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

[WhippleWhileWeWork]

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.

Thank you for answering.

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[IlDestriero]

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

Yes. The sky is falling because the evil anesthesia management companies that are destroying the specialty only offer $350 + benefits...

 

[pilotjoe]

@DermViser I'm curious, what do you think about the HPSP or NHSC to pay for medical school?

 

[DermViser]

@DermViser I'm curious, what do you think about the HPSP or NHSC to pay for medical school?

I'd go to the Military forum and find out more about the HPSP scholarship and the strings attached, if any, with respect to the match. I think it really depends on what specialty you're aiming for. If you're aiming to do primary care - then NHSC or HPSP is a great deal.

 

[IlDestriero]

@DermViser I'm curious, what do you think about the HPSP or NHSC to pay for medical school?

Its value has increased dramatically over the last decade or so. It was a big money loser for me, and I only owed 3 years. However the math is different now.
Having said that, mil med has a lot of problems and other hassles for you to deal with, not to mention landmines to navigate.
Joining the military for the money will leave most people unhappy. If you really want to serve, it's a great option. When things don't fall your way, those guys roll with it, understanding that is the nature of life in the .mil.

 

[pilotjoe]

Oh, I have looked into it (I think I probably would have done it if I didn't have a wife and baby). I was just curious what you thought about it by your advise to be an NP/PA in lieu of primary practice.

 

[starstarie]

I couldn't make it to the end of the article (too much whining) but from what I read in the beginning I would say there are some fair points... The article really needs to be renamed, though, to "Why you should be a NP/PA instead of a PRIMARY CARE doctor. Honestly, it would be a fine system to have a few NP/PAs with a head MD for more complicated cases in primary care settings, IMO.

But come on, there are tons of people in med school who are not there to be PCPs.

And as others have mentioned, the grass is always greener on the other side. There is always something to complain about in life. Being a (non-primary care) doctor is a really stimulating job compared to many many others. Come on, a LAWYER? ENGINEER?? NURSE??? please no!!

I would definitely say, if you are on the older side and want to do primary care anyway you'd be an idiot not to at least consider NP/PA, doesn't everyone know that already, though?

 

[DermViser]

Oh, I have looked into it (I think I probably would have done it if I didn't have a wife and baby). I was just curious what you thought about it by your advise to be an NP/PA in lieu of primary practice.

In general, my feeling is if you are aiming for primary care - General IM/General Peds/Family Med, then NP or PA is a much better investment, esp. from a student loan standpoint. You can have a very good lifestyle, with good pay being a PA and doing primary care, and if you ever get bored you can always switch over to a specialty field. That's what is so great about PA is its flexibility.

 

[DermViser]

I couldn't make it to the end of the article (too much whining) but from what I read in the beginning I would say there are some fair points... The article really needs to be renamed, though, to "Why you should be a NP/PA instead of a PRIMARY CARE doctor. Honestly, it would be a fine system to have a few NP/PAs with a head MD for more complicated cases in primary care settings, IMO.

But come on, there are tons of people in med school who are not there to be PCPs.

And as others have mentioned, the grass is always greener on the other side. There is always something to complain about in life. Being a (non-primary care) doctor is a really stimulating job compared to many many others. Come on, a LAWYER? ENGINEER?? NURSE??? please no!!

I would definitely say, if you are on the older side and want to do primary care anyway you'd be an idiot not to at least consider NP/PA, doesn't everyone know that already, though?

You do know that you are in no way assured of being a specialist, right? There are people who end up in primary care specialties who didn't choose it to begin with. It's just how things ended up.

 

[pilotjoe]

I really enjoyed my experience in the ER as a scribe. I am definitely leaving my options open, but I could see going to an EM/Peds residency (which would give me versatility and increase my scope of practice). But I agree with you, one would be wise to either go into military medicine or NP/PA for primary practice. I'm not very interested in primary practice (though I know that EM sees a lot of patients better suited for family practitioners).

