Why be an MD when you can be an NP?
www.wikipedia.org: Rather than a generic focus of education, Nurse Practitioners are able to specialize in an area of study they desire (e.g. Pediatrics, Family Practice, Adult, Geriatric, etc.), and provide care within the scope of their expertise. As well, Nurse practitioners in certain states can be “psychiatric clinicians” and perform similar practice (though at a different level) as a psychiatrist would.
Salary.com: Nurse Practitioner salary (25th-75th percentile) is $67,166 - $78,497. Generalist physician salary (25th-75th%) is $115,260 - $152,715.
Wikipedia: According to numerous salary reports throughout the years, CRNAs remain the highest compensated of all nursing specialties. Their average reported annual salary range in 2006, reported by the AMGA Medical Group Compensation and Financial Survey, was $140,396. The mean annual salary for an anesthesiologist in the United States in 2006 was $184,340. [1]
What’s my point? Fair question. First, NP’s have the same scope of practice as any physician. This is clear from my first statement about NP’s specializing. Whatever specialty you want as a physician, there’s an NP that can do the same thing. “But surely not for surgery?!” is the cry of retort. Well I promise you that within the next 10 years, some politician is going to realize that “Hey! PA’s and Surgical Tech’s can pop out gallbladders just as well as a surgeon can!”
Also note the salary differences. Now I can’t find information regarding the various NP specialties, but compare the lowest specialty to the most basic NP, the salaries are comparable, and the highest NP position to the highest (according to MSN.com) paid physician. When you do, you’ll note that physicians do, in fact, win. And NP’s must do 2 years of post bachelors work and one year of work experience (for a total of 3 years) compared to the 4 years post-undergrad for a physician. Big whoop. One year.
Well please note, the average med student graduates with around $200K in debt, while, according to Barry.edu (a school in FL that has both NP and PA programs) the PA program (the more expensive of the two) is $24,810.00 per year. This is roughly equivalent to medical school. However, you’re paying twice as much in med school because you go to school for twice as long. Also, one of the 3 requisite years for NP school is clinical experience. This is a paid job. RN’s make (again, 25th-75th%) $49,479 - $59,114. That means that if a med student and an NP were compared at the same time, 4 years post undergrad, the med student would be out $200,000 (roughly) and the NP would be out $521 (rounding to $25K/yr for both programs, and using the 25th percentile for RN’s). Add the interest on a med school loan, and that puts you at about $600,000 paid back (bc you pay back about 3x what you borrow, esp the financial geniuses that make up our MD population).
Now lets say that no matter what you do, you make $30,000/year more than your equivalent NP. You figure that after 30 years of practice (putting you at the nice comfortable retirement age of 66 for those of us that took the direct route) and you’re up $900K. Worth it, right? Well we haven’t incorporated malpractice insurance. Have you ever heard of anyone suing their NP? I sure as shit haven’t. Factor in 30 years of malpractice insurance bills, and I’ll promise you it brings you right back to even (not to mention that physicians’ salaries are trending down relative to inflation while all nursing salaries are trending up). Couple that with the hours worked by an NP relative to an M.D. and the paperwork/legal hassles handled by an MD that aren’t worried about by NP’s, and the conclusion is obvious.
Do the same thing for the same amount of money, and have a better quality of life. Become an NP.
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wealthandtaste said
July 18 2007 @ 8:51 pm
Howdy, I’m a paramedic wrapping up my BS in mathematics. I’m at that great crossroads of choosing MD vs. NP school… and the more experience I have in healthcare, the less the MD seems worth it. Obviously MD’s have more training, but given the current healthcare environment, mediocrity (relative to an MD) as an NP is rewarded.
Jaguar said
July 18 2007 @ 9:52 pm
Thankfully, to me, prestige is worth millions so the choice becomes easy.
kellie said
July 18 2007 @ 10:02 pm
“Do the same thing for the same amount of money, and have a better quality of life. Become an NP.”
It’s good to see you back, Hoover! I had assumed that the medical schools had gotten together and paid you to stop writing!
Some senator or money appropriator on a federal level is going to start reading your work and re-evaluating how money is spent at these places and how doctors are trained. Have you ever thought about becoming a lobbyist? Back in the day I dated a couple– they are now in jail for racketeering but they were not as smart or subtley forked toungued and they didn’t they have a mission like you could. (They went to the highest bidder.) I’m not sure what your mission would be– but you would be great at it as soon as you defined it.
