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  • So you want to become a nurse practitioner. You want to work in healthcare, but being

  • a doctor seems like overkill. Why not have many of the doctoring upsides while avoiding

  • many of the doctoring downsides. Here's how you can decide if becoming an NP is a

  • good career for you. Dr. Jubbal, MedSchoolInsiders.com.

  • Welcome to our next installment in So You Want to Be. In this series, we highlight a

  • specific specialty or profession within medicine, such as nurse practitioner, and help you decide

  • if it's a good fit for you. You can find the other videos on our So You Want to Be

  • playlist. And make sure you're subscribed if you want to vote for future videos.

  • Before we dive in, note that as with all my So You Want to Be videos, this video was created

  • with input from experts in the field. After all, I'm an MD, not an NP, and I relied on

  • practicing NP input for guidance and accuracy. What is Being a Nurse Practitioner?

  • A nurse practitioner is an advanced practice registered nurse and a type of mid-level practitioner,

  • similar to yet distinct from a physician assistant, which we covered in a previous episode.

  • NP's assess a patient's needs, order and interpret tests, diagnose conditions, and formulate

  • and prescribe treatment plans. Their training covers disease prevention, patient education,

  • managing acute and chronic conditions, and coordination of care, but they are not trained

  • to the same extent as MD's or DO's, and therefore may not be able to recognize and manage more

  • complex and nuanced conditions straight out from graduation. Do note, however, that after

  • working with supervising physicians for some number of years, they may be better equipped

  • to handle more complex levels of care. Similar to the physician assistant profession,

  • the first nurse practitioner program was developed in the 1960's to address the shortage of primary

  • care physicians, particularly in rural areas, which were most heavily impacted. By the 1970's,

  • there were approximately 15,000 NP's across the United States, and by the late 1990's,

  • close to 70,000. There are currently over 250,000 nurse practitioners in the U.S.

  • The scope of practice for an NP varies, and in some states they must work under the supervision

  • of a physician, whereas in others they can practice independently. The scope of NP work

  • has not been clearly defined, and is not only dependent on state legislature, but also on

  • what the supervising physician is comfortable with.

  • In terms of specialization, it's not a matter of choosing a residency or a fellowship. The

  • NP education model is more focused from the beginning, and you should therefore attend

  • a program that caters to your intended area of specialization. These areas include primary

  • care, acute care, family, women's health, neonatal, emergency, pediatric acute, pediatric

  • primary, and surgery. If an NP school has multiple programs, they may allow for flexibility

  • in changing, as the first year is more general education. But this is an important caveat

  • to noteyour future practice and specialization will largely depend on the NP program you

  • attend. In comparison, the medical school you attend has comparatively little influence

  • on the specialty you may pursue as a physician. And similar to physician assistants, if you

  • go into the operating room, you'll be first assist as a nurse practitioner, not actually

  • doing the surgery, which is the role of the surgeon.

  • Nurse Practitioner Myths There's a broad range of myths that confuse

  • pre-health students considering a career in healthcare. Let's set the record straight.

  • First, contrary to what some people think, becoming a nurse practitioner isn't simply

  • a matter of being an RN for long enough. It requires separate training.

  • Second, many lump physician assistants and nurse practitioners in a single bucket as

  • "doctor lite", but they're under two different training models. Physician assistants go through

  • the medical model, while nurse practitioners build upon the nursing model. While they do

  • have many similarities as mid-level providers, they are distinct entities.

  • Third, the DNP degree stands for doctor of nursing practice, but that doesn't make them

  • physicians. As the term "doctor" generally indicates "physician" in the clinical setting,

  • many find it misleading for a DNP to introduce themself to patients as a doctor, and many

  • states have legislation prohibiting this. This is an area of controversy. While nurse

  • practitioners are intelligent, capable, and contribute greatly to the healthcare system,

  • they are not physicians and do not receive the same level of training. On one hand, most

  • physicians are against NP's calling themselves doctors, as it leads to patient confusion

  • and obfuscation of roles. On the other hand, some NP's argue they've worked hard for their

  • degree and want the right to call themselves "doctor". My NP colleagues, who helped in

  • the creation of this video, believe that NP's should not call themselves doctors.

  • How to Become a Nurse Practitioner Nursing has a separate training and organization

  • structure compared to medicine. To become a physician, you attend medical school, residency,

  • and test for board certification in a given specialty. In nursing, there are multiple

  • types of advanced practice registered nurses. Nurse practitioners are what we're focusing

  • on, but there's also a certified registered nurse anesthetist, or CRNA, who provides anesthesia

  • services in the operating room and intubation in healthcare settings. Certified nurse midwives,

  • or CNM's, specialize in women's reproductive health and childbirth, and provide prenatal

  • and postpartum care and deliver babies. Clinical nurse specialists, or CNS's, focus on advanced

  • clinical knowledge and evidence-based nursing in a specific area.

  • There are two main pathways to become a nurse practitioner: traditional and direct entry.

  • The traditional pathway involves first earning your BSN, ABN, or MSN to become an RN after

  • taking your NCLEX exam. Most that take this pathway will work as an RN for a few years,

  • although this is not required. Next, they attend a master's or doctorate program to

  • become an NP. If you attend a full time master's program, it will generally take 2 years, but

  • if you are undergoing a part-time DNP program, it can take up to 5.

  • Choosing between a master's or doctorate program is not mission critical, as it doesn't change

  • your practice, pay, or licensing exams. More programs are moving toward the doctorate program,

  • which, in comparison, is more focused on research and enables you to teach.

