Thursday, January 04, 2018

Should You Become a Doctor or Nurse Practitioner?

I know a lot of you Cappy Cappites are interested in the medical field when it comes to choosing a profession.  However, the amount of education to become a doctor can be daunting, not to mention, not worth the time/pay/sacrifice, especially if you're a minimalist or don't need to make $250,000 a year.  Our Health Care Agent in the Field sent this and I believe it will be of use for any young lieutenant out there looking to enter the health care field.

PA (physician assistant) vs NP vs Education (assumes people don't start in other career tracks or other jobs).  For reference, CRNA (nurse anesthetist) has similar training time at NP but the salary is MUCH higher

Ages 18-19
PA - Pre-requisites for PA school
NP - Halfway thru nursing school for RN degree
MD - Halfway thru undergrad for Bachelors degree (pre-requisite for med school)

Ages 20-21
PA - start in PA school
NP - finishes nursing school with RN degree (can choose to take time off and actually work as RN for over 60K per year)
MD - finishes undergrad (hopefully), starts APPLYING for med school --> needs $$$ for applications and travelling to interviews, over 25% of med school students have Masters and/or PhD's and/or other degrees BEFORE starting med school.  But for sake of brevity, assume best-case scenario that this hypothetical student goes straight to med school

Ages 21-22
PA - can start working, may do an extra year of "internship" which is required for certain fields (surgical PA, ICU, etc)
NP - starts first year of NP school (already has RN degree)
MD - starts first year of med school

Ages 23-24
PA - has been working for 3 years (2 years if he/she did an internship)
NP - start final year of NP school
MD - finishes 3rd year of med school, still 1 year to go

Age 25
PA - has been working
NP - has been working and easily has been earning over 60K during first year of work (because that's what an RN makes and NP's are paid much better)
MD - starts final year of graduated med school, start looking for residency --> spend money on application process and travelling to interviews.  This assumes that the MD didn't get a dual degree (MD-MBA, MD-MPh, MD-JD, MD-PhD) which is required for certain areas (administration, research, etc) and can add 1-2 years to med school.

Age 25-28
PA - working 
NP - working at 80-100K per year
MD - doing residency and earning 50-60K per year while working 50-80 hrs per week --> please note that this is bare minimum of residency for physicians and that the average residency is actually 4 years and some of the surgery programs are 5-7 years (some academic centers require residents to take a year off clinical training and do research work and get publications)

Age 29
PA - working
NP - working, salary is probably ~100K per year at this point
MD - starts work, although > 70% will do a "fellowship" which is an advanced residency that lasts 1-3 years (ABSOLUTELY NECESSARY for some of the specialized fields) where salary 65-80 K per year (comparable to senior RN or newly-minted NP)

In reality the MD will probably be 31-32 before he/she actually starts working.  The NP will have already earned over $300K and the CRNA has earned over $400K at this point.
A primary care doctor's salary is comparable to CRNA, so a primary care doc will NEVER catch-up to the CRNA in terms of money, but this primary care doc should surpass the NP in terms of $$$ earned sometime in the late 30's or early 40's.

A specialist, who can earn over 250K (if they're investing their money and/or they have administrative duties at their hospital/clinic they can earn upwards of $500K) will surpass the NP in his late 30's and the CRNA in his early 40's.

As you told the young man: Go the NP route unless you plan to specialize, become an administrator, or really have an calling to be a doctor.

Lastly, for PA's and NP's who want to go to medical school to pickup some extra training (because there are some things that only MD's can do), most medical schools have accelerated programs that let the PA's and NP's skip entire years of medical school.  Additionally residency would be a breeze for these folks and they would have the opportunity to pick-up the actual nursing shifts on their weekends off.

11 comments:

Anonymous said...

Sorry this post is a bit disjointed, but I work in the medical research and I have a family member that has become an MD.

In 2001 my cousin finished his residency to be a pathologist. He was 35, had 300K in debt, and his first job was in a rural western state where he was paid 300K annually because nobody wanted to live there. He is doing very well now and is a partner in a private pathology practice. His story is a typical in that he a huge amount of debt (423K in today's dollars) and atypical in that he made sacrifices to get out of debt and get experience.

From what I have noticed MDs typically want to live where they can show off and spend money. The Mrs usually has a lot to do with choice of location and the conspicuous consumption.

