One significant factor to consider is where you wish to practice. You sound like Generals. #Student Nurse Practitioner; #Np I have championed your efforts in the past to avoid physician burnout and prevent suicide. Call us NPs or PAs. When they tell you to meditate and do yoga because you are too stressed out, tell them where to shove it. This proliferation of online degree NPs is a big social experiment that is going to fail miserably and the citizens of this country are going to pay the price literally with their lives. And, of course you can publish this on your blog. You are not the problem. This whole discussion makes me sad. Why would she need specific Doctors to help her rewrite this passage. However, you also have to look at the FOUNDATION that you are building this learning on. I thought her advice was very appropriate, not having heard the full conversation. Just trying to offer realistic perspective. Say NURSE PRACTITIONER, MIDWIFE, PHYSICIAN. I have no staff. Advantages of Becoming a Family Nurse Practitioner. However, nowadays, most health care employers prefer to hire nurses with a baccalaureate education or higher. If that is the case with a physician that docs license would be suspended in a heartbeat and investigation performed. You know what you are doing, writing this in this day and age when NPs are lobbying for independence and trying to replace physicians. Best wishes as you proceed with your training. Pam, I’m happy you’re conversation with Ethan took into account his concerns about training & his goals. It is not just a physician mantra. 85-90% of what I did every day was just to meet the demands of overhead and multi-million dollar salaries (definitely not mine). But not all of us have had those experiences. Reverse engineering your dream practice is the best part of this. If patients choose to see Christine Sagan NP rather than me that is fine. One is trained under the medical/scientific model (which I think I prefer), as you said, and it is a shorter (but no doubt very intense) path than medical school. I don’t know how helpful it is to other people, but I wanted to share it with someone. I’m amazed at how many comments this article has generated. For students who are thinking about a career in healthcare, the question of which path to take — nurse practitioner or doctor … You will always have your nursing education and experience to enhance your practice and you also will have a medical education. As background, I’ve been a nurse for over 30 years and a NP for over 23 of those years. Yes. There is a growing body of evidence that NPs and PAs order more tests, write more inappropriate antibiotic prescriptions, and make more unclear/inappropriate referrals when compared to MD and DO. I need 137 patients in total to meet my overhead and make more money than I did working for a hospital. Depends on each person’s propensity, life stage, resiliency, background/history, etc. 5. – And obviously, patients don’t always care about our schedules. They have left their physician because “the care was not there”. It is a blessing that I did not have to suffer that. Point is, I don’t think MD’s or PA’s really have an understanding of nursing school or nursing in general, maybe if they did, they’d be a bit more respectful. I had a full schedule and I was expected to perform well. Family nurse practitioners (FNP) earn high salaries working in a variety of settings. But, PAs, with rare exception, are trained in medical schools, alongside medical students with preceptors that are often the same attendings as the medical students. Always start with the end in mind. I was still half-assing interviews at other clinics even a week before I signed the lease. But she will be required to do several clinical based courses and have 600 clinical hours before graduating. I chose to become a NP because I’m a nurse first and that is how I can best care for my patients! The time it takes to become a nurse practitioner is significantly shorter than it takes to become a doctor. You obviously have no idea what you’re talking about and it’s very clear in your “argument.”. It’s like defining our patients as ‘drug seekers’ or ‘non-compliant’ and not recognizing the whole person. Thank you, EMC. Also, my state, West Virginia, has absolutely crazy laws…such as, I can NOT turn in a MD/DO for medical malpractice or I lose my license. I am a female MD and never once have I regretted my decision to become a physician. No training will ever separate you from anyone else unless you absorb the training, put it to use and continue to build on that knowledge every day. You mentioned statistics about safety… I would be very curious to read what your organization came up with… from what I know, it is just the opposite. Should NPs pay the same liability insurance? What a heated discussion this is! I use the knowledge I acquired in gross anatomy everyday. I believe that an organic diet, exercise, herbal teas, meditation, acupuncture, acupressure, Craniospinal therapy, etc. Excellent advice Brooke. A person’s degree doesn’t define your knowledge, skills, work ethics, professionalism. I do not think the push for autonomy is any thing more than promoting themselves. An end result is the recent suicide of Robert Chu MD—an unmatched physician. I have read through the comments along with your replies. As a nursing school, we’re a little biased, but we would never say one profession is more important than the other. I have been through these drugs a zillion times. When I started I was assured more time and work/life balance. Try being a nurse since 1972 and a psychiatric NP since 1984 only because I had 5 physicians blow smoke in my face and tell me at my interview into med school I needed to go home and become a nurse…… it was so hard to take back then and now it was the best choice I ever made because bottom line