Why you should become a nurse or physicians assistant instead of a doctor

[katiemaude]

I haven't read through the whole thread, so please forgive me if something similar has already been mentioned. I work in a hospital with a lot of young nurses, NPs and CRNAs. Today's nursing graduates who are hired where I work need to have BSNs. And they borrow A LOT to get them. Some report having as much as $100K worth of debt out of undergrad and struggle to pay it on their $50K salaries- not to say that's worse than what today's premeds have and we are taking on more interest by waiting years to get through medical school and residency. But some of these nurses have really struggled to find jobs. To advance into any kind of supervisory position, they need to have an MSN. Since they are already in debt, they need to work while getting that master's. Tack on another two years for a program they could have finished in 1 1/2-2 years. To break that $100K ceiling, they need to become an NP. NPs will be required to have a PhD in a few years. That's many more years of school, more debt, etc. Some of them get through it and think, "I should have just gone to medical school." (Sound familiar?)

I did consider being a CRNA. But even that's a hard road with few guarantees. The CRNAs I know borrowed $150K+ for two years of school, plus they barely managed to pay anything back from their BSN while they put in a year of med--surg time, two years of critical care, etc. By the time they become CRNAs they are usually in their late 20s/early 30s. This is all anecdotal of course but basically they need to keep going to school, paying through the nose for it (they get about $4K a year in help if they go to school while working full-time at my hospital ... well that covers one class), and grinding to advance. The smart ones who understand this blast their way into critical care right away, apply to CRNA programs after a year, and start making six figures by the time they are 25/26. VERY FEW of them figure it out that quickly.

Now PAs on the other hand, the ones I know are 24 and bringing in $70-80K right after getting their master's degrees. The surgeons seem to prefer the newbies that they can train in their ways. They do the suturing and work long hours and put in all the orders and stay late to round and take call. The surgeons go home when the cases are done. I don't know about primary care PAs and how that works for them. The PAs who work for a good surgeon who is not a jerk are pretty happy about life but they work 60-80 hr weeks for that salary. They can move around if they don't like the surgeon, or go into a different specialty entirely. That sounded pretty awesome to me and I seriously considered it. I still wonder if I should have gone the PA route, but I had nothing stopping me from applying to medical school. If I had a family it might be different.

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[PL198]

Have you ever seen how many scholarships there are for nursing students? Not to mention you're trying to compare undergrad loans to graduate loans, which aren't comparable at all. It's not nearly as difficult for nurses as you are making it out to be. I could be a practicing NP at 22, and have done about 1/10th the work I did in undergrad. I've literally never heard of an NP that wished they had gone to medical school. No one says that. Meanwhile I won't be an MD until I'm 23 and licensed till I'm 28.

 

[BestDoctorEver]

Exactly. This isn't an insult at all, the way people here are taking it. There are TONS of medical students who in college didn't explore their options and decided on med school. The truth is that many of them would have been just as happy doing a PA or NP.

Did you explore the NP/PA option?

 

[CaptainSSO]

Meanwhile I won't be an MD until I'm 23 and licensed till I'm 28.

Nice humble brag

 

[PL198]

Nice humble brag

Not at all, seeing as there are thousands just like me. I was comparing the time and how I could literally practice for 6 years earlier as a NP

 

[DermViser]

Nice humble brag

Maybe he did a combined program and entered at an early age?

 

[LiamNeesons]

Learning basic sciences is not "medicine" and definitely not the realities of daily clinical medicine.

I don't even know where to begin. I just finished reviewing the different types of seizures and their respective treatments.

 

[Siggy]

OK, skipping the massive amount of derp and male genital fondling in this thread (it's a privilege of being on surgery night float)...

1. One "big reason" that he misssed is that you're actually in charge. There's no "waiting for the doctor's order." This doesn't mean you get a chance to be a raging dick to the nurses and the rest of the hospital staff or end up waiting for consults to be written, but there is a big difference between following the medical orders and being able to write the medical orders.
2. Also, when it comes to medical care, the physician is still recognized as the expert, bar none. By being board certified in ____, you are now the expert in ____. That still counts for something.

Do all those reasons (my two plus the author's reasons) make up for the downsides of medical training? That's up to the individual. I do know that I would never encourage someone that I don't know to go into medicine... because if some stranger can convince you to not go to medical school, you shouldn't be going because the training (both med school and residency) will destroy you.

 

[DermViser]

OK, skipping the massive amount of derp and male genital fondling in this thread (it's a privilege of being on surgery night float)...

1. One "big reason" that he misssed is that you're actually in charge. There's no "waiting for the doctor's order." This doesn't mean you get a chance to be a raging dick to the nurses and the rest of the hospital staff or end up waiting for consults to be written, but there is a big difference between following the medical orders and being able to write the medical orders.
2. Also, when it comes to medical care, the physician is still recognized as the expert, bar none. By being board certified in ____, you are now the expert in ____. That still counts for something.

Do all those reasons (my two plus the author's reasons) make up for the downsides of medical training? That's up to the individual. I do know that I would never encourage someone that I don't know to go into medicine... because if some stranger can convince you to not go to medical school, you shouldn't be going because the training (both med school and residency) will destroy you.

You know PAs and NPs write orders, right?

 

[Siggy]

You know PAs and NPs write orders, right?