 

[starstarie]

You do know that you are in no way assured of being a specialist, right? There are people who end up in primary care specialties who didn't choose it to begin with. It's just how things ended up.

I don't know about you, but I am assured to be a specialist, yes.

 

[DermViser]

I don't know about you, but I am assured to be a specialist, yes.

And you would know that bc you just finished MS-1 at a "true" P/F school. Congrats on your clairvoyance!

 

[dadaddadaBATMAN]

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.

Sorry, this just made me curious.

Are you at a combined bs/md program?

 

[circulus vitios]

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.

You can pay off a $400-450k balance in 5-6 years if you don't mind living on $40k/yr post tax -- that's not "living like a 22 year old college kid," it's living like a solidly middle class wage earner.

Many doctors hate their jobs, but they love the money.

 

[starstarie]

And you would know that bc you just finished MS-1 at a "true" P/F school. Congrats on your clairvoyance!

Haha first off, that was a joke. Second, please don't discount my opinion just because of my year in school. I am probably older and wiser than you. And I also have a considerable amount of experience in the healthcare field.

 

[PL198]

You can pay off a $400-450k balance in 5-6 years if you don't mind living on $40k/yr post tax -- that's not "living like a 22 year old college kid," it's living like a solidly middle class wage earner.

Many doctors hate their jobs, but they love the money.

I guess, but I'd say it's not loving the money, it's just that you've done 12 years of work to that point to get the money, so as soon as you can enjoy that money, why would you leave? It's like if you worked your entire life to get into the majors, got promoted A to AA to AAA and finally to the MLB and you get a **** ton of guaranteed money, and you walk away because you don't like it. That'd be f*cking stupid. Due to over half of physicians saying they are unpaid, I wouldn't say that they love the money, just that they view pursuing another profession as a financially irresponsible move(which it is).

 

[DermViser]

Haha first off, that was a joke. Second, please don't discount my opinion just because of my year in school. I am probably older and wiser than you. And I also have a considerable amount of experience in the healthcare field.

 

[PL198]

Haha first off, that was a joke. Second, please don't discount my opinion just because of my year in school. I am probably older and wiser than you. And I also have a considerable amount of experience in the healthcare field.

Non-trad god complex, priceless. That means literally nothing. You're choosing to late enter a path that others entered from the beginning at a younger age, how does that make you more knowing or more anything than them?

 

[DermViser]

You can pay off a $400-450k balance in 5-6 years if you don't mind living on $40k/yr post tax -- that's not "living like a 22 year old college kid," it's living like a solidly middle class wage earner.

Many doctors hate their jobs, but they love the money.

Depending on the stress of the specialty, part of what makes medicine bearable is not living as a solidly middle class wage earner.

 

[starstarie]

How does it make me know less?

 

[DermViser]

Non-trad god complex, priceless. That means literally nothing. You're choosing to late enter a path that others entered from the beginning at a younger age, how does that make you more knowing or more anything than them?

I thought I'd let the stupidity of his comment speak for himself. They think that somehow being an older non-trad and having healthcare "experience" makes them have some type of advantage.

 

[PL198]

How does it make me know less?

A traditional college student enters medical school at time 0. You entered at time 0 + x, with x assumed to be 5 or more years(haven't really heard many 26 yr old M1s call themselves a non-trad), how does failing to make a decision at a younger age, which you later make at an older age, somehow reflect positively on your knowledge?

 

[PL198]

Sorry, this just made me curious.

Are you at a combined bs/md program?

ya

 

[starstarie]

Her comment.

Obviously I am the one with the god-complex, where you @DermViser are the one that has been sarcastically commenting on anyone's post that is lower in school than you and implying that their opinion cannot be valid because they don't have the same "experience" as you do.

And I will just stop here. My you folks on here get so defensive when people challenge you.

 

[DermViser]

Her comment.

Obviously I am the one with the god-complex, where you @DermViser are the one that has been sarcastically commenting on anyone's post that is lower in school than you and implying that their opinion cannot be valid because they don't have the same "experience" as you do.