For the newly minted MD that is willing to make the sacrifice, at an extremely rural hospital I worked at I was told by an endocrinologist that he came there so he could pay off his student loans in three years and then he could afford to move back to New York. That was exactly what he did. He was in his early to mid 30s when he started and had a wife and four children. Notice, once again, he was in his 30s before he started his first real job and earning money.

I also know of more than one physician that has encouraged their children to become RNs. They made the case to their children that they are not sure the ROI for medical school exists any more if you don't pursue or are incapable of perusing a high-paid specialty.

Tucanae Services said...

My God! No wonder the $$$ for 2 aspirin is $76. I have observed the Soviet/Russian medical system for a number of years as a resident over there.

K-12 ends for most at 17. Can actually be as low as 14 for those qualified gifted or exceptional talent.

MD graduates at 23-24. That assumes 2 years of university in biological sciences then 3 yrs formal training and 1 years of residency. Another words most MDs there are what we might consider specialists here. Being a GP requires more training in Russia.

RN equivalent completed in 3 years max, most in 2.

No such thing as a PA in their system.

Now here is the difference. The MD or RN is trained in a very specific niche of the medical field. So much that this is what it looks like as a patient who goes in for a physical --

* You see 4-5 nurses that may do only 1 or 2 functions. One does blood draws. Another hematology tests, etc.
* You see 2-3 doctors as a consult based on the test results.

Is their system better? Depends on your viewpoint. Here in the US you are little better than a slab of meat that gets to answer a few questions while they poke and prod you. Russia, there the doctors don't have to worry about malpractice so they are quite frank about their analysis and your prospects. Major cities the equipment is on par with what can be had here. Some of the regionals, not so much.

One last oddity -- Patients keep their own medical records. Try to get a copy of yours here.

Anonymous said...

Or how about just get an R.N. and work 12 hour weekend shifts and have the rest of the week off.

Southern Man said...

I've been teaching the general physics course that the pre-meds take for over thirty years now. I note that over half of my aspiring doctors come from medical families. Even at the beginning I heard some rumblings from the parents that the traditional pre med -> med school -> doctor route might not be for the best. Now I'm teaching the children of my early pre med students who became doctors and they pretty much uniformly say that their parents (that is, my former pre med students who are now practicing medicine) do NOT want their kids to be doctors. PA is a popular choice though, and my school's RN program is booming. My own GP (who graduated from the same college as I, at about the same time, so we're both pushing sixty now) has kids who are doctors but both he and his doctor kids are telling the next generation to avoid the medical fields altogether.

RealDoctor said...

No, most medical schools do not let NPs or PAs skip years in med school. And NP curriculum is not even close to the depth of knowledge obtained in med school so it does not give them an advantage in residency. And no one has time to pick up extra shifts in residency. Residents already work 70-80 hours a week. You are delusional and should probably do some research before publishing nonsense

Red Rhino said...

Orthopedics resident here
18-22 B.S.
23-26 M.D.
27-(33) Residency [am 30 now, need 2 more years]

Will graduate from my orthopedics residency at the ripe age of 33, then will need 2-3 years of fellowship to be competitive in the market. So will start at 35 at the earliest and will still need to establish myself in my field. You don't graduate and suddenly have patients. You need to develop a reputation, constantly guard it, and develop a practice. Even if you join a practice or hospital system, you still won't get the best cases handed to you... Bottom line, it is a LONG road. It can also be difficult to watch people live their lives while you slave away your 20s and early 30s inside a hospital full of sick complaining people. When you are on call for 24hours you are at the mercy of the workload. You may not sleep for 24 hours and it is NOT uncommon. Constant sleep deprivation and erratic schedules will make you a miserable person with a low threshold for acting out (hence the stereotype of the asshole surgeon). They cap our hours at 80 a week, but it usually comes around to 90-100 unofficially. This doesn't include case logging, operative reports, conferences, presentations, lectures, online modules, more paperwork I'm still not sure why that stuff needed filling, or preparing for the yearly exam (OITE).
To make matters worse most doctors are unimpressive physically, and certainly do not represent paragons of health, vitality, and discipline. Most are overweight and develop their own collection of medical problems. Doctors on average live 10-15 yrs less than the average person. Doesn't speak well of doctors. They can't even take care of themselves... Being a doctor these days means following the guidelines to the tee. Otherwise you can be faulted for not following the guidelines (consensus). This practically renders you a priest in the church of the American medical association.

