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Monday, October 6, 2014

MiM Mail: A married college senior deciding between NP and MD

Hey Mothers in Medicine! First I would like to say how much I have enjoyed reading your blog. I found it about 6 months ago and I find myself reading through posts weekly. The writers have so much great insight and encouragement for women in the medical field. I have a question that I would love to ask on the blog!

I am 21 and a senior in college. I am also just recently married to my wonderful, loving, bright husband who I met my freshman year. He is 22 and in his senior year of college as well. My husband and I are both biology majors and will be graduating in May 2015. On top of that we are both athletes at our Division 1 University and got married this past summer. My husband has already applied to medical school for the coming year and we are waiting to hear back from schools once they start reviewing applications. I entered college as a Biochemistry major, wanting to pursue medical school (or at least I thought I did?) Around my sophomore year of college, I began to feel a lot of unrest as to what career path I was going to choose. Medical school seemed so daunting and like it would hinder my ability to be the future wife and mother that I had the desire to be. I felt pressured to pursue the absolute highest degree (medical school) or that I would disappoint my family. I now see that they were/are just encouraging me to follow my dreams and pursue my highest potential (but still it can feel like pressure, you know?) I have always had a strong passion to help and serve others, love international mission trips, and volunteering in my community. One of the biggest reasons why I wanted to pursue a career in medicine in the first place was so that I would have a skill that I could offer to help others in need, whether in the US or abroad. But when I began to sit down and really think about my future, as a wife, and mother (we hope to have a big family and adopt!), I really began to feel anxiety about medical school. I grew up in a home where I was in daycare from 3 months old, my mom was a lawyer, and always working, even staying up until 3 am to get work done to provide for me and my siblings as a single mom. I love my mom with all my heart but I learned from her and my childhood that I want to be able to have more time and emotional energy to invest in my children, and my husband.

I began to think about nursing school instead, and even PA, but I just didn't feel peace about either of those paths. I felt like I wanted the knowledge and ability to care for others to the best of my ability, and the autonomy to be able to make decisions and have flexibility in my schedule, and just felt like I couldn't reach my potential as a nurse or PA. (I love nurses btw, my sister and best friend are both nurses). So, I bounced around from major to major for a semester, even looking in to speech pathology and special education... but something about the medical field just has a place in my heart. The two paths that I am now trying to choose between are NP and MD.

After a lot of soul searching, prayer, and talking with my husband, I am seeking your advice on a career path between Nurse Practitioner or Medical Doctor. I am interested in primary care. My situation is a little unique, because I am married in college and my husband is also pursuing medical school, and also has the potential to be drafted as a professional athlete (he was drafted this past year but declined to finish his undergrad education first). We have a lot of "unknowns" in our life right now. I want to be with my husband, support him in the path he chooses wherever he may go, and start a family in our mid to late 20s. But I do not know what door will open for him or us in the next year. I want to be there for my children and have time to spend with them. I want to also have the ability to contribute to our family income, and heaven forbid if anything happened to my husband, to be able to provide.

Right now I have applied to accelerated nursing programs (BSN) in the same areas as my husband's potential medical schools. The benefit of NP for us is that I could start making money after a short 12 month BSN program (working as an RN, relieving some of the potential financial stress of his medical school), and could move anywhere with him and work if he does play his sport professionally. I can also continue my education, either during or after starting a family, and can even do part time DNP programs which I think would allow me to have more time at home/to support my husband and better manage our debt (we will have no debt after undergrad but will have to take out loans for grad school). One more benefit to having the training of a nurse, is that those skills translate really well and are useful in all areas of care which would be great for medical missions, or even working with my husband later in life.

If I chose to pursue medical school, I would have to take a few more classes (could finish them all in 1 summer) and apply for the following year (starting in 2016). That would mean I wouldn't graduate medical school until I am 27, IF I get in my first try, and then a 3-4 year residency. So 31 before I'm really working). I would love to be completely autonomous, have the ability to set my own schedule, and have the knowledge and skill set that comes from medical school to provide excellent patient care. Also, if I wanted to work part time later in life, it would still provide a great salary, giving us the ability to give generously, travel overseas, adopt, provide for our family, etc. If we both go to medical school, however, we would be up to our ears in debt. I am also worried that medical school would make it very difficult to be have children in the first place (in my mid-late 20s), and be involved in their lives. But, I can't predict the future and when God might bless us with children, so I try not to get too ahead of myself. ;)