And I will just stop here. My you folks on here get so defensive when people challenge you.

Has nothing to do with my experience or being defensive. You said you were "assured" of being a specialist as a person who has only finished MS-1 and hasn't taken boards or finished clerkships. I called you out on it. Then you bring up being "older and wiser than you. And I also have a considerable amount of experience in the healthcare field" as if that gives you some type of advantage.

 

[starstarie]

Has nothing to do with my experience or being defensive. You said you were "assured" of being a specialist as a person who has only finished MS-1 and hasn't taken boards or finished clerkships. I called you out on it. Then you bring up being "older and wiser than you. And I also have a considerable amount of experience in the healthcare field" as if that gives you some type of advantage.

OH MY GOD THAT WAS A FUC*ING JOKEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

 

[starstarie]

Ok, now I'm really going to stop.

 

[maxxor]

Ok, now I'm really going to stop.

Gotta include the obligatory emoticon or /s tag

 

[starstarie]

never used this before. kinda fun!

 

[starstarie]

 

[BestDoctorEver]

You can pay off a $400-450k balance in 5-6 years if you don't mind living on $40k/yr post tax -- that's not "living like a 22 year old college kid," it's living like a solidly middle class wage earner.

Many doctors hate their jobs, but they love the money.

It is hard for many med students whose parents make 200k/year to understand that there are people out there who are living perfectly fine with 40k/year... I worked in nursing in multiple settings and all i heard are complaints from RN/NP/PA on how ****ty their jobs are and how the physicians are making them do all the stuff they themselves don't want to do and now people are telling me these professions have it better than physicians...

 

[BestDoctorEver]

Her comment.

Obviously I am the one with the god-complex, where you @DermViser are the one that has been sarcastically commenting on anyone's post that is lower in school than you and implying that their opinion cannot be valid because they don't have the same "experience" as you do.

And I will just stop here. My you folks on here get so defensive when people challenge you.

Obviously you are not as smart as s/he is... (sarcasm).

 

[BestDoctorEver]

I guess, but I'd say it's not loving the money, it's just that you've done 12 years of work to that point to get the money, so as soon as you can enjoy that money, why would you leave? It's like if you worked your entire life to get into the majors, got promoted A to AA to AAA and finally to the MLB and you get a **** ton of guaranteed money, and you walk away because you don't like it. That'd be f*cking stupid. Due to over half of physicians saying they are unpaid, I wouldn't say that they love the money, just that they view pursuing another profession as a financially irresponsible move(which it is).

So you are telling me that people who leave their 100k+/year job to go to med school are stupid... No matter how crappy your job is, if you are making the mighty $, you should stick with it.. Lol.

 

[RoundEyes]

Just jumping in here as a noob and MS-0, but I seriously considered PA as an undergrad, and it wasn't until after I graduated and gained some clinical experience that I decided to pursue medicine. In starstarie's defense, I think having some actual work experience gives you a better idea as to what you want in your career. Some time outside of the classroom allows you the opportunity to seriously consider what you would be sacrificing to become a physician, and if that's worth it to you, more power to you. I don't believe non-trads make their decisions lightly, considering they probably already had a career, were earning, and chose to become physicians anyway.

Disclaimer: I'm not a non-trad, nor do I think switching from pre-PA to pre-med is a big deal. I just wanted to say that just because someone didn't follow a straight path through medicine doesn't mean every other path is useless

 

[PL198]

So you are telling me that people who leave their 100k+/year job to go to med school are stupid... No matter how crappy your job is, it you are making the mighty $, you should stick with it.. Lol.

It's not the same comparison... I don't really know of any job that makes 100k a year that requires the same amount of time and dedication as being a practicing physician does. Therefore the "costs of entry" or more literally the costs of exit, are much less. I would agree with you that if you are making 100k a year, it's probably also financially irresponsible to leave your job and go to medical school. Just saying I believe the magnitude of how irresponsible it is, is less than a practicing physician leaving their practice and pursuing some other profession(assuming it's not just a different specialty and requiring another residency, which is still probably not a good idea but less financially risky).

