I wish Ethan the very best in his medical career! . This overlaps with medicine in the same way that osteopathy overlaps with medicine. NPs are not master craftspeople of medicine, i.e. How does that seem fair? I believe most just want to be respected for what they bring to table and not disrespected and degraded for what they don’t have. Stand up for your colleagues. Thank you for being a beautiful soul Dr. Wible. And if NPs want to right a controlled substance they have to have a supervising MD agreement just like us PAs do. “By the way, are you still seeing patients?”. She currently works for a doctor who has a large practice that also includes several nursing homes. colleague`s rear on more than one occasion by seeing a situation from a different perspective and throwing in my 2 cents worth. The Consensus Model states that an APRN must have a population focus ( family, neonatal, pediatric, adult/gero, womens health, psych) and a specialty (primary vs acute). Be kind and grateful on your chosen path! My decision to become an NP has never been stronger after completing your teleconferences. MIDLEVEL is a word used by health care administrators to describe revenue generators who are somewhere halfway between a nurse and a doctor (I think). RN may be the best answer for some. Supporting the practice of NPs does not mean that one thinks NPs are equivalent to MDs. It’s a dehumanizing word that lacks precision and, honestly, it’s offensive to the people who have spent so many years of their lives to achieve mastery in their chosen profession. We all have unique gift to share with the world. This will allow you to be fulfilled no matter what you choose. What can I do? Part of the reason for this is that I do not have enough information yet (aka, shadowing and seeing what family physicians/FNPs do in their practice). The mental health impact of 7+ years of medical education are far worse I can guarantee. Both an NP and a physician know that steroids are important in the management of an asthma exacerbation. I had to learn INDEPENDENTLY the value of nutrition which was not taught in med school. quest for a future career choice. *Side note: MDs may certainly find themselves cleaning up some messes caused by incompetent NPs. Nurse practitioners often already have a lot of work experience, because they start out as regular nurses, and go on to get their advanced degrees at a later time. I feel that I have had pretty good experiences. Additionally, any NP is going to be dealing with a lot of the same administrative, insurance, EMR garbage, so why not be well trained and better capable of taking care of the patients? It’s like comparing myself(Internist) to a neurosurgeon. I would absolutely go to an NP or my health care. This is what we’re working on in our little corner of Austin!! I am sure there will be days where I think “what if?”, but now that I am a nurse and I look back on my college career I never wish I would have gone a different route. The patients I have started seeing are so relaxed that my stress level is down dramatically. But it is clear and sad to me how sick, tired, stressed and deeply unhealthy American culture is today and I think it calls for a range of health care providers. I feel very lucky to work in such a supportive environment. Good luck! For example, other degrees include a Doctorate of Philosophy in Nursing (Ph.D.), Master of Science in Nursing (MSN), or a Bachelor of Science in Nursing (BSN). But you don’t really respond to the substance of Dara’s argument…. Deal with your PTSD in a productive way. In my region, MD plus residency is 8 years. The length of nursing shifts varies depending on the work environment. However, burnout is not due to the actual practice of medicine, it’s due to the excessive administrative, insurance and government burden preventing us from being the physicians we want to be. You’ll be missing half of the picture no matter what and I think you just have to pick which half you’re willing to pay for and which half you’re willing to fill in on your own. I’ve worked in unhealthy environments and subsequently left those positions. “Do no harm” should resonate in the molecules of every human being. I advocate that every nursing and medical school program should have cross training. you will never had the mastery you’d need to be fully autonomous. I thew away single use items that were more expensive than the patient visit itself. The fact of the matter is that NPs serve populations that really need them because few others will. I cannot perform ECT or surgical procedures/implants. The difference between those and the ones that scare me is humility. So, do not think for a moment that becoming a registered nurse and then an advanced practice nurse in whichever area is something anyone can do or that our degrees and licenses are handed to us on a gold plate because that is farther than the truth. Sam, since this is 2019 when you replied, surely as a health-care practitioner you know by now that most PA schools require direct patient care hours averaging around 1500 hours before matriculating into a class. As a nurse she had many years in nursing homes, worked orthopedics, administered chemo and much more. Over the 22 years I have practiced emergency medicine, I have worked with hundreds. Until it is fixed, check yourself out of the hospital. 