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MD versus PA versus NP versus CRNA!


Replies to: MD versus PA versus NP versus CRNA!

  • BingeWatcherBingeWatcher Registered User Posts: 490 Member
    I am a NP and have been one for many years, and no way do I have the knowledge or experience of physicians.

  • MagnetronMagnetron Registered User Posts: 2,187 Senior Member
    ^ You can change that if you want. The NP we go to has been in the business 40 years. There is a big difference between a new doctor and a new NP. After that, it becomes about state laws, the practice environment, and individual personalities. She takes call, does surgeries (not the big stuff, obviously, surgeons do that), has admitting and hospital privileges. She is also a naturally curious person. I would put her knowledge of complex medical cases up against any primary care physician. Education stops defining you once experience takes over.
  • hannuhyluhannuhylu Registered User Posts: 256 Junior Member
    edited April 17
    Exception not the norm, but yes we never stop learning.

    The 9500 vs 1500 clinical hours alone is astronomical!!

    (My wife is a NP too) she very humbly says no comparison and will grill the DNP model up and down.
  • wis75wis75 Registered User Posts: 12,365 Senior Member
    edited April 17
    re post #32. I disagree with you entirely. Your NP never learned the same stuff the MD did- you only see the tip of the iceberg. Experiences are different- we see things and learn about so many things not routinely expected to be seen that a nursing education does not cover. All of us physicians got the same medical education to become MDs, then added specialized knowledge. NPs got nursing degrees, without the same knowledge base of physicians. Routine office practice is a lot of repetition, most often the rare stuff is never encountered. Also, women have been giving birth outside of hospitals for thousands of years, routine deliveries are straightforward. Dealing with the unusual and complications is a good reason we have physicians.
  • MagnetronMagnetron Registered User Posts: 2,187 Senior Member
    We do live in a specialist-rich area where primary care providers would never use the breadth of education given in the med schools. Still, the docs at her clinic made her medical director. She has worked in internal medicine, OB/Gyn, and two years independently in a Spanish-speaking country, plus other places. She sees the most difficult cases and finds things that have been missed for years. You know why the death rate goes up in July in teaching hospitals? Because what happens after the education is more important than what happens during it. For a patient, it is the only thing that counts. I absolutely agree with your assessments in general, but they do not apply universally.

    One of the best design engineers I know never went to college. My mother's lawyer never went to law school. She read the books and passed the bar. She was arguably the smartest person in my hometown which included a research university.
  • wis75wis75 Registered User Posts: 12,365 Senior Member
    It is much different in the medical world than law or design. Medicine is a hands on experience where everything cannot be learned from books/computers. All physicians use the same breadth knowledge in subtle ways. Those in primary care will be up on the drugs and doses more than specialists perhaps but we all have the understanding of the pathology and ramifications of it and treatments- importantly what needs to be known (and looked up) given the circumstances.

    July is notorious in teaching hospitals because the residents are all new in their positions and still learning. Not the same as in practice beyond training. btw it is called the practice of medicine for good reasons.

    Back to the OP's concerns. So many variables and much tooo soon to plot out your son's career. In HS he should be taking the college prep type classes- in all areas, not just STEM. He will need to choose colleges that include potential majors- eg nursing and PA programs et al. Any school if his intention is premedical. If he is premed he needs a major that interests him. He will need to take the required classes and plan on a career outside of becoming a physician since so many who start with medical school intentions do not go. Nursing is a parallel field and NOT the default if he doesn't get into medical school- different personalities are attracted to each way of taking care of patients. If he chooses nursing he will have many years before he becomes a subspecialist- he must like it to tolerate the work (RNs also show only the tip of the iceberg in their daily routines and need to do so much that doesn't require the degree- if no one else does it the RN makes sure it gets done).
  • ColoSkyColoSky Registered User Posts: 62 Junior Member
    edited April 17
    I would love to hear more about this
    "Nursing is a parallel field.... different personalities are attracted to each way of taking care of patients"
    Would you mind elaborating on that last part?
  • WISdad23WISdad23 Registered User Posts: 806 Member
    @cbreeze, yes many hospitals have hospitalists. But most people here I suppose live in larger cities. In smaller hospitals, there are no hospitalists so there is a traditional model of call. Also, it depends on the specialty. I am a psychiatrist and I have been doing call for 25 years. I can tell you that I (and most like me) hate call. Some specialties have made it disappear (e.g. with hospitalists) but it still exists. In states that allow non-MD's to admit patients to hospitals - I'm not familiar but good luck with that. There is no way, I presume, that this happens without MD backup which means that the admitting person is a proxy.

    But to the point, high school aspirations to be a doctor are by nature idealistic. Time and experience will hone the reality.
  • WISdad23WISdad23 Registered User Posts: 806 Member
    @Magnetron not sure I follow completely but I think you are saying that an OB/GYN group appointed an NP as their medical director. That is fine but I can tell you that they would change that in a flash if the medical director position paid more than clinical work. In multi specialty groups, it is fairly uncommon to see a radiologist or a dermatologist take a 70% pay cut to be an administrator. This happens in mental health all the time to the detriment of psychiatry. In any publicly funded mental health system you will likely find a non-psychiatrist running it, so often in fact that it is peculiar.
  • ordinarylivesordinarylives Registered User Posts: 2,893 Senior Member
    edited April 18
    OP, don't worry about making a choice now. Things happen. People really need relevant experiences before they can make good decisions. My oldest earned a BSN. She thought she would finish her medical school prereqs and go to med school. The difference between PA/NP/MD have been discussed, but it was her assessment that if she were going in, it was going to be at the top of the food chain, not the middle.