I am so glad that I started reading your blog before considering pursuing medical school seriously.
Hoover said
July 19 2007 @ 7:39 am
Thank you for the kind words Kellie. This piece was actually written by a guest blogger. I do, however, have some stuff that I’m working on.
=)
kellie said
July 19 2007 @ 5:04 pm
You have my email address. I want to buy the first autographed book that you sell. “To Kellie, for all the bad times we never shared.”
I think you are correct in your assement that we will see NP and PA’s popping out gallbladders– will it happen in our lifetime? (I’m in my mid-30’s– I presume I am not much older than you.) Will medical care go down or improve or just become more accessible?
joe blow said
July 19 2007 @ 7:24 pm
dude you got it all wrong. Its not hte politicians that gave nurses the power to do everything as NPs, its the nurses THEMSELVES that did it.
YOu see, the nurses hide behind evertyhing as the “practice of nursing.”
Scripting a medication? “practice of nursing”
Trigger point injections? “practice of nursing”
Ordering imaging and lab tests? “practice of nursing”
Anesthesia? “practice of nursing”
Brain surgery? “practice of nursing”
You see, the state nursing boards can call building a rocket ship the “practice of nursing” and nobody can touch them. They are free to create a scope of practice for anything they want to do, regardless of how grandiose or stupid it is.
Half MD said
July 21 2007 @ 12:58 pm
While you are correct about the unequal salary distribution between MD’s and NP’s, you are incorrect about malpractice. Just because you are unaware of someone suing a nurse doesn’t mean that it never happens. My state is currently listed as being hostile to both physicians and nurse practitioners.
Guilty Bystander said
July 21 2007 @ 6:32 pm
This is kind of off topic but I thought I’d bring up this post from SDN because Hoover will definitely get a kick out of it. I didn’t know if I should find it hilarious, or feel bad for the kid.
I actually enjoy what I’m doing right now, but I still think this is pretty ridiculous…read and enjoy.
http://forums.studentdoctor.net/showthread.php?t=424817
Cherokee said
July 24 2007 @ 7:31 pm
For most patient care specialties, PAs and NPs will be given more and more leeway. Physicians will take on a more advisory role, just like pathologists.
But medical school is too damned expensive and painful to attend without knowing for a fact you gotta be a doctor. PA is a good deal, as well as a CRNA or NP.
Hoover said
July 24 2007 @ 10:28 pm
Haha GB, great thread.
CobraCommander said
July 26 2007 @ 7:30 pm
Indignant medical students are a riot. In my experience, though, the self-righteous are in the minority (though they are the most vocal.) The number of martyrs drops off drastically during junior year. Privately, everyone is all about landing that residency/fellowship that 1) is financially lucrative and 2) allows for a controllable lifestyle. Who wants to bust their ass for peanuts?
SF Doc said
August 7 2007 @ 1:51 pm
I’ve been an emergency medicine PA for 8 yrs and am going to Medical School in 2008…..
That said, If given a choice, go to PA over NP school.
I have been making between 85K (My first year) to 98-102K (the past 4 yrs).
Most good ER PA’s make at least mid 80’s.
You will be trained in the physician model, and have thousands of hours more training than an NP (Most NP programs require 500 hrs of clinical and most PA programs have more than 2000 hrs of training).
My masters in Emergency medicine had an additional 560 hrs of clinical training.
Additionally you will not be limited in your practice to only adult, women’s, pedi…etc, you can see all patients, and change your speciality if you desire without any specialized retraining.
From experience, PA’s can work circles around NP’s, and we make more money. Many of the emergency medicine groups I have worked for will not hire NP’s.
The choice to pursue medical school is a personal one. My desire is to improve my delivery of health care. I know from where I am clinically to where I want to be, this is the road I must take. I have spent 8 yrs in the trenches…I have no disillusions….
Don’t worry about the debt, there are many very creative ways to pay for medical school, and if the cost is a deterrent, question your passion.
Oh, by the way….I have never met an anesthesiologist who makes less than 350K, so check your $$$ on the salary calculations….. (My ER Docs all make between 290-350K where I currently work).
jdgonnabee said
August 17 2007 @ 6:16 pm
SF Doc is FOS.
Med student said
September 7 2007 @ 3:12 pm
I will never get back the 5 minutes of my life I wasted on this.
CJ said
September 21 2007 @ 4:09 pm
I was surfing online to find out about med schools. When I read this thread, I just had to respond!
