
Become a nurse or physician assistant instead of a doctor (2012) - jseliger
http://jakeseliger.com/2012/10/20/why-you-should-become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-school/
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ghufran_syed
I agree wholeheartedly with the sentiments and many of the arguments put
forward in this piece, but felt I should comment on some inaccuracies (in my
opinion...)

I originally trained in the UK, which had no structured residency programs at
the time, and no matching scheme. The result was the so-called 'lost tribe' of
doctors:
[http://careers.bmj.com/careers/advice/bmj.331.7514.s90.xml](http://careers.bmj.com/careers/advice/bmj.331.7514.s90.xml)

Coming to the US, it seemed to me that the match was a massive improvement.
The author claims that "Students are then obligated to attend that residency
program. They can’t privately negotiate with other programs, as students can
for, say, undergrad admissions, or med school admissions—or almost any other
normal employment situation."

However, the key to the program (the algorithm was discussed on hn a few
months ago I think??) is that a medical student can only be matched to a
residency that THEY listed as an acceptable choice of employer, and where the
residency listed THEM as an acceptable choice of resident. Medical students
are also free to try to negotiate with residencies (before the ranking
deadline)...and residency programs as just as free to say 'No'. I think it's
reasonable for the hospital to promise a set period of residency training,
with all pay and conditions specified up front, but only on the condition that
the incoming resident makes the commitment to stay for the full program.

The resident can leave simply by giving their notice: what they are unlikely
to be able to do is find another residency willing to take them on, when
they've just broken their previous commitment. In fact, one of my UCLA
Emergency Medicine classmates, Andrew Nerlinger, left our program just 6
months before finishing, for a better opportunity elsewhere
([http://www.enduraventures.com/about-us](http://www.enduraventures.com/about-
us)).

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scottoreilly
I followed my wife though the whole process from college to practicing
physician and even made an interview video about residency:
[https://vimeo.com/97738071](https://vimeo.com/97738071)

I actually agree with the premise of the article, but it paints an inaccurate
picture in a lot of places:

"Nurses, by contrast, can start making real salaries of around $50,000 when
they’re 22. Doctors can’t start making real money until they’re at least 29,
and often not until they’re much older."

Residents start making $50k salaries right out of medical school. It's only a
4 year delay from nurses.

It's not about money. It's about quality of life. Medical school is really
hard. Residency is brutal. Constant unrelenting pressure. No sleep. No
personal time. That alone is the reason why becoming a doctor isn't worth it
for most people.

Watch the part in the video starting at 3:08 where they're half way through
residency. They look like they're going to cry. I'm so glad I did those
interviews because it really captures the personal sacrifices you have to
make.

Here's the thing that the article failed to grasp, though. If you need to be
the one doing the cutting in surgery or the one pushing medicine forward with
research, you have to get that MD. Some people need to be in control and call
the shots.

If that's you, do it. Make the sacrifices, because you won't be happy doing
anything else.

If you can live a fulfilled life as a nurse or PA, though, it's a much better
choice for most people.

~~~
RubyPinch
remember which song you used for the background?

~~~
scottoreilly
It's from the Her soundtrack.

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geebee
Wow, good article.

In a way (from a financial point of view), going to medical school is taking a
bet. If you end up in certain well paid specialties (dermatology, radiology,
etc), you can have a remarkable salary without a bad work schedule. Emergency
medicine is also a good choice. Problem is, you have to go through med school
and run up that debt before you know if you'll be getting one of those
residencies.

While the article is positive about nursing and PA, I actually think the
article underplays the possible compensation in these fields. Check out US
News Best Jobs and look at compensation for nurses and Pas _in high cost
regions_. In SF, the median salary for nurses is $127,670 a year! PA's tend to
make a bit more. Certain nursing specialties (such as anesthesiology) are also
very well compensated, often above GP physician levels, though these
specialties do require a lot of training. Actually, in SF dental hygienists
earn at the median 112k a year.

Just for comparison, software developers at the median in SF earn 114k a year.

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rozerdev
Cool!

