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MD versus PA versus NP versus CRNA!

MomtofourkidsMomtofourkids Registered User Posts: 36 Junior Member
Any advice would be appreciated! My S (currently a Junior) is very interested in the medical field.
However he is not sure which medical profession to major in and some schools ask kids to decide by Nov of their senior year if they want to pursue PA school or become a nurse practitioner! He has spent last summer volunteering in our local hospital in the dementia ward so he has some experience in a hospital setting. UConn has an excellent summer program that looks into the many fields of medicine to give students further insight into which field they may want to study, however its full for this summer - and there are really no programs anywhere else like it in the New England area from what I can find. Also while he is looking into shadowing medical professionals but the confidentiality rules make that difficult to do. Any ideas on how to give him an insight into what he may want to study/become? My H and I just don't want him to spend a few years at college spending a lot of money without having a really good idea of what he should pursue.

Replies to: MD versus PA versus NP versus CRNA!

  • TooOld4SchoolTooOld4School Registered User Posts: 2,829 Senior Member
    edited April 14
    1. What is his tolerance for studying? An MD is 4yr of med school + residency + fellowship. That might be 10+ years for some surgical areas. It is a very long road and expensive if you do not have family backing, or choose to have Uncle Sam pay for it.

    DNP , CRNA, PA etc. programs are 2-3 yrs. A Ph.D. in Nursing is 4-5 years.

    2. Is he interested in research? If so MD/Ph.D or Ph.D nursing are good routes

    3. What is his tolerance for work? APNs and PAs can have a regular life. It is much harder as an MD.

    What is his GPA? He will need a high GPA to even be admitted to medical school (3.7-3.8). Has he taken the prerequisites for medical school? If not he needs to do so to even have that option open. He will have to take MCATs for med school and GRE for the others.
  • thumper1thumper1 Registered User Posts: 63,836 Senior Member
    Is he a HS junior? Or a college junior?
  • MagnetronMagnetron Registered User Posts: 2,197 Senior Member
    A family practice MD and a PA or NP in family practice have exactly the same work load and responsibilities. The difference is they get about half the pay of the MD.

    PA - Physician's Assistant - practice is tied to a supervising physician's license. Follows the physician model of care.

    NP - Nurse Practitioner - Practice is independent, though most states require a "consulting physician." Education follows the nursing model of care.

    CRNA - a different animal, tied to hospitals.
  • MaterSMaterS Registered User Posts: 1,345 Senior Member
    I think PA care must vary by state. I am shocked that I can receive PA care without an MD on site except in limited roles.
  • TooOld4SchoolTooOld4School Registered User Posts: 2,829 Senior Member
    edited April 14
    More and more states are allowing APNs to practice independently and most have prescriptive privileges. Many of them are the only primary care in rural areas. Physician pay is not what it used to be, with most MDs employees of large practices or mega health corps. Hours are less too.

  • hannuhyluhannuhylu Registered User Posts: 273 Junior Member
    I more shocked with NPs being able to provide care. This midlevel provider stuff is crap imo.

  • wis75wis75 Registered User Posts: 12,459 Senior Member
    re post#3. I doubt very much that the nurse and physician have exactly the same responsibilities, in any type of practice. There is a great difference in the educations. Nursing is a different path than that of medical doctors. Note that there is the nursing model of care. Physicians learn diagnosis and treatment, not the taking care of patients that all nurses must first learn and then work before taking more years of training and becoming a CRNA or NP.

    As a physician I would say "the buck stops here" for MD's compared to any other of the "providers". To be truly autonomous, in charge, independent, know the most basic science et al one should become a physician. To take care of patients following protocols the nursing/PA routes work. Different types of knowledge bases.

    He definitely should not be looking at just the salary. Different personalities choose different routes, and specialties within professions. He should consider other medically related fields including physical therapy. Spending time on a dementia ward is nothing like most other areas of medical/nursing care. btw- he will only see the tip of the iceberg regarding thought processing that goes on based on the knowledge base- one reason people perceive nursing specialists as being akin to physicians.

    I have no regrets about the lengthy time spent learning so much behind the final doing the work. I have a physician's personality, not a nurse's. Not gender bias- I am a woman. The two fields are parallel. Good nurses know a lot of things physicians do not and vice versa.

    He needs to do some career center testing for aptitude and interest. Check with his HS regarding what your school district offers. It may be through the HS or tech/community college. His academic strengths and weaknesses also are paramount. He needs to be a top student to handle the academic workload both as a premedical hopeful and a medical student to become a physician. He needs the personality to enjoy doing the distinct style of taking care of medical needs in different professions.