2) An amazing number of people read free community email newsletters. They also prescribe antibiotics and opioids more often than physicians. A lot of … I sat down today and wrote a short piece about my career and the things I learned in my journey. They both have their strengths and their drawbacks and I wish that this was the discussion that was had more often instead of which one is “better”. Thanks so much for reaching out! This is not unique to physicians because NPs have to follow the same guidelines. The high satisfaction ratings reported in … I am a student recently accepted to nursing school to get my 2nd degree and I hope to eventually pursue a DNP, possibly open my own practice one day. I love your dedication and compassion. NPs are held to the same standards and guidelines as MD. You should stop commenting on the role and education of NPs. It is highly competitive to be admitted and even more challenging to complete the program and pass the nursing boards. 4. What a joke. Patients without financial resources or … Seems to me the rates should not be lower. Agree. I also cannot independently prescribe schedule 2 drugs in those states. Nothing changed, except that they eventually went to key-card access to get to my exam rooms. However, I am torn as to whether I should try to become a family physician or become a family nurse practitioner. NPs are being dumped out like a candy factory right now. I did not know about the terrible treatment the students have to endure. An MD is a doctor of medicine. Yes, I do think NPs are capable of treating UTIs, strep etc autonomously and work on the same red flags that MDs do. And one other small point, from my limited experience, medical professionals dont get sued for making mistakes, they get sued because they made mistakes and pissed people off. What I recommend to this nurse in his unique situation does not reflect a lack of love for my own profession. Much of this is true and I truly believe if the NP attends a reputable program, they can become exceptional providers. Ive heard most people have trouble getting placed into a residency after completion. NPs are not commonly used in family practice in this region and so it is very competitive for those who seek FNP gigs. After BS/BA, PA’s have average 100 grad hours, sorry no history of PA, only pharm, neurology, oncology, nephrology…then 2000+ clinical hours. Why would she need to change the title? 8) Get in touch with all of the other independent providers. Turns out, writing a business plan is easy now that there is software to help you do the math. I was getting by but I felt like a complete failure all the time. For some people, the title of “Doctor” is important. The division in training models seems like it creates a problematic lack of translatability of knowledge and care models and causes more problems than it solves. Also, Ethan can be an NP in 2-3 years (if he has a BSN). I have been waiting for the Universe to show me a way to deliver patient care MY WAY. I am very fortunate that I work with so many physicians that value my hardwork and dedication to my patients and that are so willing to help if I need them. Hi Pamela, I have read through the comments along with your replies. For those who have a problem with my advice to Ethan, I’d love to speak with you. Reverse engineering your dream practice is the best part of this. I am keeping the PA option open, too, and it is a great alternative! Family nurse practitioners (FNP) earn high salaries working in a variety of settings. Also, please do not call us mid-levels. Of course we do, we are not trained to manage complex medical problems. Your nursing background will serve you well. With warmest regards, Evelyn. It goes both ways. Pam, no need to defend yourself from so many reactions of people either envious of the NP freedom or those preferentially MD with all the privilege and hiding places. I’m recommending Ethan take this route. Mostly for fun, I am accepting some insurances for a slightly different concierge model, because I want to keep seeing some of the patients I had before. Nurses, however, are with patients for the long haul, monitoring their progress, administering their medication, listening to their concerns, calming their fears, and so much more. I’ve found that (beyond degree) intellect, relentless curiosity and determination, and proper business model are prerequisites to good medical care. . Just today I walked in to the ICU to a patient with a troponin trend of 0.29, 1.5, 4.2, 5.9 and T wave inversion x10 hours. Had I a redo there is no way I would choose NP. I know I would have to do that myself, too. Like this one writing this post! That’s where the problem lies in the NP vs physician issue. I’m dismayed at the way you were attacked by physicians who took your comments as a sort of betrayal. NP’s in neurosurgery are not neurosurgeons. If that is the case with a physician that docs license would be suspended in a heartbeat and investigation performed. The nursing board is for the patients, and is not there to protect us, the nurse practitioners. But I do have a hunch that Pamela is right when she says the quality of provider you are starts with your own drive and determination to be excellent. A sad state of affairs that we can’t honor each other for all of our unique contributions to medicine. 