Yes... and a pretty large part of the article was dealing with registered nursing. Even still, depending on the state will determine how much oversight ("collaboration") is required in order to practice for mid-levels.

 

[IlDestriero]

What kind of idiot honestly believes this.

People with low expectations.

 

[acs726]

Not everyone becomes a physician for the money or prestige. Doing something you know that is meant for you is worth so much more than maximizing your lifestyle.

 

[Silent Cool]

What kind of idiot honestly believes this.

"I've been rich and I've been poor. Rich is better, honey." - Sophie Tucker

 

[circulus vitios]

"I've been rich and I've been poor. Rich is better, honey." - Sophie Tucker

At least the $70k or $75k figure that was in the news a few years ago was somewhat plausible but $40k/year, really? That's like $550-600 a week after taxes and fringe benefits.

Not everyone becomes a physician for the money or prestige. Doing something you know that is meant for you is worth so much more than maximizing your lifestyle.

Cool, let me know how that works out when the novelty of playing doctor wears off and you're frustrated with jerk patients. When it gets to that point, all you have is money and lifestyle.

 

[katiemaude]

Have you ever seen how many scholarships there are for nursing students? Not to mention you're trying to compare undergrad loans to graduate loans, which aren't comparable at all. It's not nearly as difficult for nurses as you are making it out to be. I could be a practicing NP at 22, and have done about 1/10th the work I did in undergrad. I've literally never heard of an NP that wished they had gone to medical school. No one says that. Meanwhile I won't be an MD until I'm 23 and licensed till I'm 28.

Are you directing this at me? I wasn't comparing undergrad to grad loans. I was illustrating what nurses/PAs I personally know are going through. It's not comparing apples to apples to apples, MD to NP to PA. They all have their benefits and downsides, which are pretty clear when you get to know more than a handful of each. I chose my path and they chose theirs. It's nice to have options.

If you think being a NP is a cinch comparatively speaking... If you wanted to be a NP ... what stopped you? Grown ups get to make their own decisions last I checked.

 

[TheWeeIceMan]

Not everyone becomes a physician for the money or prestige. Doing something you know that is meant for you is worth so much more than maximizing your lifestyle.

 

[PL198]

Are you directing this at me? I wasn't comparing undergrad to grad loans. I was illustrating what nurses/PAs I personally know are going through. It's not comparing apples to apples to apples, MD to NP to PA. They all have their benefits and downsides, which are pretty clear when you get to know more than a handful of each. I chose my path and they chose theirs. It's nice to have options.

If you think being a NP is a cinch comparatively speaking... If you wanted to be a NP ... what stopped you? Grown ups get to make their own decisions last I checked.

Because I didn't want to be a NP. That doesn't mean it's not a stupid choice to go to med school. I'm human and just because I decided to do something doesn't mean it's the right choice. The fact of the matter is, that going to medical school is day by day becoming a less beneficial choice. The opposite is true for becoming an NP. You talked about nurses having a lot of undergrad debt and then phrased 100k of undergrad loans for a 50k salary as if it were difficult to pay off. It's really not. The reason residents fail to pay towards the principal of their loans during residency is a) because the principal is much higher than 100k b) their loans accrue interest immediately, vs the ones an RN would take out, which do not. Not to mention I've never really heard of an RN becoming 100k in debt.. If you're going after a job that pays 50k a year, it's probably not wise to go to a private school, or out of state, when nearly all schools have nursing programs. The same can't be said about medical programs, nor is admission as easy, vs nursing where it's a shoe-in.

 

[PL198]

Not everyone becomes a physician for the money or prestige. Doing something you know that is meant for you is worth so much more than maximizing your lifestyle.

That doesn't pay your bills or keep food in your family's mouth. When push comes to shove, if the money isn't there, you aren't going to do it, unless you're a fool. You can say money isn't a primary motivator but 1) That's BS 2) if we want to play with words and not call it a primary motivator, it surely would be a primary detractor in the event it wasn't there.

 

[FutureOncologist]

You see, this is the problem that non-medical students have. They look for reasons not to go to medical school, find an article how doctors are being paid less, and go "AHA! Now I'm gonna prove to this medical student network that they made a HORRIBLE choice!"

1. Do you think Medical students and most pre-meds haven't already looked into the time commitment required to become a doctor? Spoiler alert: we already know.

2. This article assumes that people become a physician for the pay. Although true for some, most know that the pay is good, but not great. This isn't the 1980's. We know we won't be earning an absurd amount of money.

3. This article assumes that there is a HUGE gap between being an NP/PA and a Physician. On one side, the physician works ungodly hours, earns a little amount of money, never get to experience life until mid-30's, and become unhealthy. On the other side of the gap, PA's and NP's get great hours, earn a crap ton of money, live leisurely, and get to experience life as opposed to their M.D./D.O. counterparts.

I. Doctors, although have a lot of work to do during the beginnings of residency, still have time off. They can still make time for family, meet people, do things on their off time, and are allowed to have fun. They still get paid a reasonable amount to have payment plans for schooling while still live a comfortable lifestyle. Buy a new BMW? Maybe not, but they can still afford to get a house and raise a family. Doctors can never experience life in their 20's? I call Bull crap? During medical school, although I studied a lot, I still went to the gym every other day, met people, had fun on the weekends, went out on the town, traveled the state I stay in, AND still made great grades. I don't party every weekend, BUT I still enjoy life and the choices I made to get where I am.

