
Become a nurse or physicians assistant instead of a doctor (2012) - quickthrower2
https://jakeseliger.com/2012/10/20/why-you-should-become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-school/
======
outlace
New resident physician in the U.S. here. I actually really enjoy my job now
but absolutely hated medical school. Would I do it again? Probably not even
though I’m happy now. Four years of misery during my twenties was not worth
it. And the stress of $250,000+ of student loans is ever present. And unless
you’re at the top of your class at every stage of training, you have little
control over where you end up geographically which is really bad when you have
relationships to maintain. Long distance for several years sucks a ton.

So I’d only recommend going to medical school if you’re a top student who can
get scholarships (so you don’t have much debt) and so you have some control
over where you go (because you’ll be competitive for most programs). But even
so, I went to a top Med school which was my first choice and I still ended up
hating it. You’ll never know what program/city you’ll like until you try it
but once you start it’s very difficult to change Med schools or residency
programs in general.

~~~
wallace_f
Once in med school, how Meritocratic vs Subjective or Political is the road to
_top student_ status?

~~~
outlace
The pre-clinical years (usually the first two years, but many schools are
condensing this phase into 1 or 1.5 years) are very meritocratic in that your
standing depends on mostly multiple choice tests. And then you take the first
medical licensing exam called Step 1 which largely determines your
competitiveness for residency programs. The clinical years where you are
actually working in the hospital in various fields is less objective as you
are judged based on the subjective feedback evaluations of the residents and
attending physicians.

However, you are mostly rated on how much you know, how confident you are and
your social skills. So if you did really well in the pre clinical years and
are not socially inept then you’ll probably get good evaluations.

But it’s a marathon. It’s an unbelievable amount of information you have to
memorize and in the beginning it’s hard to stay motivated when you can’t see
it’s direct relevance.

So overall I’d say it’s fairly meritocratic. If you can memorize things well
and are social then you’ll do well barring any exceptional circumstances.

~~~
gcatalfamo
How does a person with your background end up on HN? Honestly curious.

~~~
tiniuclx
Anyone can read Hacker News, it's not some sort of exclusive club! As to why
someone would, there's a lot of interesting non-technical articles posted
here.

Or maybe they're also a tech enthusiast in their spare time!

~~~
gcatalfamo
That’s my point. I never said it was an exclusive club, I just implied it’s
not that common to end up here unless you had specific interests.

It is nice to have a greater breadth of backgrounds. The overall quality of
comments can only improve.

------
DoreenMichele
From the article:

 _Take JoEllen Wynne. When she lived in Oregon, she had her own practice. As a
nurse practitioner, she could draw blood, prescribe medication (including
narcotics) and even admit patients to the hospital. She operated like a
primary care physician and without any supervision from a doctor. But, JoEllen
moved to Texas to be closer to family in 2006. She says, “I would have loved
to open a practice here, but due to the restrictions, it is difficult to even
volunteer.” She now works as an advocate at the American Academy of Nurse
Practitioners._

From Wikipedia:

 _In the U.S., because the profession is state-regulated, the scope of
practice varies by state. Some states allow NPs to have full practice
authority. However, in other states, a written collaborative or supervisory
agreement with a physician is legally required for practice._

[https://en.m.wikipedia.org/wiki/Nurse_practitioner](https://en.m.wikipedia.org/wiki/Nurse_practitioner)

I have no idea how you would look this up, but when I worked in insurance,
this fact had substantial impact on claims payments. For some states, we had
to check that the nurse practitioner was supervised by a physician in order to
pay the claim. For other states, we didn't.

I've known some nurses. One nurse who was married to a soldier told me it
allowed her to have a real career as a military wife because she could get a
well-paid job anywhere, nursing was always in demand and many places have
chronic shortages. Military spouses typically suffer high unemployment rates
and have trouble getting a job at all. There are very few jobs that allow you
to have a real career in your own right as a military spouse.

~~~
Scoundreller
> In the U.S., because the profession is state-regulated, the scope of
> practice varies by state. Some states allow NPs to have full practice
> authority. However, in other states, a written collaborative or supervisory
> agreement with a physician is legally required for practice.