6) Once you make a decision and borrow/rent/lease a room or two, and you are set on a path, the whole thing gets easier. By your nonsensical reasoning, the worst M.D. BTW I’ve had more antibiotics shoved down my throat for sniffles by MD’s than NP’s or PA’s. 9 Things to Know About Nurse Practitioners With their growing presence, you may not need to see a doctor for your health care. We are not supposed to look at circumstances the same way! If you want to be a doctor, go be a doctor. Physicians can certainly make mistakes and we pay a severe price for those mistakes because we are held to a higher standard–as we should be. I hate that this article seems to have generated such divisiveness after review of the comments. Ethan: Basically, my struggle is this: I am a current RN and would like to do primary care in the future (family medicine). ADDENDUM 11/29: This is my advice for Ethan. I think you are right in that I intuitively know what is best for me, and I think FNP is a better fit. There are many benefits to becoming an FNP. If you're looking to become a nurse practitioner, you'll need … Contact me here –> https://www.idealmedicalcare.org/contact/. An NP has independent practice in SOME states, but not others, and it’s not clear what will happen regarding NP practice nationally. Using this word prolongs physician captivity and victimization. As having been a patient who between bad allergies, accidents and other health issues, I have gained a very different point of view on primary care healers. Actually it is disgusting, these are professionals that save lives for a living who turn into monsters behind closed doors. In terms of the value attached to your nursing experience, the key factor is to market it in a way which sets you apart from the opposition! During our clinical year, we were frequently on teams with medical students, residents and attending doctors. The ANP training is based on the medical model. And I think any good provider, as a lifelong learner, will continuously realize how much he/she doesn’t know or how much he/she must go back and review to be the safest/most effective provider possible. For NP’s to treat something that is simple, they will have to have plausibly ruled out all that is not simple, but appears simple. But what I don’t want is to be spread too thin and not have time for myself. I wasn’t stupid. The MD’s treat the nurses like they were treated in medical school. I think I have enough years to say to you that I loved who you were from the day we talked and being brave and speaking the truth doesn’t mean it’s easy. Also maybe MD primary care providers who are worried should look at themselves, and notice the crappy healers among them. You are much to ignorant to do so. Secret recordings expose abuse of junior doctors, Physician Suicide 101: Secrets, Lies & Solutions, Female physicians told to sit down, shut up, and get out of the way during emergencies as patients nearly die, Is medical school just for rich kids? It also can vary between specialties of both areas. I came into the profession when medical care was and still is undergoing big transformations, not sure for the better. There are a couple of bridge programs for nurse practitioners who wish to become medical doctors, but they are all based outside the U.S. I am not sure where all the animosity for fellow healthcare professionals comes from, but I will say it seems that very few on here that are not nurses understand nursing. You should do whatever you have to do.” How to go from nurse to doctor 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. I’m honored! I am appalled by your article and would recommend you work on your sense of reality and judgment prior to writing ignorant articles like this. They prescribe Doxycycline for everything and I don’t know why. Degree matters. No anticoagulant since admission 24 hours prior. And I am still heartbroken for my colleagues who have sustained such deep wounds from training. Once you’re done with training, you have a lot more control over what you want your life to be like. We’re called to collaborate not compete. I absolutely want to prevent others from losing their lives over their desire to help and heal others. We are held to the same standard of care as physicians. Definitely some thoughtful insight on this thread. If you are trying to decide if working as a nurse or a PA is the better fit, it is a good idea to … I understand that point. So regardless of the title of the provider (NP, PA.MD) anyone can potentially be a part of a toxic environment if they are working in a hospital or clinic system (as most are).”. Making more than $75,000 dollars per year won’t really make you any happier. I’m looking out for HIS future. Wow. 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. And my apologies ahead of time to Ethan, who’s future aspirations we have co-opted in turning this into a mud-slinging contest. “Burnout”btw is a smokescreen for human rights violations: https://www.idealmedicalcare.org/blog/a-smokescreen-for-human-rights-abuse/. I was a nurse for 6 years before becoming a nurse midwife! You are right. It’s been good to see the perspectives of everybody, especially those who also have families and are in a situation most comparable to mine. If I made “Doctor money”, I’d be in a better position to do that. Misery loves company. M.D.’s seem to experience burn out much quicker, I love the nursing model when compared to that of physicians. They each have different responsibilities and tasks. Please correct me if I’m wrong, I certainly understand the need of a hierarchy of knowledge and experience in the profession of medicine, but what I don’t understand is why a unified model of training (besides the fact that this would require a total change of the entire medical profession) can’t be designed, with increasing academic and clinical rigor, that would allow smart, capable, and experienced nurses to have the potential to progress to doctors, and simultaneously would require doctors to have more experience in patient care, which seems to be the most frequent complaint of unskilled or “arrogant” doctors. I do make it clear that I will not always tell them what they want to hear, but that I will offer the best medical advice I can and it will ultimately be their decision