II. This article doesn't explore the life of an NP/PA. Apparently, you can be an NP/PA by the age of 22. Most bachelor's degrees take 4 years to achieve. If you go to college at 18, you graduate at the age of 22 (ignoring accelerated programs like 2+2 or 3+1, which puts you into the workforce as an RN). According to Education-Portal.com, if you get a B.A. in Nursing, you will need to take an exam, called the NCLEX-RN, to become a REGISTERED NURSE. After so, said RN then can go for a masters/doctorate in Nursing. During so, you have to attend lectures, seminars, and do clinical rounds in healthcare management, pathophysiology, and advanced pharmacology. At this point, it is up to which state you want to practice to see if you take another exam to become an NP. These certifications go through AANP and and AANC. The lifestyle of an NP isn't glorious either. You have defended that NP's have a lot of authority that Doctors do, which is true. However, with great power comes great responsibility. NP's have to do too much than I'll name here, so here is a link to what they have to do: http://explorehealthcareers.org/en/Career/75/Nurse_Practitioner

PA's go through 6-7 years of schooling, depending on the program. Once again, you have to get a B.A. degree, but it can be in anything. What this article fails to note is that PA school is more competitive than some M.D. schools (for example, the PA program in my state allows only 105 seats a year with 1,400 applicants a year, whereas my medical school only gets ~400 a year for a class of 150). They require a ridiculous amount of healthcare hours, ECs, amazing LORs, and a great cGPA and sGPA. Once you go through PA school, you have to get licensed. Then, you work as much as a physician without any of the prestige of being a physician. Yes, less schooling, but you'll have more-experienced doctors will want to talk to a "real physician" and ignore your advice. That is the underside of having "assistant" tagged onto your profession.

This, in no way, undermines what an NP, PA, and Physician does. They all have a great responsibility and thus should be treated with the utmost respect.

tl;dr: Being an NP/PA as opposed to an M.D. isn't all glamour. It takes a lot of work, a lot of money, and demands almost as much as a physician.

References: http://explorehealthcareers.org/en/Career/75/Nurse_Practitioner
http://education-portal.com/how_to_become_a_nurse_practitioner.html

 

[PL198]

You see, this is the problem that non-medical students have. They look for reasons not to go to medical school, find an article how doctors are being paid less, and go "AHA! Now I'm gonna prove to this medical student network that they made a HORRIBLE choice!"

1. Do you think Medical students and most pre-meds haven't already looked into the time commitment required to become a doctor? Spoiler alert: we already know.

2. This article assumes that people become a physician for the pay. Although true for some, most know that the pay is good, but not great. This isn't the 1980's. We know we won't be earning an absurd amount of money.

3. This article assumes that there is a HUGE gap between being an NP/PA and a Physician. On one side, the physician works ungodly hours, earns a little amount of money, never get to experience life until mid-30's, and become unhealthy. On the other side of the gap, PA's and NP's get great hours, earn a crap ton of money, live leisurely, and get to experience life as opposed to their M.D./D.O. counterparts.

I. Doctors, although have a lot of work to do during the beginnings of residency, still have time off. They can still make time for family, meet people, do things on their off time, and are allowed to have fun. They still get paid a reasonable amount to have payment plans for schooling while still live a comfortable lifestyle. Buy a new BMW? Maybe not, but they can still afford to get a house and raise a family. Doctors can never experience life in their 20's? I call Bull crap? During medical school, although I studied a lot, I still went to the gym every other day, met people, had fun on the weekends, went out on the town, traveled the state I stay in, AND still made great grades. I don't party every weekend, BUT I still enjoy life and the choices I made to get where I am.

II. This article doesn't explore the life of an NP/PA. Apparently, you can be an NP/PA by the age of 22. Most bachelor's degrees take 4 years to achieve. If you go to college at 18, you graduate at the age of 22 (ignoring accelerated programs like 2+2 or 3+1, which puts you into the workforce as an RN). According to Education-Portal.com, if you get a B.A. in Nursing, you will need to take an exam, called the NCLEX-RN to become a REGISTERED NURSE. After so, said RN then can go for a masters/doctorate in Nursing. During so, you have to attend lectures, seminars, and do clinical rounds in healthcare management, pathophysiology, and advanced pharmacology. At this point, it is up to which state you want to practice to see if you take another exam to become an NP. These certifications go through AANP and and AANC. The lifestyle of an NP isn't glorious either. You have defended that NP's have a lot of authority that Doctors do, which is true. However, with great power comes great responsibility. NP's have to do too much than I'll name here, so here is a link to what they have to do: http://explorehealthcareers.org/en/Career/75/Nurse_Practitioner

PA's go through 6-7 years of schooling, depending on the program. Once again, you have to get a B.A. degree, but it can be in anything. What this article fails to note is that PA school is more competitive than some M.D. schools (for example, the PA program in my state allows only 105 seats a year with 1,400 applicants a year, whereas my medical school only gets ~400 a year for a class of 150). They require a ridiculous amount of healthcare hours, ECs, amazing LORs, and a great cGPA and sGPA. Once you go through PA school, you have to get licensed. Then, you work as much as a physician without any of the prestige of being a physician. Yes, less schooling, but you'll have more-experienced doctors will want to talk to a "real physician" and ignore your advice. That is the underside of having "assistant" tagged onto your profession.

