np vs md

I was wondering if anyone has thoughts on this. I was mentally preparing myself for applying to medical school in about 2 years and thought I had made my decision. My spouse has recently told me he has reservations about this decision and has asked me to consider an NP program instead because of time and money considerations. There are plenty of NP programs in this area and finding a job doesn’t look too bad. There is also less risk of taking classes and ultimately not getting in. However, I’m not really convinced that this is going to be a satisfing move. My fear is that 1 year later, I will be in the same position I am in now ( wanting to practice medicine). Is there anyone out there with some NP info that could share with me the pros and cons of NP vs MD?

I had a roommate who became an np. NP needs to work alongside, or under the authority of, an MD/DO. They have tremendous autonomy, can prescribe medications, have many of the skills of medicine, and are becoming more and more valuable (as is the newer dental DHAT) as time goes on.

It depends on your personality, and your place in life (grades, money, time, physical abilities like arthritis). If you prefer to take care of people in a deeper role than a physician and dont need 100 percent autonomy, then an NP is for you.

I do remember that when I sold accident and health insurance many many years back, that nurses were the occupation with the highest chance of back injury. NP may not do as much heavy pulling, but still there is that risk.

The schooling is still rigorous though.

I ignorantly missed your critical point of your question, should you do an np… money is not the concern, unless you believe there is a high chance of failure. If you do the math and work as either, after all loans were taken in account, you both will be financially ok. Fear of a college loan as a md, dds, dmd, eye doc, etc. is not so bad when you have the same spending habits you do now. Take it from me as a rep who watched and worked with docs who “have to get that new car” and then wonder why college tuition is expensive.

So really, the questions are:

  1. Will your husband accept you going to school?

  2. Do you believe you will make it?

  3. Is your personality better fit for being a doctor or a high level nurse?

Thanks for the info. I guess honestly my heart is in going for the MD/DO. My husband thinks that at 40 years of age with 2 kids yet to go to college, this is not a practical dream. He says that another risk is not getting a residency position in our area. I am reluctant to uproot my family and since he is the one with the bigger income, this is not so easy for him. I haven’t made up my mind yet, but these choices area weighing on my mind. I am wondering if I’m being delusional about my ability to get into MD and the effort needed there.

I may be reading this wrong, but sounds like he is scared of the unknown and comfortable where he is. The question is are you. If you decide that giving up your dream because of his salary is ok ten years down the line, then maybe it wasn’t really your dream to start with. But then again, you may really regret not taking the shot. 40 with two kids is definately not to old. just my two cents

I think you were looking at the practicality of the idea and not …

Since you said you are planning to start when you are 42 and assuming you just want to do the shortest residency, which will be family medicine, Your best shot at starting practising medicine starts when you are almost 51 or so. Anything else will take longer and then you are giving yourself only another 9 or so good years to work. Keep in mind that your body will also start breaking down. (Let us say at 60)

As you mentioned, it is easier to get into an advanced NP degree program. If you do really well, you may even end up getting some free tuition in the masters part of the NP program. You don’t have to compete with 25 year old straight A+ students to get into medical school and for residency programs. In the end, you can start working as a NP when you are 45, giving you a minimum of additional 6-7 years over the lowest form of a MD. Less chance of your body beginning to break down when you are 45 than when you are 60. You should get as much as 20 good years working as a NP. The way primiary care is going, primary care doctors are not going to be making as much as they used to and the money difference between MD/NP may not be worth the extra effort. Your social contributions will be nothing less than that of a primary care physician. Whether NP or MD, your initial working years will be spent working for some organization as a salaried employee rather than in a private practice. The take home difference between MD and NP is lesser in that scenario.

  • You did not mention anything about your past education. Were you an A/A+ student during your BS days? (Assuming you have a BS degree)

  • If not, do you feel that retaking some of the course at a high GPA puts you on par with the straight A+ 22 year old geeks out of a regular school? Are you sure you will get a high GPA from a reputable place? (To even be eligible to apply) Agreed, some medical schools look for diversity. But keep in mind that probably only less than 10% of the seats are for non traditional aspirants like you.

  • How old are your children? Are they old enough/mature enough to take care of themselves during your busy school days?

  • How confident are you that you will get into a residency program in your area? There is a good chance that 1/2 your classmates at medical program have done as well as you have and are gunning for the same residency program as you are.

  • Are you financially well off to pay for and/or recover from a potential $200k+ mistake?

