Friday, June 12, 2009

MiM mailbag: NP or MD?

I am a 30 yo woman who finally got up the nerve to pursue medical school after dreaming/obsessing about it for 15+ yrs. I'm planning to start a post-bacc program next May. But now that I'm 30, I've realized that I do want to have kids, soon, and I don't want to miss the most exciting years of their lives. Although becoming a Nurse Practitioner has never been a goal of mine, I'm wondering if you Mom MDs think it would be worth it to settle for a career as an NP in order to have more time to spend with my kids. Thoughts?


  1. I don't think it's good to settle if you have the option not to. I started med school at 27, am now a practicing family physician and mother of one. As a family physician I have the opportunity to do locums and work part-time wherever and whenever. I stay at home 4 days a week and work 3 days, so I have lots of time to spend with my 9month old.
    The benefit of starting med school later in my case is that I knew I wanted a balanced life, so I chose family med in which I can do that. I do not regret it one bit. If med is what you have been wanting to do for 15+yrs, then go for it. It's worth it. Otherwise as an NP you may always wish to be otherwise.

  2. I think you alone know why you want to practice medicine, whether as a physician or nurse practitioner.

    I avoided med school like the plague for many years and went only because I couldn't shake the thought that I had to at least try it. In retrospect, I think I was meant to be an L&D nurse.

    If you need to be in control of the situation and practice autonomously, go to med school. While practicing physicians know there is no control in medicine, we do have a little more autonomy than NPs.

    If your goal is to have great relationships with your patients while caring for their medical needs, go to NP school.

    Only you know how your brain works and where your heart is leading you. But if you're like me, you'll never truly know what exactly you are meant to do.

    Life is like that - make a final decision, then spend forever wondering if it was the right one.

  3. I think being a PA or NP is a great job. They get to do a lot of the same things as a doctor, but the hours are better, the training is shorter (and less expensive), and the responsibility is less. The pay is still very good. The PA/NPs I know in specialized fields are really really smart and do almost all the same things as the physicians, but when there's a tough case, they have/get to ask the physician for help. I don't think that's such a bad thing. They have a much better opportunity to have a life outside of work than a doctor and definitely less debt.

    Then again, if you go to NP school feeling like you're "settling", then I don't know if you'll ever be happy in the field. If you're making a big career switch, you should actually really want the career you're switching to.

  4. I went through a similar dilemma, but I had already done all my post bacc when I was trying to decide. You can qualify for NHSC either way (a consideration for me).

    I decided to do medical school. I am 36 and have two kids, both born before I started (which I highly recommend, if possible!)

    I figured I would have a similar road ahead. 4 years of residency after 4 years of med school vs. all of nursing school all the way to practitioner. I figured I would have to work shifts as a nurse that would be probably as grueling as residency and rotations. But, I think either option would have worked out well for me. I just didn't want to have to refer for cesarean pretty much.

  5. If you are using the word settling when describing one route over another, I think you are telling yourself the answer.

    Happy mom, happy child, happy family.

    Do what will make you happy.

  6. You're too young to "settle" for anything. Plus, if you have kids now, they'll be 7 or so by the time you start residency and will be in school.

  7. Although I've just finished med school and am getting ready to start residency, I think one thing is to really look at the training you're getting. I know you're thinking about NP vs MD (and you didn't mention PA)...but I know that looking back, there have been times where I thought, "Why didn't I just do PA school?" But then when I look at the amount of training they have versus what I will end up having by the time that I'm done with all of my MD stuff, it makes me feel more secure in my decision. I'm not knocking PAs and their knowledge at all, but for me, one rotation in each topic and then "ok, you're ready to practice"--which is mostly what PAs get--they have alot of on the job training...was a bit unsettling for me, and I hear how my friends who are just starting their PA jobs feel like they didn't get enough exposure. Anyhow, if you decide to do medicine, I say try to have kids the first 2 years--your schedule is SO much more predictable (still stressful, you have to have time to read and study and read) but it would be easier to skip class for a sick kid than to skip clinic or wards or whatever. Good luck!

  8. I'm from Canada, so maybe this doesn't apply to you, but I would seriously consider the med school route. Here you could do a 3 year med school, a 2 year residency and be out earning. As a family doc I set my own hours 100% and am only as busy as I allow myself to be. Our NPs are hired and on contract, a bit at the mercy of who they are working for, and they have less autonomy and less money for less satisfying work. Being my own boss is the best of all worlds.

    Also, med school is not that horrible, we just like to complain : ) Same with residency, really, compared to people who are articling for law or on call as real estate agents or working their butts off at Wal-Mart with no security. But I digress.

    But maybe it's different here?

  9. To anon: here you must do 4 years of med school and the shortest residency is 3 years. Many people end up taking longer too, what with research or maternity leave, etc.

  10. NP school and the ensuing career can be very, very flexible but you won't be happy if you feel like you are settling. Get to known an NP and spend some time with him or her in clinic to get a good understanding of the role.

