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  • Doctor, nurse practitioner, and physician assistant. Three different healthcare paths

  • with three overlapping but distinct outcomes. How can you know which is right for you? I'll

  • help you decide. Dr. Jubbal, MedSchoolInsiders.com.

  • Many students interested in healthcare and medicine find themselves deciding between

  • becoming a physician with an MD or DO, versus going down the physician assistant or nurse

  • practitioner path. After all, they all have substantial overlap, however they're also

  • substantially different. If you're the type of person who would be happy being a physician,

  • you may not be as happy as a PA or NP, and vice versa. Do note that all three are fantastic

  • professions, and no single one is better than the other. You simply need to decide what

  • you value most and choose accordingly. This is a big picture overview of the three

  • paths. If you want to dive deeper into any single one, we have So You Want to Be episodes

  • for physicians, PA's, and NP's. Links in the description.

  • Let's start with the different training paths, as this is one of the biggest differentiators

  • and a big reason many choose the midlevel path over the physician path.

  • The doctor training path, whether MD or DO, is the longest by far. After your 4 premed

  • years in college, you'll complete another 4 years of medical school followed by 3 to

  • 7 years of residency in your intended specialty. If you want to further subspecialize with

  • a fellowship, add one or more years after that.

  • Both midlevel training paths, whether PA or NP, are comparatively much shorter.

  • To become a physician assistant, you'll enter physician assistant school after college,

  • which is 2 or 2 and a half years in duration. Whereas in medical school, you spend 2 years

  • focused primarily on didactics and 2 years focused primarily on clinic time, in PA school

  • you'll have just one year of didactics and the remaining 12 or 18 months focused on clinical

  • exposure. After that, there's no residency, and you're free to start practicing as a PA

  • immediately. To become a nurse practitioner, you can choose

  • from two paths: traditional or direct entry. The traditional pathway involves first earning

  • your BSN, ABN, or MSN to become an RN after taking your NCLEX exam. 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. If you were to major nursing in college and take your NCLEX, you

  • could become an RN soon after graduation and become a fully trained NP just 2 years later.

  • 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. It's not just the duration of training, but

  • also the competitiveness and rigor of each path. Getting into medical school is by far

  • the most competitive of the three. At some schools, like at UCLA when I was there, over

  • 80% of premeds on the first day of college are no longer premed by graduation time. And

  • of those who do ultimately apply to medical school, only 40% get accepted. The average

  • matriculant stats are 83rd percentile on the MCAT and a 3.73 GPA.

  • After medical school, PA school is next in the order of competitiveness. The average

  • GPA for accepted PA students is 3.5 and they average around the 40th to 50th percentile

  • on the GRE. Note that they do have a lower average acceptance rate at 33% of all applicants,

  • and this sometimes confuses students into thinking PA school is more competitive. When

  • you consider the outcome if the average premed with higher stats applied to PA school, or

  • the average pre-PA student with lower stats applied to medical school, it generally clarifies

  • any confusion. Do note that many PA schools also require

  • over 1,000 hours of direct patient healthcare experience prior to matriculating. This doesn't

  • make it any more competitive, but you will need to spend considerable time putting in

  • those hours. While premeds don't need 1,000 hours of direct patient experience, they do

  • need to put in several hundreds of hours across multiple extracurriculars including clinical

  • experience, research, volunteering, leadership, and others.

  • NP school is the least competitive of the three and it has the loosest requirements.

  • Some programs require 1 to 2 years of prior nursing experience, while others don't require

  • any. GPA isn't highlighted as a primary factor, with most GPA cutoffs around 3.0, but this

  • isn't a hard rule. Middle Tennessee State University, for example, is reported to generally

  • accept applicants with a GPA of 2.9 or greater. When it comes to rigor, your clinical years

  • in medical school and your residency years will be extremely trying. The norm is to be

  • working 70 to 80 hours per week, but expect over 80 hours in most surgical specialties.

  • With the PA and NP training paths, you won't be expected to put in such long hours or for

  • so many years. In terms of cost, medical school is the most

  • expensive, followed by PA school, followed by NP school. The average annual tuition for

  • medical school is $40,000 to $60,000 and graduates have an average debt burden close to $200,000.

  • The average annual tuition for PA school is about $45,000 with average graduating debt

  • burden approximately $110,000. NP schools average between $18,000 to $32,000 per year,

  • with the average graduating debt burden between $40,000 and $60,000 depending on the source.

  • If you're finding the video helpful, let me know with a thumbs up, and consider gently

  • tapping the subscribe button and notification bell with surgical precision.

  • Considering the training paths, it's natural to assume that physicians have the deepest

  • knowledge and expertise when it comes to the body and how to treat its various ailments.

  • If you assume that, then you would be correct. Not only do physicians spend the most time

  • focusing on the foundations, but they also spend several years focusing on their specific

  • specialty in residency. The knowledge of midlevels is substantial,

  • but as the name describes, is less than that of physicians. NP's and PA's spend far less

  • time in training than physicians, and therefore don't have the same depth of expertise.

