The big question is...MD/DO, PA or NP?

[Handsome Robb]

I'm about 99% sure it's going to be ADN to an online BSN then probably CRNA school, that's Vanderbilt program is super tempting though.

I have a question, mostly directed at the nurses of the forum...halothane and summit...cough...but can you still work as an RN once you're a CRNA? I know we have a few flight nurses that are APNs. I just think it'd be sweet to fly. I'd love to do it full time for a while but I do want to move on to advanced practice.

Seems like if I wanted to do flight full time though I'd have to put off CRNA school until way later in life when I have a family whereas I could knock all three programs out as consecutively as possible and be done with it then start really living my life. If I get really lucky I'll be able to get a PRN flight medic spot right around the time I finish nursing school, but that would be insanely lucky. Also, getting through it basically eliminates my worries about hating bedside nursing but those fears aren't as bad lately after talking to some unit nurses that friends have hooked me up with.

I have no doubt in my mind that whatever I choose to do I can do but I'm thinking this is my choice. Funny since I started prerequisite for my BSN first semester after HS.

 

[ExpatMedic0]

I'm about 99% sure it's going to be ADN to an online BSN then probably CRNA school, that's Vanderbilt program is super tempting though.

Goodluck on everything, I am curious though, why the Nurse CRNA route instead of the Medic PA route if you don't mind me asking?

 

[mariat753]

PA, MD etc

Hi! I check into this site once in a while still and thought I'd add my two cents...I was a career EMT (yeah, I know, never even became a medic) and decided to go back to school (I already had a bachelor's degree gathering dust) at age 33. I've been a PA for 8 years now. I personally had gotten to a point where I wanted to get to know my patients and so went into Internal Medicine rather than any emergency/critical care field. I absolutely love my job. I had gotten so frustrated, nasty and burned out towards the end of my EMS life, feeling like I wanted (and had) more knowledge than I could use (although, as you can tell by my being on this site, in the rosy glow of looking back I still miss it a little). If I was younger when I went back I might have gone MD, but I agree, a lot of MDs say they wouldn't do it again.
The one good thing about PA versus NP is that you can change fields. Although everyone wants to do Emerg/CC now, you might find in a decade your interests change or you finally want an 9-5 job. Incidentally, I don't usually tell my salary because that's rude, but since you guys are thinking about what direction to go in, I do make well into 6 figures. If you have questions, please ask.

 

[ExpatMedic0]

also I remember there was some international questions earlier. Here is a good simple abstract of what areas around the globe use PA's currently. http://www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/75206

 

[Carlos Danger]

I have a question, mostly directed at the nurses of the forum...halothane and summit...cough...but can you still work as an RN once you're a CRNA? I know we have a few flight nurses that are APNs. I just think it'd be sweet to fly. I'd love to do it full time for a while but I do want to move on to advanced practice.

Sure you can. I plan to, but realistically I don't know how long it'll work out. I've known several other flight-nurse-turned CRNA's who intended on flying prn after school, but when straight time for a flight nurse is $30/hr and OT for a CRNA is $130/hr or more, money becomes a real factor. Protocol and liability and other practice issues could potentially be something you have to deal with to, but shouldn't be difficult to work out with the program medical director.

 

[Happycoop]

I think you need to spend some time reflecting on what exactly you want to do with medicine. The idea that you'll forge ahead and become a CRNA or MD/DO and still have all this spare time to do flight medic on the side is not likely to come to fruition.

PA's and NP's are great (and something I've considered seriously over the years), but they absolutely have their limitations. In particular, if you're thinking you like Ortho-surgery, you absolutely need to shadow some folks. As a PA you MAY be first assist (depending on the practice/doc you work with), and if you're ok with that then great...but know going into it that you'll likely never be more than first assist. I've spent a couple years working in the ER, and I've met a number of PA's and NP's that love what they do...but they all have been quick to mention what the limitations are.