 

[TheWeeIceMan]

Yes. The sky is falling because the evil anesthesia management companies that are destroying the specialty only offer $350 + benefits...

I never said the sky was falling. Just that the gap in income isn't as wide as it used to be. 350k is solid, but certainly not 3x more than FM.

 

[BestDoctorEver]

It's not the same comparison... I don't really know of any job that makes 100k a year that requires the same amount of time and dedication as being a practicing physician does. Therefore the "costs of entry" or more literally the costs of exit, are much less. I would agree with you that if you are making 100k a year, it's probably also financially irresponsible to leave your job and go to medical school. Just saying I believe the magnitude of how irresponsible it is, is less than a practicing physician leaving their practice and pursuing some other profession(assuming it's not just a different specialty and requiring another residency, which is still probably not a good idea but less financially risky).

You have not been in SDN for long. There are many posts here about lawyers in their 30s who are leaving 100k+/year job to go to med school... Law school is as expensive as med school...

 

[DermViser]

It is hard for many med students whose parents make 200k/year to understand that there are people out there who are living perfectly fine with 40k/year... I worked in nursing in multiple settings and all i heard are complaints from RN/NP/PA on how ****ty their jobs are and how the physicians are making them do all the stuff they themselves don't want to do and now people are telling me these professions have it better than physicians...

Yeah, except the NP and PA paid a lot less for their education with less number of schooling.

 

[TheWeeIceMan]

You have not been in SDN for long. There are many posts here about lawyers in their 30s who are leaving 100k+/year job to go to med school... Law school is as expensive as med school...

Yeah, I have seen a good amount of people just out of law school or a few years out post about changing to medicine. However, I certainly don't think many of them were making 100k+. Considering the horrendous law market and the relatively few available jobs in biglaw that make 100k+, I wouldn't say it's as much of a sign of medicine being awesome as it is that law is not a good field to be in at the moment.

Also, law school is NOT as expensive as med school. Partly due to it only being 3 years instead of 4.

 

[BestDoctorEver]

Yeah, I have seen a good amount of people just out of law school or a few years out post about changing to medicine. However, I certainly don't think many of them were making 100k+. Considering the horrendous law market and the relatively few available jobs in biglaw that make 100k+, I wouldn't say it's as much of a sign of medicine being awesome as it is that law is not a good field to be in at the moment.

Also, law school is NOT as expensive as med school. Partly due to it only being 3 years instead of 4.

Never said switching career to medicine is a sign of medicine being awesome... what I am trying to convey here is that people (doctors) think other careers are better than medicine while others outside of medicine think medicine is way better... Again it is a case of the 'grass is greener'..

Edit... I understand law school might be cheaper partly because it's 3-year, but most of these people don't make 150-300k+/year right out of law school.

 

[PL198]

Yeah, I have seen a good amount of people just out of law school or a few years out post about changing to medicine. However, I certainly don't think many of them were making 100k+. Considering the horrendous law market and the relatively few available jobs in biglaw that make 100k+, I wouldn't say it's as much of a sign of medicine being awesome as it is that law is not a good field to be in at the moment.

Also, law school is NOT as expensive as med school. Partly due to it only being 3 years instead of 4.

Yeah I doubt they were making 100K+, people that are relatively fresh out of law school and making that much went to the Big14 or whatever they call it. The 14 power law schools that are basically the only ones financially responsible to go to anymore. I doubt any of those people are leaving law to go into medicine.

 

[Mad Jack]

Yeah, I have seen a good amount of people just out of law school or a few years out post about changing to medicine. However, I certainly don't think many of them were making 100k+. Considering the horrendous law market and the relatively few available jobs in biglaw that make 100k+, I wouldn't say it's as much of a sign of medicine being awesome as it is that law is not a good field to be in at the moment.

Also, law school is NOT as expensive as med school. Partly due to it only being 3 years instead of 4.

State law schools are even cheaper. I could've gone into law and paid 20k/yr! What a bargain for a degree that won't get me a job!

