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should i be a doctor or nurse practitioner

BSN to Nurse Practitioner: Education Options and Program Overviews. As an emergency MD, I have the luck of reasonable hours, reasonable scheduling and almost no hassles with paperwork. But we do believe we can be equivalent within our limitations, and when a patients’ problems exceed our knowledge base or comfort level, we are able to resource our collaborating physician. Thanks for the comments. Happyily married for 60 years and now retired. A labor of love. There are more than enough patients for all of us so trying to stay in a space to not be burned out and leave the profession to survive is the answer. As a newly graduated MD starting residency in a couple weeks, I can say that I've met a lot of great NPs and PAs, but none have been anywhere near the level of my attendings. It’s infiltrated with variables that shouldn’t even matter. I’ve always supported your message until now because while medical school and residency was stressful and not always pretty, I went to a school that was not toxic and trained in an environment that that was incredibly supportive. RN may be the best answer for some. “That’s reassuring”, I sarcastically thought to myself when they got a part-time security guard for the front. Lay down and give up? I was thrown to the wolves and I had to learn quickly what I did not know. they get worse every. I have had PAs tell me PA school is likely just as intense/competitive as medical school, it is just that it is 2 years instead of 4, and I believe them. No matter what path I take in my education the PA, and NP that were competent as my primary care practitioners, and the good MD’s I’ve had care for me are who I would want to be like in my future second career. I think I have enough years to say to you that I loved who you were from the day we talked and being brave and speaking the truth doesn’t mean it’s easy. The difference between the 2 are day and night,its unfortunate that the laws allow NPs to have equivalent autonomy. Say what you want, schooling does not prepare anyone to do anything well. You're all valuable players in the healthcare system. Leave your ego at the door. Most PAs I know go on to medical knowing that staying as an PA is short lived and frustrating. You will learn best and retain information if you have sufficient sleep, a healthy diet, and take time to exercise. Thanks for commenting. You should stop commenting on the role and education of NPs. Research the programs and see what's best for the life you want and the career you want. People who reply are worried that you mean to generalize this advice. I know PA, docs and NPs who simply clock in for a paycheck and insurance. It’s good to hear “humility is the key” coming from a physician. What is going on with you that you place so little value in your own education and experience and in that of your colleagues? Prove that you’re worth your salt. Here are some of the things I learned in the past year, in no particular order! “Burnout”btw is a smokescreen for human rights violations: https://www.idealmedicalcare.org/blog/a-smokescreen-for-human-rights-abuse/. Each one has something unique that I really like. About 50 percent of NPs also have hospital privileges, allowing them to admit and order specialty services for patients. I don’t think she deserves this kind of vitriol. I rolled right into the MSN NP program, with 640 clinical hours. Thanks so much, again! Hi Ethan! There is plenty of research that supports NP practice as being more affordable, safe and effective. I almost didn’t publish this because I thought nobody much would read it. How dare you have your own opinion! In situations where I end up with a patient who would be better suited seeing a different provider, I am able to gather data and document a detailed H&P for them to have available when they see the patient. Lastly, I think it is important to think about the big picture. Further more, the pre-requisites for PA school won’t allow for just “practically anyone walking in from the street” to apply for school. I admire your work and passion for physician wellness. You may make more money as primary care doctor than nurse practitioner, but it may take years to catch up for the extra expenses of medical school. Thanks for your comment! Because I am 30 and settled with a partner, I have decided that the medical school model would be too tumultuous for me at this point, and that if I dedicate myself, I can have an equal impact on people’s lives via the nurse model of training. Nurse practitioners often already have a lot of work experience, because they start out as regular nurses, and go on to get their advanced degrees at a later time. I started out in 1971 as a nurses aide, then a certified medical assistant, an x-ray tech,...and as I worked in these amazing positions, I watched as doctors were no longer needing nurses and I was doing just about everything a nurse did in a doctors office, under their training and supervision. In my particular situation the difficulty in time and financial strain would aggravate my wife’s condition much more than mine. If you have to do everything from scratch, it will likely take you three years (or longer) to obtain your BSN degree, and then you will need to go back for an MSN or DNP. A group of nurse practitioner organizations responded with a unified stance: physicians do not own the title “doctor.” This group reassured physicians that nurse practitioners have no intention of misrepresenting themselves as MDs — or as a DO, DDS, DMD, … You sound like Generals. I have worked with PA's and NP's; both excellent ones and some I would rather forget. That’s not a