The MD/DO route is long and will test your limits, but is tremendously rewarding. Both will require you to take the MCAT, but if you can't pass the MCAT, you'd probably fail boards anyway so just buck up and get through it. The DO programs are easier to get into (they generally will accept folks with a lower MCAT compared to the MD programs). As a DO, you'll learn everything an MD learns, plus OMM (the manipulative medicine). The OMM is a nice bonus, but the reality is very few DO's actually use it in their practice. The downside of the DO route is that your residency choices are more difficult. My wife (a Urological Surgeon) took both the DO boards (COMLEX) and the MD boards (USMLE) in order to be able to apply to either a DO or MD residency. That being said, MD programs wanted her to have a higher USMLE score than the MD applicants (because they were dealing with a lesser well-known commodity in the DO student).

The MD/DO route isn't as bad in terms of life as many of the posts have made it out to be. It's very specialty specific. I know surgeons who only operate 2-3 days a week and spend the rest of the time with their families. Sure, they don't make what a surgeon who operates 6-7 days a week does, but trust me, they aren't hurting for money (most of the Ortho guys I know make over $1mill/yr...even part time you're clearing several hundred thousand). A friend is one year out of his anesthesiology residency and he makes $275k/yr, plus the practice that recruited him paid off all his med school loans and pays his medical malpractice.

Sounds like I'm pushing for the MD/DO route, but really I just wanted to paint a nicer picture of that side. In the end, you've got to decide what you want out of your career. I am more attracted to PA school, but it took some personal reflection before I realized that. My wife loves being a surgeon and wouldn't trade it for anything.

Best of luck in making your decision!

 

[Brandon O]

Figure out what you specifically want. With no offense to anybody here, people with no experience in either pathway can't help you much, and people with experience will almost always justify their own choice. Human nature.

If you're interested in surgery, realize that's the only thing you will never be able to do as a midlevel. If doing procedures is your interest, there are other avenues (assisting, other things like placing lines, IR, etc), but not that. If your interest is diagnosis, there's a bigger set of options.

It is hard to argue that many MD/DOs currently are unhappy and wouldn't recommend their path. But it's also probably true that this won't always be the case (things can get better), and that people getting into it now may not feel the same as those who have witnessed the field changing over the past few decades. Plus, as mentioned, some of their headaches are present for midlevels too, although you're paying less blood and money for the pleasure, which seems to be part of the reason for their widespread disillusionment.

People have mentioned many of the considerations. A few others I'd emphasize is that most things available to physicians are available to midlevels, but in many cases not as easily. You can be a great diagnostician, but not as a minimum, so you'll have to become one. You can be highly respected, but you won't necessarily be as a matter of course, so you'll have to earn it each time you meet someone. You can work in most fields, but with many regions/facilities/affiliated docs you won't be able to do what you want, so it may take time and effort to find your sweet spot. And so forth.

Contrariwise, with med school and the associated necessities, you're giving a lot to get "the big degree," and it's not just fluff cost -- it hits people in different ways, and plenty are burned out before they ever see the benefits. If you have an honest, accurate expectation of what you want and how to get there, AND that balance is worth the candle for you, then you'll be happy. If you're fooling yourself about either side of the scale, at some point it'll hit you.

I suppose the other sad fact is that, depending on who you are, probably no option will be totally perfect. You'll have to put up with some things you don't want as the lesser evil. But again, make that decision now; don't get surprised by it.

You can probably work as a medic as a PA; I don't know about NPs and physicians and would be curious to hear from a forumgoer who's still doing so, or knows anyone that has. In the long run, there may be opportunities for licensed clinicians in community paramedicine as well.

 

[Carlos Danger]

You can probably work as a medic as a PA; I don't know about NPs and physicians and would be curious to hear from a forumgoer who's still doing so, or knows anyone that has. In the long run, there may be opportunities for licensed clinicians in community paramedicine as well.

Just a few years ago I worked with two trauma services ACNP's who flew part time while working full time in trauma. I also used to know a paramedic-turned-PA who was involved in EMS, even running calls occasionally.