 

[PL198]

It's called T14 now that I look at it. Everyone I know that's involved in law says that if you can't go to one of those, then don't go into law. This is from both people that are from T14s and people that are not.

 

[styphon]

-I think I PA is a good career for a variety of reasons: someone who does not want the time commitment of MD+residency, who has trouble getting into MD school, who wants to have the ability to change fields. I think NP is good for people with a nursing background, or who know the "nursing model" and prefer that.

BUT, as a family medicine attenting, it is NOT unreasonable to go become an MD with the intention of doing primary care. I am finishing my first year out of residency at a "private" clinic from 8-4:30 M-F, plus 1-2 days at an urgent care and I make about >200k. I have a student loans over >100k (of course) - but because I work in an underserved site I applied (and was accepted) for a NHSC loan repayment of 50k for a 2 year commitment. I can renew this in 2 years, if I make another 2 year commitment - and awards are based on the needs of the community (each town/clinic has a score). If I wanted to - I could do three terms of 2 years and have 150k of loans forgiven...

 

[BestDoctorEver]

Yeah I doubt they were making 100K+, people that are relatively fresh out of law school and making that much went to the Big14 or whatever they call it. The 14 power law schools that are basically the only ones financially responsible to go to anymore. I doubt any of those people are leaving law to go into medicine.

I was not saying that people come out of law school making 100k, I was saying that I saw many posts in SDN about lawyers in their 30s (probably with experience) who are leaving their well paying jobs to go to med school...

 

[maxxor]

It's not the same comparison... I don't really know of any job that makes 100k a year that requires the same amount of time and dedication as being a practicing physician does. Therefore the "costs of entry" or more literally the costs of exit, are much less. I would agree with you that if you are making 100k a year, it's probably also financially irresponsible to leave your job and go to medical school. Just saying I believe the magnitude of how irresponsible it is, is less than a practicing physician leaving their practice and pursuing some other profession(assuming it's not just a different specialty and requiring another residency, which is still probably not a good idea but less financially risky).

Optometry and Veterinary Medicine are pretty close.

Optom = 4 years school + 1 year semi-optional residency. Starting salaries are below 100 in the cities.
Veterinary Medicine = 4 years school + many years of doing stuff to even get into school + 1 year optional residency.

They both have similar or greater debt burdens as physicians.

 

[WhippleWhileWeWork]

It's called T14 now that I look at it. Everyone I know that's involved in law says that if you can't go to one of those, then don't go into law. This is from both people that are from T14s and people that are not.

Generally this is the new rule. However top of the class at some tier 2 schools can still get the high paying energy law jobs in places like Houston, 140k+ 1st year out of school. It's happening to my buddy right now, pending a successful internship this summer. He knew this going in, that if he couldn't get into Yale/Columbia/Harvard he'd have to be top of his class at a state school to land a decent paying job.

 

[BurghStudent]

I'm aware of both regulatory battles, which still leaves me stumped- why the hell would the government want to replace physicians with a more expensive, lesser qualified, and lesser quality group of providers?

The moment Congress starts seeing NPs instead of physicians for "simple issues" I'll join the DNP movement. The masses need to realize this is not about physicians being jerks to NPs, that NPs need to be liberated from the clutches of MDs, but a matter of safe scope of practice.

 

[BurghStudent]

And nurses are a union constituency. Guess who that benefits?

If only we could unionize.

 

[DermViser]

The moment Congress starts seeing NPs instead of physicians for "simple issues" I'll join the DNP movement. The masses need to realize this is not about physicians being jerks to NPs, that NPs need to be liberated from the clutches of MDs, but a matter of safe scope of practice.

You can bet when Bill Clinton had his heart surgery, the person doing anesthesia was an anesthesiologist, not a CRNA. Meanwhile, right before he left office, he signed a Medicare regulation for CRNAs to work independently, which GWB halted. Congresspeople will NEVER see an NP when it comes to care for themselves or their own families. It's for the unwashed masses.