Different outputs for the same input is madness.

~~~
dotancohen

      > Different outputs for the same input is madness.
    

Not if you consider that we are discussing different implementations (state
laws), written by different dev teams (lawmakers), with different design specs
(cultural differences between states and parties in power in each state).

~~~
Scoundreller
That’s the heterogeneity in the process.

Maybe the diversity is a good thing, but sounds more like stronger/weaker
regulatory capture rather than differing patient safety/access goals.

------
JshWright
Alternatively, if you'd rather have all the stress and relationship
dysfunction with none of the salary benefits, become a paramedic...

~~~
felipemnoa
Unfortunately without anymore context we don't really know what you mean. Is
being a paramedic really that bad a job? why?

~~~
jedimastert
Paramedics are guaranteed to see the absolute worst medical conditions,
emergencies, and disasters. They're the front line for most of the messed up
stuff in the medical world.

Along with that, they are vastly underpaid, especially compared to other
medical professionals, and have much more knowledge and training than you'd
expect to boot.

It's rough.

~~~
busterarm
I knew an NYC paramedic 10 years ago who was making $13/hr.

~~~
jimmyswimmy
By now he would top out at about 30/hr [1]. Not great for 5 years experience.
It seems the sanitation worker... the trash man... gets to about 35/hr over
the same period [2]. Both jobs involve heavy lifting and unpleasant odors, but
the paramedic training is more demanding and it's hard to describe the daily
mental pounding paramedics have to absorb.

Paramedic is a fun job but tough. Hard to leave all of that at work.

[1] [https://www1.nyc.gov/site/fdny/jobs/career-paths/ems-
salary-...](https://www1.nyc.gov/site/fdny/jobs/career-paths/ems-salary-
guide.page)

[2] [https://www.villagevoice.com/2014/10/24/want-to-become-an-
ny...](https://www.villagevoice.com/2014/10/24/want-to-become-an-nyc-
sanitation-worker-if-youre-lucky-itll-only-take-seven-years/) (not the most
authoritative source but it was easy to find)

~~~
Scoundreller
When a sanitation worker, you will work hard every hour. This could be seen as
an advantage. I kinda dream of doing it for, say, 4 hours per week: get paid
to work out.

While a paramedic, you will work pretty hard most of the time on a big city
service, but can work up to a more rural service where you can have a lot of
downtime.

------
jl2718
This is an extremely poorly-argued point full of one-sided emotion. The fact
of the matter is that no other career path even comes close to the risk-
adjusted lifetime financial remuneration of becoming a doctor. Every once in a
while, some other career will briefly take the spotlight, like pilots in the
90s, real estate agents, or maybe even software engineers today, but none of
them last. Get your MD. Don’t talk to a 30-year-old resident about it. Look at
how 60-year-old doctors are doing compared to a random sample of their peers.
Not even close.

~~~
SkyPuncher
> The fact of the matter is that no other career path even comes close to the
> risk-adjusted lifetime financial remuneration of becoming a doctor

Does that stat include doctors who didn't place into residency. This year, 1
in 5 med school grads didn't get a residency. Some of them will match next
year, but it's typically considered a one and done process. That something
many older doctors tend to forget.

You basically go $1 million in debt (between tuition and lost wages) for a 1
in 5 chance of being a complete financial wreck with a mostly useless degree
since you can't become licensed.

Once you've made it being a doctor can be great. However, the process of
getting there is absolutely brutal.

NRMP Data: [http://www.nrmp.org/one-nine-press-release-thousands-
residen...](http://www.nrmp.org/one-nine-press-release-thousands-resident-
physician-applicants-celebrate-nrmp-match-results/)

------
rediguanayum
Not a MD but married to one, plus my brother and some friends are docs. They
would echo the sentiment in this piece. My brother has argued that being a PA,
NP or especially a dentist has a better ROI as the training is way shorter and
pay pretty good.