I think it is a little more difficult for CRNA's just because of money. The ones I've known who came from flight had every intention of flying again once they were CRNA's, but they were completely exhausted and broke when they graduated, and told themselves "I'll just take a little time to get used to my new role and get back on my feet financially before I start flying again". Before you know it another year or two has passed, and at this point they're starting to lose interest in transport and considering how much more money their time is worth doing anesthesia, they have a hard time basically donating their days off to fly.

 

[Handsome Robb]

I'm going to try and address everything. If I miss anything please don't hesitate to yell and scream a little bit.

Expat, I'm leaning towards RN/CRNA because of all the pathways it opens up between now and then. Being on short term disability I've got nothing but time so I've been doing a lot of reading and I could do my MSN in Anesthesia then do a Post-Masters from USF and get my ACNP or ACPNP. If I did that I'd honestly probably lean towards the ACPNP, at the same time though someone brought up a good point about you might as well go to med school if you're going to that much school. Then...it seems as if midlevels are moving towards requiring a Doctorate, so if that's the case I'd be looking at either DNP, DNAP or a PhD as well and would be basically at the point of med school as far as length, not including residencies and fellowships.

No matter where I go I'm going to have to specialize, so that isn't really weighing in to much on my mind. Also, I can do all the nursing pathway here where I'm established until I got to grad school then I'm going to have to relocate for a couple years unless UNR decides to start doing an NA program but I doubt that will happen. After grad school though I can do DNP here.

As far as moving, I've got no problem moving, I'd just prefer to stay here. I'm fully confident that by the time I get to the point of applying and interviewing to CRNA school that I will have a good chance at wherever I'd like to go provided I don't mess around in school.

I would like to stay in Acute Care/Crtical Care. I absolutely loved the OR environment when I was doing clinicals for P school. I wanted to go back for more but they wouldn't let me. Anesthesia is fascinating to me. I'm huge on pain management and anesthesia is one of the services that provides analgesia for both in and out patients depending on where you work. I could never get over how cool it was to take a person who's walking (maybe) and talking, put them under, make sure they're comfortable, protect their airway, they get cut wide open, then wake them up send them to PACU and sometimes send them home all in the same day, sometimes over the course of a few hours. I'd love to be a surgeon but I know myself and I know what I want in life and I'm not willing to be in school, a residency or a fellowship until I'm well into my 40s. With this plan I've got now, provided everything goes like I like it to I could potentially be done with CRNA by the time I'm 31, probably realistically 33-34, and be out doing what I love, taking care of patients.

Also, CRNA is appealing to me because of the shear amount of procedures you preform. Some might say that this isn't a good reason but I love working with my hands, I'd rather be with patients and be hands on with them than stand back and tell people what to do and write orders.

That's a great point about pay for CRNA OT vs Flight RN pay Halothane...I want to fly, but I also want to further myself in healthcare to the midlevel level. I also don't want to get the 5 years of experience, hopefully get a flight job, do that until I get bored then decide I want to go back to school later. It seems like the more time you spend out of school the more difficult it is to get back after it, especially in a program as intense as these NA programs are from what I've read at allnurses.

We have more than one PA that works PRN for us as a medic, both started as medics and worked FT for a while before going to PA school.

I also want to be involved in EMS, somehow for the rest of my career. I'm wondering if I can get an emphasis in education concurrently with CRNA. I'd love to teach medic programs PRN. I wonder if there are any NPs out there as associate medical directors? I've always said I wanted to make changes in EMS. I know I've made little changes an impacts on the people I've trained but from the top down is where you can really make the big changes. I'd love to stay involved with TEMS after all of this is done, maybe not as an operator but in some form or another, as well but I'm thinking I'm going to have to let that dream go to do nursing school and work full time.

 

[Handsome Robb]

Another question I have is regarding the transition to DNP. I've read quite a bit on it and it seems like it is still very much up in the air as to if and/or when/how it'll happen.

