Would you still become a NP or would you go the MD route?

Specialties NP

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This is my first post, but I've been reading the boards for some time.

My question for current NPs is: If you could go back in time, would you still become a NP or would you go the MD route instead?

Why am I asking? I am close to finishing my BSN and want to keep going to be a family practice clinician. I am torn between FNP and MD.

FNP: I like the holistic approach. Builds on my current education. Less $ in tuition and less time. Can work while in school.

MD: The job of a family practice MD is not much different than a FNP. What draws me is the increased scientific background and the increased autonomy.

Your feedback is appreciated.

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Specializes in allergy and asthma, urgent care.

I would still pick NP. I never wanted the debt, the years of not having a life, or all the obligations that go along with being an MD. I'm happy with my autonomy, the scope of my practice, and the ability to have a life outside of work as an NP.

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In my opinion MD route is a best option. Look at the VA jobs for nurse practitioners, pay scale is 56000 - 96000, whereas general physician (MD) salary range is 96000 - 375000. Same work but huge difference in pay scale. It is outrageous.

If you are young, and if you can afford to pay off loan, go to Caribbean and get a MD degree.

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Specializes in family nurse practitioner.

Congrats on finishing school, that's awesome. Really good question. I love being a NP, I agree with both posters here. MDs can make way more money for doing the exact same thing in a family practice. The MD I work with makes 180k a year and I make 98k. The VA pays low so dont look at their pay scale to consider becoming a NP or not. The difference with what he does is he signs the scripts for PT, OT, Home care and oxygen. There is no difference in the patients we see. But he has been a doc for 40 years and I am coming up on 1 year. So its really going to be up to you. I have spoken to many docs that are just graduating and they feel Medical school took a huge chunk out of their life and that it wasn't worth it, and they don't recommend it. One was a general Surg Resident that says his malpractice is getting ready to be an arm and a leg and his taxes are extremely high. Once its all said and done his NP wife will make more than him. He missed so many holidays, weddings and funerals its ridiculous. Lots of his friends said the same thing. I think being a Family practice MD would not be as stressful as surgery but if you are going to do it, you may as well do it. Meaning, become a MD that is really getting paid well. Doing procedures would be the best way.

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Specializes in FNP, ONP.

Do you want to do family practice/internal med or specialize? Your post said "keep going to be a family practice clinician." Is that because as a nurse that would be the natural course, or is that really what you want to do? Because if you went to medical school you would be essentially starting all over and could choose any specialty you wanted and wouldn't be "stuck" with family practice. There is a reason it is the last choice of MD/DOs, lol. ;)

How old are you? Male/female? Are you single/married, are there children? Do you want to have children? Do you want to travel extensively? Write, research, volunteer/medical missions, play a competitive sport 20 hours a week, etc?

You don't have to answer those questions on the board, but consider to yourself what it is you really want from your life and decide accordingly. You really can not have it all. If you, for instance, are a female who has or wants to have, a large family, I wouldn't recommend med school. Ditto (IMO) if you are a male, although theoretically, if you are a male you could leave the parenting to your wife (and her 2nd husband/your childrens' stepfather, lol). Figure out what it is that you want, prioritize and go from there.

Do you have debt/savings? Who is paying for your education? Who would support you while you attended medical school? Depending upon your age upon entering medical school, debt incurred and lost wages, you may or may not end up better off at retirement. Much would depend upon the specialty you choose and factors we cannot predict. You should talk to your financial adviser and do some actuarial number crunching together examining the real cost of attending medical school versus anticipated salary in your desired specialty. The 375,000 quoted above is very unlikely to be a family practice MD. I would think that would be a specialty (gastro, cards) internal med physician at the top of the pay scale. I don't know anyone in family practice making that much money, no matter what their credentials. I think we are pretty much topping out at about $200k.

I will be the first to tell you that NPs being "more holistic" than MDs is complete hogwash. I am on a personal mission to correct that ridiculous fallacy, lol. You can be as holistic as you like, or not at all, in either role. FYI.

Autonomy depends entirely on where you practice. I am completely autonomous. NPs in some states have zero autonomy. Chose wisely.

No doubt that MD education offers greater depth and breadth. If you have the time, money and intellectual curiosity to invest, why not? My only caution would be that one should pursue it for learning sake alone at this point, because there is no longer any promise of the financial return on the investment that there once way, or a least not to the degree that people think. Not once you factor in the opportunity cost and actual cost of attendance.

So for me, if my circumstances were exactly the same and I had it to do all over again, I would do it exactly the same other than I would return to NP school sooner than I did. I would not go to medical school in my circumstances. My family would have had to sacrifice too much and the trade off would not have been nearly worth it. We don't need more income and time is the most valuable commodity in our lives. Having more money would not buy us more of that, so there wouldn't me any practical advantage in it for us.

Had I been single and childless, had no hobbies or interests that required as much of my time as mine do, yes I would have applied to medical school. I can't imagine that life though, and I don't think I'd like it! YMMV.

Good luck to you.

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Specializes in Med/Surge.

What blue devil is saying has pretty much pushed me to follow an NP track, I want to have another child this decade and enjoy life. I originally didn't want to consider this route- I want the autonomy and I love school.

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Specializes in family nurse practitioner.

I agree with Blue devil. You can definetly move around more as a NP. You can do ER, peds, GI, neuro, peds, women's health, urgent care, hospice, infectious disease, urology, pulmonary...etc as a FNP. I absolutely love that because I love diversity and flexibility. The MD I work with hates primary care and wants to do cardiology. I thought...ok go do that then! But he can't. He would have to go back to school.

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Specializes in PICU.

