Young -- should pursue NP or MD?

[MikeyJ]

I am sure this question has been answered in previous posts, however, I never came across one that really answered my specific situation.

I am still young (22 yrs old) and am finishing up my BSN degree; I anticipate to graduate May 2008. I have come to realize that even though I enjoy the nursing profession, I would probably prefer to be a practitioner where I am able to diagnose, discuss treatment plans with my patients, and ultimately have a much larger patient oversight. I would also prefer the challenge of being a practitioner.

I have spoken with NP's, PA's, and MD's and I get a lot of mixed reactions. Considering I am still young, what would be my best bet? Pursue the NP or MD? What do current NP's see as the pro's and con's concerning the MD route opposed to the NP route.

Thanks for any and all input!

[MikeyJ, RN]

I am afraid that, as above, that opinion is often given based on inacurate information. I urge you to pursue information on PAs on your own and see if its a good fit. The job that PAs do is identical to the job NPs do. So, if you trust those folks that you shouldnt pursue PA your decision should be pretty easy. MD is the only option. For some people that is the case. If you want to be a midlevel provider, the decision is based on what i stated above, and a few other issues like... you can work during NP school and there are online NP schools. There are no online programs to make you eligible for licensure as a PA. There are other things also... what state are you in too? You should research the state laws and see what NPs/PAs are allowed to do.

I live in Nevada and we have pretty lenient laws regarding the practicing rights of NP/PA. We have a collaborative state and they are able to prescribe narcotics here. I've researched all of my options, and have been researching them all before I started college.

I've worked in the hospital setting, and the MD's whom I have questioned on what route to choose, they have pushed me away from the idea of pursuing PA because they feel if they are inadequately trained. Not all of them have said that, however, there were a few. There were some MD's who told me to pursue the NP route. I've only spoken to two PA's and they both advised me to pursue the MD route. I've spoken to many NP's and nursing professors, and most have told me to basically test out the waters as a nurse and see if I fall in love with nursing. If not, then to pursue the MD/DO route.

[caldje]

here's an abbreviated version of nevada's pa laws.

nevada

qualifications: graduation from accredited pa program and current nccpa certificate.

application: by pa for license (pa must send in supervision form signed by physician prior to initiating practice).

scope of practice: medical services delegated by the supervising physician; within his or her specialty; within the pa's training, experience, and competence; and approved by the board.

prescribing/dispensing: with board approval, pa may prescribe and dispense drugs and devices, including schedules ii-v controlled substances, as delegated by the supervising physician. registration with pharmacy board and pharmacy law exam required. pas who prescribe controlled medications must register with the dea.

supervision: supervising physician must be available at all times for consultation, which may be indirect (by telecommunication); physician shall regularly review and initial selected patient records. board approval required for pa utilization in remote site. supervising physician shall spend part of a day at least once a month at any location where pa provides medical services to act as consultant to pa and to monitor quality of care.

participation in regulation: three pas serve on pa advisory committee.

nevada state board of medical examiners, p.o. box 7238, reno, nv 89510; [phone] or [phone].

www.state.nv.us/medical

board of osteopathic medicine, 2860 e. flamingo rd., ste. d, las vegas, nv 89121-5270, [phone]

www.osteo.state.nv.us

i looked for a agood resource on the nevada apn practice act and all i could muster up is this (http://www.nursingboard.state.nv.us/advprac/apn%20protocol%20guidelines.pdf) which tells me enough.. in this case, apns in nevada operate under protocols which are "directions" on what to do given to them by their "collaborative" physician. although "collaborative" sounds better when you read it or say it my opinion is that protocols are more restrictive than the broad description of supervision given to pas. i mean, i used to operate under protocols as an emt. so, just look into these things and keep asking questions. :-d

as far as md/do, i think i that if you wish to pursue an area other than family practice medical school is definately the gold standard. however, i think if you went to med school and ended up in primary care you might have wished you had spent less time in school and less money on school becoming a midlevel. just my opinion.. also from what many mds tell me in frustration. ;-)

one more thing.. its important to ask people who make claims like "pas arent trained well enough." why they think so. as with everything.. some people certainly shouldn't be doing what they are doing. not all pas are created equal, for that matter neither are mds or nps. all three are great choices, if made for the right reasons and researched well.