The question I have is, are there any pros/cons to NP and MD that I haven't thought about? Do NP's feel like they are well-respected among medical professionals and patients, have autonomy and flexibility, and the academic background they desire to provide excellent care? To MD's, do you feel like you have the ability to be there for your children/support your husband during and after medical school? Do MD's think they would be satisfied with NP, or wish they had chosen the NP route to primary/family care? How is the care they provide different (patient interaction, knowledge, skills, etc?) How is debt managed during and after NP and MD school? And lastly, how did your husbands feel about your schooling/work life? My husband is so supportive and wants me to pursue the career path that will make me the happiest, but I just really want to know if medical school (or DNP school for that matter..) had an affect on you ability to love and support your husband?

I want to be very wise in the decisions I make now, because I know that they will affect the rest of my life, my family, my career, and the people I care for. I hope to be able to find a way to serve God, love my husband, be there for my kids, and provide excellent patient care. Or is that all too much to ask?? ;)

Thanks so much! I hope my question gets chosen!

Anonymous :)


Editor's note:
See also:
MiM Mail: Two doctor families
MiM Mail: Regret going into medicine?

10 comments:

  1. Being an NP or a PA is a rewarding and respected profession. Nurses can go on for doctoral degrees to teach or do research. I think you are making a thoughtful choice, even if, in the end, you don't want as huge a family as you envision or your partner doesn't make it in professional sports.

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  2. I always went back and forth between PA, NP, MD. Finally I realized, that, like you said, I would not feel "at peace" with any path besides the doctor one. Even though it is hard (and I'm in my second year), I really think that if I chose PA or NP I would have always looked back and wondered why I didn't become a doctor.

    We have one couple in our class who came to medical school engaged and married this past summer. They want to have a family. Most people do.... I mean we must make it work, right, otherwise there would be no female doctor parents!

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  3. I considered nursing as my mom is a nurse, but at the time I knew that I would always think that I could have been a doctor. Now I'm a family physician and enjoy it for the most part. I was single when I finished residency and started practice. I met my husband a few years into practice and we now have a 3 1/2 year old and a 20 month old. Life is hectic! I have everything I always wanted but there are times when I wonder if I should have considered being an NP or a PA. when I was in undergrad, I never really knew about PAs and that wasn't on my radar at all. I don't think I really thought about being an NP either. I now look at our PAs and NPs in our clinic and they basically do the same thing as I do (though lower complexity of patients and they don't deliver babies of course), but they don't take call. Their lifestyles are better than mine, I'm sure. However, you can do primary care as a physician and just do outpatient medicine and not take call, too. No matter what path you choose you can find a practice that fits your lifestyle and your family. You just need to figure out what that is. By the way, keep praying about it. God will lead you! Way to go for standing up for your faith in the arena of D1 athletics. May God bless you in your future endeavors!

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  4. I think the only reason to go to medical school is if you feel like you'll always regret it if you don't. From everything else you said, it doesn't sound like you get any benefit from medical school above becoming an NP. If all that matters for you is caring for patients in a primary care type setting, and you don't long to care for complex patients, be in charge, or have a very high salary, then I really just don't see the point of putting yourself through all that work.

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  5. I just read this on Kevin MD and I thought I would share:

    http://www.kevinmd.com/blog/2014/10/pa-md-appreciation-physician-education.html

    Just one voice but very applicable to your situation, I thought.

    You strike me as such and educated and thoughtful person with wisdom beyond my years when I was at your stage in the game. I plundered into medicine without a consideration for the toll it would take on my family. And it took a toll, but I am happy where I am now with no regrets. Good luck to you in your decision! Both paths are excellent choices.

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  6. I am an RN in a DNP program. I considered medical school but I am older (47)and didn't feel it was the right decision for me at this point in my life. As I was contemplating my decision, I asked some of the NP's I worked with for advice. They all said they wished they had gone to medical school. In the particular setting I worked in at the time (LTACH) they felt they were not respected or paid adequately and we're frustrated with their practice limitations. Just some thoughts from a few that have been in the trenches. Keep praying and exploring your options. You will find what is right for you.

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    Replies
    1. Jana (et al),

      When comsidering your age and the frustrations of the NPs you worked with, would you do the same thing again?