  • Physician assistants follow the medical model, similar to physicians, while nurse practitioners

  • follow the nursing model. But note that after completing PA school or NP school, you're

  • fully trained and able to join the work force, without any required residency for specialty

  • training. PA's and NP's get a great deal of their specialty training on the job after

  • joining a practice. While this is very useful in getting up to speed quickly with pattern

  • recognition for common presenting concerns, you won't be well equipped to identify and

  • manage rare or complex conditions. Given the on-the-job training, it's also much

  • easier to change specialties later in your career if you get bored of one or want a change

  • of pace. That's not feasible to do so for physicians, who would have to reapply to residency

  • and complete another 3 to 7 years of structured training. PA's are considered to have the

  • most flexibility and are sometimes found in surgical specialties, either handling pre-

  • or post-operative patient floor work or assisting in the operating room. NP's have flexibility

  • as well, but you'll need to be intentional with which program you attend, as each program

  • trains you toward a specialization, such as primary care, acute care, family, women's

  • health, and so on. If you are interested in surgery, note that

  • only surgeons with an MD or DO are qualified and have the sufficient knowledge and expertise

  • to perform surgery. With the PA or NP routes, the most you'll be able to do in the OR is

  • be first assist, helping the surgeon by retracting, suctioning, suturing, and the like. That's

  • the level of responsibility of a medical student or junior resident. Which brings us to the

  • hotly debated topic of scope of practice. Scope of practice refers to what each type

  • of professional is expected and allowed to do.

  • Historically, the NP and PA training paths were created to address a shortage of primary

  • care physicians and were to serve as an adjunct to physician-led care, not as a replacement.

  • In this model, NP's, PA's, and physicians all work together in harmony in service to

  • the patient. Since physicians have the most robust knowledge and training, midlevels were

  • generally working alongside physicians, and would easily be able to ask for assistance

  • on more complex or rare presentations. Physicians and midlevels have worked harmoniously

  • as designed for several decades. However, in recent years, there's been a growing power

  • struggle between physicians and midlevels over scope of practice.

  • On one hand, NP's and PA's are lobbying for greater scope, meaning they want to do more

  • things physicians traditionally do, such as independent practice. The primary arguments

  • are two-fold: first, we have a shortage of primary care physicians, and midlevels can

  • help alleviate that. And second, they argue that midlevels receive sufficient training

  • to practice independently and safely. On the other hand, physicians are pushing

  • back, primarily focused on patient safety concerns. After all, NP's and PA's receive

  • far less training. My physician mentors and colleagues have shared they find the NP's

  • and PA's in their practice are valuable in handling much of the bread and butter, meaning

  • the most common and simple cases. However, when it comes to a complex or rare presentation,

  • the training differences are starkly contrasted. But are physicians really more qualified?

  • Comparing the expertise and capabilities of someone who receives over 20,000 hours of

  • supervised patient contact compared to just 500 to 2,000 seems like a no-brainer. It would

  • seem obvious that the physician with 20,000 hours will have greater clinical expertise

  • than the NP or PA with a small fraction of that. The only way for all parties to be equally

  • qualified, despite the massive difference in training hours and rigor, is if the following

  • assumptions are true: either medical school is massively less efficient and medical students

  • massively less intelligent or capable, or if midlevel training paths are massively more

  • efficient and their students massively more intelligent or capable.

  • Scope of practice creep is very much about money. After all, if you're able to do more

  • and practice more independently, similar to a physician, then you can make closer to a

  • physician salary. The average primary care physician makes $240,000 per year and the

  • average specialist physician makes $340,000. In comparison, NP's average approximately

  • $110,000 per year and PA's average approximately $100,000.

  • Note that laws governing the scope of practice for each type of healthcare professional vary

  • from state to state, which adds further complexity to the situation.

  • The reason this is important and you should care is because of patient safety. If you

  • or anyone you care about will ever receive any medical care, then this is deeply relevant

  • to you. The fields that are currently most significantly affected by scope creep include

  • anesthesiology and primary care. But go on Reddit or med-Twitter and you'll see other

  • specialties cropping up. Ultimately, the surgical specialties are the safest from scope creep

  • issues. If scope creep is ultimately harmful to patients,

  • then why has it gone so far? Two main reasons: first, in the current climate of prioritizing

  • emotions over facts, many organizations are focused on inclusion to a fault. Being equal

  • as humans doesn't mean that we all have equal training and capabilities. Second, and more

  • importantly, the AANP and AAPA are much more effective at lobbying compared to the AMA

  • and physicians. It's easy to point to the insanely demanding schedules of physicians

  • to explain why they don't have time for advocacy work, but that has to change. If you are looking

  • to learn more, get involved, and make a difference, check out the Physicians for Patient Protection.

  • Link in the description. In deciding between the three paths, there

  • is no correct answeryou need to decide what is important to you. Are you willing

  • to work extra hard as a premed and crush the MCAT to get into medical school? If not, the

  • PA and NP paths are much more attainable. Do you prioritize shorter training and lifestyle,

  • or being the expert of your field at the expense of your 20's and even early 30's? Do you want

  • to perform surgery, or would being first assist in the operating room be enough? How important

  • is income compared to these other factors? I dive into all these details and more on

  • my So You Want to Be a PA and So You Want to be an NP videos. Much love, and I'll see

  • you guys there.

Doctor, nurse practitioner, and physician assistant. Three different healthcare paths

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Doctor vs PA vs NP | Which is Right for You?

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    Summer posted on 2021/09/11
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