This, in no way, undermines what an NP, PA, and Physician does. They all have a great responsibility and thus should be treated with the utmost respect.

tl;dr: Being an NP/PA as opposed to an M.D. isn't all glamour. It takes a lot of work, a lot of money, and demands almost as much as a physician.

References: http://explorehealthcareers.org/en/Career/75/Nurse_Practitioner
http://education-portal.com/how_to_become_a_nurse_practitioner.html

The dude that made this thread is a derm resident. Therefore he was among the most competitive and dedicated medical students when he was one. Pre-meds have 0 idea the time commitments that being a medical student entails, let alone being a resident. Have you talked to the average pre-med before? They're barely aware of who the president is. Imagine if he were white. 1/3 of them would probably only know who he is. 2nd point: Refer to my post above yours. 3) If you think PA school is more competitive than medical school, then we're not going to be able to have a reasonable debate. Those numbers you supplied aren't significant at the competitiveness at all. I did something like 150 credits in 2 years(including AP and CLEP, so I'm a cheater or whatever). This is of real pre-med material. You make me do the same thing for nursing classes, and I'll do that instead laughing and sleeping 10 hours a night. No one says they get paid a ton, they just make a decent wage ,especially for the amount of time/financial commitment necessary to be one.

 

[Silent Cool]

What is it with people and money? 70K, really? Yeah, sure, I could get by on that. But honestly..having money rocks. And having more is better than having less. You can do all kinds of cool stuff with money. Maybe it won't change my baseline happiness or something, but it makes traveling to Europe possible, or buying an Aston Martin, or taking autotech classes so I can learn about cars, or affording guitar lessons for myself and my kids, or paying the mortgage, or going to nice restaurants, which I enjoy, etc...

Seriously.

Or, in the words of the great @jetproppilot

Why make 150K when 450K is out there?

http://forums.studentdoctor.net/threads/why-make-150k-when-450k-is-out-there.509725/

 

[katiemaude]

Because I didn't want to be a NP. That doesn't mean it's not a stupid choice to go to med school. I'm human and just because I decided to do something doesn't mean it's the right choice. The fact of the matter is, that going to medical school is day by day becoming a less beneficial choice. The opposite is true for becoming an NP. You talked about nurses having a lot of undergrad debt and then phrased 100k of undergrad loans for a 50k salary as if it were difficult to pay off. It's really not. The reason residents fail to pay towards the principal of their loans during residency is a) because the principal is much higher than 100k b) their loans accrue interest immediately, vs the ones an RN would take out, which do not. Not to mention I've never really heard of an RN becoming 100k in debt.. If you're going after a job that pays 50k a year, it's probably not wise to go to a private school, or out of state, when nearly all schools have nursing programs. The same can't be said about medical programs, nor is admission as easy, vs nursing where it's a shoe-in.

Well then you made YOUR choice.

It is actually not that easy to pay off $100K in loans on $50K. Subsidized loans are capped and a lot of those loans would be PLUS loans at higher rates. Also? None of these nurses I speak of left the state. The state schools where I live don't have great nursing programs, and they are also not that cheap either. Also? There ain't no nursing shortage here, bro. You are making it sound like being a nurse is a great deal all around and it's not for everyone. It's got high points and low points, just as I'm sure you've found working in medicine. You've worked, assuming?

 

[TheWeeIceMan]

What is it with people and money? 70K, really? Yeah, sure, I could get by on that. But honestly..having money rocks. And having more is better than having less. You can do all kinds of cool stuff with money. Maybe it won't change my baseline happiness or something, but it makes traveling to Europe possible, or buying an Aston Martin, or taking autotech classes so I can learn about cars, or affording guitar lessons for myself and my kids, or paying the mortgage, or going to nice restaurants, which I enjoy, etc...

Seriously.

Or, in the words of the great @jetproppilot

Why make 150K when 450K is out there?

http://forums.studentdoctor.net/threads/why-make-150k-when-450k-is-out-there.509725/

Eh, looking at it as more money is always better than less money is kind of dumb, but maybe you were just exaggerating for good measure. Maybe not 70k, but I'd wager there is a point where making more money at the expense of other things just isn't worth it. Of course, based on that linked thread, maybe you don't believe that and will be gunning for neurosurgery or whatever the highest paying specialty you can get into is.

 

[BestDoctorEver]

I guess it is a case of 'the grass is always greener on the other side'... I have met a lot of RN/PA/NP that said if they had a do over, they would go med school and there are many out there that after being a RN/PA/NP for many years who went or are going back to school to become MD/DO. Come to think of it, have you guys/gals met a physician who went back to school for a complete career change... Not talking about business school.

 

[PL198]

I guess it is a case of 'the grass is always greener on the other side'... I have met a lot of RN/PA/NP that said if they had a do over, they would go med school and there are many out there that after being a RN/PA/NP for many years who went or are going back to school to become MD/DO. Come to think of it, have you guys met a physician who went back to school for a complete career change... Not talking about business school.

no because they can't afford to.... The stats are like 50 % of docs say they wouldn't go into medicine if they had to do it again or something like that if I recall right.