  11. Your situation sounds much like mine. I spent many years dreaming of medicine but settled for my second choice of physical therapy because of lifestyle and mostly because I never thought I could be accepted to medicine. After 6 years of practice I was 29 and faced with the realization that the medicine bug was still in me, and that if I didn't at least try to get in, I would always have regrets. My husband is a surgeon and having already been through med school, convinced me that I could do it. I went back to school to take physics and chemistry, took the MCAT, and after 3 attempts to get in, started med school when I was 32. I had my first child after my second year of med school (and took a year mat leave), and my second child in my final year (with two months mat leave). For all of the first two years and about one third of my final two years of school I commuted 2 hrs back and forth.
    All this not to toot my own horn, but to say you CAN do it and still have a family. The past five years haven't always been easy but they have been the most satisfying of my life. You don't need to be brilliant - I'm certainly not. You just need the motivation and persistence, which it sounds like you have.

    If you have been obsessing about this for 15 years you should do it! I just graduated two weeks ago and trust me, the feeling is incredible. I can hardly believe it myself. I wouldn't change a thing. Good luck:)

    1. Thank you so much for sharing your experience. I am a Critical Care nurse who wants out of her career and ability to interact with patients. I was stuck on the NP/MD decision and applied to both programs. I received my first MD rejection and was crushed to be honest (I figured after working as a resource nurse and ICU I kinda have seen nearly everything)...Your comment about re-trying despite family priorities and the "age" factor us women face was extremely inspiring and encouraging. Thank you once again! I have gained a new found ambition and zest.

  12. If you want to be a doctor, then be a doctor. If you think being a PA/NP is settling, then they aren't the right careers for you... And how frustrating might it be to those you spend three- four very challenging years with to have to hear that you've settled to be among them, LOL, no thanks. You can do it, look at the shining examples here on this blog!

    Now, if you find that the philosophy/model of care of a NP/CNM is more in line with your goals, personal philosophy,etc., then by all means become an NP!

    And finally as a side note, NP school is not always cheaper... Several NP/CNM programs are at ivy league institutions, so if you chose a state medical program, you might come out cheaper.

    Do what makes you happy!

    As a midwife I'd have never been happy as an OB, and never considered being one. I've carried midwifery in my heart and mind the same way it sounds like you carry medicine... We desperately need both kinds of providers... A happy provider makes a better provider :0)

  13. I am 28 and still have 2 years of residency left. Residency (in OB/Gyn) has been the hardest time in my entire life. I can't wait to be finished and I'm planning to have a baby during my last year of residency. It just takes so long with 4 years of med school then at least 3+ years of residency. That's likely 10% of your lifetime. Life is so short. I'm not sure that I would have went down this same road again just due to the length of the training. I enjoy the kind of work that I do, but it's a big sacrifice. Personally, I wouldn't do it if I were starting now. To me, your thirties should be the best years of your life with spending time with your family, enjoying good health, but having a little bit of financial resourses to enjoy life. Of course, work can be a very rewarding part of your life. If you think you can be happy as an NP, I would go for it.

  14. So, what did you decide to do? I'm an pediatric NP who has been practicing for four years. I've enjoyed it, but often wish I just knew more, had more autonomy, and a better salary. It's a lot more responsibility and work for not much money that one makes as an RN.

  15. As an ACNP graduating from the University of Michigan, I don't feel that I settled. I chose to go into this program and have been very happy with my decision. I smile when people say, " you are smart enough to be a doctor". For me, I appreciate having a job I love but also being able to leave it at night and weekends. Good luck with your decision but know that choosing to become an NP isn't settling.

  16. I am 25 and was accepted into a post-bacc program but did not accept. I am afraid that the long road of medical school plus residency will leave little flexibility for the rest of life (family, friends etc) and the NP road seems less restrictive. I am going to take the GRE and apply to a few NP programs to see if I get in. I am planning to defer to the post-bacc program so that I have this year to make my decision but I have the same fears many of you have articulated--sacrificing so much to the med school route versus feeling like I'm settling to be an NP b/c I will have less knowledge. Hardest decision of my life to be made and I need to make it soon!

  17. Good luck with your decision Anonymous. I can completely empathize. I am a later 20-something who got accepted to med school and decided to defer this year for personal reasons, mainly to do some final soul searching to confirm the MD path is right for me. I am using the time to give the NP route more thought and consideration because I have been bit by the baby bug too and would like to make sure family life can find harmony with my work life. I have received mixed responses and advice from family and friends. I look forward to reading more of the wonderful and honest notes on this blog.

  18. Good luck with your decision Anonymous. I can completely empathize. I am a later 20-something who got accepted to med school and decided to defer this year for personal reasons, mainly to do some final soul searching to confirm the MD path is right for me. I am using the time to give the NP route more thought and consideration because I have been bit by the baby bug too and would like to make sure family life can find harmony with my work life. I have received mixed responses and advice from family and friends. I look forward to reading more of the wonderful and honest notes on this blog.

  19. I know this is an old post but I'm very curious to know what you decided. I'm 23 and just finishing up my first year as a registered nurse in a busy emergency department. I'm beginning to contemplate medical school vs DNP school. I could literally apply for a DNP program today, could keep my job, and wouldn't have to move. Medical school on the other hand would require for me to complete some more pre-reqs (the ones that were not required for my nursing degree), take the MCAT, and move. My husband has a great career where we live and is in line for a promotion. I just wonder if I'll always play the "what if" game either way.


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