I read the AACN "Essentials of Doctoral Education for Advanced Nursing Practice" statement and am having a difficult time understanding it. Are they wanting a DNP plus your specialty on top or is the specialty included in the DNP program?

 

[Handsome Robb]

Another question I have is regarding the transition to DNP. I've read quite a bit on it and it seems like it is still very much up in the air as to if and/or when/how it'll happen.

I read, admittedly skimmed some sections, the AACN "Essentials of Doctoral Education for Advanced Nursing Practice" statement and am having a difficult time understanding it. Are they wanting a DNP plus your specialty on top or is the specialty included in the DNP program?

Parts seem as though the specialty would be added on to the end of DNP however other parts indicate rather than a research paper or dissertation, since it's a practice degree rather than research, that your specialty would be your final project.

The DNP seems like they're sitting at 3 years for a BSN to DNP degree full time, 12 months a year which only adds a year to most masters programs, less in some, so it's not like it's going to be a massive change in time requirements. Unless they add specialty school at the end rather than included. Then you're looking at another 1-2 years at least and at that point why not go to med school? Especially if I wanted a dual specialty such as CRNA and ACNP or ACPNP.

http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf

 

[Brandon O]

For what it's worth, I don't know of any similar movement for the PA profession toward a doctoral requirement. Historically they've been fairly content in their role. Granting master's degrees seems like it's becoming ubiquitous, but that's more along the lines of "why not, the credits are there."

And while the concept of formal specialization via residency/fellowship is proliferating somewhat, it's far from clear that it'll ever become the norm for PAs. It's still considered a generalist's training.

I'd recommend some shadowing in anesthesia. I think the subject naturally appeals to many EMSers (essentially specializing in life support), but that doesn't mean you'd necessarily enjoy the day-to-day work. There is a lot of sitting and staring.

 

[Carlos Danger]

Another question I have is regarding the transition to DNP. I've read quite a bit on it and it seems like it is still very much up in the air as to if and/or when/how it'll happen.

I read, admittedly skimmed some sections, the AACN "Essentials of Doctoral Education for Advanced Nursing Practice" statement and am having a difficult time understanding it. Are they wanting a DNP plus your specialty on top or is the specialty included in the DNP program?

Parts seem as though the specialty would be added on to the end of DNP however other parts indicate rather than a research paper or dissertation, since it's a practice degree rather than research, that your specialty would be your final project.

The DNP seems like they're sitting at 3 years for a BSN to DNP degree full time, 12 months a year which only adds a year to most masters programs, less in some, so it's not like it's going to be a massive change in time requirements. Unless they add specialty school at the end rather than included. Then you're looking at another 1-2 years at least and at that point why not go to med school? Especially if I wanted a dual specialty such as CRNA and ACNP or ACPNP.

http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf

The specialty is included in the DNP program. The doctoral part is basically just added on to the already-existing MSN programs. Generally speaking, the DNP is specifically intended to be a practice-oriented degree (as opposed to a PhD, which is research-oriented) so I would expect most DNP's do not require a dissertation. What I think you are seeing is programs describing the earning of board specialty eligibility in lieu of the dissertation that is required of a traditional PhD program.

As for the second part that I highlighted......that is a good question. Very different pathways; probably more similarities than differences (but the differences are potentially very important) in the end. Only you can decide which is the better option for you.

I'd recommend some shadowing in anesthesia. I think the subject naturally appeals to many EMSers (essentially specializing in life support), but that doesn't mean you'd necessarily enjoy the day-to-day work. There is a lot of sitting and staring.

I would recommend shadowing several members of ANY profession one is considering entering. Personally, I spend a lot less time sitting in the OR than I did sitting at the base when I worked in HEMS.