      I am 29, my husband is a 33 yo MS4 and will be matching next spring into EM, and I am doing some serious soul searching with regards to pursuing a career in medicine (like I wanted to when I first went to college).

      I'm wondering if my age and my current ability to manage stress (currently working through panic disorder which is most likely due to dissatisfaction with my (perceived?) lack of purpose career-wise) would pre-dispose me to choosing the FNP route.

      I also wonder if I would kick myself for the rest of my life for not pursuing full on MD/DO. I am smart enough - but is having a family viable with a two doctor family? (We have been married 6 years and if I started taking steps toward med school or an FNP program, at least my early if not most of my 30s would be spent in training).

      I'm kind of in awe at the fact that this question was posed today as I feel like I'm in such a similar position.

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  7. One doctor here who wished I had done NP or PA. Married to a doctor with 2 kids and really changed my priorities after having children. It seems to me like your priorities are very similar to mine and I think you can achieve your family and career goals as a np/ pa. If you are looking for reassurance I will say you have to know yourself and your values . Each person has their own perspective and you will meet plenty of MDs who will admit they regret the time commitment, amount of debt, family sacrifices, level of stress, etc. you have to be willing to sacrifice and it is a very long road. Don't go in hoping for otherwise. Also in primary care your income potential doesn't really offset the time /debt. Don't do it for money.

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  8. I'm an RN, FNP. I watched my brother go through the hell of medical school and I chose a different path. I job share...work 2 days one week, 3 the next week.. I have a great collaborating MD and we work well together. I have my own patients and do my own thing, collaborating of course when necessary and when with a complex patient. I have not worked full-time since my daughter was born (husband is an engineer) but now that my daughter is in high school I have another part-time gig that allows me to be done by 2:30 on my "off days." I make good enough money for us, can flex my schedule around concerts, booster club meetings, vacations and summer and for the most part I love life and love my job. I had to step up to the proverbial plate this summer when my husband was laid off and we found my full-time income to be more than solid enough to keep us afloat. Now that the unemployment nightmare is over, I'm back to flex-time. I was done by 3 today, picked up my daughter, fed her early dinner, took her back for orchestra practice and then picked her up again. During that time I worked out, pulled out the fall decor and caught up with an old friend. I would say for the most part that is the balance in life I generally have and I love it. Now tomorrow is an office/family practice day so I will work from 8:30 - 5 and probably not finish charts,refills, call backs until well after 6. Those days are much crazier for sure. But I don't work weekends, take call or work holidays.

    I was never one to have a burning, inner passion for medical school/MD and came into being an NP as a natural progression from exercise physiology to RN to loving to teach and implement primary prevention interventions and feeling I could do that more as an NP. If you have it in your heart to be an MD and won't be able to look at the next 20 years without regret then you have to do it. The women here are amazing and I admire the heck out of them.

    Unlike one of the above posters, I don't personally know any NPs who wish they had gone the MD route. In fact, all 3 of my closest colleagues from NP school work some variation of part-time, flex time and they are solid in the path they chose.

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  9. I echo the above poster who advised not to do it for money. Your professed ideas of entering medicine to help people would seem to suggest primary care for you, and I don't see how the "perks" of autonomy offset the added cost of your education (and extra time it would take to get it). Furthermore, if you plan to be part-time so you can be a central figure in the lives of your children, your earning potential as a physician will be diminished. I don't mean to be dismissive of your decision. I am an MD who also chose this path over nursing because I felt like I needed the buck to stop with me. But I also went back to work 6 weeks after both of my kids were born because I was paid on a productivity model and was hemorrhaging money by taking time off. In that sense, I didn't feel like I truly was in control of my work schedule. I also think the job market for NPs is so diverse -- you could do outpt primary care (and I think there will always be steady demand for this), or you could be a hospitalist, work in an ED or NICU, assist in the OR, or do skin biopsies all day. That sounds like a recipe for finding a job that fits your life, rather than the other way around.
    I was single when I chose medical school, and I'm now happily married to a full-time OBGYN. I suppose part of me chose med school because at the time, I felt I needed to pick a career that could financially sustain me if I never married. Since it's looking like yours will be a marriage with 2 medical professionals, you can make the choice upfront to have less debt, more flexibility, and (sigh) no pager attached to you when you leave work.
    Good luck with your choice.

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