The other disadvantage that I learned about recently is the whole resident match thing that is done at the end of medical school. You could complete all 4 years of medical school, pass all of your exams, and then get placed in a specialty you don't want to do, or not get placed at all and never actually get to be a doctor. One of the 4th year med students I was working with really wanted to do peds, but he matched to a family practice residency, so he will never be able to go into a peds specialty. But at least he matched, 18 of his classmates did not, and if they can't find residencies in the "residency scramble" thing, then their medical career may be over for good. Hearing all of that made me really happy to be finishing NP school, where I had complete control over the specialty I want to go into. I considered MD school before I started nursing school, and I am SO glad I went the nursing route.

Another anecdotal comment, one of the MDs I work with comes from a family of MDs. He was saying he sees the outlook for MDs as being so dismal that he isn't sure what career to suggest to his sons. I told him nursing, and I could see he never thought of that before, but he couldn't argue against it. There is just so much opportunity!

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Specializes in Pediatric Pulmonology and Allergy.

Another point to add to what others said before. If you have a hankering for more knowledge, nothing is stopping you from picking up medical-school level textbooks and educating yourself. I find that my master's has prepared me enough that I can teach myself minimum what a typical medical student learns. And when it comes to CME we read the same journals and attend the same conferences as medical doctors do. I don't get involved with ******* contests about who's smarter and who knows more, and I'll always defer to the person with greater knowledge and experience, no matter what their title is.

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Specializes in ICU, LTACH, Internal Medicine.
The other disadvantage that I learned about recently is the whole resident match thing that is done at the end of medical school. You could complete all 4 years of medical school, pass all of your exams, and then get placed in a specialty you don't want to do, or not get placed at all and never actually get to be a doctor. One of the 4th year med students I was working with really wanted to do peds, but he matched to a family practice residency, so he will never be able to go into a peds specialty. But at least he matched, 18 of his classmates did not, and if they can't find residencies in the "residency scramble" thing, then their medical career may be over for good. Hearing all of that made me really happy to be finishing NP school, where I had complete control over the specialty I want to go into. I considered MD school before I started nursing school, and I am SO glad I went the nursing route.

Another anecdotal comment, one of the MDs I work with comes from a family of MDs. He was saying he sees the outlook for MDs as being so dismal that he isn't sure what career to suggest to his sons. I told him nursing, and I could see he never thought of that before, but he couldn't argue against it. There is just so much opportunity!

Future residents choose their own specialty and programs to apply, nobody can do it for them. But because the chance to get no match is real (less common for US MD grads and much more for everybody else), almost all of them include a few of less competitive places, like Family med programs situated in the middle of nowhere, in their "lists". If they match there, little can be done in terms of changing specialty as well as future career prospective.

I agree that NPs can be as "holistic" or not as they want, but at least they can try if they wish to do so. An MD cannot legally prescribe or even "legally" (i.e. documenting the fact) recommend anything which is not approved either by FDA, pharmaceutical industry or specialty guidelines. An MD who is licensed to practice family medicine can "learn" how to do lunch-break face lifts, Botox shots and such during a weekend "seminar" and then set up a "spa" and practice it all, and that's legally OK until something bad happens. The same MD cannot, legally, recommend melatonin pills for a senior patient suffering from insomnia, although in Europe it is an established practice. Here in the USA only habit-forming benzos and things like enzopiclone (Lunesta, $10/pill) are "approved as being safe and effective" for the purpose.

I had a good chance to go other way, and after some very hard and very long thinking chose NP way. My foreign diploma would eliminate the problem with school debts, but moneys won't buy me time off my life, time with my family, time for my patients, freedom of specialty choice and freedom of recommending alternative therapies when indicated. And I'm free to read the very same books doctors read - believe me, there is no rocket science in clinical medicine, and no special talents or qualifications are required to learn biochemistry or molecular biology.

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Specializes in FNP, ONP.

In all fairness I don't think failing to match at all is really very common except among poorly performing students. I could be wrong, and perhaps some of the lurking medical students can better inform us, but I believe if you are smart about your residency applications (based on your STEP scores) you are not likely to fail to match. You might not LOVE your residency spot, but not everyone is going to do their residency at Hopkins, and that is just the way it is.

Now, some residencies are extremely competitive and few are going to get interventional rads, derm at all, much less at the most prestigious institutions. However, if the OP really wants to do family practice I don't think s/he is going to have any trouble. Also, my understanding is the peds is one of the very least competitive so not getting a peds residency seems odd unless one's grades/scores/interviews are pretty bad. That's just hearsay from MD colleagues, I have no 1st hand experience obviously. My only point is that it isn't quite as dismal as it has been made out to be and I do think we have to be a bit more objective, lol.

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Specializes in PICU.
In all fairness I don't think failing to match at all is really very common except among poorly performing students. I could be wrong, and perhaps some of the lurking medical students can better inform us, but I believe if you are smart about your residency applications (based on your STEP scores) you are not likely to fail to match. You might not LOVE your residency spot, but not everyone is going to do their residency at Hopkins, and that is just the way it is.

Now, some residencies are extremely competitive and few are going to get interventional rads, derm at all, much less at the most prestigious institutions. However, if the OP really wants to do family practice I don't think s/he is going to have any trouble. Also, my understanding is the peds is one of the very least competitive so not getting a peds residency seems odd unless one's grades/scores/interviews are pretty bad. That's just hearsay from MD colleagues, I have no 1st hand experience obviously. My only point is that it isn't quite as dismal as it has been made out to be and I do think we have to be a bit more objective, lol.

That's good to hear that it maybe isn't quite as bad at the students were telling me. But even having to go into a specialty that you're not interested in, seems like a big deterrent to me. Of course, I'm really pro-nursing:D

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