 

[BestDoctorEver]

no because they can't afford to.... The stats are like 50 % of docs say they wouldn't go into medicine if they had to do it again or something like that if I recall right.

What do you mean they can't afford it? You are telling me a FM doc with 250k student debt can't pay it back in 7 years if he/she wants to have a career change... In addition, most other trainings don't take that long...

 

[TheWeeIceMan]

no because they can't afford to.... The stats are like 50 % of docs say they wouldn't go into medicine if they had to do it again or something like that if I recall right.

Exactly. Kind of hard to switch careers when you are in your mid 30s, 6 figures in debt, and in a career that is basically the only way to pay off the 6 figure debt in a reasonable time frame.

 

[BestDoctorEver]

@TheWeelceMan ... Yeah! You truly think that is the reason they don't do it when other people are living 100k/year salary to go back to med school...

 

[Silent Cool]

Eh, looking at it as more money is always better than less money is kind of dumb, but maybe you were just exaggerating for good measure. Maybe not 70k, but I'd wager there is a point where making more money at the expense of other things just isn't worth it. Of course, based on that linked thread, maybe you don't believe that and will be gunning for neurosurgery or whatever the highest paying specialty you can get into is.

No. I'm just saying that I would rather be better off than worse off. You don't need to do something as extreme as Neurosurgery. I mean, if FM residency is three years and anesthesia is four, why not just train one more year to make 3x the income?

 

[TheWeeIceMan]

@TheWeelceMan ... Yeah! You truly think that is the reason they don't do it when other people are living 100k/year salary to go back to med school...

100k/yr, but without the student loans of a doctor? Much easier to leave.

Okay then, why do you think physicians are less likely to change careers? Is it because medicine is the best career out there?

 

[TheWeeIceMan]

No. I'm just saying that I would rather be better off than worse off. You don't need to do something as extreme as Neurosurgery. I mean, if FM residency is three years and anesthesia is four, why not just train one more year to make 3x the income?

Yeah, that's fair. I think that 3x number has narrowed a bit since JPP posted that thread, though.

 

[PL198]

@TheWeelceMan ... Yeah! You truly think that is the reason they don't do it when other people are living 100k/year salary to go back to med school...

Are you trolling? You literally cannot see why someone that is an attending, and finally making real money after all the years of delayed gratification would be unable to go into another career? Really? Ok so let me work for something for 12+ years(undergrad, med school and residency) get debt on average of 300k(not including interest) and the moment I finally start making real money, I'm going to walk away from that? Or even the moment I pay my loans off I'm gonna walk away from that and start the whole process over? You realize that people at the age of 35-40 with an MD don't enjoy living like a college student, right? But yeah, I'm sure they're going to go back to school to be an NP or an MBA. Get real. Don't take that long? You realize you'd be back to the student role, while you have an MD, right?

I'm pretty sure you're trolling. I can understand a pre-med thinking this, not someone actually in medical school. They must have some good kool-aid wherever you go.

Here's some facts. 50 % of docs say they wouldn't do it again. To me, that says their pretty dissatisfied with their job. Look up how many of them leave the profession to pursue other fields each year. I bet it's under 1 %. Why? Because they're tied down. Just because you have your loans paid off, doesn't mean its advisable to leave a profession where you make 200k+ a year.... Some financial literacy would do you some good.

 

[BestDoctorEver]

100k/yr, but without the student loans of a doctor? Much easier to leave.

Okay then, why do you think physicians are less likely to change careers? Is it because medicine is the best career out there?

Because of the money to be blunt... I will bet that 90%+ of people out there will not change their career for another when they know they will make a lot less (I mean less than half) in the other career... I don't know if medicine is the best career out there, but I know many are leaving their careers to go into medicine--not the other way around.

 

[BestDoctorEver]

Are you trolling? You literally cannot see why someone that is an attending, and finally making real money after all the years of delayed gratification would be unable to go into another career? Really? Ok so let me work for something for 12+ years(undergrad, med school and residency) get debt on average of 300k(not including interest) and the moment I finally start making real money, I'm going to walk away from that? Or even the moment I pay my loans off I'm gonna walk away from that and start the whole process over? You realize that people at the age of 35-40 with an MD don't enjoy living like a college student, right? But yeah, I'm sure they're going to go back to school to be an NP or an MBA. Get real. Don't take that long? You realize you'd be back to the student role, while you have an MD, right?

I'm pretty sure you're trolling. I can understand a pre-med thinking this, not someone actually in medical school. They must have some good kool-aid wherever you go.

Here's some facts. 50 % of docs say they wouldn't do it again. To me, that says their pretty dissatisfied with their job. Look up how many of them leave the profession to pursue other fields each year. I bet it's under 1 %. Why? Because they're tied down. Just because you have your loans paid off, doesn't mean its advisable to leave a profession where you make 200k+ a year.... Some financial literacy would do you some good.

If they are so miserable, why don't they leave? They can pay back their loan in 7-8 years if they want to...

 

[PL198]

Because of the money to be blunt... I will bet that 90%+ of people out there will not change their career for another when they know they will make a lot less (I mean less than half) in the other career... I don't know if medicine is the best career out there, but I know many are leaving their careers to go into medicine--not the other way around.

Which is literally what I said initially.

 

[PL198]

If they are so miserable, why don't they leave? They can pay back their loan in 7-8 years if they want to...