  • Even after you get your MD, are you savvy enough to setup your own shop? Do you have any experience on the business side of things?

  • Do your immediate family members have any medical conditions that you may be prone to develop and slow you down during your older years? (See my note on body breaking down)

  • How important is your desire to massage your ego? Are you the type who will look down on NPs? If so, what makes you think you may want to stop at being a MD in family practice? You may feel like getting a degree in surgey or neurology, in which case you are 55+ when you are done. Are you trying to prove something by being a MD? Or just looking for a viable financially/mentally fulfilling midlife medical career change to also help the cause of your family?

    If you were 22, with a great GPA, definitely MD makes sense. But at 40, NP/DNP with some advanced specialization of your liking is the far better option. Most of the DNP programs are part time/online. You can be working, making 90k and still pursuing a DNP program. And may even get your employer to pay for it.

Thanks to both for the input. I think LisaRay hit most of the points for NP that I was thinking of. I got my BS in Biology in '93 and did a graduate certificate in Clinical laboratory sciences in '96. My cGPA is about a 3.1 without a current retake of the prereqs. I’m scared that even with 4.0s in the postbaccs, my cGPA will only be 3.2. I really don’t know how that puts me on par with 22years olds with 4.0s. I know some of you have done it, but I’m scared of spending 2 years working toward getting in and then not getting in.

Age is also less of an issue to me, but my husband thinks that 10 years from now, just when I’m finishing residency, things may be different.

Private practice was never my goal anyway. I am not really of a mindset to set up a business, I just like the practice of medicine. I was going to go for a salaried position anyway( hospitalist).

Currently I work as a hematologist in the lab of a community hospital and I do love the work, but it is definately not enough in terms of money, nor satisfaction. I do want more patient interaction and to stretch my self intellectually. I find that I’m stretching the limits of what I do to make it more challenging. For example, I’m constantly looking at what our pathologist is doing because I find it more interesting than what I’m doing.

The positive points of NP have been discussed in my house and my husband thinks that the decreased financial risk and the opportunities to specialize ( easily ) make this choice more practical. I have already told him that if the choice were left to me, I would try for MD, but because I have a family, I’m trying to take everyone’s concerns into my decision. I just have this horrible feeling when I think that I’m giving up my dream and I can’t shake it. Practical–no. But very real.

I’m meeting with some folks from a local NP program later on and I’ll let know what I find out.

Thanks to you both for the analysis.

Actually, if you are thinking about hospitalist, the difference between type of practice (in terms of what you would be doing)between some types of in-hospital nurse practitioners and an hospitalist is not that large. I think one strategy might be to investigate some large and small hospitals near you, find out if there are NP’s working (as NP’s) in them (pediatric nurse practitioners, nurse anesthetists, as examples), and try to meet and possibly shadow a couple of NP’s and hospitalists. That way you would really see what you are comparing.

I’m a CNM and worked with a practice briefly where part of my job involved doing hospital rounds, admissions, discharges, etc for the practice. I did enjoy that part of my job and could see the appeal of being a hospitalist, although not my strongest interest.


I hope I don’t get flamed for my response, but NPs who work on inpatient teams at academic centers are like perpetual interns-- doing the daily paperwork of writing orders, discharge summaries etc, that someone else tells them to do. Intern year was bad enough without doing that for the rest of my career.

On the other hand, NPs who are in an outpatient setting, especially in under-served or rural areas are able to practice much more independently. Just my 2 cents.

Although to some extent, the NP level of autonomy depends on the factors such as the availability of physician coverage, the personality of physicians in the practice, their level of trust in the NP’s ability to make correct decisions, and the culture of the hospital environment. You are somewhat correct in your statement that NPs who work on inpatient teams at academic centers are like perpetual interns-- doing the daily paperwork of writing orders, discharge summaries etc, that someone else tells them to do.

Thanks for the info. I think shadowing an NP in the hospital is a great idea. Good points also about perpetually doing the work that someone else tells you to do. Outpatient settings are appealing to me as well, but I heard the salaries can be very inconsistent depending on what the physician and office manager decide you are worth. Congratulations on your acceptance to WSOM. From your experience as an NP, can you tell me why do you want to switch to MD? Do you feel you can help the patient more with the medical model of training as opposed to the nursing model? Did you feel as if you needed a deeper knowledge base than NP had to offer? Any insight would be appreciated.