I am currently a Family NP and work in an ER. Like SF doc, I make about 85K a year working approx. 35 hours a week. The facility where I work prefers NP’s although we have some PA’s that work per diem. One of the NP’s attended an Emergency NP program.
Although it is true that NP’s do not have as many clinical hours of training in school. Most NP’s have many years of experience as an RN and work while attending school.
As a family nurse practioner there are no limits on the ages I can treat. As an NP I have also worked as a pediatric first responder to trauma alerts, assisted in surgeries, taught nursing students and worked as a clinical nurse specialist in an ER. Additionally, with my Masters degree I have taught at 2 local colleges in the nursing program which has been very finacially lucrative for me and is also helping develop upcoming health care professionals.
In the ER specialty, MD’s make about 3 times more than NP’s. For this reason, I would consider going back to school to become an MD. I am still undecided at this point.
I have been an RN since 1991 and have had many opportunities in the healthcare field. If you are considering NP versus PA, after school both are very comparable in salary. I do believe there are more varied opportunites with a NP degree and at this time many states offer more autonomy for NP’s than for a PA.
jaymac13 said
October 7 2007 @ 11:48 pm
Just like “cjsaid,” I was also surfing the net but not for MD schools. I became a NP because I am a RN with a BSN and wanted to continue on. I am a Family NP and work in an ER setting that is a level 2 trauma center in a group that has only MD’s and NP’s and will not hire PA’s. In my state, NP’s work autonomously in both practice and prescriptive rights. I make about half (90K+)of what the ER MD’s (180K+) make and am getting ready to take another job making about 130K. When I was in the family Practice setting, I made 80K and the MD’s were making around 120-160 depending on the MD and their performance. We talk about the difference between our degrees and they are vast and yet still converging at one common ground which is patient care and treatment. I did not have to pay for either of my degrees (BSN & MSN-FNP) as I there is a vast amount of subsidies for these degrees. For my MSN, the federal government (NIH) paid my tuition because I was receiving a provider degree in primary care. I actually have been paid for every year that I have attended school and still took out student loans that have also been paid by my group and state. My MD counterparts have from over 100K in loans to over 200K in loans to date. As far as malpractice insurance, I pay about 1/10th of what the MD’s pay and this is because of the low rate of malpractice claims in my area for NP’s. Looking at the difference in schools, I had 2 undergraduate years of nursing with over 1300 clinical hours which includes my summer between junior and senior year externship. In my FNP program, I was required to obtain 780 hours but actually gained 820. Total hours over 2100 which is more than what a PA receives in their program. The PA’s have the same required prereq’s as what I had to get with the exception of us receiving Anatomy & Physiology and Microbiology, as a prereq where the PA’s receive this during their program. Most PA programs require that the applicant have a number of patient contact hours in either a CNA or EMT type setting where my undergrad program required that we be CNA’s with a number of contact hours. You cannot overlook the amount of hours that I received as a RN before and during my NP program.
I became a NP not because I could not go to medical school, which was never the case, but because I did not want to be a MD. I enjoy and continue to practice in a holistic manner and would not change that. I utilize non-pharmacological methods as much as I can and practice evidence based medicine daily (it has recently come out after a recent study that MD’s do not feel comfortable using EBM as they say that they were not properly trained. I can perform minor surgery (lump and bump removal, colposcopy, etc.) that I have been trained on and certified in. I am in my mid-30’s and will continue on to get my Doctor of Nursing Practice and I am glad that they have pushed for this as it helps to make us a stronger career field that in most states can only bill at 85% of what a MD bills. The hope is that with the DNP this would change.
Mike Staples said
March 26 2008 @ 1:29 am
I’ve worked in the Medical field as a Radiation Therapist (and a few other things) for 30 years. Almost every MD I know, and I know a lot of them since I’ve also worked in sales Nationwide, are making more money than god. A friend MD of mine walked into Siemens a few years ago (when I was working for them) and bought a $2,000,000 linear accelerator with his Visa card, then used the points to fly to Switzerland on the weekends to go skiing. Only the guys who work in hospitals and take a professional split or a salaryend up making $200K+. Everyone else is at least $400K/year, and a lot of them are making millions. So don’t give me that song about the money not being what it use to be. Get your MD and you’ll have plenty.