Lol did you literally just ignore my entire post and re-write your previous post? I don't think you understand anything about money. Have fun living like a 22 yr old college kid when you're 40.

 

[TheWeeIceMan]

If they are so miserable, why don't they leave? They can pay back their loan in 7-8 years if they want to...

Because they will be almost 40 with a near zero net worth. Going back to do something else would be *****ic at that stage.

Because of the money to be blunt... I will bet that 90%+ of people out there will not change their career for another when they know they will make a lot less (I mean less than half) in the other career... I don't know if medicine is the best career out there, but I know many are leaving their careers to go into medicine--not the other way around.

People change between careers all the time. The average person has like 3 different careers in a life time. The discrepancy between the number going into and out of medicine can be (at least imo) partly explained by the difficulties in leaving medicine.

 

[BestDoctorEver]

@PL198 ... My point was that a lot of you are talking about RN/PA/NP as a better career choice than MD/DO when these people are switching for MD/DO... As a former nurse, I talked to these people (friends, former classmates, family members) and I know they are not that happy with their careers as people are portraying it here... Like I said it's a case 'the grass is always greener'...

 

[OCDEMS]

Disclaimer: A lot of this article is intriguing, especially the parts about the labor lissues surrounding the match and residency, but I wanted to address the issue of financial reward separately:

I wanted to add a different perspective to this thread, as I see a lot of anti-physician comments. First, I had a previous career and was, by several metrics, very successful in my 20's. I did all the crap that people lionize on here as part of the delayed gratification that physicians have to endure. While the blog is well written, it sugar coats what the real world is like. I'm not saying that family practitioners don't have a right to be pissed, but the real world is tough for the vast majority of Americans. The one where you have to pay a mortgage, maintain a drivable car, and do all the other "cool" things that you're somehow supposed to afford in your 20's on $40k a year (before taxes...gasp!). Too many doctors (but not all) have never had to do that because, well, they didn't. It sucks. You won't be flying first class to Monaco, climbing Everest, or sailing around the world on a middle-class salary. If you are, then mommy and daddy are subsidizing your existence.

One of the things that virtually all of these articles fail to address is purchasing power, which if you're remotely familiar with buying things more expensive than a Playstation, is very important. Try buying and putting 20% down on a typical single-family home making $40-50k a year and then try doing it as a physician making $200-300k and see which is easier. First, it is deceptive to look at the yearly salary of a $40-60k/year nurse and then add it up, under the best of circumstances, and conclude that lifetime earnings will surpass a physician. Most people are terrible investors and buy stupid ****. You may numerically surpass a physician but you're much more likely to waste the majority of it on poor decisions, inflation, etc. It would take a tremendous amount of discipline over many years to obtain a physician's purchasing power as the average nurse. Second, a physician's purchasing power is magnitudes greater than the average middle-class worker. In the vast majority of cases, a physician making $200k a year is still making $150k more a year than someone with a middle-class income (minus the higher tax burden), because so many people in the middle-class never invest enough to get out of the cycle of living paycheck to paycheck. I say this from both my own anecdotal experience with coworkers and the amount of literature stating as much. Furthermore, only half of all privatized U.S. workers participate in a retirement plan at all. The average 401(k) balance of most 65 year olds is $25,000. That's a month's worth of income for plenty of docs. Many of you may lambast having to wait until your thirties to enjoy the fruits of your labor, but there are few excuses (we're all smart people, if a bit "dull" according to the author) for not taking that income and maximizing its potential with a little bit of research and smart investing.

Next I'll address the fallacy of the debt burden. Yes, it's real for physicians and yes it is burdensome, but I can't help but notice how the author glosses over the fact that plenty of regular run-of-the-mill college graduates have high debt to income ratios. Do you realize how many "kids" graduated into the recession only to retreat to grad school for a master's degree of questionable utility? Do you know how many people I went to school with who now have MBAs from low-tier schools and over $100k in debt? Do you then realize how many of them make less than the average nurse? Don't get me started on recent law school graduates. My point is that many students have student debt ratios equal to or greater than their annual salaries. They pay a high percentage of their income toward loan repayment, even if the total number is smaller than what we all have.

Finally, plenty of "regular" workers hate their jobs. I worked with nurses and they're not all rainbows and butterflies. Sure, is being an NP or PA a good gig? Yeah, duh, but if you're pursuing medicine only for financial incentives then it's probably not the place for you anyway. Many of the people who brag about the good deal they got going to NP or PA school are really just trying to justify why they didn't go to medical school, for whatever reason, otherwise they wouldn't be bragging about it. People who are comfortable with their accomplishments don't find the need to run around yelling "I told you so" to every doctor they meet. And for every happy PA there is another who complains about the feeling of being a perpetual resident. The rigors of the training are part of the attraction. Few professions have such a high barrier to entry, require the level of scientific understanding inherent to medical education, and then impart such great responsibilities on their members. Does medical school blow 80% of the time? Yep. Does barely getting by in the modern American economy? Yup.

Should you do your research before medical school? Yes. Will it be a 100% guaranteed awesome time? No. Is it still a good gig for the right person? Sure, probably.