philosophy, it’s a fact. Once again, my point being, I use my constant upgraded nursing , & integrative medical education to assess them as a RN and assist them in healing their own self when possible. People are what make you happy. Do I think Ethan will emerge with less mental health struggles as an NP? An an NP myself, I obviously agree with your advice. One more fact. The NP or PA route will be far less expensive. Some are pressured into medicine by parents. Dr Denmark, pediatrician, in Alpharetta was seeing patients at age 103. There isn’t one right answer about the best degree for you. In the last 10 years of my career I had the good fortune of training and working with a FNP who ended up making me tremendously more productive and had the skills and autonomy of 3rd- 4th yr. resident. Stranger to stranger–proud of you! I would have expected more, much more from a fellow physician. Do you not like NPs? I have practiced Psych prescribing for 8 years and had excellent on-the-job training by my former supervising doctor. They continue to work full time AND take classes AND do clinicals at the same time. If I wanted to be a "doctor" I'd go to med school. Ethan: Basically, my struggle is this: I am a current RN and would like to do primary care in the future (family medicine). Yes to all of the above. Thank you for your comments Roxana. But who doesn’t? All you need is some work to make the money to invest. I have gone thru 3 years in my training. I love the term ‘healers” – that is what we ALL are. As far as medical experience, most PA programs require real medical working experience,like EMT, PTA, RN, LPN, RT.. not volunteer or shadowing. for the kind words about the blog. 8) You don’t need help. For every article you have that shows they are equal there are articles that show they aren’t. As a patient, my experiences with NP's have been at least as good as and in many cases better than my experiences with doctors. Because that is an incredibly similar situation you are promoting here. Also a couple of notes: 1) The evidence indicates that NPs w/o nursing experience do just as well. Prior to this I was an EMT, then a nurse then I became a PA. While this may be the case for a few schools, it is definitely not for all and this is post nursing school and working as a RN. I’ve suffered with chronic sinusitis for years, the MD’s popped in acted like jerks, and shoved pills down my throat, and a DNP had the insight to figure out a course of treatment, and referred me both to an ENT, and an allergy clinic. Be sure if you choose the nursing route that you do NP, as NP is the only APRN credential that is at least recognized in all states. I agree that this advice is individualized. Egos have no place in the practice of medicine. None of us know everything, and it’s better to swallow pride than to risk a life. is better than the best NP? Well this has changed but until we all work as a team without the bullying in health care, there will be a divide between MD’s and NP’s. Raylen04. Please correct me if I’m wrong, I certainly understand the need of a hierarchy of knowledge and experience in the profession of medicine, but what I don’t understand is why a unified model of training (besides the fact that this would require a total change of the entire medical profession) can’t be designed, with increasing academic and clinical rigor, that would allow smart, capable, and experienced nurses to have the potential to progress to doctors, and simultaneously would require doctors to have more experience in patient care, which seems to be the most frequent complaint of unskilled or “arrogant” doctors. You don’t have to, but I use an EMR (Kareo, $150/month) and most of my non-urgent patient communications are through that. While my peers went the NP route, I recieved my masters of science in nursing in administration. I do agree with you that a 12-18 months program may not be enough. I then graduated Nurses school with an RN and worked in many different settings with my degree. NPs work for years as RNs before and while attending their NP program. Nurses as bsn holders have had more interaction with doctors in the hospital and clinical settings than a PA ever will. Over the 22 years I have practiced emergency medicine, I have worked with hundreds. Say no. I already had about $60k of undergrad debt and I was looking at acquiring at least $200k more, and deferring both debts for a residency. I wonder what the authors of the original email and the comment from 2 years ago decided to do. However, this too is changing, & state by state, NPs are pursuing legislation (some bills have been passed) to sever that needed tie.I disagree w/ the statement above that the 'nursing model is inferior.' And ultimately if providing high quality primary care is Ethan’s goal, (not becoming a surgeon or specialist), a nurse practitioner can very well provide that. Also, please do not call us mid-levels. When I worked in surgery, those residents were facing $250K in loans, and 5 years of clerkship - 3 as a resident, 2 as a fellow, and God help them if they wanted to sub-specialize - 15+ post-graduate years. NPs do get too much nursing theory which has been a waste of time for me. A financial writer for CBS wrote: “It… takes between 11 and 14 years of higher education to become a physician. I was so impressed with his assessment skills…..honestly pretty jealous really. (above excerpted from the article: 7 Shaming words to stop saying now). We all come from different walks of life, we’ve all been blessed with different opportunities, a person’s credentials do not determine their values. Even when the decisions are poor. We were never meant to take the place of doctors. I have little respect for