhere- like where that particular NP is the only (healthcare) game in town. If the NP school where you live does not offer a midwife program, then you can just go to a midwife program at another school after finishing your FNP. When you get another specialty after getting your NP, it does not take as long as getting the inital NP degree. Also, I wanted you to think about some things, and I don't mean to rain on your parade. I just wanted you to think about things from a different perspective....

If you are seriously considering getting into a situation where you deliver babies, either as a PA or as an NP, you need to realize some things. It all sounds very neat when you think about it in theory, but there are some serous downsides to delivering. For one, your is considerably higher. The practice you work for may take care of this for you, but sometimes they don't. It would be good to get in contact with an insurance company and see what the difference is. Also, remember that the number one reason for a malpractice lawsuit in this country is because of a 'bad baby'. Getting sued would be a real risk for you everyday. It sounds like you have small children and a family. Is that a risk that you and your family can deal with? Don't get me wrong, it may be worth it, if delivering babies is really your passion, but it is still something I would think about. I used to work in wound care (which is also a lawsuit-happy field). This may sound weird, but I always really loved wounds- I really loved helping them heal, etc. I wasn't prepared for the non-compliance of patients in this field and that their non-compliance could result in an amputated limb. Even if I knew that I did everything right, it was still enough of a risk of getting sued that I had trouble sleeping at night. As much as I liked the field, I left it because I just wasn't willing to live under that cloud. Now, I am an overly anxious person, and I know that about myself. You may not be. I just wanted you to think about that.

The other thing is that you need to find out about practice laws of both NPs and PAs in your state. Are they both allowed to write prescriptions? Are they both allowed to practice when an MD is not on site? What are the limitations? This can make a big difference. Also, when you look up jobs in the paper-who has more jobs advertised-NPs or PAs? That is probably the most important thing to consider. The point of going back to school is to get a better paying job in both the geographical area and the specialty area that you want to get it. Anyway, hope this helps. If you have any more questions I would be happy to hlep you.

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Yes, those are some very good points. I do have quite a bit of concern about the liability one takes on when delivering babies. It's a little awkward for me to even say it, but my father is a medical malpractice lawyer who has prosecuted plenty of OB/GYNs and midwives. He held his tounge for the most part about my using a midwife and having a birth center birth, but I know it bothered him. I think my becoming a midwife would be a big issue. My sister is on her way to becoming an OB/GYN, so we've been talking about the costs, but I suppose neither one of us can really imagine what the personal and professional costs of defending a lawsuit would be. It is a complicating factor and adds to my feeling that it is probably best that I get a good broad base of training and experience before I decide if delivering babies in any capacity is something I want to pursue.

As for the PA vs. NP part, it seems that both have generous practice laws in the states I'd like to live in. NPs do have more options for independent practice, but I can't predict with any certainty if I'd ever want to excercise that option. I think that I will likely choose to do the FNP program at my local university because it fits in very well with other aspects of my life. My reservations have been/are about whether the coursework and # of clinical hours will be sufficient to prepare me to practice competently soon after finishing school. I'm realizing though that I've been wanting to rely on a degree or program to make me a good clinician. I can't do that. I have to use whatever education I am getting to my full advantage but also recognize that it will be my effort, dedication, and gathering of experience that will develop me into a good clinician. I am confident that I'll get there - I've been a very good clinician in my current field - and I could take it slow and stretch out the time I'm in my NP program so that I can work more hours as an RN if that will help me be ready for work after school. Also, it occurred to me that if after my pre-licensure year rotations, I feel certain that there is a specialty that I want to concentrate my schooling in, I could stop, work as an RN in that area for a couple years, and then move to a specialty NP program.

Thanks for the input on my situation; it is helping me think through all the implications of my different options. Life has certainly gotten more complicated. I don't think this decision would have been easy when I was fresh out of college either, but as my husband said, at that point, everything we owned fit in a small truck, we had no pets (not to mention no child), we had no mortgage, we were still on our parents' health insurance plans, and we were ready for adventure. I still want adventure, but now there's more to lose if things don't go as planned.

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i didnt realize you are already an RN. You should look into stanford's and UC Davis' PA programs. After you graduate from the you can also take the FNP boards. PA training, NP politics. Its a good deal.

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caldje- no, I'm not already an RN. If I do a masters entry NP program, I'll be an RN after the first year of training and then could do the rest of the program more slowly so that I could work part-time as an RN to gain experience before graduation. I'm looking at that as a way to balance the relatively small number of clinical hours required to graduate.

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oops, double post.

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