is our AANP association advocates for us, they support us and they have worked to advance us as human beings… school can’t even stop the hazing and abuse much less the suicides from it……you can tell anyone that I agree with everything you have said and I’m one of the “old” girls that helped roll that boulder uphill so that NP’s can practice autonomously…. Then you have at least 6-8 or more years of school (assuming the RN has a bachelor’s degree and not an associate degree. Good luck with your decision. MDs, DOs, NPs and PAs are all in it. I think NPs/PAs can do this, too, but by and large I presume that physicians do this more consistently. Please answer my question. I know there are probably sub-par NP programs out there, but I know there are very good ones, too (I am thinking Columbia, Vanderbilt, University of Illinois–well known state/private schools). Dr Wible, I’ve not followed you for quite sometime. For others I might recommend something totally different. I think it is dangerous for them to be practicing without any physician supervision in any setting and I’m happy to share any one of the hundreds of stories I’ve collected–including my own–which may help you understand why I feel this way. cudo!!!. As for me I’ve been on the phone with many many parents who have lost their children (sometimes their only child) to suicide during medical school or residency or beyond. I’m honored! I wanted to throw my experience in the mix here because I feel like I was going through the exact same thing as you were and it wasn’t until a year into my program, when every other day I was either elated to have chosen to become an NP or crying and devastated that I had not gone to medical school, that I finally came to the ridiculously simple conclusion that there is no perfect choice. NPs are not on 80-120 hour shifts during training. There’s a reason NP’s have the ability to be autonomous and PA’s can never be, which is why I decided to decline PA school and go the NP route as starting my own practice someday is an idea and a possibility I can venture. Man did I get hell for thinking independently and clearly (and my approach was supported by literature), 3) Throughout my education in medicine, I have been belittled for not only my compassion, but also my eating whole foods plant-based diet. I believe you have a gross misunderstanding of how the nursing board works. 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. You could EAsily have an ideal practice as NP… Refer when you have to but my god, be a learner and a healer and enjoy your practice!!!!!! I am open for interviews. It was exhausting and exhilarating. We are the ones who help set the stage for a society, creating a ripple effect to the masses. The difference between those and the ones that scare me is humility. At this moment, as a NP, I could not move to California or Florida (I want sun) and easily start my own practice. In my particular situation the difficulty in time and financial strain would aggravate my wife’s condition much more than mine. Most of it will be yes or no questions. NPs can get a degree ONLINE now. Ultimately, I believe one’s education is what one makes of it. Thanks, Pamela. Agreed. And that is why I would WANT to work with a physician for a few years in my specialty before branching out. BUT YOUR ALTERNATIVE, online certification, long distance learning, a quickie drive through approach frankly wont do for me or my family. I certainly did not read it as Dr. Wible denigrating physicians, she was simply giving an individual advice when he asked for it directly. 🙂 And nothing but the best as you begin your career as an attending–finally! It’ matters because your blog is well established and respected. Ethan, I suggest you stop using it too. Would love to talk more, especially because we share a nursing background in common. Your lives will have been a mere flash in the span of a 14.5 billion-year-old universe. Yes you do have more in school clinical training, but nurses already went to nursing school where they learned the foundation of their training, making extra clinical hours unnecessary. I left my nursing program healthier and more whole than I have ever been. I feel that you have now ended up on the opposite end of the spectrum and become what you have been fighting against, someone who derides and puts down what is a very special calling for me and many others. All this anti-NP sentiment has really been shocking to read. You have to look closely and carefully at the schools and training programs. The high satisfaction ratings reported in … I guess I’m just crazy enough to think we have to get beyond this mindset displayed in alot of these comments to actually change the medical world. Many of these posts now have me wondering what they really think of me. So I have decided that I either want to be a Nurse(and later Nurse Practitioner) who works in a Naturopathic Clinic, or become a doctor who uses natural and alternative . An NP has independent practice in SOME states, but not others, and it’s not clear what will happen regarding NP practice nationally. I fell in love with surgery: especially plastic surgery and dermatology. whether you are NPs or Physicians. I love your dedication and compassion. Ethan: Basically, my struggle is this: I am a current RN and would like to do primary care in the future (family medicine). Yes. When your boss says you are burned out, call them out on it. I’m sure it passes with time, though, and there are other things in life that are far more important. With these experiences, I may be able to offer a little more firsthand insight into the difference between the nursing vs medicine path as it stands. It’s good to think that the negatives will go once I take that first step. You won’t be a student/resident forever. Pamela gave one guy one opinion about something he already