the abusive ways that medical system treats it’s own students and how corp med treats physicians. I’ve read your email and subsequent comments by Dr. Wible and others.Thank you for sharing your feelings and concerns. That was literally just based on him being an RN. It is the system that is broken, it is not you. That is so pathetic but then I think they don’t even care for their own residents so why would a patient be different. I know they say, it's never too late to get additional schooling, but at 59 is it too late for me to consider a Nurse Practitioner career? It depends on what you want to do. NPs are being dumped out like a candy factory right now. Complacency is fatal in our industry, and I will NEVER just automatically trust any provider based on the letters behind their name. I am a retired MD who started out in FP, then considered OB/GYN and ended up in Orthopaedics I can appreciate your uncertainty and apprehension. I think if I was able to get into a reputable program like one of those with a solid curriculum, I could be satisfied with that kind of training/foundation and then be happy to keep learning and learning from there. All providers (including physicians) have different skill sets based on what they see in practice/how often they perform a specific skill. Your post is asinine at best! All that is required is that the doctor review and sign off on the treatment plan written by the nurse practitioner after the patient has left the office. I have sat and held the hand of a dying patient because there is no one else, I have done the simple things that often mean so much, like arranging for patients to go outside in their hospital beds just to feel a bit of sun on their face. I don’t need a “more educated” person to do my Pap, physical or treat my UTI or strep throat or many, many other things . I must say that this particular issue brought me to this page. I am in my last term in NP school and the way MDs treat NP students in clinicals is shameful. Dr Pamela is doing a great job. Our health finance paradigm needs to change, so I’ve made a new one: http://www.changehealth.today. Hello Ethan. Each individual practitioner is going to be as good as that individual wants to be, regardless of title. to learn by having this conversation. I changed careers in midlife, from business executive to NP. Physicians aren't required for everything - UTIs, HTN, HLD, vaccinations - all of those are important medical services that can be managed by mid-levels. I do think some of the 661+ doctor suicides on my registry may have been prevented had another more appropriate (even non-medical) career been selected. I can tell you that most physicians in my area do not accept Medicaid or CHIP for low income kids. That being said, I was a commercial banker prior to my MD. Much of this is true and I truly believe if the NP attends a reputable program, they can become exceptional providers. You give MDs a good name with your compassionate example, my prayer is your impact continues to promote mental wellness for MDs and students. So regardless of the title of the provider (NP, PA.MD) anyone can potentially be a part of a toxic environment if they are working in a hospital or clinic system (as most are).”. My criticism was viewed a treason and offensive as well. Anyway, I am considered a peer by my physician colleagues and they poke fun at me when I address them as Dr. xyz instead of by their first names. Recently she issued a statement about collaboration with MD’s due to their strong opposition. It is learned in the real world, providing excellent patient care while working with all members of the healthcare team. I think nursing attracts a different type of person that, to be blunt, has better people skills and that's why patients like NPS. Excellent advice and sorry I did not mention before the value of shadowing docs and NPs. 4) My wife insisted on seeing a business plan before she would support me. My only incentive is helping individuals who reach out to me and honestly answering their concerns via emails and phone calls I answer—for free. I really learned to hone in on my intuition, though, and that takes time, years of seeing patients. Do you even know there are NP programs 100% online with almost no clinical training at all? It goes both ways. I thought I was 100% going to do orthopedic surgery, and I got a job in orthopedic surgery and hated it. #1 – Multiple research studies have shown that NPs are as effective and safe in primary care as physicians. Thank you for being a beautiful soul Dr. Wible. Know your limits and consult/refer appropriately. I need to figure it out soon, I'm entering my sophomore year of college and not 100% sure on my career. On the other hand you will be essentially limited to caring for the worried well. But there is a reason these teams have been traditionally physician-led. You obviously have little insight into your own beliefs and the damage that this does to the physician profession. One day, you may want to open your own clinic. However, that the medical model is occasionally compatible with nurses’ values, and in certain settings can enhance and support nursing care. Our training… we are taught to utilize medical modalities in treating our clients pediatrician... Life circumstances to forget some very important to understand but we all must follow our own.! Happy you have no idea and explained it to grow and remain stable for the.... 3Rd, or hospice always ask for clarification on what you ’ d love to talk you! Or experienced to even using the word ‘ burnout ” which is 12 hours day! Special initials, we should spend less time infighting and toxicity think is is... 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