[marty6001, EdD, EMT-P, APRN]

sorry i didn't answer your question in my last post. i am an acute care nurse practitioner and an adjunct professor of nursing. the reality is that apn's, through national and state nursing boards and laws, work under a collaborative practice with physicians. semantically, i agree that there is little difference between the practice of apn's and pa's, though looking at the letter of the law, pa's are supervised by physicians while apn's have a different relationship. this is not to say one is better or worse than the other, but apn's choose to hang onto our identity as nurses, and because of this, we provide a unique and valued service to our patients. why pa's have not worked to change this idea of supervision is unknown to me, an di do not wish to get into a yelling match (on a nursing forum mind you) with any pa's about this issue.

people choose their careers for themselves. i choose first to be a nurse, then an apn because of my experience. i am glad to work with physicians, pa's, apn, rn, and anyone else who wants to put letters after their name because i want to make a difference in the life of my patients. i leave the bickering and arguing to the lawmakers.

i also was an emt, as well as a paramedic, and also hold a degree in forensic science as well as my masters in nursing. i can assure anyone who wants to know that apn's operate much differently, and much more independently than i did as a medic or emt. or at least they do in my state. to the original poster, research all three professions well. they each bring a much different view of medicine to the patient, and all are needed in the years to come to ensure that patients thrive and do well.

[core0]

sorry i didn't answer your question in my last post. i am an acute care nurse practitioner and an adjunct professor of nursing. the reality is that apn's, through national and state nursing boards and laws, work under a collaborative practice with physicians. semantically, i agree that there is little difference between the practice of apn's and pa's, though looking at the letter of the law, pa's are supervised by physicians while apn's have a different relationship. this is not to say one is better or worse than the other, but apn's choose to hang onto our identity as nurses, and because of this, we provide a unique and valued service to our patients. why pa's have not worked to change this idea of supervision is unknown to me, an di do not wish to get into a yelling match (on a nursing forum mind you) with any pa's about this issue.

people choose their careers for themselves. i choose first to be a nurse, then an apn because of my experience. i am glad to work with physicians, pa's, apn, rn, and anyone else who wants to put letters after their name because i want to make a difference in the life of my patients. i leave the bickering and arguing to the lawmakers.

i also was an emt, as well as a paramedic, and also hold a degree in forensic science as well as my masters in nursing. i can assure anyone who wants to know that apn's operate much differently, and much more independently than i did as a medic or emt. or at least they do in my state. to the original poster, research all three professions well. they each bring a much different view of medicine to the patient, and all are needed in the years to come to ensure that patients thrive and do well.

there is a lot of discussion about the supervision aspect of the profession, for the most part the relationship works so why mess with it. as far as the difference from my point of view np's tend to have their degrees in functional areas that may or may not limit them. for example a pnp would not be able to see adults. the fnp can see all age groups. the other thing that we are seeing in our market is the hospitals are refusing to credential fnp's for inpatient work (this is a recent development due to acnp programs i think). this may or may not limit your work environment. the good aspect of supervision and being tied to a physician is that your only limitation is what your sp allows you to do.

all three professions have pluses and minuses. you need to look carefully at the market you think you want to work in and the type of medicine that you want to work in. md's can work in any market. depending on the market there may be an advantage to being an np or a pa (there are tremendous local variations). ultimately if this is what you want to do you should carefully examine all the options.

david carpenter, pa-c

[npingeorgia]

if you have any feeling at all that you may want to go to medical school, then do it. i have a friend that is in his 2nd of medical school and was a parmedic before that. he is now 31 and lots of schools like nontraditional students, so don't let the age thing get you. I am even thinking about it myself, take a look at programs that offer biology,chem,organic chem and physics in a year and then give you the option to skip your glide year and start med school right away, once you're accepted of course.

john hopkins, goucher are 2 that i have looked at but there are many more.

hope this helps.

[MikeyJ, RN]

here's an abbreviated version of nevada's pa laws.

nevada

qualifications: graduation from accredited pa program and current nccpa certificate.

application: by pa for license (pa must send in supervision form signed by physician prior to initiating practice).

scope of practice: medical services delegated by the supervising physician; within his or her specialty; within the pa's training, experience, and competence; and approved by the board.

prescribing/dispensing: with board approval, pa may prescribe and dispense drugs and devices, including schedules ii-v controlled substances, as delegated by the supervising physician. registration with pharmacy board and pharmacy law exam required. pas who prescribe controlled medications must register with the dea.

supervision: supervising physician must be available at all times for consultation, which may be indirect (by telecommunication); physician shall regularly review and initial selected patient records. board approval required for pa utilization in remote site. supervising physician shall spend part of a day at least once a month at any location where pa provides medical services to act as consultant to pa and to monitor quality of care.

participation in regulation: three pas serve on pa advisory committee.

nevada state board of medical examiners, p.o. box 7238, reno, nv 89510; [phone] or [phone].