Some of my observed pros and cons of the medical profession:

MD pros

    
    
      * Respect
      * Pay
      * Satisfaction that a resuscitation saved a life (PA don't run those at my wife's group)
    

MD cons

    
    
      * Required overnight shifts for some specialties e.g. ED or hospitalist.  PAs at my wife's group don't do overnights.

Practitioners all have stories of friend of friend doc falling asleep at the
wheel and getting into fatal accident. * PAs work under the supervision of the
MD, hence all more medically challenging cases go to the MD along with the
stresses e.g. running a code (resuscitation) or getting a difficult admission
through.

PA cons

    
    
      * Seems like the PA coverage expands and contracts depending on how the hospital is doing financially, while the physician coverage is constant.
    

Cons for both MD and PA/NP

    
    
      * Dealing with drug seeking patients

~~~
amedstudent1
Under MD cons I wouldn’t necessarily put night shifts. More often than not the
way nursing units are staffed is a shift based roster meaning you’ll be doing
evening and nights for your whole career. Contrary to popular belief a lot of
medical work is business hours with on call for after hours work. Depends on
the speciality some are shift based (ED for instance) but in general the
nurses do more night shifts than we do over their career.

------
amedstudent1
I would have to disagree with the title of this submission. Rather I’d phrase
it to you like this:

Healthcare is a team sport. There’s multiple well defined and some not so
defined roles to fill. Some people are happy to take orders and just do what
they’re told. Others want some autonomy but don’t wish to or want to care
about anything other than their topic of interest. Yet others want of lurk in
the background and assist after the main event is over. Etc. but you get the
point. Where doctors come in is they’re usually either the one overseeing the
ultimate care of the patient, or are called in as the subject matter expert in
a certain field.

Or to sum it up crudely, you do medicine because you want to be the boss. You
do nursing/PA because you want to work with a boss.

As an aside, the way our health system is structured in Australia makes NP
quite unpopular. We don’t have PA here and NP operate under direct
supervision. We have a decent proportion of them in rural areas (they
basically keep the rural and smaller regional hospitals running) who earn
doctor pay. But in our metropolitan areas only very few exist. Reasons I would
guess is due to cost. They get paid above a junior doctor but you can assign
more responsibility to a junior doctor and also abuse them more (you can’t pay
an NP for 40 hours after working them 80 hours a week with no breaks).

------
dang
Thread from 2015:
[https://news.ycombinator.com/item?id=9125538](https://news.ycombinator.com/item?id=9125538)

2012:
[https://news.ycombinator.com/item?id=6115688](https://news.ycombinator.com/item?id=6115688)

------
aabajian
Article asks about residents and whether they can unionize.

I'm a resident at UW in Seattle. Despite being located in a wealthy city, UW
mostly serves the poorer populations of the WWAMI states and consequently
doesn't make a lot of money. The University has historically done everything
to avoid raising residency salaries.

It's an interesting read about the steps residents had to get to unionize:
[https://uwha.com/history/](https://uwha.com/history/)

------
tells
The academic rigor that nurses and PA's must go through is not the same as a
doctor. There are many instances where a nurse or a PA would unknowingly pass
something off as normal when a more trained eye could save a persons life. We
shouldn't be dumbing down our medicine. Create more medical schools while
keeping the bar high for quality of care.

~~~
throwaway62333
The opposite can happen too — nurse practitioner immediately demanding
unnecessary biopsy or other tests because they cannot confidently rule
something out. This happened to me recently when I went to a np for a known
problem I have had for years that was already diagnosed by multiple doctors. I
also find np is much more likely to prescribe antibiotics. Of course this is
all anecdotal. I used to be very much in favor of expanding the scope of what
nurses can do but now I feel like that may do more harm than good.

~~~
Scoundreller
Not only anecdotal, but unknown which one is more correct.

Any biopsy or test that comes back negative could be considered unnecessary,
but we don’t know that in advance.

Is it worth testing for a 5% likely disease that would be serious if found?
Not running it will save time/money 95/100\. Doesn’t mean it’s the right
approach.

------
Swivekth18
Except that nursing is very different from being a doctor.