    She went to work in a large teaching/university hospital. And met physicians. And doesn't like what they do. At all. This is not the kind of stuff one learns by a shadowing experience or two in high school but by day in/day out exposure to the medical community. (If your child is really interested in medicine, get a job in the hospital!) She will start an MSN in the fall, with a goal of a PhD program after that. She will not earn what a physician earns, but she won't have the debt either.

    You also want to keep an eye on what is happening in the fields of interest. The hospital where oldest works no longer wants new master's level NPs. It wants DNPs. Great, the more training the better (at least from my perspective as a patient!), but the field is changing. Healthcare is also a huge field. There are people associated with direct care (RNs, MDs, RRTs, NPs, CNAs etc) but there are also accountants, admins, HR personnel...

  • wis75wis75 Registered User Posts: 12,365 Senior Member
    edited April 19
    Parallel means they are separate fields. The nurse is not in the same field and just lower in the chain of command/on the ladder. Post # 40 offers an example of how very different the fields are even while taking care of the same patients in the same setting. Different types of people choose different types of work (even with fields- psych and surgery personnel are different). Poster #40's D discovered that indeed nursing was the better choice for her and getting more education in that field was more to her liking. It is not a matter of being able to do either job as nurse or physician, it is a matter of the type of work one prefers.

    People who basically want the large income should go into business- the job to make money and not endure the lengthy training with all of the guts/gore/pressure... unless one really likes medicine. The financial return on one's investment is not a reason to become any profession (unless it is a business field where that is the objective).
  • thumper1thumper1 Registered User Posts: 63,483 Senior Member
    edited April 19
    I live in an area where almost all of the hospitals are smaller...and they all have hospitalists. All of them.

    Actually, the larger city hospitals with larger medical practices have more doctors on call where I live.

    But really...back to the OP. This is a HS kid. He doesn't have to make up,his mind what he really wants to do...for years.

    I'm not sure why the OP feels she needs to lock step her kid into a certain track now.
  • shawbridgeshawbridge Registered User Posts: 5,249 Senior Member
    @ColoSky, I think what @wis75 is alluding to is not just a different level in the food chain. It is true that doctors were the top people in health care, though now it is often corporate types at places like HCA and insurers who drive a lot of medical practice. Doctors are second in the food chain (and are sometimes the execs). NPs and PAs are lower in the food chain and PAs are generally required to be supervised by an MD and NPs in some states are required to do so or at least to bill through an MD. In other states, NPs can run their own clinics.

    But, the distinction I think @wis75 is getting at is philosophical. NPs are trained in patient-centered care. They look at the whole patient. They probably spend more time talking to the patient. MDs are trained in the medical model, which is symptom/disease-centered care. Both have studied the diseases but the MDs have typically done so in more depth, sometimes in considerably more depth.
  • worth2tryworth2try Registered User Posts: 925 Member
    I am a medical student who posts here from time to time and figured I would weigh in. Given that BSN is what is required to go on to NP or CRNA level of training, and pre-med is difficult to combine with a BSN, I think you're thinking about it at the right time. Has he shadowed any? From my experience, CRNA's and NP's will say things like "Dr. X likes it this way, and Dr. Y likes it that way." I knew then and I know now that I want to be the person deciding "how I like it," not practicing according to someone else's style on a given day. I originally started in a BSN program at the suggestion of my father, but realized I wanted the challenge of getting through the most rigorous training, and haven't regretted it.

    Look carefully at the COA of medical school and PA school - they're closer than you think. Last year, my school's average PA debt and MD debt was just 10k apart. The caveat may be that MD students come from better off families, some of whom definitely cover the entire cost. Many others are also happy to help with some extra expenses to make their children's lives a bit more palatable. Far from all medical students live this hellish books-only existence that many seem to think. Anyway, I am biased :) Feel free to message me.
  • PBDPBD Registered User Posts: 46 Junior Member
    I am a physician, and so is my spouse. None of our 3 kids are going into medicine with the exception of my daughter who is pursuing a phD in psychology, a highly competitive field that is harder to get into than medical school. (Partly because most good PhD programs pay you, instead of the other way around- though her motivation is that she doesn't want to take care of deeply disturbed individuals who would require the car of a psychiatrist.).

    Anyway, I believe that an MD is still a great choice if you are driven, can do it at low cost and/or can choose a highly paid field (mostly subspecialties such as gastroenterology, invasive cardiology, etc.). For primary care you're better off pursuing a PA or RNP degree because the opportunity cost of being a physician is too great.

    Despite the growing physician shortage, being a physician is not an easy life even after medical school and residency. Frankly, most potential doctors are capable of doing many other things, and in general I'd advise you to do so unless you have a deep desire to serve, in which case it can be very gratifying.
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