  • The second pathway, or direct entry nurse practitioner programs, are for those who earned

  • a bachelor's degree in something else. These are 3-5 year programs, where you will take

  • both the NCLEX to earn your RN but also complete a master's or doctorate program to become

  • an NP. Again, more programs are transitioning to the doctorate program, which is generally

  • longer by approximately 1 year. At the end of either path you choose, you'll

  • take your certification exam, which is the nurse practitioner board exam. It does vary

  • based on your area of specialization. And after that, you can apply for licensing in

  • your state and find a job. In terms of cost, nurse practitioner tuition

  • costs are lower than PA or medical school paths. In-state tuition averages to about

  • $18,000 to complete a NP program, while out-of-state is around $32,000. Online programs are in

  • the middle, totaling around $22,500 for completion, while private universities are more expensive,

  • around $45,000. Average compensation is around $110,000 per

  • year, but there is variation depending on the certification. Women's health are at the

  • bottom, around $98,000, whereas acute care NP's and psychiatric mental health NP's are

  • at the top, around $114,000. What You'll Love About Being an NP

  • There's a lot to love about being a nurse practitioner. There's a favorable work/life

  • balance, usually without call. You'll also have varying levels of autonomy, where you

  • can be a provider making decisions, yet the training is not nearly as hardcore or as lengthy

  • compared to that of a physician. NP training is shorter than becoming a physician,

  • lasting generally 2 to 4 years compared to 4 years of medical school plus 3 to 7 years

  • of residency. The cost is much lower too, so you'll likely graduate with substantially

  • less debt than if you went the MD or DO route. As an NP, you also won't have to take work

  • home with you or deal with things like overnight callthese are all factors that come with

  • the added responsibility of being a physician. And because you're not the person on the

  • line, there's less stress about malpractice or things going sideways, unless you're

  • practicing independently. If you're ever unsure about something, there's often a supervising

  • physician to run things by. Most RN's don't get the opportunity to build

  • longitudinal relationships, but as an NP, particularly in a primary care role, this

  • is the norm, and many find it highly gratifying. Hours are usually regular and predictable,

  • depending on your practice setting. While it depends on the specialty, you can expect

  • to work around 40 hours per week. What You Won't Love About Being an NP

  • While being a nurse practitioner has its perks, it's certainly not for everyone.

  • If you're interested in primary care, the NP route is great, but if you want to keep

  • your options more open and possibly consider something surgical, there tends to be more

  • opportunities going the PA route. While the training is much shorter, you will

  • also be making 1/2 to 1/3 of the average physician's salary. If you care about prestige and respect,

  • which are not great reasons to base your future career off of, then the MD or DO route may

  • satisfy that to a greater degree. On the other hand, if you're able to put your ego aside

  • and understand your role on the team, including your responsibilities and scope of practice,

  • this likely won't be an issue. If you want to have extensive knowledge of

  • the human body and how to manage various ailments, the NP route will give you the foundations,

  • but it won't offer you the same level of training as going the physician route. You'll be able

  • to handle the majority of bread and butter primary care, but when things get more complicated,

  • you may want to seek physician guidance. Between PA, NP, and physician, NP's usually

  • receive the fewest clinical hours, somewhere between 500 and 1,500 depending on the program.

  • In comparison, PA's are required to have 2,000 clinical hours and physicians between 16,000

  • and 20,000 at minimum. There's a tremendous deal of controversy over

  • the scope of practice for NP's. The American Association of Nurse Practitioners has been

  • lobbying hard for increased scope of practice, meaning allowing nurse practitioners to provide

  • more care independently of physicians. After all, with greater scope comes greater autonomy

  • and compensationbut so does liability, as some are learning the hard way in malpractice

  • cases. YSK that if you are treated by a CRNA and

  • they make a mistake, they will not be held legally liable

  • In a court ruling filed on June 16, 2020, an appellate court decided that "nurses are

  • not supposed to be experts in the technique of diagnosis or the mechanics of treatment"

  • even if they work as nurse practitioners or CRNAs. This ruling occurred after a CRNA made

  • a completely avoidable mistake that led to the death of a 3-year-old child. Even after

  • the death of the child, the CRNA was not punished and is still working in a hospital today.

  • Opponents to increased scope push back about the implications on patient safety. After

  • residency, a physician has accrued approximately 20,000 or more hours of clinical experience

  • in their particular specialty. In comparison, a DNP only needs a fraction of that, between

  • 500 to 1,500 hours of patient contact hours to graduate, which aren't necessarily focused

  • in their ultimate specialization. My NP colleagues tell me that those pushing for increased scope

  • of practice are a vocal minority, but that most NP's don't share this mentality.

  • Don't get caught up in the online hypethis isn't about physicians versus nurse practitioners.

  • The healthcare team needs to work together to serve the patient. When both groups of

  • professionals work together and as intended within their scopes of practice, everyone,

  • including the patient, wins. In recent years, given the growth of diploma mills and online-only

  • programs in conjunction with increasing scope of practice, there are growing concerns regarding

  • patient safety. If you'd like to learn more about this issue, I recommend checking out

  • the Physicians for Patient Protection, an organization with great articles and presentations

  • about this subject, which go much deeper than I can cover in this video.

  • Should You Become an NP? How can you decide if becoming a nurse practitioner

  • is a good fit for you? If you enjoy being a team player, educating

  • patients, and making decisions regarding patient care, the NP route may be a good fit. Those

  • who may not like the patience or cost required for medical school will likely appreciate

  • the shorter and less costly option of going the NP route.

  • If you are currently on the nursing tract and want to go to the next level, consider

  • becoming an NP. If you prefer the medical model, then you may want to consider the PA

  • route instead. If you want more control, autonomy, and depth,

  • knowing all the ins and outs of various diseases, including the obscure ones, and be at the

  • pinnacle of patient care and research, go to medical school and become a physician.

  • These are all tradeoffs and there's no right or wrong here. No specific path is better