www.state.nv.us/medical

board of osteopathic medicine, 2860 e. flamingo rd., ste. d, las vegas, nv 89121-5270, [phone]

www.osteo.state.nv.us

i looked for a agood resource on the nevada apn practice act and all i could muster up is this (http://www.nursingboard.state.nv.us/advprac/apn%20protocol%20guidelines.pdf) which tells me enough.. in this case, apns in nevada operate under protocols which are "directions" on what to do given to them by their "collaborative" physician. although "collaborative" sounds better when you read it or say it my opinion is that protocols are more restrictive than the broad description of supervision given to pas. i mean, i used to operate under protocols as an emt. so, just look into these things and keep asking questions. :-d

as far as md/do, i think i that if you wish to pursue an area other than family practice medical school is definately the gold standard. however, i think if you went to med school and ended up in primary care you might have wished you had spent less time in school and less money on school becoming a midlevel. just my opinion.. also from what many mds tell me in frustration. ;-)

one more thing.. its important to ask people who make claims like "pas arent trained well enough." why they think so. as with everything.. some people certainly shouldn't be doing what they are doing. not all pas are created equal, for that matter neither are mds or nps. all three are great choices, if made for the right reasons and researched well.

primary care is something i definitely do not want to do. i find it self-gratifying when i am an expert at one thing, rather than being decent at a variety of areas (both in the medical aspect and non-medical aspect). that is one reason why i have been seriously considering medical school. you can "specialize" as an np or pa and work in a variety of specialized settings, but i would be afraid of not being an expert in the subject area.

i think i have answered my own question and will probably pursue medical school. however, the idea of committing to something that requires so many years of your life is a scary thought.

[caldje]

I think you've answered your own question too. Congrats on your new found path.. just duck your head and run. It will be over before you know it. Now you just have to find people to talk to about what you are now intending on doing. Best of luck to you and remember to hire a couple midlevels! :-D

[aklim3]

I am sure this question has been answered in previous posts, however, I never came across one that really answered my specific situation.

I am still young (22 yrs old) and am finishing up my BSN degree; I anticipate to graduate May 2008. I have come to realize that even though I enjoy the nursing profession, I would probably prefer to be a practitioner where I am able to diagnose, discuss treatment plans with my patients, and ultimately have a much larger patient oversight. I would also prefer the challenge of being a practitioner.

I have spoken with NP's, PA's, and MD's and I get a lot of mixed reactions. Considering I am still young, what would be my best bet? Pursue the NP or MD? What do current NP's see as the pro's and con's concerning the MD route opposed to the NP route.

Thanks for any and all input!

Well, firstly, how honest can you be with yourself? You don't have to post the answers here but you need to ask yourself some hard questions.

I got paid the same as I would in my nursing job with 10 yrs experience. Only difference is 8-5 hours and no every other weekend. Is that an issue with you?

What are your plans? You will earn more as an MD but with specialization opportunities. You are young yet. If I was your age, I'd go MD but I was 38 when I started this route so the money won't be there before I retire after paying off all the loans and all that.

There is talk of having to have a DnP but I don't think it will affect you. Check carefully and be careful because if it does, you will probably be better of as an MD.

It is your life but if you are going to be doing the same thing for less money, are you willing to live with that? Of course, if you do think you might want to be a specialist like in Cardio, Neuro, etc, etc, you have to go the MD route. That is the one that will earn the big bucks.

As I said before, you don't need to spill your guts here. However, you need to be honest with yourself. How much is the money worth to you?

[aklim3]

Primary Care is something I definitely do not want to do. I find it self-gratifying when I am an expert at one thing, rather than being decent at a variety of areas (both in the medical aspect and non-medical aspect). That is one reason why I have been seriously considering medical school. You can "specialize" as an NP or PA and work in a variety of specialized settings, but I would be afraid of not being an expert in the subject area.

I think I have answered my own question and will probably pursue medical school. However, the idea of committing to something that requires so many years of your life is a scary thought.

Didn't read this post yet before I replied. Oh well.

Rodney Atkins has a song about that

Well you know those times

When you feel like there's a sign there on your back

Say's I don't mind if ya kick me

Seems like everybody has

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And you don't know where you are

Use the needle of your compass

To sew up your broken heart

Ask directions from a genie

In a bottle of Jim Beam

And she lies to You

That's when you learn the truth

If you're going through hell

Keep on going, Don't slow down

If you're scared, don't show it

You might get out

Before the devil even knows you're there

Well I been deep down in that darkness

I been down to my last match

Felt a hundered different demons

Breathing fire in my back

And I knew that if I stumbled

I'd fall right into the trap that they were laying, Yeah

But the good news

Is there's angels everywhere out on the street

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The one's that you been dragging for so long

You're on your knees

You might as well be praying

Guess what I'm saying

If you're going through hell

Keep on going, Don't slow down

If you're scared, don't show it

You might get out

Before the devil even knows you're there

Yeah, If you're going through hell

Keep on moving, Face that fire

Walk right through it

You might get out

Before the devil even knows you're there

If you're going through hell

Keep on going, Don't slow down

If you're scared, don't show it

You might get out

Before the devil even knows you're there

Yeah, If you're going through hell

Keep on moving, Face that fire

Walk right through it

You might get out

Before the devil even knows you're there

Yeah you might get out

Before the devil even knows you're there

Yeah.