I’ve worked (locum tenens) in 40+ hospitals and private clinics. The difference between a nurse…even a nurse practitioner… and an MD in a hospital is like night and day. There is only one king of the hill in a hospital, and that is the MD. No one else. Not the Administrator… or anyone else. Everyone kisses the doctor’s rear end, whether he/she is right or wrong… and he/she is always right. They park where they want. They eat where they want, when they want. They call the shots. The only people doctors have to contend with is other doctors higher up on their food chain. But everyone else works for them. That too is part of what a few years in medical school buys you.
Yes, you have to work hard. Who the hell doesn’t? If you think that four years of medical school and a residency is harder to crank than, for instance, a PhD in medical physics where you have one mind-numbing math class and an original Disertation to construct and defend before you specialize in Medical Physics, you are mistaken. The very, very mistaken idea here is that if you don’t work hard in MedSchool, you won’t ever have to work hard. Think again. Everyone works hard…12 and 14 hours a day. Fact is that the lower level jobs like asphalt-slinging road worker probably work harder than you will ever come near. The difference between being a nurse and an MD is that you have lots of money, a big house and some fancy cars to console yourself.
You don’t have to bust your butt when you get your MD. Most MD’s do because they are type “A” over-acheivers that went o Harvard on daddy’s money. Fine for them. A doc friend of mine I know made it a habit for years to work 6 or 7 months, then take a year off to bum around Europe. When he ran out of money, he worked again for 6 or 7 months, and took another year. He could make enough in that 6 or 7 months to live quite well for a year… and then some.
Another friend decided he didn’t like surgery, so he opened a holistic center. You can do that, you know. You can hang just about any kind of shingle out that you want because you are an MD. Just like in my profession, there is a law against anyone running my machine without a lincese to run it… unless you are a doctor. Then you do whatever the hell you like. Or there is the case of the C.G. Jung institute in San Francisco. To get in, you have to already have a lincese in psychotherapy or psychology … unless you are a doctor. Then you just waltz on in.
Come on, guys. Suck it up and get through your few years of hard concentration. Then you’re set up for life. You can sit in your office and read medical journals, talk on the phone with refering docs (and your broker), scribble a few lines on an x-ray, and churn out a nice article to make yourself famous. And when the day is done, you can jump in your BMW and drive back to your million dollar house on pill-hill while I try to figure out how I’m going to pay next months rent.
Angela said
April 11 2008 @ 12:36 am
I must comment on this subject as a practicing NP. Now I truly understand the problem with health care the lack of unity and understanding each persons role in health care. MDs and NPs are destinctly different and both provide an a service that should benefit our society. As a NP, I understand my role and function well within the scope of my practice, I do not and will not pretend or function in the role of a MD, MDs not only have a broader scope but also have several years of preparation to functions as physician. NPs are and should be nurses who have at least 5 yrs of nursing experience to be an adjunct in this time of shortages of nursing and physicians. It saddens me to think that we don’t have enough physicians because our youth of today, don’t want to commit to the longevity, nor do they have the intestinal fortitude to stick to something longer than a day. And for those of you who read this and think, I am some nurse who wanted to be a doctor, “no” to that, I am a nurse who has always wanted to be a nurse, but one with integrity and one who contributes, not one who wants to get “paid”, and one who does not understand that MDs/NPs make sacrifices and it takes sacrifices not what you expect to make and the long hours and not feeling compensated for what you do, if you want to enter the health care field for money, then no matter what you chose you will never be happy, no one could ever pay you for what is given to humanity. When you take care of another human being with compassion and your knowledge is so great that it allows you to figure out things that maybe no one else thought of or was to busy to see, then that is payment, striving to improve the human condition, I am glad to be a nurse practitioner and I am equally impressed by those who are physicians, and truly hope that we are choosing our career paths based on more than just salaries.
Val said
December 22 2008 @ 9:55 pm
NP/PA vs MD
Gosh, as a patient I’m really scared to listen all these comments by so-called professionals and wanna-be MDs, NPs or PAs. I just hope you care for me as a patient as much as you care for the prestige your title brings or the money your job pays. In the end, it doesn’t matter what your personal hang-up is as to why you don’t want to be an MD/PA/NP or why you do because my health and my life is all that matters to me. You are nothing but one spoke in a wheel to help me maintain my health or heal me. Don’t let that get to your head if you’re shooting for MD (”prestige” reasons). If you’re want to treat patients, you better be good at it and get that “God-like” image out of your head. That’s not who you are and maybe you should be put on Haldol for a while…..
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