 

[PL198]

Everything you listed is stupid people doing stupid stuff. Not saving for retirement? Stupid, their fault. Getting a joke degree? Stupid, their fault. Going into business from a low ranked business school or same thing for law? Stupid, their fault. The things affecting physicians are out of their control, as it's politicians waging war on the medical industry, without actually knowing anything about it. Excuse me while I don't feel sorry for people that f*ck up, vs physicians that are having it ripped out of their hands(not fighting is a f*ck up, but not a direct one). No one has said anything close to the lifetime earnings of a nurse equaling those of a physician. I don't understand why everyone deals in absolutes and gross figures. The point is that relative to the hours worked, people say there is a higher gain from being a NP than an MD. Not to mention the fact that generally these proclamations are made that the future landscape for being a physician will continue on it's current trajectory and get worse for doctors and better for NPs. A physician doesn't make 200k out of the gate, versus a nurse of any kind, that makes their money when they start.

Please don't vilify people who pursue medicine for the money. I'd say they're ill-advised, but if that's their sole reason, there is 0, zip, nada, zilch, wrong with that. Medicine is not a calling, not a duty, and you are no more noble than them for whatever your reasons are. Also stupid people being stupid, doesn't somehow reflect negatively on people that pursue medicine. The perils of my situation are not minimized by the perils of others that are reached by their stupidity.

 

[radkat101]

@DermViser, I hear you, and I'm about to be starting school in a couple of weeks. Perhaps I've spent too much time reading SDN and articles like this while I've been waiting to start but I'm seriously beginning to get a little freaked out. Is there anything (other than turning back now) that I can do while in school to avoid regretting my decision, or am I screwed? Should I just gun for certain specialties from day 1?

FWIW I'm in Texas and will be coming out with very little debt.

 

[OCDEMS]

@PL198 , We'll have to disagree. You absolutely shouldn't go into medicine for the money and, as someone who had a previous career in the medical field "helping" people, you're foolish if you do, least of which because there are host of other ways to make physician levels of money (see the 7-11 discussion earlier in the thread). Sure, it may be easy for some physicians working in certain specialities to loose sight of their immense importance to their patients, but many physicians do make a difference in the lives of their patients on a routine basis. Yes, many even save a life or two once in awhile. So yes, it is a noble profession and yes patients do deserve to have society's very brightest at their side. It's easy to be jaded when the last 7+ years of your life has been around your medical school/residency/attending colleagues, but I dare you to spend a few days in other professions and you'll quickly see that our most dysfunctional members are still typically impressive people. I had the pleasure of working with a good swath of the American public, walk into their homes, and see the difficulties they face. Not everyone is a victim and plenty of smart people move through life trying to get by because of decisions like not going to medical school. I have friends in a variety of professions who complain incessantly about the BS they deal with in the microcosm of their little universe. Engineers complain about regulatory issues, job satisfaction, and other professional issues the same way we do and many of them don't break $100k/year.

The median income for a NP in the U.S is roughly $93k. I've lived on that level of income and a doctor it does not make. Nor do most nurse practitioners follow a completely continuous, unbroken pathway to that level of practice. Many work as RNs for several years while then going back to school part-time, so there is some level of delayed gratification, although I wouldn't pretend to equate it to what we're all doing.

I'm not here to say that the article isn't right in many circumstances, because the author does make some good points. I'm just saying that the other side of the fence isn't full of unicorns and pots of gold.

 

[DermViser]

@DermViser, I hear you, and I'm about to be starting school in a couple of weeks. Perhaps I've spent too much time reading SDN and articles like this while I've been waiting to start but I'm seriously beginning to get a little freaked out. Is there anything (other than turning back now) that I can do while in school to avoid regretting my decision, or am I screwed? Should I just gun for certain specialties from day 1?

FWIW I'm in Texas and will be coming out with very little debt.

Everyone guns for certain specialties on Day 1. I don't know how that changes anything. You'll only know what specialties you're eligible for once you have the entire picture: Class rank, Preclerkship grades (if it's not "true" P/F), Step scores, Clerkship grades, etc.

 

[AsclepiusMD]

For me, I had a choice between medicine and working at a 7/11 my dad would buy (100% serious, this was my parent's plan for me if medicine didn't work out).

There's nothing wrong with the latter choice, but I did not want to become a page in my father's history book. Medicine gave me a chance to avoid that fate.

I guess I don't mind not having the romance and sex stuff, never having experienced romance or sex.

$100 will fix that problem for you.
($400 if having all their teeth is a requirement)

 

[DermViser]

Yes... and a pretty large part of the article was dealing with registered nursing. Even still, depending on the state will determine how much oversight ("collaboration") is required in order to practice for mid-levels.

18 states allow NP independent practice.

 

[DermViser]

What do you mean they can't afford it? You are telling me a FM doc with 250k student debt can't pay it back in 7 years if he/she wants to have a career change... In addition, most other trainings don't take that long...

A FM physician can not pay back his 250 K debt in 7 years being anything BUT a physician.

 

[DermViser]

Everything you listed is stupid people doing stupid stuff. Not saving for retirement? Stupid, their fault. Getting a joke degree? Stupid, their fault. Going into business from a low ranked business school or same thing for law? Stupid, their fault. The things affecting physicians are out of their control, as it's politicians waging war on the medical industry, without actually knowing anything about it. Excuse me while I don't feel sorry for people that f*ck up, vs physicians that are having it ripped out of their hands(not fighting is a f*ck up, but not a direct one). No one has said anything close to the lifetime earnings of a nurse equaling those of a physician. I don't understand why everyone deals in absolutes and gross figures. The point is that relative to the hours worked, people say there is a higher gain from being a NP than an MD. Not to mention the fact that generally these proclamations are made that the future landscape for being a physician will continue on it's current trajectory and get worse for doctors and better for NPs. A physician doesn't make 200k out of the gate, versus a nurse of any kind, that makes their money when they start.