knew he wanted to do. Fortunately, I am unaware of any harm done to a patient (after all, and error or incorrect act does not always result in harm). Everyone has a place in a healthy medical model, but ours is broken and this is a great example of why it is. I’m 42 with PTSD, in debt, and my wife also has general anxiety disorder. Frankly I think all healthcare professionals would benefit from having to do CNA work, might be good to learn a little humility from the sounds of some of the comments on here….. I think they are skilled to do these things without a collaborating physician. Like, oh, why not grab a seltzer water for me while you’re up at the fridge? I hate that this article seems to have generated such divisiveness after review of the comments. But they are both mid-level healthcare professionals who take on some of the responsibilities of a doctor such as making diagnoses, creating treatment plans and writing prescriptions. Any diagnosis you make is because of the team working with you. I mean in all those many years of extra training surely the doctors are learning something beneficial to the patient. And why then do I see them dumping NPs out like a candy factory. Do I want my hospitalist to be a MD? They also are licensed differently. The ongoing intensive apprenticeship with attending physicians and emphasis on evidence based medicine is vital to developing skills as a proficient family medicine physician. Ah yes, title was geared toward my advice to this gentleman. You are not the captain of the ship. My passion is in healthcare. She had more then twenty years of nursing experience prior to getting her np. The reason I am asking you to consider the PA route is because we are educated and trained to practice medicine and you would have the best of both worlds. Assembly-line medicine falls short for the same reason. Your nursing background will serve you well. We have to be able to have a friendly banter without vitriol and insults. Pamela – Why did you become a doctor if you are telling others to go the NP route? The what ifs still pop into my head all the time and there are a few friends that I’ve avoided for over a year because I’m not ready to talk to them about it and feel any judgement. I sincerely apologize for the negative tone of this post, particularly to my NP colleagues who have done a wonderful job of taking the high-road and remaining polite and respectful despite the temper-tantrums thrown by our M.D. It does take personal initiative and finding a good program of study will help, not to mention humility enough to know ones’ limits. Capable can and should be measured in multiple ways. Your internal motivation has a lot to do with how you eventually practice. Additionally, primary care NPs refer patients to specialists more without a basic workup a physician knows to do. Please educate yourself before commenting on my career. Are you serious!? Maybe your dream is to become a nurse practitioner, or maybe you have another goal and a nursing degree will help you get there. The best NPs were trained under a physician and not granted autonomous practice without a thorough clinical experience. But you see, all space for teaching has been taken by medical residents. Ethan, if you want the best training, go to medical school and pursue a residency. I’d suggest changing the title of this post, (“Why Ethan Should Chose NP School”) redirecting current traffic to a new URL (easy in blog dashboards to do), and if you DO want to rank #1 in Google for the search phrase, “Nurse Practitioners vs Doctors”, that you can post a new article that myself or other physicians would be happy to guest write for you. As a PA student I called my husband on my way home while I drove to save time. I’ve known many health professional (of all degrees) who may dangerous to their patients when left in toxic work environments, sleep deprived, hypoglycemic, emotionally distressed and with 5-minute assembly-line appointment slots. I think our education leaves us grossly unequipped for this type of care and I fully agree with the enraged physicians above who feel it is unsafe and inappropriate for new grad NP's to be in these types of jobs. They also prescribe antibiotics and opioids more often than physicians. Then after working full time as a NICU RN for several years, I went to a 4-year DNP Neonatal Nurse Practitioner program. This is advice to one person based on his mental health, finances, desire to start a family soon, etc. Anyway, would love to read your response! – Also, training is time-limited. However, I think as a whole physicians are more adept at thinking beyond those algorithms and catching the finer details in care and building on the foundations they have. Sharon. Absolutely. to showcase their success to the world. but as long as we can provide valuable contribution to better someone or a patient life.. Who CARES!!! NO care than (B.) Dr. Wible, the only thing I agree with is the lifestyle may be better for NPs due to burn out rates of physicians. Admittedly it was a seriously crappy plan that I would not be around to deal with after it was completed. Tags: career, career-quiz, quiz. My criticism was viewed a treason and offensive as well. 8) You don’t need help. It is still an honorable profession in my eyes. Who do you think tell doctor interns what to do prescribe, how to prevent errors and how to function? Except she didn’t actually ask about his goals, values, etc before saying she was thinking NP for him. colleague`s rear on more than one occasion by seeing a situation from a different perspective and throwing in my 2 cents worth. While FNPs perform many of the same responsibilities as doctors, the position offers the intimacy of working directly with patients. I am so proud of being a nurse practitioner and I love all of my colleagues and strive to work together with them all for the betterment of my patients. Totally ridiculous question. I do think that (based on the brain’s capacity to retain only a certain amount of information for so long), most of this scientific knowledge is forgotten (at least I know I constantly have to go back and review fundamental scientific/pharmacological concepts from nursing school), and from what I have observed so far much of medicine (whether one is a doc or an NP/PA) is algorithmic. on this thread really suggest NPs refer too much? Just trying to stay informed (but not think too much!