    As an anesthesiologist I am a physician first, then my specialty. Likewise CRNA's are first nurses, then have skills in giving anesthetics. They do not have the same training to first make diagnoses that physicians do. That medical knowledge is very evident in the anesthesiology orals! Had to be the internist, pediatrician, cardiologist, every specialty in deciding which tests to order, exam significance as if no one else was available. The surgical procedure and techniques were the least of it. Again, patients see only the tip of the iceberg.

  • sorghumsorghum Registered User Posts: 3,311 Senior Member
    An MD can potentially make millions per year. And saying "physician here" is way cooler than saying "nurse practitioner here".
  • MomtofourkidsMomtofourkids Registered User Posts: 36 Junior Member
    He is a high school junior.
  • TTGTTG Registered User Posts: 694 Member
    Maybe he could do a program to get certified as a Certified Nursing Assistant (CNA) or EMT. One of my high school kids is doing a program this summer to become an EMT. It's a 3-week program. It is sometimes offered through community colleges. One of their friends got certified to be a CNA last summer. That way your S could get some hands-on experience, which might help determine if he's interested in medicine and what type. Good luck!
  • thumper1thumper1 Registered User Posts: 63,836 Senior Member
    edited April 15
    Ok...if he is a HS junior...really...his career focus could change multiple times over the next many years.

    The only reason your kid would need to decide in senior year of HS is if he is considering applying only to direct admit PA or nursing programs.

    To become a NP, he would need to first become a NURSE....and some kids do direct admit to nursing schools as well.

    But really...if he isn't sure...why would he do that? There are plenty of routes to PA and NP...that do NOT require a commitment in the senior year of HS. For a kid who isn't sure......take one of those other routes.
  • SybyllaSybylla Registered User Posts: 1,541 Senior Member
    And some of these HS programs are vocational vs for those aimed at being an MD or even competitive BSN. It might be a different thing here, but I do hear of kids who will take A&P over AP bio or that kind of CC class and yet talk about going to med school. Make sure you know what leads where. I would make sure the kid has highest rigour in all classes before doing any kind of DE if they are aimed at competitive uni entry, unless you have evidence the classes are of equivalent rigour. .
  • SYMSYM Registered User Posts: 45 Junior Member
    He may also consider dentistry. He can practice right after dental school with high salary.
  • thumper1thumper1 Registered User Posts: 63,836 Senior Member
    He could consider pharmacy...or verinary medicine. Or he could decide to be a teacher, or a banker, or an accountant, or a researcher. Or anything else.

    He is in 11th grade. He could change his mind 10 times before he even gets TO college...and another 10 times when he is enrolled in college. And many folks actually get jobs that are unrelated to their college major.

  • shawbridgeshawbridge Registered User Posts: 5,256 Senior Member
    edited April 15
    As @TooOld4School pointed out, the path to being an MD is many years longer -- 4 years of undergrad plus 4 years of med school plus internship/residency plus possible fellowship, possibly ten or more years after undergrad. I think PA is 2-3 years after undergrad. NP is also 2-3 after undergrad. ShawD was in a five year BSN/MSN program but her school had a 3 year program (including summers) to take science major BAs and make them into BSN/MSNs, I believe. Here's an article I found regarding the differences between PAs and NPs: http://nursejournal.org/nurse-practitioner/np-vs-physician-assistants/. However, I think the differences are much greater in principle than in practice. Many of the jobs she looked at advertised for NP or PA, so I think that functionally they would be doing the same work whichever person was hired.

    On pay, @TooOld4School is directionally right. I wouldn't suggest deciding on financial grounds, but that pay differential is a bit deceptive. Based upon my cursory Google search, NPs/PAs appear to get paid 50% to 60% of what family practice physicians make. However, they are not on call (where some family practice physicians are). More importantly, becoming an NP/PA takes many fewer years of education. ShawD is working as an NP at age 23. Given that she is young and not used to high spending and that many of her friends are living on lower salaries, she is saving $35K to $40K a year. When she was training, doctors would come up to her and say, "You're so bright. You should go to medical school." Relative to medical school, she is avoiding something like eight years of additional training and substantial debt. Someone can correct me, but my Google search suggests that interns/residents/fellows are paid at a level similar to a starting nursing salary. Saving that much early in her life and not having to pay student debt for medical school, it will probably take a number of years before the NPV of attending medical school exceeds the NPV of becoming an NP/PA.
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