 

[joshrunkle35]

If you are interested in nursing, and already have a bachelor's other than nursing, you can do the Graduate Entry Option at OSU. It's a 3 year MSN program, where you get your RN and MSN in the 3 year program without needing an RN/BSN prior to entry into the masters program.

http://nursing.osu.edu/sections/aca...ram-overview/graduate-entry-introduction.html

 

[TransportJockey]

If you are interested in nursing, and already have a bachelor's other than nursing, you can do the Graduate Entry Option at OSU. It's a 3 year MSN program, where you get your RN and MSN in the 3 year program without needing an RN/BSN prior to entry into the masters program.

http://nursing.osu.edu/sections/aca...ram-overview/graduate-entry-introduction.html

Hmm I like the sound of that program. Especially as I was planning on a BS in ems before I look at going on

 

[SunshineCamo]

I'm tackling a similar question, although mine is a little more forward thinking. I've still got one year of Medic classes, but even after a few months of working in EMS I know this is not something I would want to do forever.

So my question is NP or PA. The decision kind of hinges on if I want to stay in the National Guard. If I want to stay in, going RN to NP seems smarter. I could finish my RN in time to still be young enough to get commissioned, and then continue on to NP.

However if I decide that I'm done with the military (which I'm very close to do as of late) then the PA route is a little more appealing. I've got about a year before I really need to make a decision but it weighs on my mind.

 

[Wheel]

I'm tackling a similar question, although mine is a little more forward thinking. I've still got one year of Medic classes, but even after a few months of working in EMS I know this is not something I would want to do forever.

So my question is NP or PA. The decision kind of hinges on if I want to stay in the National Guard. If I want to stay in, going RN to NP seems smarter. I could finish my RN in time to still be young enough to get commissioned, and then continue on to NP.

However if I decide that I'm done with the military (which I'm very close to do as of late) then the PA route is a little more appealing. I've got about a year before I really need to make a decision but it weighs on my mind.

If staying in as a PA is an option, look into applying for IPAP. It's pretty competitive, but they send you to school in exchange for a commitment contract. It might be a good option for you and it may not, but doing some research into it might be a good idea.

 

[KellyBracket]

I'm late to the discussion, but I wanted to weigh in as a former paramedic, now emergency physician.

TL;DR version - this is a great job!

Yeah, some doctors make a big stink about discouraging others from coming into the field. Yeah, the money is going down, paperwork is going up, and it ain't the good ol' days. There ain't no such thing as a free lunch... Some folks are just plain gloomy. (My theory is that a bunch of the old guard screwed up their retirement planning with real estate and Bernie Madhoff in 2008, and are unable to retire now, and they take out their frustration on the world!)

This job is amazing. Yes, the training chews up a good deal of your life, but it gives you opportunities you just don't get in other, shorter, training programs. A midlevel/advanced care practitioner can be quite well-accomplished in one area or field, but the breadth of that domain can often be somewhat circumscribed.

It's true that PA or NP training takes less time, and you'll start working sooner. It's hard to argue against this economic perspective. Heck, it's hard to argue against staying a medic for the same reason.

 

[VFlutter]

Something I have been strongly considering is the US Army CRNA program (USGPAN). One of the best CRNA programs in the country. It is a 3 year DNP program. School is paid for, get paid while going to school, and then have a 5 year commitment.

http://www.northeastern.edu/bouve/nursing/add/armyprograman.html

https://www.sites.google.com/site/armynurseanesthesia/

Here is an awesome blog by an Army CRNA showing his deployment in a Forward Surgical Team. I do not think you could find a better Trauma Critical Care experience anywhere.
http://gotosleep2005.blogspot.com/

 

[ExpatMedic0]

3 years of school, 5 years of commitment, why not become a doctor?

Something I have been strongly considering is the US Army CRNA program (USGPAN). One of the best CRNA programs in the country. It is a 3 year DNP program. School is paid for, get paid while going to school, and then have a 5 year commitment.

http://www.northeastern.edu/bouve/nursing/add/armyprograman.html

https://www.sites.google.com/site/armynurseanesthesia/

Here is an awesome blog by an Army CRNA showing his deployment in a Forward Surgical Team. I do not think you could find a better Trauma Critical Care experience anywhere.
http://gotosleep2005.blogspot.com/