–a challenge…haha) until it’s time for me to decide. There are degrees of mental illness and medical school IS destabilizing in a way that other training program sare not. Second: NPs are not “mid-level providers” or “physician extenders”. I just wanted to share my experience and hopefully provide some perspective to what seems to be a very polarizing topic. Most nurses have more medical experience in general than PA’s, who can have a degree in basket weaving prior to applying to PA school (nothing against basket weavers). Thank you for sharing it. Back in the day an engineer title took six years of work to obtain after completing a four year degree…actual work hours with overtime was 18000 hours working alone and supervised, that was just to achieve competency. . I also had a plan. She said walk away, then give yourself and your patients the love and compassion they deserve. What frustrates me is that the division between training styles of nurses and doctors seems more to be a holdover from a historically gender divided profession – women as nurses because they are “caregivers” and “less able to perform intellectual tasks” and men as doctors because they are “more logical” etc etc. Some countries do, I think Australia does. Just think of your dream, focus on it, and go for it. Thanks! I absolutely LOVE physicians. If you want to be a doctor, go be a doctor. 1. Dr Wible: Generally I respect the light you have brought to physician burnout, suicidality,etc, however, I feel this piece may be showing your burnout. Do I think that experienced NPs are intrinsically less well suited to providing primary care than MDs? Continue learning and challenge yourself professionally, do not get stuck. In many cases, these are very complex patients that the docs wouldn’t want handle because of the extensive amount of time required. I can honestly say that I have been envious of friends who started PA school after me, finished their training before me, live in a nice house, and drive a nice car, while I am working near 80 hour weeks and sacrificing so much. The current NP and DNP mills are churning out these practitioners while they are still wet behind the ears from nursing. I give them the pros and cons and allow them to make their own educated decision. No degree guarantees that you will practice ethical, safe, accessible medicine for your patients. I am in my last term in NP school and the way MDs treat NP students in clinicals is shameful. I am angry beyond words! She currently works for a doctor who has a large practice that also includes several nursing homes. So, don’t think for a moment that we are not capable to learn or better ourselves in our profession… I do advocate that every FNP program should be followed by at least one year program residency in Family Medicine. If a midlevel education is sufficient for practicing medicine, then why in the world does anybody go through this process. I also believe that folks who have mental health issues that could experience YEARS of instability should potentially choose another career altogether. In my opinion, they must remain supervised. They told me about their schedule while in school, which is pretty much nonstop for 2 years straight. I adore physicians. So what are you waiting for? I am a solo-solo doc and I have never been happier. 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. As a trained family Nurse Practitioner, I work in a specialty clinic at an academic medical center. So glad you are happy in your career, and I wish you the very best, too! It took me 5 years to “pay back” the 3-year scholarship (poor fit, general downsizing due to the clinic having to reimburse Medicare about $1.3 million back). Training does in fact matter. It really is about the individual and their internal environment. I can tell you that most physicians in my area do not accept Medicaid or CHIP for low income kids. I have been researching for a long time and I am trying to figure out what I want to do. I am not God and I do not pretend to be. But what I don’t want is to be spread too thin and not have time for myself. 2 Comments on “Should I Become a Nurse Practitioner … You know how to take a blood pressure. NP curriculum is full of management and nurtrition classes. Similarities between a PA and Registered Nurse. Just curious. Nurse Practitioner vs Doctor: Filling an Urgent Need Should you feel a need to clarify a comment in your original response to Ethan’s email, do so. The laws are different by state but there is great autonomy esp. Absolutely. As far as medical experience, most PA programs require real medical working experience,like EMT, PTA, RN, LPN, RT.. not volunteer or shadowing. We literally are all in this—TOGETHER. I did my OWN research to discover much of what I was never ever taught (plus later found out our residency was one of the sites for Premarin testing on women). But as an NP in the ED, care is going to be passed off to a physician and there will be limits in what they are allowed to do (ex: take care of coding patient, etc). Unless you’ve been an MD, DO, PA, or NP you have no place minimizing the education and practice of these different providers, you don’t know what it was like to actually go through their program of study. 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