Bottom line, as said above, make sure the ROI is in your favor because this job will consume your life in ways you probably can't fully appreciate. It isn't worth it unless you go into a high paying specialty. Or are a woman and want access to potential high-paying specialty mates. I think you get the picture.

SC Sopha said...

The author, a ‘frustrated economist’ is correct that physicians have delayed earning potential until early to mid-30’s, which, coupled with enourmous debt from training, interviewing, and boards certification means physicians are not as rich as the general public believes.

Whether or not it was intended, the article does highlight the enormous depth of training, expertise, and dedication a physician has as compared with other lines of training.

Where the author truly shows his/her naivete is in the last paragraph. There is no such thing as “weekends off.” Every weekend, residents and fellows continue to round on their patients on service from at least 06:00 to 12:00, and likely will be on call for 36 hours starting either Saturday or Sunday. Resident physicians do not neglect their patients, with whom they feel a significant bond, simply because the conventional work week is over. Training is about training—not earning money—and this is one of many points where physicians diverge from other lines of training.

SC Sopha said...

The author, a ‘frustrated economist’ is correct that physicians have delayed earning potential until early to mid-30’s, which, coupled with enourmous debt from training, interviewing, and boards certification means physicians are not as rich as the general public believes.

Whether or not it was intended, the article does highlight the enormous depth of training, expertise, and dedication a physician has as compared with other lines of training.

Where the author truly shows his/her naivete is in the last paragraph. There is no such thing as “weekends off.” Every weekend, residents and fellows continue to round on their patients on service from at least 06:00 to 12:00, and likely will be on call for 36 hours starting either Saturday or Sunday. Resident physicians do not neglect their patients, with whom they feel a significant bond, simply because the conventional work week is over. Training is about training—not earning money—and this is one of many points where physicians diverge from other lines of training.

SC Sopha said...

A few points:

A ‘newly minted MD’ refers to someone who has finished medical school, not residency or fellowship (a ‘newly minted’ MD would never make > $300k since residencies pay only about $50k —for an 80-hour work week—you do the math). So whenever you are seen by a resident or fellow, you are being seen by a bonafide physician.

Secondly, your bias is showing. ‘The Mrs. determines the MD’s spending’ —really? Is this 1950? More than half of medical students today are women, and recent peer-reviewed medical joirnal articles have even shown that women physicians have better patient outcomes than men physicians. Please get in your time travel machine and come back to 2018.

Dara Grieger said...

I am a physician (MD) who was a NP first. I did both a little later in life as well. The economic situation you describe is pretty accurate. One can become a NP or PA sooner and start earning money faster than a MD can, most likely with lower student loan debt. You miss the time worked in residency, too. Most residents work much closer to 80 hours a week.

Your last paragraph is simply wrong and reflects a misunderstanding of the details of how these training systems work. Your assertion that most medical schools give NP and PA a full year's worth of credit is simply not true. There may be a handful that I am unaware of, but it is NOT the norm. The vast majority of NP and PA who go on to medical school must complete the entire curriculum and get no credits given for being NP or PA. It's a good thing, too because the medical school curriculum is far more rigorous and in depth than any NP or PA curriculum. The typical reaction of a NP or PA who goes to medical school is that they become humbled at realizing they didn't even know what they didn't know. And your statement that residency would be a breeze for a PA or NP who then becomes MD is laughable. Residency training is vastly more difficult than any clinical training a NP or PA goes through, and involves a completely different thought process. And supposed advantage a former NP or PA has is minimal and disappears quickly.

Finally, the opportunities for moonlighting during a residency are minimal. There is no such thing as "weekends off". Most residents only get one weekend off a month, as mandated by the organization that oversees residency (the ACGME). Residents are limited to 80 hours a week of work and that includes moonlighting. Even if one had the time, scheduling moonlighting around the obligations of residency would be challenging at best. Plus residents still have to study. They are expected to be engaged and learn more in depth information about the conditions their patient have, as well as prepare for an annual exam to assess their knowledge.

So, no, becoming MD after being NP or PA is not "a breeze"

Ginny said...

This. ^^^ Where did come up with this bogus? I don’t know if any MD programs who let PAs or NPs skip medical school training and physician training is much more in depth and rigorous. You also forget to consider the patient in your scenarios above and only consider lifestyle for the person doing the training. But medicine is dangerous if practiced by someone with inadequate training, so you have to consider the safety and outcomes of your patients when you decide how much time and effort you want to put into your training.