Please don't vilify people who pursue medicine for the money. I'd say they're ill-advised, but if that's their sole reason, there is 0, zip, nada, zilch, wrong with that. Medicine is not a calling, not a duty, and you are no more noble than them for whatever your reasons are. Also stupid people being stupid, doesn't somehow reflect negatively on people that pursue medicine. The perils of my situation are not minimized by the perils of others that are reached by their stupidity.

He's an MS-0 and is the BestDoctorEver (hence the username).

 

[DermViser]

@PL198 , We'll have to disagree. You absolutely shouldn't go into medicine for the money and, as someone who had a previous career in the medical field "helping" people, you're foolish if you do, least of which because there are host of other ways to make physician levels of money (see the 7-11 discussion earlier in the thread). Sure, it may be easy for some physicians working in certain specialities to loose sight of their immense importance to their patients, but many physicians do make a difference in the lives of their patients on a routine basis. Yes, many even save a life or two once in awhile. So yes, it is a noble profession and yes patients do deserve to have society's very brightest at their side. It's easy to be jaded when the last 7+ years of your life has been around your medical school/residency/attending colleagues, but I dare you to spend a few days in other professions and you'll quickly see that our most dysfunctional members are still typically impressive people. I had the pleasure of working with a good swath of the American public, walk into their homes, and see the difficulties they face. Not everyone is a victim and plenty of smart people move through life trying to get by because of decisions like not going to medical school. I have friends in a variety of professions who complain incessantly about the BS they deal with in the microcosm of their little universe. Engineers complain about regulatory issues, job satisfaction, and other professional issues the same way we do and many of them don't break $100k/year.

The median income for a NP in the U.S is roughly $93k. I've lived on that level of income and a doctor it does not make. Nor do most nurse practitioners follow a completely continuous, unbroken pathway to that level of practice. Many work as RNs for several years while then going back to school part-time, so there is some level of delayed gratification, although I wouldn't pretend to equate it to what we're all doing.

I'm not here to say that the article isn't right in many circumstances, because the author does make some good points. I'm just saying that the other side of the fence isn't full of unicorns and pots of gold.

You know that not following the "continuous, unbroken pathway" is a choice right?

 

[maxxor]

Interesting, thank you for your perspective. Where would you say something like gen surg would fit on that continuum?

To answer a question I missed earlier:

Gen surg clinic was in the middle of the spectrum. Their clinics made me feel more like an old "GP", because they didn't turf nearly as much as true specialists do, but they also did office procedures, evaluated potential operative candidates, and had the power to say "no". They were able to defer the crappy stuff to the PCP (disability paperwork, referrals, all that coordination of care stuff) and tended to see patients for a certain issue that once it was done, they didn't need to see the patient any more. Of course, this was a general surgeon who had a largely elective practice, didn't do trauma, and only did the occasional semi-urgent appy and chole when on call.

He also had a nice semi-threat to smack patients over the head with for lifestyle modification: "If you don't stop smoking 4 weeks before I fix your hernia, I will cancel the surgery" or "if your A1C isn't under 7 by the operation, I'm canceling it". And he would.

General surgery (and medicine in general) eats you alive when you lose that power to say no. I think that's why I always preferred surgery to medicine. At my institution, surgery could refuse an ED admit; medicine could not. Perhaps the changes to radiology with the move to employed attendings will mean it loses its ability to say no as well, but I'd rather read a ton of reports than fight and justify my medical decision making with an insurance company prior authorization system. If that happens, I'll switch over to programming.

 

[DermViser]

To answer a question I missed earlier:

Gen surg clinic was in the middle of the spectrum. Their clinics made me feel more like an old "GP", because they didn't turf nearly as much as true specialists do, but they also did office procedures, evaluated potential operative candidates, and had the power to say "no". They were able to defer the crappy stuff to the PCP (disability paperwork, referrals, all that coordination of care stuff) and tended to see patients for a certain issue that once it was done, they didn't need to see the patient any more. Of course, this was a general surgeon who had a largely elective practice, didn't do trauma, and only did the occasional semi-urgent appy and chole when on call.

He also had a nice semi-threat to smack patients over the head with for lifestyle modification: "If you don't stop smoking 4 weeks before I fix your hernia, I will cancel the surgery" or "if your A1C isn't under 7 by the operation, I'm canceling it". And he would.

General surgery (and medicine in general) eats you alive when you lose that power to say no. I think that's why I always preferred surgery to medicine. At my institution, surgery could refuse an ED admit; medicine could not. Perhaps the changes to radiology with the move to employed attendings will mean it loses its ability to say no as well, but I'd rather read a ton of reports than fight and justify my medical decision making with an insurance company prior authorization system. If that happens, I'll switch over to programming.

Exactly. Internal Medicine does not have the power to say no, bc EVERYTHING is a "medical" problem. Now go thru 3 years of that.