whether or not they follow my advice. Ultimately, you aspire to become both best healer and best, happy, healthy family man. Going to medical school does not automatically make you a wonderful provider just like going to NP school doesn’t automatically make you a subpar provider. This is advice to one person based on his mental health, finances, desire to start a family soon, etc. Thanks Sydney. There are more than enough patients for all of us so trying to stay in a space to not be burned out and leave the profession to survive is the answer. And in a low-overhead model where they can spend 30-60 minutes with a patient NPs may give higher value than a doc locked in a big-box assembly-line clinic in a 7 minute visit. I will definitely be considering your response when it is time for me to go back to school. Very sad and disappointing. Less training, less burnout, more free time = less knowledge, less expertise. Going the MD route just wasn’t something I saw as a probability at 18. Secrets to loving your life in healthcare. You obviously have little insight into your own beliefs and the damage that this does to the physician profession. No degree guarantees that you will practice ethical, safe, accessible medicine for your patients. Answer this: When you wake up tomorrow morning, what will your perfect life look like? I know I would consider it. NP programs are not rampant with human rights violations. I loved my schooling. I applaud him on knowing his limitations. Ideal Medical Care Movement has been the most frequent term I’ve used. Does it piss me off the amount of distress the meded has cause my physician peers? She was talking to Ethan, not me. When did you move from fighting for us to being one of “them” and dumping on us? Hospitals throw everything away even if it works, and it goes all goes somewhere. The rub for me, as I explained, is if the extra time spent in medical school/residency would be worth what I think I want to do–which is primarily outpatient primary care–teaching patients, getting to know them over time, being able to care for them as a whole. That’s the only reason I can think of for their angry responses. is that a very hard route to go? You will learn best and retain information if you have sufficient sleep, a healthy diet, and take time to exercise. Constantly I found myself thinking in nursing school, THIS is the stuff that the physicians need to learn, and as I studied with my medical school friends I thought, THIS is the stuff that I need to learn! I chatted with an MD student who had no idea and explained it to him. If you’re so passionate about giving advice about your chosen profession, start your own site, create your own tribe, tell your story, do you. In many cases, these are very complex patients that the docs wouldn’t want handle because of the extensive amount of time required. It’s okay to refer or to collaborate with other providers MD/DO, PA, and NP alike. The work and hours are demanding, we all know this. is where I feel my work begins, not ends. I guess it’s just about knowing yourself and your strengths and abilities, what is best for YOU, knowing how to take reasonable risks (and for the right reasons) and knowing when to be humble and step back. This time last year I was strongly considering checking out. I’m not equating an MD/DO with an NP. They do not know what they do not know and in many cases are harming patients. There are pros and cons of each. Leave your ego at the door. I can tell you that most physicians in my area do not accept Medicaid or CHIP for low income kids. I want to keep my patients safe and protect my doctor and myself from liability. I’m not quite sure why you are asking me if I have a problem with NP’s when I clearly state that they are a vital part of the health care team and that I have worked with them for many years. The biggest and scariest problem with mid levels is they don’t know how much they really don’t know. RNs are typically used to doing shift work with time on and type off. Pam! I am one for fast, effective, and cheap options when one exists to get to your goal. I was a Nurse Practitioner before I went to medical school. I was thrown to the wolves and I had to learn quickly what I did not know. Impeding quality of work life and life in general. Sometimes, I say HEALERS. 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. The trick is knowing what you dont know. For those of you who have not “met” Christine Sagan in the video I recommended above, here she is (really worth watching): The happiest nurse practitioner in Alaska. 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…..med 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…. Let’s fix that problem! The kicker is, though, I think it is much better to be in THIS position than the aforementioned one…know what I mean? Happy holidays and I wish you all the best in the new year! Even though I worked very hard in medical school, my first days as a resident were difficult. NPs can get a degree ONLINE now. Inversely the practice of medicine appears to be moving in the same direction also, as far as holism and care partnership goes. Ethan: Here are the things that attract me to becoming … 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. There exists a plethora of variables when considering your terminal career goal. Thank you for helping me understand that I am not alone. I don’t want to feel like I settled although to be honest I do feel that way sometimes because PA school was hell and nursing school has been so enjoyable. For Ethan’s circumstance, becoming an NP is an excellent decision. 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